1

Police Encounters with Persons with Mental Illness in the Capital District Introduction In the course of an average year, the Albany and Schenectady police departments have hundreds of encounters with individuals who have a mental illness. Since these individuals are often not suspected of criminal activity, police officers must deal with them in ways that differ from standard criminal procedures. The New York Civil Liberties Union (NYCLU) initiated this study to see how local police agencies deal with these encounters and whether there are practices they might adopt to improve outcomes of such encounters. We begin with an introduction to research concerning persons with mental illness. We follow with a description of model programs currently being used by law enforcement agencies when their officers encounter such persons. We continue with a description of the current policies and programs in the Albany and Schenectady police departments. We then offer recommendations that we believe will enhance each city’s ability to effectively handle encounters with persons with mental illness, to appropriately divert these individuals away from the criminal justice system, and to aid in the provision of treatment. We also include an analysis of the each jurisdiction’s civilian police review board processes and policies with an eye towards increasing access to the complaint process by persons with mental illness. This report is not meant to review mental health services or evaluate individual officers; rather, it focuses on department-level policies. This report is not meant to compare the departments: they are different jurisdictions with different resources and issues. Our goal is to provide recommendations as to how the Albany and Schenectady police departments and their respective civilian police review boards may better serve persons with mental illness.

2 The main focus of this report is police encounters with persons with mental illness. However, the umbrella term “Emotionally Disturbed Person” (EDP) occasionally will be used. This term is used to describe any person in crisis who demonstrates symptoms of mental illness; who is under the influence of a substance; who is experiencing a specific type of medical problem, or who is experiencing extreme situational stress. The occasional use of this term is a necessity because police departments often use this umbrella term when the exact cause of the emotionally disturbed behavior is unknown. Data collection for this report included: a review of the relevant literature; interviews with mental health advocates, mental health-care professionals, and criminal justice system representatives; a review of the Albany and Schenectady police departments’ policies; a focus group of uniformed Albany Police Department personnel; sixteen hours of police ride-alongs, and a brief self-administered survey of uniformed personnel in the Albany and Schenectady police departments. This project was made possible through a grant from Disability Advocates, Inc. The opinions expressed herein do not necessarily reflect the opinions of Disability Advocates, Inc.

Background Prior to the 1960s persons with mental illness in the United States were primarily detained and treated in large state-run institutions. These institutions often did not have the capacity or resources to adequately treat mental illness. Beginning in the 1960s there was a shift away from these large state-run institutions to community treatment. Between 1955 and 1985 there was a dramatic decrease in the number of persons with mental illness in state-run mental hospitals. In 1955, there were 558,922 patients

3 institutionalized for mental illness; by 1985 this figure was reduced to 109,939. This change is even more dramatic when factoring in the population increase during this time period. In 1955, 336 people were institutionalized for every 100,000 people in the population; by 1985 this had decreased to 46 per 100,000. This does not represent a decrease in the number of persons with mental illness but, rather, a change in the treatment of mental illness. The goal behind deinstitutionalization was to provide better treatment at lower cost. However, resources necessary for community treatment were not adequately allocated. Research suggests that a significant percentage of persons with a serious mental illness are not receiving treatment. Narrow et al. analyzed the National Institute of Mental Health’s (NIMH) Ecological Catchment Area Program data from the early 1980s. They found 40 percent of persons with a serious mental illness were not receiving any treatment during the study year. Kessler et al. conducted a similar study using the NIMH’s National Comorbidity Survey from the early 1990s. They found that 54 percent of persons with serious mental illness did not receive treatment during a twelve month period. . Hiday et al. found rates of nonviolent victimization among individuals with mental illness are similar to those of the general population but persons with mental illness were two and a half times more likely than the general population to be violently victimized. Increased levels of victimization mean persons with mental illness will have more contact with the police.

Police Encounters with Persons with Mental Illness A police department is one of the few public service agencies likely to have repeated contact with persons who have a mental illness. The prevalence of such encounters has increased over the past forty years due to deinstitutionalization, stricter civil commitment criteria,

4 inadequate funding for community-based mental health treatment programs, and changes in policing strategies which emphasize greater police contact with the community. In a 1996 survey of 174 departments, Deane et al. found that approximately 7 percent of law enforcement contacts nationwide, including complaints and investigations, involved persons believed to be mentally ill. This measure could be used to develop an approximation of the number of police encounters with persons with mental illness in individual jurisdictions. The question of statistics is difficult to address in a paper such as this. How an officer reports an incident or how a dispatcher interprets the circumstances of a call may differ from one incident to another, from one person to another, or from one department to another, even if everyone is operating with the best of intentions. One person’s surly teenager may be viewed by another as someone in the midst of a psychiatric emergency. Throughout this report we have used figures that were available to us but we present them with the caveat that they may not always be categorically indisputable. There are two distinct legal principles for police contact with persons with mental illness. First, police have the power and authority to protect the safety and welfare of the community. Second, the principle of Parens Patriae dictates that the state shall be responsible for the care of individuals who cannot care for themselves. When people with a mental illness are a danger to themselves or others it is the state’s responsibility, through local law enforcement if necessary, to provide treatment or services. Police officers in New York State are authorized to detain a person with mental illness under the New York State Mental Hygiene Law (NYS MHL section 9.41) which states: “The department may take into custody any person who appears to be mentally ill and is conducting himself or herself in a manner which is likely to result in serious harm to the person or others.”

5 It is important that this custody not be handled as a standard arrest. These individuals must not be booked or brought to police lock-up: they are only to be transported for evaluation to an authorized hospital. The disposition of an encounter with a person with mental illness is often left to the discretion of an individual officer. Therefore, it is important to offer information to police departments on strategies for providing comprehensive service in such instances.

Model Police Programs Police departments have adopted several model programs to specifically address these encounters. Many of these programs were created after an unfortunate or even fatal encounter between the police and a person with mental illness. Successful programs are those that increase the capability of the department to help people in crisis, to divert them away from the criminal justice system, and to keep officers and persons with mental illness safe. There are three recognized model programs for police response to persons with a mental illness. These are (1) police-based mental health response, (2) mobile crisis units and (3) policebased crisis intervention training programs (CIT). In a 1996 survey of 174 departments serving populations greater than 100,000 Deane et al. found that 45 percent had some form of specialized response to emotionally disturbed individuals. This survey found that 12 percent of departments had police based mental health response; 30 percent had a mobile crisis program; and 3 percent had a CIT program. Hails and Borum conducted a survey of 84 agencies in 1999 with wide variation in the size of the departments and found 32 percent of agencies had some form of specialized response: 13 percent had police-based mental health response; 8 percent had a mobile crisis program, and 11 percent had a CIT Program. Hails and Borum indicate that the variance between their results and those of Deane et al. could be due to differences in the size of the

6 responding jurisdictions or could indicate a growth in the use of CIT programs. A 2003 Police Executive Research Forum study indicates growth in the number of CIT programs nationally.

