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A Blue Wall of Silence
With Mary Zdanowicz,
Founding Executive Director, Treatment Advocacy Center
Tuesday, July 3, 2001; 1 p.m. EDT
Prince George's County police officers shot and killed people at rates that exceeded those of nearly any other large police force in the United States from 1990 through 2000. Almost half the people targeted by police were unarmed. Police officials declared all of the shootings justified but kept details about them secret. Police have shot at least a dozen mentally ill or emotionally distraught people since 1990, including six whom officers were initially called to help.
Mary Zdanowicz is the founding executive director of the Treatment Advocacy Center, a national organization working to eliminate legal and clinical barriers to treatment for millions of Americans with severe brain disorders. The center, a nonprofit organization, works to educate communities of the benefits of treatment to decrease homelessness, jailings, suicide, violence and other devastating consequences. Database (PDF) of preventable tragedies of 1998.
Zdanowicz's articles,"A Sheriff's Role in Arresting the Mental Illness Crisis" was published in the National Sheriffs' Association magazine Sheriff (2001), "We Should Know How Many People With Mental Illnesses Are Killed By Police" was published in the center's Catalyst,(May/June 2001), and "A Shift In Care - Law Enforcement Agents Bear Increased Responsibility" (PDF) was published in Community Policing Consortium's magazine Community Links (2001).
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washingtonpost.com:
Thanks for joining us today, Mary Zdanowicz. Today's installment of The Post series "A Blue Wall of Silence" detailed the difficulties posed by interactions between police and mentally ill people. Were you surprised by The Post's findings?
Mary Zdanowicz: I wish I could say that I was surprised by the Post's report of people with mental illness being killed in altercations with police. Sadly, these tragedies occur too frequently. There is no official count of the number of persons with severe and persistent mental illness who are shot by police each year. And despite an unfortunate wealth of such tragic incidents, no organization of any type keeps track of them. The Treatment Advocacy Center records details on some in its Preventable Tragedies Database at www.psychlaws.org. The Database has selected U.S. newspaper accounts of the consequences of non-treatment for individuals with severe mental illness including suicides, victimization, violence, and police shootings. But, the daily search from which the Database is compiled does not include all newspapers, police shootings are not always covered in the press, and it is not always reported that a person who is shot has a severe mental illness.
Therefore, we know that the Database cannot possibly contain all incidents of police shootings of persons with severe and persistent mental illness (SPMI). Still, the Database shows that at least 37 people with SPMI killed by police in 1998. Even this conservative estimate indicates that people with severe and persistent mental illness were killed at a rate of 5.3 per million, a rate 4 times higher than in the general population (1.4 per million. The fact that this is a conservative estimate cannot be overemphasized.
Lacking any official statistics on the number of prior shootings, it is unknown whether the rate of SPMI shootings is declining, or--as we dread and fear--on the rise.
Landover, MD:
If an individual poses an immediate threat to the life of a law enforcement officer, should the officer jeopardize his or her life because the individual may be mentally ill?
Mary Zdanowicz: It is unrealistic to expect an officer not to react in self defense when his life is in danger. However, there are some model programs that can prevent an officer from being put in jeopardy.
A 1999 survey of 194 U.S. cities found that more than 40%have a special program that instructs officers on how to handle the mentally ill. These programs are consistent with the paradigm shift in police methods in recent years from a traditional enforcement model to a community oriented policing model which involves “problem-solving” orientation to operational problems and community partnerships to accomplish operational objectives. Using community oriented policing, departments focus on serving the needs of specialized populations, including those precipitating more service oriented calls or contributing to public disorder. Police agencies have applied these principles to create crisis response programs with the following objectives:
meeting the needs of people with mental illness in crisis;
keeping people with mental illness out of jail;
minimizing the amount of time officers spend on calls; and
maintaining community safety.
