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On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to KHI.org.

Handling Kansans with mental illness a matter of training for law enforcement

By Jonathan Shorman | October 24, 2016

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Editor’s note: Reporters from the Topeka Capital-Journal and KHI News Service collaborated for a six-month exploration of how the state’s legal system deals with people with mental illness. This is the second in a four-part series, “Mental health on lockdown.”

At first, the man appears drunk.

He’s walking along an on-ramp from Lackman Road onto Interstate 435, a major highway snaking through the Kansas City metro area. At 1 p.m., traffic is heavy.

A four-part series

The man doesn’t react well when a police officer arrives.

“He takes a few swings at the officer. They’re obviously not a Mike Tyson swing, but they’re swings nonetheless, where if something happened right there it could very easily spill over from the shoulder onto the highway where somebody would really get hurt,” Lenexa Police Capt. Wade Borchers said, recounting an incident from earlier this year that involved another officer.

But no highway brawl breaks out. Instead, the officer just talks with the man. He calms down and the officer is able to get him off the road. Then he handcuffs him.

The difference between what could have happened and what did happen rests in the officer’s training, Borchers explained. The officer was able to recognize the man was not actually drunk but instead had a developmental disability.

Photo by Thad Allton/Topeka Capital-Journal Kansas City Police Sgt. Sean Hess speaks during a meeting on crisis intervention team training in Wichita. Hess discussed efforts to encourage more law enforcement departments to adopt the training and the initial resistance from some rural departments.

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The story Borchers told serves as just one example of countless police interactions throughout Kansas that have been shaped by training focused on situations involving people with mental illness and developmental disabilities. Law enforcement agencies are attempting to pay greater attention to how they interact with people with mental health issues, though what that looks like can differ sharply among departments.

In particular, police approaches to mental illness exist along an urban-rural divide within the state. Large and midsize cities in Kansas have access to greater resources, while law enforcement in small towns and rural areas must grapple with limited resources and simple geography: Vast expanses of land often separate police from mental health professionals.

But police, especially in the eastern part of the state, also face acute challenges stemming from ongoing problems at the state’s psychiatric hospitals. With some individuals waiting days to be admitted to Osawatomie State Hospital, officers have grown increasingly frustrated.

“If they don’t have the ability to pay, they’re going to get quicker service at the jail than they will in the community,” Borchers said.

A push for CIT

At a time when the mental health system is under increasing pressure, police have taken a more active role dealing with people in crisis. They must respond to all situations, no matter how difficult.

“There’s a lot of people who need specialized help that I don’t think we’re providing very well,” said Sedgwick County Sheriff Jeff Easter during a gathering on mental health training for law enforcement and civic officials this fall in Wichita. “We’re trying to do the best we can in law enforcement, and obviously you guys are as well by being here today. But we all know the system right now is broken, in my opinion.”

Many larger police departments in Kansas over the past few years have embraced crisis intervention team training, commonly called CIT. The aim is to equip officers to appropriately respond to situations involving people with mental illness or developmental disabilities.

[ Related story: Washington state takes lead on police mental health training ]

CIT training involves both how officers act in the moment to defuse situations and how they guide people with mental illness to appropriate services.

“Not only learning the things to say, but also definitely focusing on the things not to say and do,” said Lane Mangels, a detective with the Salina Police Department.

“Policing has changed a lot just in my career, and it’s definitely different than it was 25 to 30 years ago,” he said. “We’re trying to get them to recognize when they see these signs and symptoms that if they focus on having a little bit of empathy in understanding where this person is coming from and think outside the box in ways to assist them, maybe they can de-escalate that situation.”

“We’re trying to do the best we can in law enforcement. … But we all know the system right now is broken.”

- Sedgwick County Sheriff Jeff Easter

That can range from recognizing that a transient walking the highway may have a mental health problem to being aware of how a mental illness may affect someone in a standoff with police. Research suggests 10 percent of police contacts with the public involve individuals with serious mental illness.

Once an officer stabilizes a situation, CIT training emphasizes attempting to channel the individual with mental health issues to community services rather than jail. In some cases, this involves getting a person on the phone who can speak with the individual and perhaps persuade them to get help.

Other times, it involves deployment of a co-responder to the scene. The co-responder, often a mental health professional, may speak with the individual one-on-one and perhaps even transport that person to treatment if needed.

