Seattle police: what they're doing right with troubled people

Appropriate tactics with mentally ill people increase police officers' satisfaction with their work, steer the sick to needed care, save time and money, and boost citizen faith in the force. Training works, but police also need to have other kinds of public support in place.

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Appropriate tactics with mentally ill people increase police officers' satisfaction with their work, steer the sick to needed care, save time and money, and boost citizen faith in the force. Training works, but police also need to have other kinds of public support in place.

Good teachers get demoralized by constant public complaints about incompetent teaching, and good police officers in Seattle are feeling hammered by reports about excessive use of force in the SPD. The recent review by the Department of Justice was scathing, and media stories have been caustic.

There's been questioning, as in this article in The Seattle Times, of the handling of people behaving erratically by Seattle police, who have long been regarded as leaders in appropriate treatment of people dealing with mental or chemical disorders.

Excessive use of force can never be righted by reminders that Seattle Police Department (SPD) officers do courageous, unsung good work in a dangerous world. But it still seems fair to note that the rate of complaints in Seattle in 2010 about undue police aggressiveness was one-third lower than the average rate in other major U.S. metropolitan areas. This statistic and others in a recent SPD report may help explain why not everyone shares the negative perspective on the department now dominating the media.

For many people concerned about police responses to the mentally ill, it is encouraging that hundreds of officers in Seattle and King County have taken extended training in how to use noncombative intervention tactics with nonviolent persons who are in trouble (or causing it) due to psychiatric or drug-related problems.

The improved tactics are all the more necessary when holes in the social safety net have turned law enforcement sectors into society’s de facto caretakers for more and more people suffering from such illnesses. Since the 1960s, many state and county psychiatric hospitals have been shuttered, new legal restrictions on involuntary commitment have appeared on the books, and funding for community mental health programs has tanked. This means more police encounters with sick people on the streets

If the number of encounters has risen, one thing hasn't changed, said Sgt. Joe Fountain, who heads SPD's Crisis Intervention Team and teaches crisis intervention strategies to Seattle's officers. “Police have always been on the front edge of the social safety net," Fountain said. "It’s always been an officer forcing the door to find the person in the bathtub with wrists slit or the guy who hasn’t eaten in three days beating on the neighbor’s wall.” In such cases, law enforcement officers have traditionally been expected to make the first judgment call.

What has changed over the past couple of decades are ideas about what defines a good judgment call. In situations where a person experiencing a psychological meltdown is creating a disturbance but not committing a serious crime, crisis intervention tactics have proven across the country to be the most effective options.

An 11-hour standoff in 1997 with a man wielding a sword in downtown Seattle was one incident among several that prompted SPD to improve its protocols for encounters with people in crisis. A man with paranoid schizophrenia who was released after 10 years at Western State, into a world devoid of care or housing for him, paced the corner of Second and Pike downtown for hours, brandishing a sword and refusing to put it down. Police finally had to pin the man against a wall with a fire hose and hold him there with a ladder to disarm him.

SPD asked other cities what they were doing in such cases, and in 1998 the department held the first in a new series of classes for police in how to handle incidents involving disruptive people probably experiencing a psychiatric crisis. The training went beyond models common from the '60s to the late '80s, when the belief was that bias and ignorance were what compromised police responses to mentally ill people. “First-generation” efforts simply to destigmatize mental illnesses and teach officers about them had little effect on police performance, says research published in 2002 by the Los Angeles Police Department. Seattle’s version of Crisis Intervention Training (CIT) drew on second-generation models based on the “Memphis Plan,” launched in that city in 1988.

Crisis intervention training in Seattle 

CIT combines educational and anti-stigma instruction with various techniques for interaction including verbal de-escalation skills learned through role-playing. Officers trained in CIT know how to cool down potentially hot encounters with a person whose mind is unbalanced, said Fountain. They also use knowledge based on previous calls about a particular person to anticipate his or her probable health needs before a case gets to the point “where the only thing possible is use of force or barricading, like with the sword man downtown."

Trainees also learn different techniques to deal with the major mental disorders — schizophrenia, bipolar disorder, and clinical depression — but the goal is not to turn police into shrinks in blue. They learn to focus on a person’s behavior when responding to any problem, Fountain said. “The mistake a lot of people make is in thinking that diagnosis is what we’re concerned with. It isn't. Someone running down the street with no clothes on, we wouldn’t treat any differently whether mentally ill or not. The person is in crisis.”