Police-based Mental Health Response Police-based mental health response is a model in which a police department employs mental health professionals to provide on-site or telephone assistance to officers during encounters with a person with a mental illness. When an individual officer determines that a call involves a mental health issue, the mental health professional in the department is contacted or brought on site to provide advice and instruction. The mental health professional then assists in determining procedures for the encounter and aids in the diversion of the individual to social service agencies. Under this model, individual officers may not necessarily be fully trained to deal with persons with mental illness, nor do they necessarily know to what social service agencies they may refer individuals. An example of a police-based mental health response is Los Angeles’ System-wide Mental Health Assessment Response Team (SMART). The SMART Program pairs a police officer who has been specially trained in mental health issues with a mental health professional who is employed by the police department. SMART consists of two supervisors and four twoperson teams. This program provides on-site assistance to officers who encounter persons with mental illness. The team evaluates the individual involved and determines the appropriate disposition, ranging from hospitalization to referrals for service. In an evaluation of the SMART Program, Lamb et al. found incarceration occurred in 2 percent of 101 consecutive encounters between September and October of 1993. The SMART Program is still in effect today.

7 Mobile Crisis Units In the mobile crisis unit model, a mental health agency provides on-site emergency response to persons with mental illness. Individual police officers may call upon the mobile crisis unit to respond to an encounter. Often this type of response works in conjunction with law enforcement but units may also respond to crisis situations without the police. Mobile crisis units provide community-based services to persons with mental illness, limit the need for hospitalization, decrease the use of arrest, and reduce the need for police officers to respond to mental health emergencies. Mobile crisis units are typically staffed by mental health professionals and provide 24-hour-a-day assistance. Scott compared 73 psychiatric emergencies handled by mobile crisis units and 58 handled by routine police response in DeKalb County, Georgia. The study found that mobile crisis units were less likely to resort to involuntary hospitalization than routine police responses. Scott also found intervention by mobile crisis to be less expensive than intervention by regular police. Scott found a lower use of arrest for the mobile crisis unit than routine police response in DeKalb County, Georgia, although the difference was not statistically significant. The DeKalb County Mobile Crisis Unit is still in operation today.

Crisis Intervention Training Program (CIT): CIT is a model in which a select group of police officers is given specialized mental health training for crisis intervention. The officers serve as front line responders and links to the mental health system. When they encounter persons with mental illness, CIT officers handle the emergency situation. They seek to prevent or reduce injury and to appropriately divert people to social service agencies. Individual officers are not trained to take the place of mental health care

8 professionals; rather, they receive increased training to understand and handle encounters with persons with mental illness. The goal of CIT programs is to have officers handle all department calls with a mental health component. These officers are to arrive on scene and de-escalate the situation. The CIT officers are to then determine what kind of assistance an individual needs. If evaluation is necessary they will facilitate transport to a treatment facility. If evaluation is not necessary officers will refer the individual to appropriate services or simply help the individual through his or her crisis. CIT programs require a fundamental change in the relationship between law enforcement and persons with mental illness in the community. CIT officers must understand the individual’s problems or symptoms and then assist that individual in obtaining assistance. They must move beyond the sole mandate of law enforcement and actively engage individuals who are experiencing signs and symptoms of mental illness. The Memphis Police Department created this model in 1988 and called it the Crisis Intervention Training (CIT) program. Memphis CIT officers receive 40 hours of training; they respond to all situations having a mental health component. Memphis CIT training is conducted by volunteer staff and includes role playing, crisis de-escalation, visits to mental hospitals, psychopharmacology, and defense weapons training. In 2000 the Memphis CIT Program consisted of 130 officers in a department of 1,354. The shifts of CIT officers were arranged so they would be available around the clock. Although the Memphis CIT program has served as a model for CIT programs throughout the nation many jurisdictions have modified the program to fit their own needs and resources. These different forms of CIT have a number of important common elements. In most cases, CIT officers volunteer and are then screened for selection. Only officers who can approach persons

9 with mental illness with calm and compassion are selected as CIT Officers. CIT officers generally are trained in various aspects of mental health, mental illness, and in de-escalation techniques. CIT programs develop partnerships with mental health agencies in the community. In many programs CIT officers carry out routine patrol functions and respond to any call with a mental health component. There is also a general recognition of the importance of accurately dispatching CIT personnel to calls involving a person with a mental illness. If calls with a mental health component are not accurately classified, CIT officers will not be dispatched appropriately. Without proper dispatch CIT cannot be an effective response. The Rochester Police Department launched a CIT-based program called the Emotionally Disturbed Persons Response Team (EDPRT) in March of 2004. EDPRT officers receive approximately 80 hours of mental health training, which is more than what most CIT programs offer. EDPRT training covers mental illness indicators, hospital protocol and procedure, mental health and chemical addictions, medications, local mental health resources, the mental health court, liability issues and the mental hygiene law. Ten to twelve hours are devoted to role playing. Also, the National Alliance for the Mentally Ill conducts two four-hour blocks on schizophrenia and other forms of mental illness. There are 35 EDPRT officers in a department of 480 officers, as well as six civilian counselors and social workers. Departments which use this form of response claim a number of benefits. The Memphis Police Department found a reduction in the use of deadly force, fewer injuries to officers and citizens, lower arrest rates, and a decrease in the number of mental health consumers in county jails. The Albuquerque Police Department’s CIT program found a substantial improvement in the relationship between the police department and mental health treatment providers. Costs associated with Albuquerque’s CIT program were offset by grants and volunteer instructors.

10 Albuquerque found a reduction in the risk of injury or death for officers, a reduction in liability claims for use-of-force complaints, and a reduction in SWAT team activations and associated overtime.

A Comparison of Model Programs It is important to determine whether these model programs offer a benefit over response by routine police patrol and to identify any model that may be superior to the others. Successful specialized response should reduce the use of arrest for persons with mental illness and divert these individuals into the mental health system. It is therefore important to provide a baseline for the frequency of arrest during police encounters with such persons. Green conducted a study of police encounters with persons with mental illness in Honolulu, Hawaii, in 1993 in which officers filled out incident forms for all such encounters where an arrestable or citable offense occurred. Green found that arrest occurred in 14.9 percent of encounters between police and persons with mental illness. Engel and Silver used officer’s perceptions of mental illness to analyze the frequency of arrest during police encounters with persons with mental illness. The data came from the Police Services Study (PSS) from 1977 and the Project on Policing Neighborhoods (POPN) from 1996 and 1997. Engel and Silver found arrest occurred in 7.6 percent of encounters with persons perceived by officers to be mentally ill in the POPN Study. The PSS study data revealed that arrest occurred in 16.2 percent of encounters with persons perceived to be mentally ill by the police. Engel and Silver’s research may underestimate the police use of arrest for persons with mental illness because they utilize police perceptions rather than clinical diagnoses of mental illness. Teplin conducted a 1984 study of police to compare arrest rates for mentally disordered and non-disordered subjects.

