Mental Health Rules a Quandary for Law Enforcement
Sept. 21--Even with a basic understanding of mental illness, Colorado Springs fire Capt. Dave Rocco knew that the woman whose home he and other emergency responders were repeatedly dispatched to did not need to go to the ER. The middle-aged patient, whose name was withheld to protect her privacy, has a lifelong medical history of seizures, PTSD, dementia and multiple personality disorder, Rocco said.
But, Rocco knew from experience, a trip to the ER was the worst recourse for her.
"We constantly get calls to her house because of her seizures, but taking her to the ER is probably the worst thing we can do for her because she has panic attacks when she is forced to leave her home," Rocco said. "So we flagged her as a high-intensity patient and now we know how best to help her."
Collaborative response
Trying innovative response models to deal with mentally ill patients is a new trend with emergency personnel and law enforcement in Colorado Springs. Through Crisis Intervention Training, mental health professionals at AspenPointe teach police officers how to identify behaviors that could indicate mental illness and how to approach a mental health patient.
A response unit that would include police, fire, paramedics and mental health professionals for calls involving mentally unstable people is in the works, Colorado Springs police Commander Thor Eells said.
"By bringing a member of each agency together and having them work as a team, they will be best equipped to assess immediate needs, possible risks, and get individuals the help they need," Eells said.
Rocco is part of the fire department's Community Assistance and Referral and Education Services program, that is adopting a new way for law enforcement and emergency responders to interact with mentally ill patients.
Through CARES, which began in 2012, a paramedic, health care professional and a behavioral health professional team up to respond to calls that involve people who may be mentally unstable or have been flagged as high-intensity patients. CARES was created to attend to a small segment of the population who call 911 for low-acuity or non- life-threatening conditions, as well as mental health issues that would be better served with on-the-spot resources rather than complex medical interventions, said Fire Community Health administrator Jeff Martin.
"The objective is to redirect patients into the most appropriate care setting, so when they call 911 and it's not really an emergency, our team can spend some time with them and figure out what type of help they really need," Martin said.
"For a lot of folks, it's an education issue. It's a knowledge of resources issue, and we help them navigate that information."
How long is long enough?
Regulations that dictate how police handle the mentally ill have come under scrutiny by law enforcement personnel, most recently by Teller County Sheriff Mike Ensminger during a 2013 meeting.
He was particularly concerned that the maximum length of a mental health hold order, known as an M1 hold, may not be enough time to thoroughly evaluate a person's mental state.
"We have to prove that these people are actually a threat to themselves and to others," the sheriff said during a Teller County Board of Commissioners meeting. "We only have 72 hours. If that person wants to leave after 72 hours, they can leave. Is that enough time to evaluate and diagnose a person, and be able to come up with a remedy to recommend certain medication, evaluate if the medication worked, and assess if that was the right medication? Is 72 hours an adequate time to do that?
"I don't think so."
The questions raised by Ensminger are not unusual among members of law enforcement, and many agree the regulations that dictate how police officers interact with mentally ill individuals are often open to interpretation.
That forces officers to make judgment calls they may not be equipped to make.
"Deputies are trained to do their job, but they're not mental health professionals," said El Paso County Undersheriff Paula Presley. "They receive a lot of training, but they're not psychologists, so it's important for them to be able to recognize the signs of mental health issues. And they need to know what the best resources and actions are."
A deputy's role, Presley said, is not to diagnose mental illness, but to assess a situation and ensure the safety of everyone involved. She also questioned the length of the M1 hold.
"There's no magic number of hours that a person needs to be held to be able to adequately assessed," Presley said. "There are factors that complicate matters. If the person is intoxicated, they can't be properly evaluated, so they have to be placed in detox, delaying the process even more."
Liability concerns also limit law enforcement officers during a situation with a person who could be mentally ill, Eells said. Officers cannot legally stop a person from killing themselves unless they are a danger to someone else, and the law prevents police from intervening, Eells said.
"Being suicidal is not illegal. Personal violence is not a crime, so we can't force our way into someone's house because they could hurt themselves," Eells said.
Officers must balance public safety with a person's constitutional rights, but weighing those rights against providing help that could save their life is an easy choice for Presley.
"If I saw an individual that I felt was truly going to be a threat to themselves or someone else, and if I felt that when I left there something could happen, then (it is) better to be safe than sorry," she said. "I would take that person into custody and request the M1 hold for an evaluation."
Working on a new approach
Mental health professionals have also adopted new practices to treat mentally ill individuals instead of the customary ER visits that tie up resources and raise medical costs, said Jason DeaBueno, AspenPointe's vice president of health services.
"El Paso and Teller counties operate similarly in that mental health professionals do not get involved until the person is evaluated and assessed at a medical facility," DeaBueno said. "If we were more proactive with our care, we may be able to provide a better avenue of care instead of the ER, which isn't always what mental health patients need."
Under the current system, DeaBueno said, mental health professionals get involved after ER staff has assessed a patient's mental condition. The ER's personnel become the liaison for the care coordinator to bring in the mental health professionals, so the interface between law enforcement and mental health professionals isn't where it needs to be, DeaBueno said.
AspenPointe is leading efforts to implement the Crisis Stabilization Unit, a program DeaBueno said will be instrumental to provide better care to the mentally ill and use law enforcement and mental health professional resources more efficiently.
"First-response systems will be used as outpatient systems for further evaluation rather than taking the person straight to the ER," DeaBueno said.
"The connection between law enforcement, mental health professionals and the patients will happen much more seamlessly. All parties involved will be able to communicate on-site, making information and treatment much more timely."
The Crisis Stabilization Unit, expected to begin in October, will consist of highly skilled and trained mental health professionals, working with law enforcement, to provide a secure and reassuring environment in which the patient will have the chance to stabilize and defuse, giving trained personnel a chance to de-escalate the situation, get to the root of the problems and find efficient treatment options, DeaBueno said.
"I think it's just the way the system is set up right now because when you have an individual with significant mental health needs, the ER and hospital staff have to handle the care of that person," he said. "Law enforcement can't sit around and wait for the results of all the labs tests that mental health professionals conduct, so they have to leave the patient there. It's to be expected that people will fall through the cracks, and that's what we want to prevent."
DeaBueno said a major flaws in regulations that guide law enforcement's treatment of the mentally ill is that the same type of treatment is applied to every patient -- without taking into consideration mitigating factors such as environment, medical issues and substance abuse that affect how a person may behave or react to a situation.
"Because we apply the same standard to everyone, the ER has become the place for an outpatient system, where we could have a more localized and individualized approach to the evaluation of people who just need help," DeaBueno said.
"We will get this right as a community, I am confident of that. I think people will start to see that there is a way for an entire community to respond to a crisis that's quite clearly affecting everyone in the community."
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Contact Andrea Sinclair: 636-0235
Copyright 2014 - The Gazette (Colorado Springs, Colo.)
