Last year, the New York Police Department responded to more than 87,000 calls having to do with emotionally disturbed persons, or "EDPs," the department’s label for people with mental illness. The majority of such cases are handled by regular police officers, who receive 14.5 hours of training on topics such as identifying mental illnesses and interacting with people affected by them. Their efforts are supplemented by a specialized response team called the Emergency Service Unit, or ESU, whose 400 officers receive 16 hours of tactical training and 40 hours of emergency psychological training, and are called in to respond to difficult situations.

In response to several recent police shootings of people with mental illnesses—including the separate deaths in November of unarmed 18-year-old Khiel Coppin and 29-year-old David Kostovski—the city is starting to re-examine its approach to such cases. The NYPD and Department of Health and Mental Hygiene have convened a "Link Committee" comprised of agency representatives, mental health advocates and consumers, lawyers, and researchers to assess NYPD policies and procedures. Similarly, City Council held a hearing on Feb. 28 to call on the NYPD to continually review its approach to people with mental illnesses. The Link Committee has restarted this year after a lull caused by the Nov. 2005 death of NYPD Deputy Training Commissioner James Fyfe, who is widely credited with initiating progress in this area.

One of the things the Link Committee likely will discuss is the models used around the country to guide interactions with people with mental illnesses. One of the more popular and well-regarded approaches is the Crisis Intervention Team (CIT) model, which started in Memphis in 1988 and has proven effective there and elsewhere. Under the CIT model, officers who volunteer to participate in the program receive 40 hours of specialized training to learn how to more effectively interact with individuals with mental illness. These officers are then the first to respond to emergency calls that bring them into direct contact with people with mental illnesses.

City Limits reporter Tram Whitehurst and editor Karen Loew sat down last week with a panel of specialists to discuss the challenges and possibilities of police interactions with people with mental illnesses in New York City. The NYPD and the Department of Health and Mental Hygiene both declined our invitation to participate.

The Brian Lehrer Show on WNYC continued this discussion on March 27. To listen, click here.

What follows is our wide-ranging conversation with:

Spencer Eth, M.D., vice chairman of the Department of Psychiatry and Behavioral Sciences at New York Medical College, and senior vice president and medical director of behavioral health services of the Saint Vincent Catholic Medical Centers of New York. Eth served on the first Mental Health Advisory Committee, and has consulted with the NYPD police academy on officer training issues.

Fred Levine, attorney, mental health advocate and public policy consultant. Levine has consulted with the NYPD on its training of officers, and currently participates in the police academy’s training on EDPs. Affected by bipolar disorder himself, Levine was a member of the original Mental Health Advisory Committee, and now serves on the Link Committee.

Amanda Masters, senior staff attorney and coordinator of the Opportunity and Access Program at New York Lawyers for the Public Interest (NYLPI). Masters represents the mother of Kevin Cerbelli, a mentally ill man who was shot and killed by police, in a lawsuit against the NYPD. She is also the treasurer of the National Police Accountability Project and founder of the New York City Policing Roundtable.

Louise Pyers, president and founder of Connecticut Alliance to Benefit Law Enforcement (CABLE). Pyers has worked with police departments across Connecticut to implement the CIT model. She is a certified police instructor in critical incident stress management, suicide intervention and citizens with special needs.

Melissa Reuland, senior research consultant at Police Executive Research Forum (PERF), based in Washington, D.C. Reuland was the project director for the Law Enforcement track of the Council of State Governments Justice Center’s Criminal Justice/Mental Health Consensus Project. She has been researching the policing people of with mental illnesses for 15 years. (Reuland participated via teleconference.)

Collaboration between police and mental health professionals

Fred Levine: There is one glaring thing that is on the top of my thoughts this morning and that is the need for the NYPD and for the New York City Department of Health and Mental Hygiene to coordinate their activities. When this is done well, the NYPD could receive up-to-date information from the New York City Department of Health and Mental Hygiene on what is the latest and the state of the art in interacting with people who have emotional distress. Unfortunately, in the past four years there was no discernible communication between the NYPD and the Department of Health and Mental Hygiene. But in the absence of a good working relationship, the NYPD will be left to its own devices to have to develop these training materials.

Spencer Eth: I think the issue of what we are really addressing is the issue of violence and the management of violence, and the police have protocols to manage dangerous and violent people. Psychiatrists and mental health professionals also have protocols, and in an ideal world we all would share the knowledge and work together to minimize harm. Sadly, this is not done effectively and the two systems tend to operate fairly independently, and that is to the detriment of people with mental illness who are violent to both the police and to mental health professionals. And it’s unfortunate because this is a city in which there is a very sophisticated police department, a very knowledgeable mental health community. I think each new event, which seems random, calls to attention the need for this. The most recent event in which the victim was a clinical psychologist [the stabbing of Kathryn Faughey last month] again reminds us that we need more effective collaboration, because the danger is not going to go away.

