“I don’t have ID,” Floyd is saying, “they won’t let me into the shelter without ID.”
Welcome to a Monday in the Hurst, Euless and Bedford Behavior Intervention Unit, the BIU.
Floyd, a clinically depressed, 64-year-old homeless Euless man, is speaking with Officer Casey Sanders and Ken Bennett of the BIU. On weekdays, Sanders and Bennett, a clinician, seek out people with disabilities, like mental illness, to check on their welfare.
They are part of a team of certified Texas Mental Health Peace Officers paired with clinicians, who patrol three cities. They don’t diagnose, but they are trained to gather the right facts to connect a person who has a mental illness and might be in distress with health professionals.
The idea is to proactively help this population get care before problems become crises that result in crimes and jail time. The program is uncommon and may well be unique, and the approach is making a significant difference in North Texas by averting mental health crises, reducing the numbers of mentally ill in jails, and understanding better the community officers serve.
“When you get out of the hospital,” Bennett tells Floyd, handing him a card, “call this number. We’ll pick you up, and drive you to homeless outreach. They’ll help you get an ID so you can get in the shelter and back on your feet.”
“Thank you, man. I’ve even thought about killing myself,” Floyd says.
“How would you do it?” Bennett asks.
“I’m probably gonna hang myself.”
“OK,” Bennett says, “we can get you some help.”
Sanders, who has known Floyd for more than a decade, said Floyd’s been shot, stabbed, and run over.
“He’s a fighter,” Sanders said later. “For him to come out and say, ‘I’m depressed, I’m suicidal?’ That carries a lot of weight.”
New mission of policing
There are ten times more people with serious mental illnesses in America’s prisons and jails than in state mental hospitals, according to a 2014 report from the Treatment Advocacy Center. Some of our nation’s largest psychiatric in-patient clinics are in county jails in Chicago, Los Angeles, New York, and Fort Worth.
“The clients we’re dealing with are not treatment- or med-compliant,” Bennett said, at BIU’s Hurst storefront office. “They might have a history at a local mental health clinic, but they’re no longer in services. Now they’re coming in contact with law enforcement.”
We in law enforcement are incredibly bad at communicating important trends like this. Don’t get me wrong, cops will gripe. But it’s not in our nature to complain about the mission.
And mental health has become a big part of the mission of policing.
The BIU is an expansion of a program begun almost a decade ago as a joint effort between Tarrant County My Health, My Resources and Hurst police. Three years ago, when it was expanded to build on the success of Hurst’s program, the BIU’s mission was to increase jail diversion: bringing mentally ill people with minor charges to mental health services instead of jail.
About one in four people arrested in this country, according to the National Alliance on Mental Illness, suffers from both severe mental illness and drug or alcohol abuse disorders.
“Our jail population this morning was 4,100,” Tarrant County Sheriff Bill Waybourn said, “and 25 percent of those people are mental health patients; they’re on mental health meds.”
The day was not unusual.
How mental illness became a police problem
America’s mental health situation is the result of cuts by Republican and Democratic administrations during the past 50 years. In the early 1960s, when asylum stays were measured in years, President John F. Kennedy sought to move mental patients from asylums to community mental health centers. But after Medicaid launched in 1965, the funding never fully materialized.
“State hospitals at that time were seen as barbaric,” Bennett says. “They were unsanitary, people weren’t being treated humanely. Many people wanted de-institutionalization.”
In 1980, the Carter administration passed the Mental Health Systems Act, to expand community mental health centers. But President Jimmy Carter lost his re-election bid. For the second time in 17 years, a president couldn’t follow through on broad mental health legislation.
Reagan-era policies led to more cuts. Those, and rulings against involuntary commitment without a specific danger to the patient or others, opened the floodgates. Millions moved from mental hospitals to streets and parks, and the contemporary homelessness problem was upon us.
Policies have shifted on things like reimbursement rates and reduced duration of outpatient treatment. Phrases like Medicaid Match, trans-institutionalization, and other government gobbledygook are responsible for reduced care, and there is a wild differential in state hospitalization rates based on how each state plays the game.
President Barack Obama spoke of major advances in mental health care under the Affordable Care Act, but those are primarily governed coverage by private insurance carriers, not funding of mental health services for the indigent.