11 Teplin found a significantly higher likelihood of arrest for mentally disordered subjects than for non-mentally disordered subjects and found that police were more likely to under-identify than over-identify mental disorder. Studies have not directly compared arrest rates by routine police response and model response programs but these studies do indicate a baseline of arrest during encounters with persons with mental illness between 8 percent and 16 percent. Steadman et al. (A) conducted a comparison of the three model programs for police response. This research analyzed 100 mental disturbance calls and 100 incident reports from mental health disturbance calls for each model program. The call data were analyzed to determine who responded to the incident and identify if the call resulted in arrest. The incident reports were analyzed to compare the efficacy of the three models in avoiding arrest and incarceration; these models were not directly compared to routine police response. Steadman et al. (A) found that arrest occurred in 5 percent of mobile crisis encounters, 6 percent of CIT encounters, and 13 percent of encounters for police-based mental health response. Police-based mental health response has similar arrest rates to the known research on the use of arrest during routine police encounters with persons with mental illness. Mobile crisis units and CIT programs use arrest to a significantly lesser extent than police-based mental health response. The research suggests that mobile crisis and CIT arrest rates are significantly lower than routine police response because these models have a lower arrest rate than the 8 percent to 16 percent baseline arrest rate found in the previous research. This is a very significant benefit. There are a number of non-arrest outcomes that can occur when police encounter a person with mental illness. These include transporting the individual for treatment; referring the person to treatment, or resolving the situation on scene. Steadman et al. (A) found mobile crisis was much more likely to make referrals for treatment, while police-based mental health response

12 was more likely to resolve the situation on scene. CIT response was more likely to transport an individual with mental illness to a treatment location than the other forms of specialized response. Seventy-five percent of CIT calls resulted in transport while 42 percent of mobile crisis and 20 percent of police-based mental health response resulted in transport for treatment. It is important to stress that this research does not identify whether or not transport or hospitalization was involuntary; nor does it indicate what happened at the hospital in terms of detention and treatment. The CIT program allows officers to be present at significantly more calls involving persons with mental illness than does any other type of specialized response. Steadman et al. (A) found CIT officers were present at 95 percent of such incidents; mobile crisis was at 40 percent, and police-based mental health workers were at 28 percent. The ability of mobile crisis to respond to calls involving persons with mental illness was limited because of its longer response time. The ability of police-based mental health response to respond to these calls was hampered by a limited number of mental health practitioners available. CIT has a significantly higher capacity to respond to situations involving persons with mental illness. Research indicates that mobile crisis units and CIT offer advantages in reducing arrest. CIT is best at responding to calls involving persons with mental illness.

Police Training The Police Executive Research Forum recommends 16 hours of education in mental health and mental illness in its model curriculum for academy training of police officers. However, this standard is rarely met. Hails and Borum conducted a survey of 84 medium and large law-enforcement agencies across the country. Their study found that the average amount

13 of training nationally was 6.5 hours for academy recruits and 1 hour of in-service training by the responding departments. Most programs were derived from material developed by a police department or a relevant state agency. Only a few departments used local mental health services in the development of the course or tapped them for instructors. New York State’s Office of Mental Health (OMH) and Department of Criminal Justice Services (DCJS) Police-Mental Health Coordination Project developed a specialized police academy training course for understanding and appropriately handling encounters with persons with mental illness. The training, mandated since 1993, consists of 14 hours of course work and describes the characteristics of emotionally disturbed persons; it specifically includes training on mental illness. It covers the use of New York State Mental Hygiene Law as well as information gathering and assessment during encounters, and it teaches intervention in both high and low risk situations. It also covers appropriate documentation of encounters and liability issues. An important element of the Police-Mental Health Coordination Project academy training is role playing. This covers a range of situations including encounters with persons who are emotionally disturbed and potentially violent as well as situations that do not involve violence and therefore have to be dealt with differently. Role playing allows officers to experience situations in which they learn how to maintain composure while looking for verbal, environmental, and behavioral clues of emotionally disturbed behavior. The New York City Police Department is not covered under the OMH/DCJS mandate. The city does have a training course similar to the one developed by the Police-Mental Health Coordination Project, although there are those who dispute its quality.

14

The Albany Police and Persons with Mental Illness According to Albany mental health service providers, in 2004 at least 4000 individuals with mental illness lived in Albany county, and approximately 3071 received treatment. Population statistics cited here are at the county level because mental health treatment is provided at this level. Since national studies indicate that large numbers of people with mental illness go untreated, it is probable that these figures may understate the reality. Mental health services are primarily provided through the Albany County Department of Mental Health. There is an array of services available for persons with mental illness in Albany, including the Capital District Psychiatric Center (CDPC), the Veteran’s Hospital (VA), and other outpatient services such as the Green Street Clinic or Potpourri Club. Since the CDPC is the catchment facility for nine counties, it brings persons with mental illness from outlying areas into Albany.

The Albany Police Department The Albany Police Department employs approximately 338 officers and is one of the largest departments in the state of New York. Officers of the Albany Police Department received the 14-hour OMH and DCJS cadet training. The Albany Police Department received additional in-service training conducted by members of the Albany County Mobile Crisis Unit and the CDPC in the winter of 2005. This training was a truncated version of the OMH and DCJS Police-Mental Health Coordination Project academy training, with the inclusion of issues and resources specific to the city of Albany and the police department. The training served as a refresher for the material taught in the academy. This three-hour course dealt with identifying the signs and symptoms of mental

15 illness, understanding the operation of the mobile crisis unit, and experiencing encounters with emotionally disturbed individuals through role-playing. This training was attended by all officers. The department’s written policy regarding encounters with emotionally disturbed persons is consistent with the literature on police encounters with this population (See Appendix A). Police policy regarding persons with mental illness falls under department policies for encounters with emotionally disturbed persons (EDPs), an umbrella term used to describe persons exhibiting signs and symptoms of mental illness with the cause being unknown. The procedures dictate that officers should ascertain whether the mobile crisis unit is en route; they should proceed with extreme caution and remain alert. If possible, officers should not confront the subject alone and should be aware of any item which may be used as a weapon. Police procedure indicates it is important for officers to appear calm when communicating with EDPs. If possible, officers should solicit the aid of the subject’s friends and family to enhance communication. Albany Police Department encounters with persons with mental illness can result from one of four sources: calls for service; police initiated encounters; calls for assistance from mobile crisis, or pick-up orders from authorized mental health treatment providers. For calls not initiated by mobile crisis, officers make the determination if assistance from mobile crisis is needed. If mobile crisis is not contacted for assistance individual police officers have the discretion to determine the outcome, including calling mobile crisis for assistance and treatment, detaining the individual for evaluation, and transporting the individual to the CDPC. Or, they may take no formal action. During imminent crisis situations when there is an immediate threat

16 of harm to the subject or others, the officers may approach the individual before mobile crisis is present. We conducted a brief self-administered survey of a portion of uniformed officers in Albany (See Appendix C). Of the 85 uniformed personnel in two stations, 32 responses were received; a 37.6 percent response rate. The umbrella term EDP was used in this survey. The responses to the survey show that individual officers indicated that they approached EDP calls differently than routine calls and that the mobile crisis unit is a good resource for encounters with EDPs. The survey responses indicated that mobile crisis was available when it was needed and that encounters with EDPs were successful in diverting the individual away from the criminal justice system, with nearly all reported encounters resulting in treatment outcomes rather than arrest. The survey suggests that mechanisms in Albany for diverting persons with mental illness away from the criminal justice system appear to be working. Call and incident data from the Albany Police Department may not capture the exact frequency of encounters between persons with mental illness and the police. The department does have a call designation for EDP calls but this alone does not accurately reflect the frequency of encounters. Not all emotionally disturbed persons are mentally ill. On the other hand, calls may involve a person with mental illness but not be designated as EDP calls. The Albany Police Department does not file reports on calls that result in transport and evaluation through mobile crisis. The survey does indicate nearly half of the responding personnel believe that more than one quarter of their calls involve an EDP. The Albany Police Department had 136,788 calls for service in 2004. Deane et al’s national survey indicated that 7 percent of complaints and investigations may have involved a person with mental illness. Using Deane et al.’s measure would indicate there were

17 approximately 9,575 encounters between the Albany Police and persons with mental illness. Of course, one would expect that many of these would be informal in nature and would not be likely to appear in police statistics. The Albany Police Department and Albany County Department of Mental Health have administrative contact at a number of levels. They work with other agencies such as the social service agencies and emergency response organizations in the Program Service Coordination Committee (PSCC). PSCC meets once a month and identifies individuals who have a serious diagnosis of mental illness and who have been resistant to other interventions. The PSCC will identify these people and discuss and develop treatment options for them.