So CIT is also “knowing about resources available, knowing how the mental health care system works, knowing about mental health court, 72-hour holds, case management, competency, and the web of support” that the person in trouble might have access to, said Fountain. “It takes a 40-hour training to get officers to where they can use that knowledge in problem-solving out on the street.”

About 400 SPD officers have taken the 40-hour CIT course, including 273 who are assigned to patrols, or more than one-third of the patrol force, said Fountain. The total is “easily one of the highest in the country, if not the highest,” he said. Still, that amounts to only about 30 percent of the department’s 1,300 sworn officers.

So, SPD is moving to extend and improve training in de-escalation and communication strategies, in response to recommendations about use of force made last year by the department’s Office of Professional Accountability (OPA). For example, according to an OPA document, 75 officers took a day-long course in "verbal judo," communication tactics aimed at eliciting willing compliance from civilians.

The intensity and physicality of an officer’s demands on another person to behave in a certain way have traditionally escalated according to the rising pattern "Ask-Tell-Make." Verbal judo focuses on persuasion by means of the series "Ask-Explain-Present Options-Confirm Choices-Act." Appropriate use of force is “an option when verbal skills alone will not accomplish a lawful outcome,” says the OPA document. And of course strategies practiced and role-played in classrooms don’t neatly translate to practice on the streets, where officers or civilians can get hurt or killed.

SPD also noted a real need for more training in light of a concern about Washington state’s Basic Law Enforcement Academy (BLEA) for police recruits, which does not teach CIT: “the overall message at the BLEA emphasizes physical defense strategies over verbal de-escalation options.” The emphasis is particularly consequential for Seattle at a time when baby-boomer retirements and other factors have left SPD with one-third of its members having three years or less in post-Academy experience (according to remarks last February from OPA Auditor Anne Levinson at a Crosscut meeting). Recent Academy graduates should get in-service CIT training.

In this light, it's ironic to see the Academy's training information page (on a state Criminal Justice Training Commission site) with an image captioned, "Interested in a great career? Learn more about becoming a police officer!" It depicts a man in blue frisking a civilian spread-eagled against the hood of a car. If police culture is to evolve to where a law enforcement career evokes in the imaginations of young men and the general public a wider variety of actions than physically subduing suspects, concerted top-down effort will be needed.

CIT in King County

Susan Schoeld, King County’s crisis diversion program manager, said CIT helps officers engaging with nonviolent ill people who are acting out meet their needs better than does booking them or taking them to a hospital ER. A CIT course gives officers both the best options for relating to a particular troubled person in the moment and the resources available in the community, she said. Over time, police can then start interacting with mental health service providers with greater ease, trust, and understanding, producing better outcomes for people needing care.

Schoeld has been impressed by reports of officers having learned CIT “who all of a sudden get it and intervene with a new approach, and find that it makes a complete difference in the response from the individual” they're engaging. Bob Graham, program manager for Criminal Justice Training Commission (CJTC), who oversees CIT for county first responders, said he has seen similarly dramatic evidence.

For example, two officers on the King County hostage negotiation team were called out of their CIT class to deal with “a barricaded subject” one morning, said Graham. En route to the emergency, they used a resource they had just been told about in class and accessed the barricaded person’s mental health history. With this information and the CIT tactics they had learned, resolution went smoothly and they were able to return to class, Graham said. “Officers use these skills the minute they get back to work.”

A crucial skill for CIT trainees is knowing how to slow down the encounter, said Graham. “Persons experiencing a crisis process at a slower rate,” but officers “are generally geared to find the problem, solve the problem, and move to the next problem. Mental health calls usually take longer than other calls." If the brain of the person an officer encounters "is not working properly,” the person will take longer to comply even if there is desire to comply, he said — a profoundly saddening point in light of the seeming haste of a Seattle officer to fire his weapon in the killing of John T. Williams.

Another essential CIT discipline is not agreeing with a person’s delusion, but not trying to confront or refute it, either. “You’re not going to get anywhere by trying to buy in or disprove,” Graham said.

Police using CIT in the field can do more than increase public faith in their competence. Skillful crisis interventions, with social services ready to be drawn on, save time and public money. They reduce the number of occasions, so frustrating and demoralizing to officers, when someone detained is back on the street before the paperwork is finished, because they couldn’t contact a mental health professional quickly enough to certify the person as needing involuntary psychiatric commitment. And the strategies minimize wasteful, ineffective stays in jails or hospitals for nonviolent people who are sick, steering them to destinations where they can get the care they need and even start managing their symptoms.