Louise Pyers: In Connecticut, there is a wonderful collaboration between the Department of Mental Health and Addiction Services and our Crisis Intervention Teams that are located in different parts of the state. Some departments even have their own CIT clinician. Many of the clinicians have a police radio, some of the clinicians ride with the police, so there is that real collaboration even on the street level. Many times it’s a matter of, 'You know what, he is already in our system, let’s see what’s happening and see if we can get back to the hospital or reconnect that person to their case manager.' But again, that wouldn’t happen without the full buy-in and collaboration of both our police and our Department of Mental Health.

Melissa Reuland: I think when we focus only on the crisis cases and put people on the defensive and so forth, we’re losing sight of the critical importance of figuring out how police can be involved in a partnership with the mental health community to prevent some of these situations from occurring. If we were to look back at some of the cases that have devolved into these terrible tragedies, I would be interested in how many times police had responded to those individuals or those locations where very little was done to link the person effectively with treatment and follow-up to make sure that treatment was being accessed. But the argument that needs to be made to folks is that by making these changes in training and knowledge and coordination and collaboration, they’re going to be able to hopefully prevent these types of critical incidents from occurring in the first place. So I have a proactive approach.
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The revived Police-Mental Health 'Link Committee'

Fred Levine: I think a proactive approach makes perfect sense. With the recent tragedies that occurred, I think that it, unfortunately, was put higher up on people’s priority list, such that Dr. David Rosin of the Department of Mental Hygiene and [NYPD Assistant Commissioner for Training] Carol Ann Roberson got together and said that they needed to start this. They agreed between themselves to draw up a list of people who they knew and then they contacted their respective lists, and they asked people on those lists to contact other people and see if they could widen the circle.

So what they have done is they have divided themselves into four workgroups. They are looking at the 911 call center, because if the way in which information comes to the 911 call center is not properly received and interpreted and then transmitted to the patrol car, the quality of the interaction will be immediately diminished. They have another subcommittee that’s looking at models like the CIT model. And hopefully, for the first time we’ll get an answer: is the CIT model transferable to New York, yes or no and why? Rather than just a conclusive statement, 'We are New Yorkers, it doesn’t work here.'

And another subcommittee is something which Dr. Eth is really familiar with, the so-called handoff at the hospital: the way in which people are transported to the hospital by an NYPD officer when the officer concludes that the person is dangerous to himself or others, and then handed off to that intern, resident or emergency room person. There are so many issues involved in that, because it’s not just about violence. It’s about the way in which you treat people that may or may not facilitate their entry back into the mental health system. And that, while not as grave as the tragedies that we have seen in recent times, is a tragedy.

And then, I think this is last, a subcommittee on the way in which information flows between the Department of Health and the NYPD, on a recurring basis. Not just the creation of a loose-leaf binder that no one looks at three months later. An ongoing interface between the knowledgeable people on both sides.

Diversion to the mental health system

Spencer Eth: Let me just react to one thing that Fred mentioned with regard to the handoff. The police officer has enormous discretion regarding whether or not to arrest the person who appears disturbed and has perhaps committed a crime, even a crime of low significance. That makes an enormous difference in how that person is handled—whether that person actually goes to a psychiatric emergency room or not. That all occurs prior to that person being seen by a mental health professional, and is often left to the discretion of officers who haven’t had recent or adequate training.

Louise Pyers: One thing that we found with the CIT training in Connecticut: we did a recent survey of 100 police officers who were trained in CIT, and 95 percent of them said, given somebody has committed a low-level offense and they have a mental illness, they are more likely to divert that person into the mental health system rather than into the criminal justice system. These officers get that 40 hours of very intensive training, so they have a better understanding of people with mental illness in general. So they are much more likely, if it’s a low-level offense, to make that diversion into the mental health system. We know it does have an impact on the discretionary powers that the police do have.
        
Spencer Eth: It is said that Rikers is the largest mental healthcare—if you could call it mental healthcare—facility in the country. Or the L.A. County Jail is. But those are people who are not diverted into the mental health system which, presumably, is much better equipped to help somebody through an acute exacerbation of a mental illness, and protect the person at a lower cost.

Will Crisis Interventions Teams work in NYC?