Albany County Mobile Crisis Unit Mobile crisis is one of the primary agencies in Albany responsible for handling crises involving persons with mental illness other than the police. The mobile crisis unit was created in reaction to the fatal police shooting of a person with a mental illness in 1984. Albany’s mobile crisis unit operates 24 hours a day, seven days a week and responds to crisis calls in Albany County with and without law enforcement. It is funded entirely by Albany County except for the donation of office space from the CDPC. The unit is primarily staffed by masters-level social workers. The crisis unit handles approximately 1500 calls a year. In 2004 there were 698 police requests for mobile crisis and approximately 400 of those calls originated in the city of Albany. Conversely, mobile crisis units also called Albany police for assistance more than 400 times. In addition, police often called mobile crisis for advice and referrals. Jeanne Kavanaugh, director of the Albany mobile crisis team, says, “Often the police will say, ‘You probably don’t have to come out but could you talk to this guy on the phone and give him a referral.’ Or, on the other

18 hand, they’ll call and tell us the circumstances and we’ll say, ‘You don’t need us to come out there; you’ve got enough to bring the person in for evaluation under the mental hygiene law’.” Mobile crisis has a maximum of two teams on duty at any given time. Because these teams do not use flashing lights or sirens when they respond to calls, their response time essentially is governed by Albany traffic patterns. However, there are times when teams may be delayed or be completely unavailable because they are on call elsewhere in the county which is relatively large and contains substantial rural areas with steep hills. At such times, the crisis unit maintains a staffer at its base to triage calls that may come in. If a more critical call comes from Albany police, a mobile crisis unit will be diverted from its initial call. Both police and mobile crisis report feeling that each is generally available and present at incidents when needed. Mobile crisis has a number of options when it responds to a crisis call. It may, for instance, bring the EDP to a hospital for a psychiatric evaluation. Individuals can be evaluated if they give their consent. If there is an imminent risk of injury to the EDP or others at the scene the individual may be involuntarily detained for evaluation. Involuntary detention can only occur through the police. Mobile crisis may also help the individual to make appointments for further mental health treatment; assist in getting mental health services in place to limit further crises; abate the current crisis on site, or even determine that a crisis did not exist. Mobile crisis conducts outreach to local homeless shelters and performs outtake functions for persons discharged from the hospital who are not yet receiving community outpatient treatment. Often when individuals are released from a hospital or are referred for treatment there is a gap in services between the referral and the beginning of out-patient treatment. Mobile crisis will provide services to bridge this gap between referral or release and treatment.

19 Interviews with mental health treatment providers and contact with Albany police personnel indicate that interaction between law enforcement and mobile crisis serves as a training tool for both parties. Mobile crisis personnel learn about the function and role of the police and the police officers increase their knowledge and understanding of persons with mental illness. Despite access to a mobile crisis unit, the Albany police do encounter persons with mental illness without seeking mental health assistance.

Recommendations It is important to emphasize that persons with mental illness in crisis should be treated as people who are in need of help. The goal of any successful police strategy in dealing with persons with mental illness should be to divert them away from the criminal justice system and into the social service arena where they will receive appropriate services. We recommend the following for the Albany Police Department: 1)

Collect statistics on the prevalence and outcome of EDP calls in order to accurately evaluate the performance of the department. This will help identify whether specific officers are overusing arrest powers and help determine whether or not there are issues that effect the diversion of persons with mental illness away from the criminal justice system and into the mental health system.

2)

The department may wish to add a police-based CIT program. In this model police officers receive specialized mental health training for crisis intervention. This would give the department more flexibility when mobile crisis is not available and should reduce the criminalization of persons with mental illness.

20

The Schenectady Police and Persons with Mental Illness According to mental health service providers in Schenectady, at least 1400 individuals with mental illness live in Schenectady county, and approximately 1200 receive mental health treatment. Interviews with mental health service providers and advocacy groups indicate most of these persons live in the city of Schenectady. As noted earlier, national studies suggest that many individuals with mental illness go untreated, so the figure of 1400 may understate the reality. Mental health providers are funded largely by the state and county. Nearly all treatment providers are located in city of Schenectady. The Capital District Psychiatric Center (CDPC) also operates a treatment clinic in Schenectady. Mental health services in Schenectady are overseen by the Schenectady County Office of Community Services which serves as a contract agency for all mental health services in the county. These contracted services include inpatient and outpatient treatment, forensic services in the county jail, housing assistance, an Assertive Community Treatment (ACT) Team, and case management. There are limited crisis response capabilities and outreach services in Schenectady county. There is no service comparable to mobile crisis in Albany county. If police encounter a person having a mental health crisis, the individual will be brought to the Ellis Mental Health Crisis Center for evaluation. Ellis Mental Health at Ellis Hospital is one of Schenectady County’s primary treatment providers. The Crisis Center, based in the emergency room, conducts psychological evaluations, and is staffed 24 hours a day, seven days a week primarily with MSW crisis workers.

21 The Schenectady Police The Schenectady Police Department (SPD) has approximately 160 sworn officers making it the seventh largest police department in New York. The officers received the OMH and DCJS Police-Mental Health Coordination Project academy training. SPD officers received in-service training on encounters with persons with mental illness in the winter of 2004 conducted by the Schenectady County ACT Team. This in-service training was a one-hour course attended by all members of the Schenectady Police Department at the rank of lieutenant or below. The training focused on reducing the stigma of mental illness. It dealt with causes and effects of mental illness, types of mental illness, homelessness and its relation to mental illness, and economic issues associated with mental illness. The training also provided practical information for encounters with persons with mental illness, including such topics as invasion of personal space; keeping an open stance; body position and language, and being non-threatening during encounters. The Schenectady Police Department’s written policy regarding encounters with emotionally disturbed persons is also consistent with the literature on police encounters with this population (See Appendix B). Again the umbrella term EDP is used to represent individuals with signs and symptoms of mental illness that could be due to a variety of factors. Department policy is: “to protect emotionally disturbed persons from injury to themselves and others and to adhere to the New York State Mental Health and Hygiene Laws”. Department policy stresses that officers should not use lights and sirens when approaching because it may upset the EDP. Encounters with EDPs should involve at least two officers on scene unless the situation warrants immediate action. Procedures direct officers to respond with kindness and understanding and to establish rapport and trust with the disturbed individual. The procedures also emphasize that an

