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Police and the mentally ill: LAPD unit praised as model for nation

The call comes in from a high-rise complex on Third Avenue in mid-city Los Angeles: A woman is again throwing items from her ninth floor apartment balcony.  On this day,  it’s a large picture frame, its glass now shattered in the courtyard below.

A special LAPD team joins patrol officers on the scene. In the hallway outside the apartment, Officer Dennis Nguyen meets with supervising Detective Jim Hoffman and tells him that the woman inside is acting “a bit erratic.”

“She's been standing up, sitting down, making making furtive movements,” he tells Hoffman before heading back into the apartment.

Rather than arrest the woman, Nguyen and his partner — a mental health clinician — talk with her in an attempt to calm her down. Eventually, their efforts pay off:  the woman agrees to allow the pair to take her to a hospital, where she’s placed on a 72-hour psychiatric hold.

Caption: Detective Jim Hoffman, left, checks in with Officer Dennis Nguyen during a call at Park La Brea Apartments on Thursday, Dec. 11, 2014. Nguyen and Hoffman are part of the LAPD's Mental Evaluation Unit. (Maya Sugarman/KPCC)

The incident marks another successful intervention for the LAPD’s Mental Evaluation Unit, a nationally renowned operation that's credited with defusing potentially explosive encounters with people in the midst of a mental health crisis. The unit's work also results in the diversion of  hundreds of people each year to treatment instead of jail.

Comprised of teams that pair officers with mental health clinicians, the operation also seeks to help those whose mental illness causes them to cycle in and out of hospitals and jails. Its leaders say that program has saved the city and county millions of dollars and freed up thousands of hours of patrol time by taking over these often complex calls from street cops. 

The LAPD mental health detail represents a type of specialized policing that's gaining traction as law enforcement agencies nationwide struggle with how best to handle those in crisis. The task is a challenging one. Minor encounters can quickly escalate out of control even when officers have some mental health training,  as was the case with last week’s killing of a man by LAPD officers on Skid Row. (The Mental Evaluation Unit was not involved in the Skid Row incident.)

The unit, which is the  largest and among the oldest mental health policing programs in the nation, is highly regarded by law enforcement and by mental health and civil rights advocates.  A 2009 report by the LAPD’s independent federal monitor praised the operation, saying the department “now has the recognized best practice in law enforcement for this subject area,” and is “in the national forefront of this important policing issue.”

"They're setting a great example for other departments to emulate," says Jerry Murphy, a criminal justice mental health policy specialist at the Council of State Governments Justice Center.  In 2010,  that nonprofit organization designated the LAPD one of six national training sites for specialized mental health policing.  Since then, the unit has shared its approach with nearly 60 law enforcement agencies throughout the U.S. and with 10 agencies in five other countries. 

The Burbank Police Department is among those that have sought training here.

"As it evolved, it got more and more comprehensive," Michael Albanese, captain of Burbank PD's patrol division, says of the LAPD's Mental Evaluation Unit.  Albanese says he considers the operation to be "on the leading edge as far as how to manage incidents and/or individuals with mental health disorders."

Newly elected Los Angeles County Sheriff Jim McDonnell says he, too, is open to considering the LAPD program as model for his department, which has a spotty record when it comes to dealing with the mentally ill.  Last month, McDonnell told the 21st Century Policing Task Force in Washington D.C. that in 2013, nearly 40 percent of all use of force incidents “involved individuals suffering from mental illness and in too many cases we arrest our way out of these encounters rather than diverting individuals to the community treatment and care they need.”

The “SMART” approach

Caption: Detective Michael Morlan leads a roll call for the System-wide Mental Assessment Response Teams on Thursday morning, Dec. 11, 2014 at LAPD Headquarters. (Maya Sugarman/KPCC)

A visit to a recent morning roll call on the sixth floor of LAPD headquarters illustrates how different the Mental Evaluation Unit is from a typical police detail. No one in this room wears a uniform when working the streets and only about half of those in attendance are police officers.