“I’ve talked to people direct and try to get them to voluntarily go somewhere, and they don’t want anything to do with it, but then I call Johnson County Mental Health and they talk to him for two minutes — ‘OK, I’ll do that,’” Borchers said. “And I’ve been standing here for half an hour trying to get you to do that, and you talk to them for two minutes and now you’re going to go. ‘Well, yeah, but they’re not a cop.’ OK, fair enough.”

A 2012 research paper in the journal Best Practices in Mental Health found only limited data on the number of people police are diverting toward services rather than funneling into the criminal justice system. But the authors suggested that law enforcement’s role as gatekeepers to both the mental health and criminal justice systems is increasing as state budgets are slashed.

The National Alliance on Mental Illness, CIT International and other groups have developed a curriculum for CIT training that typically takes 40 hours for an officer to complete.

Some of Kansas’ biggest police departments have sought training for large numbers of officers.

Photo by Thad Allton/Topeka Capital-Journal Topeka police captain Bill Cochran watches a speaker during Kansas’ annual crisis intervention team training summit in Wichita. Cochran plays a leading role in Topeka’s police program.

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The Topeka Police Department has trained 149 of its 300 sworn officers, or almost half. Upward of 75 percent of officers on the street are trained, Topeka Police Maj. Bill Cochran said. He said there is a good chance a CIT-trained officer will be responding to any given call, whether they’re specifically requested or not.

The 40-hour training commitment can present a challenge to smaller departments, however.

“It’s very difficult for a small agency to send someone out of town for a week for training like that,” said Ed Klumpp, a former Topeka police chief who now works as a lobbyist for several law enforcement associations in the state.

Klumpp estimates 75 percent of law enforcement agencies in Kansas have fewer than 10 officers. For some agencies, voluntarily giving up an officer for a week represents an unacceptable loss of manpower. A week of hotel and meals for one or more officers also can strain budgets.

To combat that, the Topeka Police Department has developed a training regimen that takes place on nonconsecutive days. Cochran said the department has offered trainings once a month or once a week every other week to make CIT training more accessible for smaller agencies.

But those small agencies often must decide whether to pursue CIT at all. A department with just a handful of officers may not see the return on investment that makes training worth it.

Sgt. John Bryant of the Kansas City, Mo., police helps lead efforts to promote CIT in Missouri, including rural areas.

Bryant said some rural agencies have resisted CIT training. The key, he indicated, is to have law enforcement make the case for the training to other officers. Efforts to persuade smaller departments to adopt CIT have to be driven by law enforcement peers, he said.

“It’s kind of sad,” Bryant said. “Sometimes we’d go out to these smaller agencies and try to convince them they need CIT. ‘Oh, we don’t need that stuff, we know how to talk to people.’ Six months later, we’d see them … getting sued because they did something bad.”

He added soon after: “Hopefully, you guys can get to folks on your side of the state quicker than we did on ours.”

A large component of CIT training is building relationships between police and mental health professionals, not just training an officer how to react in a given situation.

In rural areas, those local mental health resources may simply not exist.

Rural challenges

The High Plains Mental Health Center headquartered in Hays serves 20 counties that cover more than 19,000 square miles. Walt Hill, the facility director, said that while High Plains has good relationships with law enforcement, the CIT approach doesn’t make as much sense in rural northwest Kansas.

Instead, agencies in his corner of the state often turn to mental health first aid.

“Because of the number of small departments and turnover, and just the geography, mental health first aid has made more sense to us and to them because we don’t have really the critical mass that you would have in Topeka or KC metro area,” Hill said.

Mental health first aid is an eight-hour course developed in 2001 in Australia. In the United States, its umbrella organization is Mental Health First Aid USA, overseen by the National Council for Behavioral Health and the Missouri Department of Mental Health.

Mental health first aid carries a broader aim than CIT and can be taken by social workers, clergy and other civic leaders. Because training lasts a single day, it presents an attractive option to small police departments and cash-strapped agencies.

A University of Kansas researcher in 2013 found that mental health first aid had positively affected public mental health in Kansas. The course acted as a useful refresher for those with previous mental health education, the researcher said, and provided a solid base of knowledge for those with a limited mental health background.

Klumpp likened the difference between mental health first aid and CIT to the difference between completing a first aid course and becoming an EMT. Cochran said both programs will help officers identify signs that may point to mental illness, but CIT goes more in depth.