22 outward appearance of control by the officers should be maintained and that officer demeanor is “one of the most significant factors in achieving a smooth resolution to the call” (SPD, Appendix B, #3E). Schenectady Police Department encounters with persons with mental illness can result from one of three sources: calls for service; police-initiated encounters, or pickup orders from lawfully mandated mental health professionals requiring police to transport an individual for evaluation and treatment. In other encounters the tone and outcome are based on the discretion of the individual officer. When an officer feels people are a threat to themselves or others, the officer can detain and transport them to Ellis Mental Health’s Crisis Center for evaluation. If an individual is willing to be evaluated, police can provide transport to the crisis center for evaluation. If the encounter does not warrant detention and evaluation the officer can provide information on agencies where an individual may gain assistance. Alternatively, officers may take no formal action. The Schenectady Police Department has a drop-off agreement with Ellis Mental Health’s Crisis Center which allows officers to bring persons with mental illness in need of evaluation to the crisis center and allows the officers to promptly return to their patrol duties. This arrangement encourages officers to bring persons exhibiting signs and symptoms of mental illness to the crisis center for evaluation; officers do not have to spend a significant amount of time waiting for an individual to be evaluated at a hospital emergency room. Steadman et al.’s (B) research has shown officers are more likely to resort to arrest or not take appropriate action when faced with long delays waiting with persons with mental illness in need evaluation. This drop-off agreement is an important resource for diverting people with mental illness away from the criminal justice system. According to an Ellis official, police may use the drop-off function

23 as little as two or three times a week or as often as six or seven times a week. It is used most heavily in the afternoon and evening. Police officers may sometimes be lax in filling out required paperwork when they drop individuals at the crisis center. We conducted a brief self-administered survey of a portion of uniformed officers in Schenectady. We received a total of 11 responses from 90 uniformed personnel in the department; a response rate of 12 percent. The response rate was too low for the survey data to be included in this report. This report cannot determine if Schenectady Police Department personnel are appropriately diverting persons with mental illness from the criminal justice system into the mental health system. It is difficult to determine the exact frequency of police encounters with persons with mental illness in Schenectady. Although the SPD does have an EDP call designation, calls may involve individuals with mental illness that are not designated as EDP calls. In 2004, police dispatchers labeled slightly fewer than 500 calls as EDP related. Not all emotionally disturbed persons have a mental illness. Officers may also encounter persons with mental illness where no formal action was taken by the police officers. Without the survey data it is difficult to determine the frequency of encounters between Schenectady Police Department officers and persons with mental illness. Schenectady had 83,113 calls for service in 2004; using Deane et al.’s measure there would have been approximately 5,818 encounters between Schenectady Police and persons with mental illness. Obviously, many such encounters would be informal and of short duration so they would be unlikely to appear in official police logs. Interviews with mental health service providers indicate that Schenectady Police Department officers may be hesitant to use their powers to initiate mental health arrests under the

24 New York State Mental Hygiene Law in situations where they were not issued a pick-up order by a mental health service provider

Recommendations The Schenectady Police Department is responsive to the needs of mental health care providers but there may be a gap in service to people who are in need of mental health assistance but are not at imminent risk. Because there is not a comprehensive crisis response service, individuals who are not a threat to themselves or others may not get the services they need unless they are transported to the crisis center for evaluation. We recommend the following for the Schenectady Police Department: 1)

Enhance communication between all mental health service providers and the Schenectady Police Department. Dialogue is often limited to the issuing of pickup orders to the police by authorized county mental health professionals. Better communication would increase the capacity of the police department to respond to crisis situations. More communication could also provide information on possible police mistreatment of persons with mental illness. In the past, mental health providers in Schenectady met every four to six weeks to discuss cases. This practice has fallen into disuse. Reviving these conferences—and, this time, including representatives from the police—would improve chances of fostering a comfortable relationship between police and the mental health community.

2)

Update policies to reflect the current drop-off agreement with Ellis Mental Health and the greater role of police officers during encounters with EDPs. When

25 these policies were written they reflected a period in which greater outreach was conducted by Schenectady county mental health services (circa 1993). Outreach services were curtailed due to funding restrictions. Policies need to be updated to reflect changes in the dynamic of these encounters. Police officers should pay particular attention to filling out paperwork when they drop people at the crisis center. According to an Ellis official, police are expected to fill out a standard document describing the circumstances that led an officer to bring someone to the center. Currently, according to this same official, there is only about a 50 percent compliance rate by police. Lacking this form, the crisis center staff is forced to operate without benefit of full knowledge. We realize that too much paperwork, from a police officer’s viewpoint, might seem to undermine the very purpose of a “drop off” center. Perhaps police and Ellis representatives should meet to review the current form to make sure it is as short—but also as useful—as possible. 3)

Expand in-service training for police, including increased emphasis on practical actions during these encounters and role playing of scenarios. The one-hour training session on mental illness received by officers in 2004 should be expanded and made more comprehensive. It is encouraging to learn that two lieutenants recently attended an intensive, two-day training event in this field and are scheduled to conduct in-service sessions during 2006.

4)

Collect statistics on the prevalence and outcome of encounters with persons with mental illness calls in order to accurately evaluate the performance of the department. This will help identify whether specific officers are overusing

26 arrest powers and help determine whether or not there are issues that effect the diversion of persons with mental illness away from the criminal justice system and into the mental health system. 5)

Implement and develop a specialized response program. There are two possible approaches: a mobile crisis team or a police-based CIT program. Creation of a stand-alone mobile crisis team in Schenectady may be costly. There is currently a well functioning and capable mobile crisis unit operating in Albany county. Schenectady should determine if a jointly funded mobile crisis unit could be developed which would serve both counties. Alternatively, Schenectady should develop a CIT program, with specific officers specially trained to handle encounters with persons with mental illness. A CIT program would increase the capacity of the department to respond to these encounters safely and effectively. The cost could be lessened with the assistance of mental health practitioners for training purposes. This program could also result in reduced liability for use-of-force complaints or lawsuits alleging police misconduct. A reduction in liability was experienced in other departments which implemented CIT Programs. The department already has a drop-off agreement in place with Ellis Mental Health, an important element to a successful CIT program. A CIT program would allow specially trained officers with the compassion and the personality to effectively interact with persons with mental illness to handle these calls, but would not remove these officers from routine patrol.

27

Civilian Review We reviewed the policies of the Albany and Schenectady Civilian Police Review Boards (CPRB) with regard to complaints by persons with mental illness. Neither review board has in place any special considerations or accommodations that would help persons with mental illness to file complaints or gain assistance in the adjudication of a complaint.

Complaint Process Albany and Schenectady have a similar complaint process. In both jurisdictions complaints are filed and then turned over to the respective internal review mechanisms in the police departments. The Albany CPRB may appoint a monitor to conduct an investigation parallel to the department’s and write a report for the board. The Schenectady CPRB is currently seeking to hire an investigator to review complaints. After an internal review of the complaint by the department, the findings are given to the boards for review. In the case of Albany this happens before the final decision on discipline of the officer is made by the chief of police. In Schenectady this occurs after the chief has made a decision regarding the complaint. The review board then decides if it agrees or disagrees. It may also determine that the findings are inconclusive or that more information is needed. The respective police departments then review the decision of the board and respond to the board’s questions. In Albany a final decision is rendered by the chief of police. In Schenectady the board’s view is sent back to the chief. If the board agrees with the findings, the internal disposition is upheld; if the board disagrees the investigation is reopened for further review.