Melissa Reuland: I am struck by Fred’s statement that there has been a committee to say CIT, yes or no, why or why not? I want to ask and broaden the discussion from just CIT. When I say that CIT may not work in New York City – like it has probably not worked in L.A. and probably not worked in Houston, and it remains to be seen how it’s working in Chicago – I don’t suggest that therefore the police do nothing. There are lots of other options and variations, adaptations on essential elements of the police responses that may be very appropriate for very large and, by the way, very small communities.

But some of the very large departments do have very particular problems. CIT has worked beautifully in medium-sized communities all over the country. But if you talk to Houston and you ask them how many of their CIT calls actually get a CIT officer dispatched to them, and we all would agree, they have been doing fabulous training, they’ve trained their dispatchers. They have more than 25 percent of the department trained. They have found that of the calls they know a CIT officer should be dispatched to, only 25 percent of them actually get one there.

That’s because of deployment problems. Because of the size of the city, the sheer geography that they have to deal with, and getting the CIT-trained officer who is or is not on shift, is or is not in the middle of a call, can or cannot make his or her way in the 15 or 20 minutes it’s going to take in traffic to get to that call. There have been some tragic shootings in Houston in the last year or so that have prompted the mayor and the City Council to reinvigorate their discussion about what they are going to do.

My philosophy and the way I approach this is, I think that the community’s response needs to be related to what the problem in the community is. Once that problem has been identified, then you need to sculpt a response that’s based on the problem that you are experiencing. You’re going to have to be creative and you’re going to adapt what other people have done and make it your own.

Changing NYPD policies and procedures

Amanda Masters: I think that one thing that is clear is that the policies of the NYPD need to change. I think that it’s notable that although the training may have been modified under [Former deputy training commissioner James] Fyfe, that the policy that’s in place in the patrol guide hasn’t materially changed since around 1985, shortly after the Eleanor Bumpurs incident [in which an emotionally disturbed woman was killed by police, a 1984 case that still serves as a touchstone in the city for these issues].

I think that there are around 1,400 or 1,500 cadets in the academy right now. There are two classes a year and there are probably around 40,000 police officers out on the street every day, some of whom were trained in the 1980s. So you really have to change the policy, not just the training materials. Even 40 hours of the best training in the world isn’t going to make a difference for an officer who has been on the beat many years and has been taught by his cohort what the real procedures are.

The police officers in New York City follow the rules in the patrol guide, which is sort of a bible that tells them about everything from how to dress to how to deal with a whole variety of situations that they have to deal with. Essentially, when a police officer perceives an imminent threat of deadly physical force or serious bodily injury, they are permitted under the patrol guide to use deadly force. For NYPD officers that means using your firearm and aiming at center mass. One of the core problems with the policy as described in the patrol guide is that it doesn’t rein in the discretion of the police officer or give them guidance about how to figure out whether it’s an imminent threat.

They have been trained to do this thing called 'isolate and contain' and 'maintain a zone of safety.' In [the Cerbelli case], when the officers were deposed, reciting that mantra was about all they could do by way of explanation of what that means. What it means essentially is encircling the person, or forming a semicircle or enclosing them, and maintaining at least a 20-foot distance from them, on the theory that if they’re holding a sharp object, as long as they’re 20 feet away, it’s relatively less of a risk. Then they wait. The Emergency Services Unit is called automatically in those situations. The ESU—I think there may be six or eight trucks in New York City—it takes quite a bit of time for them to arrive, and it’s a teeny, tiny fraction of cases when they actually do arrive. The ESUs are trained on how to use non-lethal weaponry, but they’re not a specialized unit that deals with mental health issues. They deal with everything. They’re sort of the SWAT team.

So what we have seen is a situation where the officers are sort of set up in a very scary situation, where they’re not given the proper tools. And in our case they were all simultaneously shouting at this young man with their guns pointed at him. It’s in our view not reasonable to expect an inherently unreasonable person to behave reasonably when surrounded by shouting police officers.

Fred Levine: I think it’s important to talk about the zone of safety, but it’s also important to get the statistics about how many calls to the 911 center result in actual interactions with someone who in fact is a person with emotional distress. Because more and more people are learning that if they call 911 and say, 'I have a hysterical person here, and they have a weapon,' they get a faster response. It’s important to get the statistics, which hopefully we’ll get this year, on the so-called 200 calls a day and how many of those on the front end actually involve someone who is dangerous to himself or others, and requires special tools and special methods of interaction. The point I want to continue to make is that it's an extraordinarily small number. And police officers can be trained to help [EDPs] move toward getting services that may be available in the community.