The rest are clinicians with the Los Angeles County Department of Mental Health (DMH) assigned to the unit. In total, 28 clinicians are on staff, along with 61 officers and detectives  — a far cry from the two detectives who staffed the unit when it opened its doors in the early 1980s.

Roll call on this morning is for the “System-wide Mental Assessment Response Teams.” Known by the acronym SMART, these teams — made up of a police officer and a psychologist, psychiatric nurse or other clinician — are the Mental Evaluation Unit’s front-line troops. Nguyen, the officer who dealt with the woman in the high rise, is among them.

Caption: Detective Charles Dempsey heads training for the LAPD's Mental Evaluation Unit. (Maya Sugarman/KPCC)

The LAPD began deploying SMART in 1993, says Det. Charles Dempsey, head of training for the Mental Evaluation Unit. Dempsey says the LAPD borrowed the concept from the Mental Evaluation Team program at the L.A. County Sheriff’s Department. That agency operates five of these “co-deployed” teams; the LAPD has 18 of them.

Sometimes, the work SMART does is high profile, like talking a jumper off of a ledge or assisting S.W.A.T. teams with dangerous standoffs.

But on most days, it entails relieving patrol officers of time-consuming calls involving people in the midst of a mental health crisis.

Caption: Detective Michael Morlan heads the System-wide Mental Assessment Response Teams for the LAPD's Mental Evaluation Unit. (Maya Sugarman/KPCC)

Pairing cops with county mental health workers is a game changer, says Det. Michael Morlan, who heads the SMART detail. The partnership means the teams can better manage cases, as the cop has access to police records that the clinician isn't privy to and the clinician can review medical records that privacy laws prevent an officer from accessing. And, Morlan says, medical records include all-important health insurance information.

“The Department of Mental Health has the ability to find private beds, private facilities that, otherwise, we as police officers would not be able to [find],” he says.

The result? About half of those who qualify for emergency psychiatric hospitalization get transported directly to a private facility with an available bed where treatment can start immediately, Morlan says. Without that insurance information, officers must transport people to the county’s overcrowded psychiatric emergency departments where those in crisis can too easily fall through the cracks.

SMART provided crisis intervention in response to 4,724 calls last year, says Dempsey, adding that it would have handled a larger number of calls if it had more personnel and if there were more beds available to handle those in crisis.

Still, he says, by taking over those calls from street cops, SMART saved the LAPD more than 6,600 hours of patrol time in 2014.

The Triage Desk

Caption: Officer Shiou Deng works a shift on the Mental Evaluation Unity's Triage Desk, giving advice to street cops out on mental health-related calls. (Maya Sugarman/KPCC)

SMART members also pull shifts on the Mental Evaluation Unit’s Triage Desk, a ground zero of sorts for the entire operation.

Last year,  Dempsey says, the unit logged 14,238 phone calls from street cops seeking guidance on handling people in the midst of  a mental health crises.  LAPD policy requires all patrol officers who roll on calls in which mental illness appears to be a factor to call the triage desk before taking any action, says Lt. Lionel Garcia, the Mental Evaluation Unit’s lead officer. (Last week’s fatal Skid Row encounter apparently escalated to violence so quickly that the officers never had a chance to call in.)

The goal is to avoid what is often the default police response to such situations: Cuff the individual, put him in a squad car and drop him off at jail so the patrol officers can get back on the streets more quickly.  

"Jails were not set up to be treatment facilities, people get worse in jail," says Mark Gale, criminal justice chairman for the Los Angeles County Council of the National Alliance On Mental Illness.  

Caption: Officer Craig Rawls works a shift on the Mental Evaluation Unit's Triage Desk on Thursday morning, Dec. 11, 2014. Rawls holds a Mental Evaluation Report, which is used for every call the desk receives. (Maya Sugarman/KPCC)

When working the Triage Desk, SMART officers and clinicians help street cops determine whether to recommend to psychiatrists that someone be put on a 72-hour psychiatric hold allowed under state law for those considered a threat to themselves or others. Last year, more than 10,000 of the Mental Evaluation Unit’s calls resulted in such hospitalizations, according to training chief Dempsey.