28

Recommendations Interviews with criminal justice system representatives indicate there are complaints filed by persons exhibiting signs and symptoms of mental illness in Albany but it could not be determined if this occurred in Schenectady because identifiers are removed from the information provided to the board. Barriers to the complaint process could include lack of knowledge regarding the existence of the system; lack of understanding how to obtain complaint forms and fill them out properly; lack of understanding of the complaint process, or fear or anxiety in making a complaint. We therefore make the following recommendations to facilitate access to the complaint process by persons with mental illness. We recommend the following for both the Albany and Schenectady civilian police review boards: 1)

Increase outreach to mental health service providers. Currently, complaint forms are available in Schenectady from the police department, the NAACP, the Human Rights Commission, and at City Hall. In Albany, complaint forms are available from a number of organizations including the police department, the Albany Housing Authority, the Center for Law and Justice, the NYCLU, Albany High School, and the Government Law Center. To facilitate access to the complaint process by persons with mental illness, complaint forms should be available at mental health service centers and community organizations such as Bethesda House, Ellis Mental Health’s Collage Social Club, and the Law, Order and Justice Center in Schenectady and the Green Street Clinic, the CDPC outpatient clinic, the Clearview Center, and the Potpourri Club in Albany.

29 2)

Train select mental health workers to aid persons with mental illness to accurately complete complaint forms. There are a number of organizations in both Albany and Schenectady that assist individuals in filling out complaints about the police. In Albany these include the Albany Community Development Agency, the Center for Law and Justice, the Capital District Gay & Lesbian Community Council, the NYCLU, and One Hundred Black Men of the Capital Region. In Schenectady the Human Rights Commissioner and the NAACP are the primary agents to assist in this process. It is important that complaint forms be filled out properly to facilitate investigation.

3)

Develop a clinic to provide assistance to persons with mental illness in filing complaints against the Albany or Schenectady police departments. The complaint process can be stressful and confusing to any individual filing a complaint and perhaps more so to a person experiencing a mental illness. There is already a relationship between Albany Law School and the Albany CPRB; this would be a natural expansion of that relationship. In Schenectady this clinic could be provided through the Human Rights Commission. These clinics would allow persons with mental illness to be provided assistance in not only filling out the complaint form but also assistance in understanding and navigating complaint process.

These recommendations will facilitate access to the complaint process by persons with mental illness. Allowing all individuals to access the complaint process is important for any police department seeking to be responsive to community concerns.

30

Conclusion Police encounters with persons with mental illness in both Albany and Schenectady occur frequently. It is important that these calls be handled appropriately by diverting persons with mental illness away from the criminal justice system and keeping officers and these individuals safe. This report issues a number of recommendations to both Albany and Schenectady to appropriately handle encounters with persons with mental illness. For Albany this includes data collection specifically related to these encounters and the possible adoption of a CIT program. For Schenectady this includes increased communication with mental health service providers, enhanced training, data collection, and the development of either a mobile crisis unit or CIT program. We would like to take the opportunity to thank all agencies and individuals which assisted in the preparation of this report. We would especially like to thank both the Albany and the Schenectady police for their willingness to participate in this research. We hope this report and these recommendations will help each department respond to and understand encounters with persons with mental illness.

31

Appendix A: Albany Police Department Policy for Encounters with Emotionally Disturbed Persons Emotionally Disturbed Persons 1. Techniques of the Call A. Ascertain through dispatcher whether Mobile Crisis is available/enroute. B. Proceed with extreme caution and be alert to every move the subject might make. C. Whenever possible, do not confront the subject alone. D. If possible, move any item in the room that might be used by the subject as a weapon. E. Attempt to appear calm. If communication with the subject is possible, keep voice and manner as toned down as possible. F. Make use of friends and relatives familiar with the subject; whenever appropriate. G. if taking the subject into custody, do so with calmness and deliberation; use ample restraining devices to avoid any further complications. Sufficient legal force may be exercised in order to subdue to the subject. H. Refer to NYS Mental Hygiene Law as needed. (Current MHL allowing an Admission Standard applies under the following sections: MHL – 9.39, 9.41, 9.43, 9.45, 9.55, and 9.57). 2. Transportation of the Persons with mental illness and Report Taking: All emotionally disturbed persons needed to be transported, MUST be transported via ambulance OR by “Mobile Crisis”. The Officer shall accompany the subject(s) to the hospital for purpose of report taking and advising the attending physician of the situation. Note: No report is necessary if Mobile Crisis transports the subject to a facility or hospital. The unit may still follow the Crisis Unit transport, if requested by Mobile Crisis.

32

Appendix B: Schenectady Police Department: Field Contact with Emotionally Disturbed Persons I.

Purpose

The purpose of this procedure is to clarify the authority and responsibility on an Officer when dealing with persons under the New York State Mental Health Law. II.

Policy

It shall be the policy of the Schenectady Police Department to protect the emotionally disturbed persons from injury to themselves and others and to adhere to the New York State Mental Health and Hygiene Laws. III

Procedures

The following procedure should be adhered to when responding to calls or any encounters with emotionally disturbed persons. 1.

Responding to the Scene Upon receiving a call that involves or is believed to involve an emotionally ill or berserk person, the Officers shall use extreme caution. In most instances the red lights and sirens should not be used, as it may case the disturbed persons to become even more upset. Emergency driving procedures shall be adhere dot if the communicator states that a life may be in danger. In such instances the red lights and siren shall be cut before actually arriving on the scene.

2.

Initial Survey Notify the communications center that you are on the scene. Enter the building and/or approach the subject with extreme caution, only after there are at least two (2) Officers on the scene. If a single Officer decides that the situation warrants immediate action to preserve and protect human life, he/she may act alone.

3.

Techniques on the Call a. Be alert to every move the person might make, proceed with caution. b. Keep radio volume low and any radio transmissions should be out of hearing of the subject. Safety should dictate. c. If possible, remove any item in the area that might be used as a weapon by the subject.

33 d. The subject will probably respond more favorable to kindness and understanding. Establishing a rapport and/or element of trust is essential. The Officer should be mindful of how any physical or verbal actions might be viewed. e. Maintain outward appearance of complete control, be firm and direct. The Officers demeanor is one of the most significant factors in achieving a smooth resolution to this call. f. Be aware that friend or relatives can sometimes be helpful in dealing with the subject. g. Any Officer desiring assistance should request a Patrol Supervisor. h. If an officer determines there is reasonable grounds to believe an individual is dangerous to themselves or others, they should adhere to the following procedures: 1. The Officer shall detain the person. 2. When taking this subject into custody do so with a calm and deliberate manner. Restraining devices may be used to avoid further complications. Necessary physical force may be exercised in order to subdue the subject. 3. When the decision for transport has been made, as Officer at the scene shall notify the communications center and the appropriate arrangements will be made. i. Emotionally disturbed persons should be transported in an ambulance. If, due to circumstances, transportation is going to be done by police vehicle, prior approval from the Patrol Supervisor of Desk Officer must be granted. Mental Health staff are not permitted to transport patients in a private vehicle. An involuntary patient will not be allowed to transport himself or be driven by family or friends. Officers will respond to the Hospital and describe the subjects behavior (how he/she was dangerous to themselves or others) to the E.R. staff, and fill out a copy of the report as described in “l” of this section and attach to the S.I.R. as a supplement. j. If criminal charges are involved, the Officers will notify the Desk Officer after the person charged is in custody at Ellis Hospital. The Desk Officer will make the necessary arrangements for supervision and booking of a hospitalized prisoner.