Two innovative programs in the region

SPD’s Crisis Intervention Team was launched in October 2010 as a two-year pilot project funded by the city through a Bureau of Justice Assistance grant from the U.S. Department of Justice (DOJ). In its daily work, the C-I-Team (to distinguish it from CIT) joins forces with Public Health-Seattle & King County, the state mental health division, and the Washington affiliate of the National Alliance on Mental Illness (NAMI).

The C-I-Team has three members besides Fountain. Justin Dawson, a mental health professional employed by DESC (Downtown Emergency Services Center), rides along with CIT-trained Seattle officer Dan Nelson, to address emergencies that seem fueled by mental health problems but where crime is not the issue and an arrest is unlikely. The third member is an officer who specializes in working with high-risk mentally ill offenders released from prison, said Fountain. “He’s the only cop they know who they trust.”

Graydon Andrus, DESC clinical service director, described the C-I-Team as “a social and clinical intervention that lets officers get back to their main work” of maintaining community safety.

When a typical 9-1-1 call is routed to the C-I-Team, said Dawson, “I look up the person’s name in the King County system to see if they are already connected with services I can refer them back to. Depending on their presenting issues, I might call them on the phone and talk with them, or Officer Nelson and I will go out and try to meet with them at their residence.” If the problem turns out not to have been urgent enough for calling 9-1-1, Dawson and Nelson give the caller that clear message, plus Dawson’s number or another office number to call next time. It doesn’t always work.

One woman was calling 9-1-1 ten times a day between about 2 a.m. and the hour she left for her place of employment. Eventually she got arrested for harassment, but the behavior didn’t stop after she was released. According to Fountain, the woman's calls came during the hours when she had experienced a serious trauma. “She needed that reassurance for something very real to her,” he said. But hundreds of calls came in from her every month, and because they were 9-1-1 calls, officers had to respond. “An average call takes about half an hour — receive it, dispatch, the officer arrives, and clears it. She was not an immediate danger to self or others, not committing a crime, but this behavior couldn’t go on. So Justin and Dan engaged her.”

The C-I-Team uses graduated intervention strategies, starting at the lowest level and then escalating if necessary, said Fountain. Dawson and Officer Nelson started with phone calls, and then tried to meet with her face to face at her residence. Both efforts failed. “We’d show up at their house and get hold of her husband but not her,” Dawson said.

The next higher level, said Fountain, was calling her at her place of work “to say, ‘This has to stop, and if it doesn’t, we’ll come talk to you there.’ She needed to be given alternatives.” She also needed the presence of both team members when they finally met — Officer Nelson to embody the threat of sanctions, and Dawson to say, “I’m trying to encourage officers not to arrest you” and to help her develop strategies to control her behavior. She started seeing a psychiatrist and taking medications again, said Dawson. “Now I call her every once in a while just to see if she’s on track. She was wobbly for a while, but has been stable since May.”

In short, one contact with a troubled person rarely suffices. “These guys are working like gangbusters,” said Fountain. “The numbers of cases they clear fill their days.” But with its small staff, the C-I-Team can do outreach or followup on only about 25 percent of the cases, starting with the ones where there is an imminent risk to safety. “We hop on those right away,” Fountain said. Second in priority come instances where the team notices that different officers on different shifts have reported problems with the same person which, taken together, seem to be escalating toward a danger point. Third come specific requests from officers for C-I-Team followup, and fourth on the list are callers who repeatedly dial 9-1-1. “They’re a profound drain on police forces.”

King County, too, has created a cutting-edge partnership between police and mental health professionals. The county’s Mobile Crisis Team (MCT) was launched in November 2011 as part of the crisis diversion system the county built through its MIDD (Mental Illness and Drug Dependency) plan. The mobile unit operates 24/7 with rotations of two pairs of mental health professionals from DESC, sometimes with overlapping shifts, said Schoeld. The MCT is serving one police precinct in its startup phase.

When the DESC Crisis Solutions Center diversion facility opens, MCT will serve the entire county and is expected to provide crisis intervention services for about 3,000 people each year, she said. Most will be taken to Crisis Solutions for treatment. Now that a King County Superior Court judge has ruled against a petition to block the facility in DESC’s chosen location on S. Lane Street just south of downtown, it should open its doors in a few months. At that point, the mobile unit will start covering the county — or trying to, with its small staff.

Like Seattle’s C-I-Team, the MCT responds in the field to mentally ill and chemically dependent persons experiencing a meltdown and tries to route them to appropriate services. Until DESC’s diversion facility opens, outreach to follow up the next day is particularly important, but further contact depends on the person involved being willing to provide contact information. “We nudge them along,” said Schoeld. “We get people to the right places in the community, and sometimes that’s all it takes.”