Paying extra attention to the relationship between police and mental health professionals, as well as technology, can present a workable alternative to CIT.

“So for us and law enforcement here, their preference is two things: the training we provide and second, to have this partnership with them if they have situation, we encourage them and they do call us and ask for assistance in dealing with situations,” Hill said.

More than 1,000 people in the 20-county area that High Plains serves have mental health first aid training, Hill said. Those trained often are first responders.

High Plains also uses telemedicine systems that allow an individual with a mental illness to speak with mental health professionals who might be hours away.

Photo by Thad Allton/Topeka Capital-Journal Florida Judge Steve Leifman is a proponent of transforming the way the criminal justice system handles people with mental illness.

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Telemedicine and telepsychiatry can be used to overcome some of the challenges found in rural areas, said Steven Leifman, a judge in Miami and chair of the Florida Supreme Court’s task force on substance abuse and mental health issues.

“There’s a horrible shortage of psychiatrists nationally, even for a beautiful, urban community like Miami,” Leifman said. “We can’t get people to come down here. I can’t imagine how hard it is for rural areas. So I think all of us need to start looking at telepsychiatry to improve access, and we need to teach within the community on how to respond to these issues.”

Cochran recognizes mental health first aid is a better fit for some agencies. The key for him, however, is that officers have some sort of mental health training.

No requirement exists in Kansas for officers to receive additional instruction on mental health issues beyond what they do in their initial training. But officers are almost certain to deal with individuals in a mental health crisis daily, Cochran said.

“Yet, there’s a lot of agencies that provide absolutely no additional training on mental health situations,” Cochran said. “If you don’t know how to effectively deal with people in crisis, then you get yourself in trouble.”

Stung by lack of resources

Even extensive officer training can be rendered ineffective by a lack of mental health resources.

Renovations at Osawatomie State Hospital a year ago led to a reduction in the number of beds at the facility. The psychiatric hospital also lost its federal Medicare certification last year after security lapses, causing it to forfeit upward of $1 million a month in federal funds.

Officers are well aware of the hospital’s ongoing troubles.

The reduced number of beds has created a waiting list for admission to the facility. The time to be admitted fluctuates but can last days.

Photo by Thad Allton/Topeka Capital-Journal Narciso Narvais, a deputy with the Sedgwick County Sheriff’s Department, speaks about the use of force by law enforcement. Narvais said case law outlines elements that must be present to justify force.

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Officers who believe an individual poses a danger to themselves or others can seek to have that person involuntarily committed to a state hospital. Given the current situation at Osawatomie, the process can prove frustrating for police.

Often, because immediate admission to Osawatomie isn’t an option, police may take an individual to the emergency room while he or she is on the waiting list. That frequently drains police resources because an officer may need to watch over the person.

Beyond the issues at Osawatomie, officers also perceive a reduction of resources, especially over the past decade, going toward mental health services.

The combination of those factors — the situation at Osawatomie and a decline in mental health resources — changes the behavior of officers on the street.

“The whole time I’ve been a police officer, the laws have been the same,” said Borchers, the Lenexa police captain.

“But what I’ll tell you is, 10 to 15 years ago, what I would do an involuntary committal (for) won’t even come close to it today,” he said. “It’s nothing that’s changed legislatively, it’s all been procedurally. And we are not getting people the help like we did 10 to 15 years ago. That’s just a bottom-line fact.”

Mental health care in Kansas has essentially become a triage operation, Borchers said. The state hospitals simply try to stabilize patients and get them out so the next person can go in, he said.

“The ones that get left holding the bag, really, are law enforcement,” he said.

Borchers said he doesn’t blame an officer for deciding to arrest a mentally ill person for a minor infraction — perhaps disturbing the peace by cursing — because if they go to jail, they’ll see a doctor within a day. If the officer seeks an involuntary commitment, they may sit in an emergency room for days before going to Osawatomie.

The scenario runs counter to the whole concept behind CIT: to identify people with mental health issues and keep them out of the criminal justice system.

“Of course, that’s where you have to rely on those mental health resources,” Klumpp said. “And unfortunately when those resources are overburdened or nonexistent, people end up getting charged with minor criminal acts because that’s the only way we have to resolve the issues.”

Jonathan Shorman is a reporter for the Topeka Capital-Journal.