You can listen to the radio story about the Triage unit by clicking the "Listen" button at the top left of this story.

Treatment, not jail

Caption: Officer Ted Simola heads out from LAPD Headquarters to a call on Thursday morning, Feb. 26, 2015. Simola is an officer on the System-wide Mental Assessment Response Teams. (Maya Sugarman/KPCC)

On a recent day, SMART Officer Ted Simola handles a typical call: A 60-year-old man with paranoid schizophrenia has urinated outside a bank and is talking to himself inside the building.

Simola gathers more details about the man’s behavior, which he enters into a report that's filed into a special database that will be used to inform any future contacts with the man. 

"Paranoid? Disorganized?" he asks the patrol officer from a check list of questions created for these telephonic evaluations. “Does he know what kind of medication he’s supposed to have?”

The field officer reports back that the man has three outstanding warrants for low-grade misdemeanors, including public drinking. Technically, any of them qualifies him for arrest. But, Simola says, he won’t be carted off to jail.

“He’ll have to appear on the warrants later,” he says. “But immediately he’ll get treated for his mental health.”

Garcia says not everyone with a mental illness qualifies for such diversion. 

"Low-grade misdemeanors we’ll try to divert them to placement rather than an arrest," he says. "If it’s a felony in this city, they’re going to jail."

Last year, 8.7 percent of the calls that came into the unit resulted in arrest and jail. Garcia says when that happens, his teams track the person through incarceration to ensure he’ll get some treatment while in custody and when he gets out. 

At the Triage Desk, Simola determines the man he's helping to evaluate could benefit from a more in-depth assessment. He checks a computer screen that tracks the whereabouts of the four to six SMART units that are typically in the field during any one shift and calls one: 

"Hey I know you guys are swamped there, West LA, but  do you want one more?" he asks the SMART clinician who picked up his call.

On this morning, Simola is in luck: the team says it can make room to evaluate the man who is later admitted to a psychiatric hospital. 

Dempsey says about two-thirds of all mental illness crisis calls funneled through the triage desk involve a "one time crisis" that's resolved with that first contact. 

"We engage them, they get help, they get services, and we never hear from them again,” he says.

Last year, the unit reports that it also provided guidance on about 2,000 calls in which a mentally ill individual had reportedly committed a crime.  Dempsey says only about 60 percent of those resulted in arrest and jail. The remainder, he says, were minor enough offenses to warrant diversion rather than incarceration.

“That’s 800 people who are getting the appropriate service they need,” says Dempsey. “They’re going through the health care system where they belong.”

Caption: Peter Eliasberg is the legal director at the ACLU of Southern California. (Maya Sugarman/KPCC)

“It’s exactly the right thing to be doing at that initial step,” says Peter Eliasberg, legal director at the ACLU of Southern California and co-author of a recent study that advocates for diverting the mentally ill from incarceration to community-based services whenever possible.

"Many, many people in jail with mental illness are not charged with violent, serious offenses and they shouldn't be in jail," Eliasberg says, adding that drug use charges are an example of a low-grade offense that's often rooted in a person's mental illness. "Because in large part, people with mental illness try to self medicate their own condition," he says.

Caption: Lieutenant Lionel Garcia is the lead officer of the LAPD's Mental Evaluation Unit. (Maya Sugarman/KPCC)

Success in these operations doesn’t translate to traditional police department statistics, Garcia says. Progress here, he says, is defined by less typical means, such as whether a link to community service helps someone stave off a mental health crisis – even if it’s just for a little while.

“This is not your typical police work that you’re trying to measure,” Murphy agrees. “You don’t want to rush things. You want to slow down the pace.”

You can listen to radio story about the SMART program by clicking the first "Extra Audio" button at the top left of this story.