34 k. If no criminal charges are pending the Officers should notify the communication center after the person is under control and clear the scene as soon as possible. l. In all case, both 9.39 and 9.45 admissions, police officers will be required to complete the Ellis Hospital “Police Officer Report on Emotionally Disturbed Person” report available at the nurse’s station in the E.R., and forward a copy to the Commander of the F.S. B. and also attach a copy to a S.I.R. and file with desk officer. On 9.45 admissions, the officer need only complete the top portion of the Hospital Report and submit a copy with the Transport Order to the F.S.B. Commander and another copy to the S.I.R. report to be filed. m. Officers should be aware that on-site consultations and telephone consultations from the Community Services Team operating form Ellis Hospital Psychiatric Clinic are available to assist Officers in dealing with emotionally disturbed persons. 4. Police Requested Evaluation by Mental Health Clinic a. Requests by police for Mental Health Evaluations and requests by Mental Health for Police back up during evaluations will occur only on weekdays from 8:30 A.M. to 5:00 P.M. at this time. b. On scene, either Officer at scene or dispatcher of Desk Officer calls Mental Health Clinic #38-3300 and requests a crisis worker. Mental Health Worker travels to scene immediately if possible. If not, arranges either another Mental Health staff member to go immediately or arrange to go ASAP. M-H will give priority to these requests over consults in the E.R. c. M-H workers speaks with Officer at scene to determine the nature of assistance requested. This includes request to evaluation subject/patient for suitability of involuntary transport, request to negotiate with subject/patient to obtain his/her voluntary cooperation, to advise Police in dealing with subject/patient, etc. d. M-H worker talks to subject/patient as necessary. Police remain on scene to insure safety. Police take charge of the situation if they determine safety is at risk and M-H worker will comply with Officer’s instructions to leave the scene, etc. e. After M-H worker evaluates, M-H worker and police Officer(s) discuss situation to form a plan. 1. If M-H worker determines that subject/patient is in need of treatment and is dangerous, PD should order transport per 9.41 of the N.Y.S. Mental Health Laws.

35 2. Officer may order the 9.41 transport at anytime regardless. 3. M-H worker and Police may agree that involuntary transport is not indicated. M-H worker will make appropriate referrals. 4. After assessing subject/patient, M-H worker may elect to remain on the scene to work with subject/patient further after Police have left, but police will remain on scene while M-H worker is there if asked to. f. If transport to Ellis is decided on, Police will contact ambulance. Transport vehicles will notify ER by radio on arrival. g. M-H worker will report reason for transport and for 9.39 hold to E.R. physician or Charge Nurse. 5. M-H Requests Police Back-up a. M-H personnel may request that Police accompany him/her in order to assess a patient’s mental status. M-H worker will do this by calling the Desk Officer or Dispatcher. M-H worker will advise PD of the reason for the request – i.e. whether there is imminent danger requiring police assistance, whether visit can take place as time permits, and of other relevant information – i.e. patient has a weapon, history of assaultiveness, etc. b. M-H worker will meet PD at agreed location and wait for PD to arrive before approaching patient. PD will give their ETA if possible. c. M-H worker will interview patient. M-H. worker will inform him/her of the order that they be evaluated in a hospital. Police will stand by in immediate areas until assessment is complete. Police will assume control of the situation if safety warrants it; M-H worker will then comply with PD directions. d. M-H worker will decide whether involuntary transport per M-H law is appropriate and advise Police accordingly. If transport is not appropriate the M-H worker will make other interventions as necessary. 6. Pick-Up Orders a. Police will be requested to assist in bringing individuals to Ellis E.R. for psychiatric evaluation under MHL 9.45. b. The request will be made by the Director of Community Services or his designee when an individual is alleged to be mentally ill and dangerous. c. The request may be made verbally by the DCS or designee by phone, or relayed verbally to the police by Mental Health personnel.

36 d. In all instances, the Police will be given a written request on from OMH 474A/ 476A, (Custody/Transport form) of the Mental Health Services, to confirm the authorization of for the pick-up. Because of the time constraints in emergencies, the Custody/Transport form will be delivered in one of three ways: 1. A completed form will be given to a Desk Officer or an Officer on the location before pick-up. 2. The form will be Faxed to the Police Department and the original mailed later. 3. An original will be mailed or hand delivered to the Desk Office after the transport has been carried out on a verbal request. e. In order to maintain a level of security during those times when our Department has to be notified via telephone of an MHL 9.45 pick-up, those persons so authorized to make such requests have been issued personal identification numbers. The authorized person calling this agency must give his/her P.I.N. so that his/her identity can be confirmed. The P.I.N. numbers will be maintained/stored in our Department Computers as well a file at the Lieutenant’s Desk. f. On all 9.45 admissions only, police officers will fill out the top portion of the “Police Officer Report of Emotionally Disturbed Person” report form available at Ellis E.R. nurse station and submit a copy to the Commander of the F.S.B. along with the Transport Order. Section 9.41 of the NEW YORK STATE MENTAL HEALTH HYGIENE LAW—Officers under authority where they are empowered to take into custody a persons whose behavior is dangerous to himself or others. Section 9.45 of the NEW YORK STATE MENTAL HEALTH HYGIENE LAW—It is the duty of a Police Officer to assist representatives of the Director of Community Services to take into custody and transport and such person to Ellis Hospital. If officers encounter any emotionally disturbed individuals who are not endangering themselves or others but may require Mental Health Services, a telephone referral should be made to the Ellis Hospital Mental Health Clinic during business hours at (386-3300) describing the persons behavior and giving all pertinent information.

37

Appendix C: Police Encounters with Individuals with Mentally Illness in Albany Patrol Officers Survey Your participation in this study is completely voluntary and can refuse to answer any question. By completing this questionnaire you are indicating you understand your rights as a human subject. After completion of the survey please place survey into the envelope and then place the envelope in the provided container. Part I - Please circle the response which best describes your agreement with the items below. Strongly Disagree

Somewhat Disagree

Somewhat _Agree_

Strongly Agree

1) Many of the EDPs which I encounter during my job I have dealt with before.

1

2

3

4

2) It is difficult to tell if a person is abusing drugs/alcohol, is mentally ill, or both.

1

2

3

4

3) The Mental Hygiene Laws restrict my discretion during encounters with EDPs.

1

2

3

4

4) Many EDPs are not getting the treatment they need.

1

2

3

4

5) EDP’s are more likely to be violent than others.

1

2

3

4

6) EDP calls are more unpredictable than other types of calls.

1

2

3

4

7) I approach known EDP calls as any other routine call.

1

2

3

4

8) The Mobil Crisis Unit is a good resource when dealing with EDPs.

1

2

3

4

9) The Mobil Crisis Unit is available when I need them.

1

2

3

4

10) I feel that I have an adequate understanding of symptoms that may be displayed by an EDP.

1

2

3

4

11) I would like more training for encounters with Emotionally Disturbed Persons

1

2

3

4

12) I have a good understanding of NY States Mental Hygiene Laws.

1

2

3

4

Part II -The following three questions have to do with your last encounter with an emotionally disturbed person. Please check the appropriate answer.