Flaws of the mental health system

Amanda Masters: I think that [the Khiel Coppin case] is a situation where the police officers’ actions didn’t de-escalate the situation. But I think it’s also an illustration of what others are talking about in terms of the disconnect between the mental health system and the police. Not just because the police officers didn’t know about the state of the art for interacting with people and how to talk to people, but also because this is a family that sought mental health services repeatedly for years and wasn’t able to get adequate services for the son. And that really is a proximate cause to what happened as well.

Spencer Eth: I just wanted to make a comment about fragmented mental healthcare, which of course is a serious, serious problem. The police can get all sorts of data on people and tap into computerized systems and find out the arrest records of anybody they pick up. They bring that person to a psychiatric emergency room and that person might have been seen the day before in another emergency room, or been hospitalized for six months in a facility and none of that information is available to the mental health professional. It makes it very, very difficult to make informed decisions about a person you’re seeing for the first time, who is not really capable of giving you thoughtful information and there is no other way to access it. Medical information is highly protected and there are firewalls that prevent access to that information.

Another comment I want to make is that when the police encounter somebody who appears dangerous, the normal response is fear. And police, being human beings, experience fear and all too often respond in a way that escalates their own fear and the fear in the person they’re dealing with. The fact that they have weapons makes it a very volatile and dangerous situation. Mental health staff of course experience fear. We have no weapons and so we never shoot to kill, in the center of mass or anywhere else. When police come to a psychiatric unit, the first thing they are told is, 'You have to leave the weapons off the unit. You can’t come on to a psychiatric unit with a gun.' And you would think we were stripping them naked and we were throwing them to the wolves. The guns are so important to them and so overvalued and so dangerous. And it’s a whole culture issue that has to be addressed.
        
Louise Pyers: A lot of this has to do with the failure of the mental health system to be able to respond to people. After the whole de-institutionalization movement [to move the mentally ill out of large facilities in recent decades], the money that was there in closing these large state hospitals did not follow into the community so that adequate community-based services could be set up. Unfortunately, the police become the de facto responders, and they are not getting the tools, and then they get blamed for when things go wrong. So hopefully this dialogue and collaborative models to bring people together will address this, so that the police are not left at a disadvantage when trying to do this, when trying to interact with people.
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Training first responders pays off

Louise Pyers: Policies are very, very important, but I would hesitate to throw in rigid policies with regard to responding, only because situations are so fluid when it comes to being on the street. Things can change within a second. I think if you have very structured policies, it can really hinder the situation rather than help it.

The rest of it comes down to the training aspect and I think, again, it puts police officers at a real disadvantage to say contain the person and then wait, especially in a situation that can be very, very fluid and things can change at a moment’s notice. To give those officers the de-escalation tools, the patrol, the first responder, to not have to wait for the ESU or another unit to come and respond. It does a real disservice to those first responders who are there, right then and there, who are not able to do anything and perhaps, again because they don’t have the training, unknowingly escalate the situation.

And they don’t even know they are doing it. Because they are following their training in terms of how to deal with the bad guy, the bank robber or whoever who is not mentally ill, where intimidation really works. In a person with a serious mental illness, it can instill so much fear that sometimes they don’t even hear it. Or a person with schizophrenia who may be hearing voices doesn’t have a clue what’s going on outside of them because those voices are competing, so what does the officer do but yell louder and louder, which is more intimidating and brings the fear level up. The person’s going to fight back sometimes, with tragic consequences.

It’s a matter of not making the policies too stringent, to give them some wiggle room and really concentrate on the training of the first responder so that they can de-escalate and not have to wait for somebody else to do it. We’ve heard so many times from our first responders. They’ve said, 'There’s this guy who every time I tried to get him to the hospital we ended up rolling on the grass. I ripped my pants, pulled my shoulder out.'

And later he says, 'You know what, I used the training in the de-escalation, and he walked with me to the cruiser. We had a nice conversation and went to the hospital peacefully.' What a concept! And again, it’s just a matter of knowing, it’s not magic and it’s not difficult. It’s just a matter of knowing how to approach somebody.
        
Fred Levine: [Former deputy training commissioner James] Fyfe used to say that the first five minutes of any interaction were the most critical. I like what you’re saying, Louise, about the key to making first responders comfortable, knowledgeable about this. The other thing I really like about what you just said is that it isn’t so complicated. When you talk to police officers in real terms, when you acknowledge that this is a subject that they can learn, that it will also help them better not just handle the interactions with the so-called EDPs, but it will help them better interact with the three-card monte job, or a domestic violence situation or robbery, because they will assess the facts, not jump to conclusions, take their time, speak in a low voice, approach people quietly. You also demystify this, and when you demystify mental illness, then it’s not such a taboo.