When it’s time for 'CAMP'

Caption: The Case Assessment Management Program pairs LAPD detectives with LA County Department of Mental Health clinicians. (Maya Sugarman/KPCC)

The most complicated cases that come into the Mental Evaluation Unit are assigned to the "Case Assessment Management Program," or CAMP. Launched in 2005, the program pairs police detectives with DMH clinicians. Their mission: finding solutions to the department’s most challenging mental health puzzles.

“A lot of these folks have chronic persistent mental illnesses,” Dempsey says, “or they’re developmentally disabled with a mental health issue, or [they have] a substance abuse and a mental health issue.”

Last year, CAMP's six detective-clinician teams handled 712 cases, according to the LAPD. Their cases typically include those whose mental illness causes them to heavily use or abuse emergency services and those who are at greatest risk for violent encounters with police or others.

“They’re very complicated cases and it requires a lot more work,” Dempsey says.

But, he adds,  it’s work that pays off in improved lives and dollars saved.

In 2014, the detail linked more than half of its clients to services that addressed their particular mental health needs, saving the city and county nearly $10 million, Dempsey estimates.

Caption: Detective Paul Scire heads the Case Assessment Management Program for the LAPD's Mental Evaluation Unit. (Maya Sugarman/KPCC)

One of the unit’s first cases involved a 35-year-old homeless woman, recalls Det. Paul Scire, who heads the CAMP detail. The woman had paranoid schizophrenia that led to repeated run-ins with police. Scire says it wasn’t until he and his clinician partner mapped out all of the department’s 26 contacts with her that a pattern of behavior emerged.

“She would either hit somebody or step out in front of a police car and flash a police car," he says. " "She would be arrested, and she would get right back out."

Armed with that information, Scire and his clinician partner appeared in court on the woman’s behalf and arrange for a conservatorship. And that ultimately led to the discovery of her relatives in Washington State.

“She got reunited,” Scire says, “and we’ve never heard from her again, so it was a great success story.”

You can listen to radio story about the CAMP program by clicking the second "Extra Audio" button at the top left of this story.

One of the tough cases: Lisa

Caption: Lisa sits inside a group home for women in El Sereno on Friday, March 6, 2015. Lisa, who was diagnosed with bipolar disorder, was homeless and living in downtown Los Angeles when CAMP became involved in 2008. (Maya Sugarman/KPCC)

Some of the people CAMP takes on pose significant challenges to the teams. Take the case of Lisa, who was homeless and living in downtown Los Angeles when CAMP got involved with her in 2008. Diagnosed with bipolar disorder, she also battles severe alcoholism. For years, she called 911 on a regular basis.

“I was calling them too many times,” she recalls, “saying I was going to kill myself, which I wasn’t.

When asked why she made the calls she responds: "I think it was just a habit.”

Despite CAMP’s best efforts, Lisa — whose name is omitted for privacy reasons  – contacted police emergency services 97 times between 2008 and 2014. And that doesn't include the many emergency psychiatric hospitalizations she also received.

Finally, last September CAMP linked Lisa to what it and she hopes is a long-term solution: a group home for women in El Sereno where Lisa’s taking medication for bipolar disorder; is learning basic life skills and has stayed sober for six months – which she says is her longest stretch of sobriety, ever.

"She’s better," Dempsey says. "She’s not tying up services. She’s getting the services she needs. It's a success."

CAMP defines success as at least six months of stable behavior, which is achieved in more than half of its cases, Dempsey says.  But because these cases are so complex, success is always tenuous. For example, while Lisa is in a good place now, her future isn’t certain.

“It’s like knocking on wood,” says Dempsey.

Success in this unit also depends on establishing rapport and trust with families, when possible.

“Our experience has been really good,” says Richard Smith, who asked that his real name be withheld to protect his family’s privacy.

Smith is the father of a 27-year-old college student diagnosed with autism and obsessive-compulsive disorder, which he says greatly frustrates his son.

“There was a lot of anger, and it manifested itself in the home,” he says, adding that in several instances, violence erupted. “There were some ugly incidents … that required the police to get involved.”