38

13) How would you have classified this call? (check all that apply) Attempted Suicide___ Assault___ Person Annoying___ Assist Mobile Crisis___ EDP Call___ Other:__________ 14) Who was present at your last call involving an EDP. (check all that apply). Another officer___ Supervisor or Sergeant___ Mobile Crisis Unit ___ Assertive Community Treatment Team___ Other Mental Health Worker Other________________ 15) What was the outcome or disposition of your last encounter with an EDP? Advise and Release___ Arrest___ Referral for Service___ Transport to Psychiatric Center___ Released to Mobil Crisis___ Part III – General Questions. Please check the appropriate answer. 16) What percent of calls do you feel involve an emotionally disturbed person? Less than 25%___ Between 25 and 50%___ More than 50% of calls___ More than 75% of calls___ 17) What percentage of EDP calls do you feel involve an attempted or completed suicide Less than 25%___ Between 25% and 50%___ More than 50% of EDP calls___ More than 75% of EDP calls___ 18) What types of training you have had for encounters with Emotionally Disturbed Persons. (Please check all that apply) In-Service Training___ Academy Training___ On-the-Job Training/Experience___ Other__________ 19) Which training was the most helpful or useful in encounters with EDPs. In-Service Training___ Academy Training___ On-the-Job Training/Experience___ Other__________ 20) What shift or time of day do you work? A shift___ B Shift___ C Shift___

Flex Hours___

21) Which station do you primarily work out of? South___ Center___ North___

West___

22) How long have you been with the police department? Less than 1 year___ 1 to 5 years___ 6 to 10 years___

More than 10 years___

23) What is the highest level of formal education you have completed? High School or GED___ Some College___ Associates Degree___ Bachelors Degree___ Graduate Degree___

39

References Albany Police Department. (2005). Crime Info. Obtained from www.apdonline.org. Bowers, D. and Petit, G.. (2001). The Albuquerque Police Department’s Crisis Intervention Team. The FBI Law Enforcement Bulletin. Federal Bureau of Investigation. 70:2. p. 1-6. Deane, M., Steadman., H., Borum., R., Veysey., B. and J. Morrissey. (1999). Emerging Partnerships Between Mental Health and Law Enforcement. Psychiatric Services. 50:1. p. 99101. Engel, R., and Silver, E. (2001). Policing Mentally Disordered Suspects: A Reexamination of the Criminalization Hypothesis. Criminology. 39: 2. p. 225-252. French, Laurence. (1987). Victimization of the Mentally Ill: An Unintended Consequence of Deinstitutionalization. Social Work. November-December: p. 502-505.

Hails, J. and R. Borum. (2003). Police Training and Specialized Approaches to Respond to People with Mental Illnesses. Crime and Delinquency. 49: 1. p. 52-61. Hiday, A., Swartz, M., Swanson, J., Borum, R., and R. Wagner. (2002). Impact of Outpatient Commitment on Victimization of People with Severe Mental Illness. American Journal of Psychiatry. 159:8. p. 1403-1411. Green, T.. (1997). Police as Frontline Mental Health Workers. International Journal of Law and Psychiatry. 20:4. p. 469-486. Kessler, R., Berglund, P., Bruce, M., Koch, R., Laska, E., Leaf, P., Manderscheid, R., Rosenheck, R., Walters, E., and P. Wang. (2001). The Prevalence and Correlates of Untreated Serious Mental Illness. Health Services Research. 36. p. 987-1007. Krieg, R. (2001). An Interdisciplinary look at the deinstitutionalization of the mentally ill. The Social Science Journal. 38: p. 367-380.

Lamb, H., Weinberger, L, and W. Decuir. (2002). The Police and Mental Health. Psychiatric Services. 53: 10. p. 1266-1271. Lamb, R., Roderick, Sh., Elliot, D, Decuir, W. and Foltz, T. (1995). Outcome for Psychiatric Emergency Patients Seen by an Outreach Police-Mental Health Team. Psychiatric Services. 46:12. p. 1267-1271. Levine, F. (2004). Why Is It Important for Police Officers to Know About Mental Illness. Unpublished.

40 Marley, J., and Buila, S. (2001). Crimes against People with Mental Illness: Types, Perpetrators, and Influencing Factors. Social Work. 46:2. p. 115-124. Mechanic, D. and D. Rochefort. (1990). Deinstitutionalization: An Appraisal of Reform. Annual Review of Sociology. 16: p. 301-327. Narrow, W., Regeir, D., Norquist, G., Rae, D., Kennedy, C., and B. Arons. (2000). Mental health service use by Americans with severe mental illness. Social Psychiatry and Psychiatric Epidemiology. 35. p.147-155. New York Lawyers for Public Interest (NYLPI) (No Date). Obtained June 26, 2005 from www.nylpi.org/area_2_police.html. New York State Consolidated Laws. (2004). Mental Hygiene: Article 9 – Hospitalization of the Mentally Ill. Penn, D., and Martin, J. (1998). The Stigma of Severe Mental Illness: Some Potential Solutions for a Recalcitrant Problem. Psychiatric Quarterly. 69:3. p. 235-247. Perez., A., Leifman S., and A. Estrada. (2003). Reversing the Criminalization of Mental Illness. Crime and Delinquency. 49:1. p. 62-78. Phelan, J.C. and Link, B.G. (1998). The growing belief that people with mental illnesses are violent: the role of the dangerousness criterion for civil commitment. Social Psychiatry and Epidemiology. 33:s7-s12. . Police Executive Research Forum. (1997). The police response to people with mental illness: Trainers Guide. Washington DC. Psychiatric Patient Advocate Office (PPAO). (2004). Submission Regarding “Review of the System for Complaints by Public Regarding the Police. Reuland, M. (2004). A Guide to Implementing Police-Based Diversion Programs for People with Mental Illness. Police Executive Research Forum and the Substance Abuse and Mental Health Services Administration. Rochester Police Department (RPD) (2004) Rochester Police Department Annual Report 2003. Spellman, A., Stapleton, M., Wildman, L. and W. Williford, (No Date). Police Mental Health Training Program: Officers Guide. New York State Office of Mental Health, New York State Division of Criminal Justice Services, and Ulster County Mental Health Services Scott, R.. (2000). Evaluation of a Mobile Crisis Program: Effectivess, Efficiency, and Consumer Satisfaction. Psychiatric Services. 51. p. 1153-1156.

41 Sheridan, EP. And T eplin L. (1981). Police-referred psychiatric emergencies: advantages of community treatment. Journal of Community Psychology. 9: p. 140-147. Silver, E.. (2000A). Race Neighborhood Disadvantage, and Violence Among Persons with Mental Disorders: The Importance of Contextual Measurement. Law and Human Behavior. 24:4. p. 449-456. Silver, (2000B). Extending Social Disorganization Theory: A Multi-level Approach to The Study of Violence Among Persons with Mental Illness. Criminology. 38:4. p. 1043-1075. Speaking, M.. (2002). Schizophrenia. National Institute of Mental Health. Obtained December 20, 2004 from https://www.nimh.nih.gov. Steadman, H., Deane, M., Borum, R., Morrissey (2001A). Comparing Outcomes of Major Models of Police Responses to Mental Health Agencies. 51:5. p. 645-649. Steadman, H., Stainbrook, K., Griffin, P., Draine, J., Dupont, R., and C. Horey (2001B). A Specialized Response Site as a Core Element of Police-Based Diversion Programs. Psychiatric Services. 52. p. 219-222. Teplin, L.. (1984). Criminalizing Mental Disorder. Psychology in Action. 39:7. p.974-803. Teplin, L., Pruett, N. (1992). Police as Streetcorner Psychiatrist. International Journal of Law and Psychiatry. 15. p139. Vickers, Betsy. (2000). Practitioners Perspectives: Bulletins from the Field – Memphis Tennessee, Police Department’s Crisis Intervention Team. U.S. Department of Justice. Weaver, E. (2005). Emotionally Disturbed Persons Response Team. 2nd Annual Bridges and Barriers Conferences. Albany, New York. US Department of Census. (2005). Obtained January 2005 from www.census.gov.