On an occasion when transit police called the unit about a person who was disruptive on a Metro bus but did not fit criteria for being taken to jail or a hospital, in less than an hour the team was able to coax the woman into their vehicle with all her possessions and return her to her housing unit, said Schoeld. “They kept the bus moving, and the passengers and transit police happy.”

Fountain called the MCT “a big hit,” with “a dramatic increase of officers on all watches calling out the unit.” The advantage, he said, is in being able to work together to solve the problem. “So often the frustration for officers is they really don’t have options. They respond to a call, the person is suffering from acute symptoms of mental illness but doesn’t rise to the statutory standard of immediate danger of injury to self or others and hasn’t committed a crime.” Officers know they'll have to come back again if the person isn’t helped. “And a lot of officers really do care. They know that they’re dealing with a person with mental illness in crisis and would like to do something for the person.”

Making enough difference?

Here's the bad news about CIT: We underfund public health agencies that might partner with trained police to receive most of the troubled people needing treatment. Thus officers take them to jails or ERs, which provide inappropriate, overly expensive interventions, or make a discretionary choice not to intervene at all. It seems reasonable to ask citizens and elected officials in the region, who want police to be more competent and successful in the future, to start paying for more of what the officers are doing well.

And funds for CIT training are also down across the state. Since 2008-2009, when the legislature first provided fiscal support for implementing the program statewide through a DSHS Mental Health Transformation Grant, support for CIT in Washington has dropped, Graham said, “from $306,000 to $16,000, and then to zero.” Fortunately, the voter-approved levy for the Mental Illness and Drug Dependency plan provides "backfill" funding for CIT in King County, he said, adding that if it didn’t, CIT couldn't survive there.

DOJ grant dollars for Seattle's C-I-Team will be gone by October 2012, said Andrus at DESC, and a second grant is unlikely. “A continuation grant is hard to get. Usually they want you to prove [your project] works, then take it on.” Dawson, his colleague at DESC, put the feelings of everyone who values the C-I-Team in a nutshell when he said, “It makes me nervous, the financial situation.” When the program should really be expanding, especially in a major metropolitan area like Seattle, it may instead have to shut down entirely.

No one interviewed for this article wanted to comment on the Department of Justice report about SPD’s use of force. But several reflected on the work police do in relation to people struggling with psychiatric or drug problems.

Amnon Shoenfeld, director of the county’s mental health and chemical dependency services, remarked on the “resentment and frustration” that may arise when police must take care of people the mental health and chemical dependency system should be tending, “especially when they see the same persons over and over. We could do a lot more if we had the resources instead of cuts. But the cuts continue, a lot of people out there are pretty desperate, and so it makes it hard to relieve the burden on police.”

Dawson said that for anyone whose field isn't law enforcement it’s easy to forget how police “just have to try to keep going, going, going” every day. At least now, having worked on the C-I-Team, he “can tell people in the mental health field who are frustrated with a police response, ‘This is why they made the decision they made at the time.’ It’s really varied and diverse, what police officers have to pull out of their hats.”

Sgt. Fountain, who said that his opinion is his own and doesn't represent an official SPD position, said what keeps police officers from doing their best with people who have mental illnesses or addictions is that, with force numbers at a historic low, there's too little time for resolving a complex situation. If what's needed is to “call Crisis Clinic, call a family member, wait for the family member, talk to the clinic person, arrange what happens next, it takes a couple hours,” he said. Low force numbers also keep officers out of CIT trainings. Taking a person off patrol for a course would leave the squad without that officer for five days.

And Fountain vehemently disagreed with any idea from the coverage of the DOJ report that police officers use force because they lack the skills to persuade people to comply voluntarily. Out of 3,000 mentally ill or drug-disordered people engaged by the police, he said, “I can only recollect a handful, maybe 10, where there was any force used. I read those reports every single day. Someone wants to kill himself or is delirious? Officers bring calm, bring control, make the person safe. That’s what cops do,” he said.

CIT provides more tools for doing what cops do.

They will use the tools more effectively and department-wide if they are supported by a police culture in which deft verbal engagement in the field is a genuinely desired, openly admired alternative to physical force. And if — the bigger "if" — there are adequate social services that officers and the rest of us can call on to shelter, treat, and relieve the damaging isolation of people with chronic mental illnesses and addictions.


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