After a half dozen run-ins with police and several forced hospitalizations, the son’s case was assigned to a CAMP team. Smith says the detective and clinician were always available for guidance.

“From my perspective, I thought they were great,” he says. “I think that they were truly trying to make a difference.”

CAMP arranged for Smith’s son to move into a group home, but problems arose and the Smiths had to remove him. And, as is often typical of these cases, other placements worked for a while but then failed.

Smith’s son is now living in an apartment near his school, and, for now at least, he’s stable. But even so, CAMP won't be closing his case, or Lisa's or any of its others as long as the client remains in the area, Scire says. 

Instead, he says CAMP's cases always remain open “because even if we link somebody to some kind of services …there might be that relapse.”

These efforts by the Mental Evaluation Unit don't come cheap. Running it 20 hours a day, seven days a week, costs the LAPD about $6 million a year in salaries alone. Then, DMH spends another $4.8 million for its part of the operation, says Irma Castaneda, the agency’s division chief for training.

And while that’s a hefty price tag, it’s nevertheless considered a bargain when compared with the cost of incarceration, especially for those who need the most intensive treatments.

"We have around 300 inmates in need of inpatient mental health treatment, but have only 40 licensed beds," McDonnell told the Washington D.C. task force.  Contracting with private facilities for the needed beds costs up to $900 a day per inmate, he says. 

A model for the Sheriff’s Department?

Caption: Badges from police departments who have adopted the LAPD's approach to mental health are on display in the Mental Evaluation Unit offices. Police departments as far as Ireland and as close as Irvine have taken on the LAPD MEU's approach. (Maya Sugarman/KPCC)

Dempsey believes the Mental Evaluation Unit’s approach “could easily be transported” to the Los Angeles County Sheriff’s Department, which has a record marred by incidents of excessive use of force by deputies, especially in the jails; reprimands from the Department of Justice and directives from the Los Angeles County Board of Supervisors for better training.

Sheriff McDonnell says he wants to improve things, and in an interview with KPCC expresses openness to exploring what his department could learn from the Mental Evaluation Unit. Earlier in his career, McDonnell served as head of LAPD's detectives, which include a half dozen who work on the mental health team.

“Certainly I look for an opportunity now for increased collaboration to be able to share resources and to be able to share best practices,” he says, adding that he “absolutely” is amenable to seeing which parts of the unit’s approach he might replicate at the Sheriff’s Department.

But McDonnell says that while the LAPD operation works well, it’s not a one-size-fits-all solution. Even if funding weren’t an issue for the county, he says, adopting the full Mental Evaluation Unit approach would only address part of the challenges faced by the Sheriff’s Department. McDonnell points out that his agency has the added task of running the county jails, which receive inmates from 88 different cities and unincorporated areas.

That, he says, means “housing and caring for the mentally ill," which is no small feat in LA County. On any given day, more than 3,000 inmates diagnosed with severe mental illness are behind bars in the county’s overcrowded jail facilities, he says.

Some believe the answer lies in a controversial plan to build a nearly $2 billion jail that would, in part, treat mentally ill inmates.

Regardless of what happens with that proposal,  McDonnell and others say a long-term solution will depend on a commitment to a broader approach – one that pairs a robust community-based mental health care network with a criminal justice system committed to keeping the mentally ill out of jail.

These days, many are hopeful that the county will move in that direction, by way of an initiative started by Los Angeles County District Attorney Jackie Lacey.

Lacey has convened a task force that’s now studying mental health diversion programs – including the LAPD’s Mental Evaluation Unit – for their possible integration into a larger, countywide system.

And that, mental health advocates say, would be a step in the right direction.

You can listen to the four-part KPCC radio feature story by clicking at the buttons at the top. Part 1 deals with the LAPD Mental Evaluation Unit's Triage Desk. Part 2 deals with the unit's SMART program. Part 3 tells the story of the CAMP program. Part 4 is an interview with L.A. County Sheriff Jim McDonnell and others.