And with insufficient funding for hospitals, and a homeless population rife with mental illness, self-medication, and desperate poverty, jails have become America’s largest mental health providers. The reality today is that the first responders to mentally ill people in America aren’t doctors or clinicians, but cops.
De-escalating with empathy
Whenever cops make mistakes and people get hurt, people understandably become upset. But how can police get it right?
“I guess the first thing is to be very non-threatening,” said Officer Sanders. “To establish that you’re there to help them. You want to establish some rapport, where you can change their behavior, and that all begins with empathy.”
This is one of the most vivid examples of how, in law enforcement, we can argue about policies, transparency, and oversight, but these are intimately human, dynamic, inter-personal encounters.
Unlike most clinicians, Bennett has negotiated, face-to-face, with armed suicidal people. When he spotted Floyd in J.A. Carr Park, they had a long conversation before Floyd admitted being suicidal.
Floyd didn’t ask for help. Actually, his most pressing problem was broken ribs: Floyd could barely breathe and was wheezing. Bennett noticed a hospital band on Floyd’s wrist and suggested the BIU transport Floyd back to John Peter Smith Hospital for treatment before going to homeless outreach.
Then Sanders recognized Floyd — Floyd’s appearance has changed over the past decade. Sanders' face lit up. He was genuinely happy to see Floyd. And I saw Sanders exude the empathy he had described. Even when he patted down Floyd for weapons, the officer continued a light-hearted chit-chat that Floyd responded to with openness and trust.
One of the biggest problems the BIU faces is diverting people to mental health facilities when there are no beds available. The question administrators ask most often is: Divert to where?
The question became more relevant this year when the Texas Legislature passed the Sandra Bland Act, which shifts responsibility for caring for the mentally ill back to Texas' mental health care system. Whether Texas has the capacity to handle a major influx of new patients is a troubling, unanswered question.
Sheriff Waybourn recently emailed all Tarrant County police chiefs: If you have someone mentally ill in jail, transport that person to the county jail’s MHMR unit.
“We’ll take ‘em,” Waybourn said. “We can get them straight into services, so they don’t de-compensate.” (Decompensate means to lose the ability to maintain normal psychological demeanor and revert to anxiety, delusions or even plain depression.)
As I interviewed Sheriff Waybourn in his office, a labradoodle puppy wearing a tactical harness trotted into the room and placed her muzzle on his leg. The puppy, Corporal Nova, is the jail’s comfort dog.
Finding enough beds
Waybourn’s solution for inmates is great. But finding a hospital bed for a mentally ill person who doesn’t need to be in jail is very challenging.
An officer can take an hour signing someone in to Tower Ten, a room at John Peter Smith filled with recliners and people milling around, waiting for disposition. It can take a lot longer if the client needs medical attention first.
The client will sometimes wait a day or more to get one of 96 beds, only to be sent out to the lobby to wait four to eight hours to get back in, and then start waiting again. And in Tower Ten, decompensation means time is important.
Floyd was admitted to JPS. We learned later that he was released because some thought he was just seeking drugs. In an overcrowded system, a patient sees emergency medical technicians, an admitting nurse, an emergency room doctor, a psychiatric nurse, a psychiatrist, and along the way, the system is trying to weed out and triage. Of course they’re suspicious of people.
And also, by the time all those people got to see him, he had been fed for the first time in three days. He’d had some morphine, so his pain was more bearable. Maybe he wasn’t as suicidal as he was when we found him in the park.
Or maybe he suckered us. Neither Sanders nor Bennett care. To them, a mentally ill man needed physical and psychiatric help, and they brought him to it.
I think about the will-power it took for Bennett to envision and create a job and a strategy no one asked him to create; to convince the chiefs of police, the city council, the mayors and the lawyers of three cities to try something so new you can’t even agree on how to measure success. And think about the risks that all those officials took in moving forward at all.
There was no political penalty for sticking with traditional policing. They built the mental health group anyway.
“This can be a very emotional job,” said Bennett. “Every call you deal with is someone who’s mentally unstable. We can’t save everyone. But if we do our jobs and we’re proactive, we’ll probably save more than if we just took a reactive approach.”
You can listen to this article in the form of a 30-minute podcast, Divert to Where?, at Quality Policing.