Also, officers trained in the way you’re describing will be better able to deal with the mental health issues of their colleagues as well. When a partner who they are working with in the patrol car each day starts going out at night and having one or two too many drinks, they can do something, or as we saw in New York this year, an NYPD officer who was a decorated officer committed suicide. Dealing with it openly won’t be such a taboo.

Trust and open dialogue

Melissa Reuland: In terms of being able to move past the current state of affairs in New York City, it goes to Louise’s point that we need to listen to all parties. You can call me Pollyanna as much as you want to, but I do believe that the police department does want to do the right thing. I think there are legitimate and important reasons why they have not changed their policies, and I just don’t want to think that it’s because they haven’t had the time or don’t think it’s important. Unless we really understand what is driving the current policy, I don’t think we have much hope of changing it.

Amanda Masters: One of the things as a litigator that I find really troubling is that the natural role of the attorneys for the city is to be very protective of their client and defend the client very zealously and, personally, I wish that there was a different model of lawyering, or a way for lawyers to be a little more productive in these discussions. Where it wouldn’t necessarily be about prosecuting the civil rights case and defending the civil rights case to the death, but also giving the policy advice to the client that a city attorney can give. You know, I want to defend my individual client, but also [say to the] municipality: You really should look at this policy. Is it the best? And let’s be a little more open to change.

Melissa Reuland: Yes, but the millions of dollars that are at stake are really just getting in the way. I agree with you. I wish there was a different way. The way to do that, to try to get beyond the litigious, you know, the lawsuit enforcement policy, is to do exactly what is happening now. And that’s to have open discussions that are respectful of the police department, the mental health [community], the consumer, the family member perspective, so people can gain trust in each other and be free to share information that’s necessary to change policy without fear of any party being sued. I think New York has really grappled with that a lot.

I know in other cities—and I could toss off, for example, Los Angeles, Detroit, Washington, D.C.—these are cities that have consent decrees issued by the Justice Department, all of which have addressed the issue of policing and people with mental illness. And those consent decrees have served to instigate policy change, not that I’m suggesting that’s a good way to do it, but it’s another heavy hammer that can sometimes be a really great thing. I think for L.A. it was a great thing. But we need to find another way. There is an appreciative inquiry process that might be helpful somewhere along the way, where instead of talking about what doesn’t go right in the New York City Police Department, we can engage in a dialogue about what does go right. And then set goals based on wanting to do more of that. So turn the dialogue around and make it about positive work that’s happening in the police department, about our trust in law enforcement officers to do their jobs.

I think that if I was going to diagnose a little early issue with the way the committee is set up, unless you get the [NYPD] operations commissioner into this forum, what happens is the training person is going to do their training thing. Unless you involve very early on the operations piece of this, the people who are in charge of the patrol officers, then you are not going to go very far.

Fred Levine: Unless the parties who have been brought to the table can give a good open give and take, and not be concerned that what they are suggesting or not suggesting is going to be published in the New York Post the next day, or City Limits online, it’s difficult to engage in that collaboration. You’re absolutely right: the people who are brought together in this informal way have got to be the right people and it’s not just about training. I’ve been a lawyer for over 30 years and I’ve been involved in litigations, but I’ve never seen a litigation in which all the parties walk away and win. So I don’t look for litigative solutions. I also am glad we’ve moved away from an era in which we’ve had to make FOIA [Freedom of Information Act] requests to get documents from the NYPD.
        
Louise Pyers: I have to again reiterate what Melissa is saying with regards to really listening. One of the ways is just ask about their training, ask them to go on ride-alongs, ask them if they can be part of the training side-by-side with the police officers. Once you show your interest and that you’re not there to completely revamp, but that you want to understand, it makes a huge difference. It also makes a huge difference to that patrol officer’s perspective of you as well, because you’re showing an interest that you want to learn more about their jobs, the challenges that they face. That opens the door a little bit wider to their being willing to have that dialogue. I think when we push too hard and say this is not the way to do it, this is the way you should do it, people tend in any profession, not just the police, to dig their heels in and say, 'Well wait a minute. You don’t understand our work or how we operate, or how we have to do things.' It’s true, you don’t. So the more the dialogue can be opened up about what they’re doing and why they’re doing it, then the door can open to say 'Gee, we have found that this works and you know what, you’re actually safer.'

Those types of things that they buy into even more, basically a lot of it is about officer safety. When that officer feels safe, guess who else is safe? When that officer does not have that fear, that person with mental illness is a lot safer. So again I think that listening is key to making this really work and it won’t happen without that. I think that Link Committee is a huge step, but perhaps maybe have the mental health people on that committee take some training. Shoot-don’t-shoot scenarios—I know that opened up my eyes. I took it in Connecticut. I would have shot my own grandmother, center mass. We r