Sophisticated law enforcement executives are trying to prevent tragedies involving the mentally ill by applying community oriented policing strategies, two of the basic tenets of which are partnerships and problem solving. One of the best examples of applying these doctrines to police encounters with the mentally ill is the Memphis Police Department’s Crisis Intervention Team, implemented in 1988 after the tragic shooting of a mentally ill individual. It is a collaboration of the police department, treatment providers, individuals with mental illness and their families. Uniformed police officers volunteer for the team and, if selected, attend an initial 40-hour training curriculum provided by a volunteer faculty of mental health providers, family advocates, and consumers of mental health services at no expense to the city.
Team officers are trained in special duty assignment—responding to emotional disturbance crisis calls. Officers who have expertise and experience with the mentally ill take charge of the scene during a crisis. The officers are trained to de-escalate a mental illness crisis situation. When appropriate, officers also divert mentally ill individuals from the criminal justice system and into treatment. An essential component of the Memphis model is that police officers can transport individuals and transfer custody to a centralized psychiatric facility for evaluation and treatment. In Memphis, police officers are back on the streets in 15 minutes on average after bringing an individual to the mental health facility.
While there are other crisis intervention models, a study of police in three jurisdictions employing different models disclosed that a significantly higher proportion of officers rated their program as being highly effective in dealing with the mentally ill when the Crisis Intervention Team was used. The Memphis Police Department also experienced a significant reduction in officer injury rates during calls with mentally ill individuals.
Roseville, MN:
How can we get the lawyers and police out of the mental illness system and return to the health care system? No wonder families are reluctant to call for help.
Mary Zdanowicz: There is no question that the responsibility for caring for the persons with severe mental illness must be shifted back to the mental illness treatment system. Law enforcement agents are the front line mental health workers when a person is in crisis. A survey of sheriffs in Virginia disclosed that virtually all survey participants had encountered arrestees with psychiatric illnesses. In another study, sheriffs in California reported that 9 percent of emergency calls were related to a crisis involving mental illness crisis. There is evidence that law enforcement involvement with the mentally ill is increasing. For example, the number of police responses to complaints about “emotionally disturbed persons” in New York City rose from 20,843 in 1980, to 46,845 in 1988, to 64,424 in 1998. There are nearly five times more people with mental illness in jails and prisons in this country than are in state psychiatric hospitals. Many of the most severely mentally ill are in a revolving door of hospitalization, jailings, and the streets or the "back bedroom."
It is the crisis that necessitates the involvement of law enforcement and the lawyers. To stop the cycling from crisis to crisis, we must ensure that those with mental illness get consistent and sufficient treatment and services.
Hannibal, MO:
Your website lists a factsheet pointing to the pitfalls of deinstitutionalization and thus the "shortfalls" of community based treatment for the chronically ill despite the proven cost effectiveness by numerous studies and state health depts. which indicate otherwise. In the current political arena and administration, how do you propose to actually increase funding for state hospitalization for the mentally ill, and measure its effectiveness as a longterm treatment for those with chronic illness?
Mary Zdanowicz: The Treatment Advocacy Center certainly does not favor hsopitalization over community treatment. In fact, one of our main goals is to enhance the effecvieness of treatment in the community. However, we are concerned that in many communities there is not sufficient inpatient capacity for for those who need acute hospitalization or long term care.
Since 1955, we have effectively closed more than 91% of state psychiatric hospital beds. But, this is not a thing of the past. Twice as many hospitals closed in the 1990s than in the previous two decades combined. In the 1990s, the number of state psychiatric beds were nearly cut in half. Last year several states, including Virginia, New Jersey, Florida, and North Carolina announced more closures. This problem is going to get worse before it gets better.
Herndon, VA:
I have a 9-year-old son with childhood onset bipolar disorder. He's on medication and is in therapy but every day is a struggle for him and we don't know what the future holds for him. Though he is in awe of the police now, I can imagine that 10 years from now he might have an episode that would require the police to be called. Is there anything we can do now to work with the local police to avoid the type of responses that occurred in Prince George's County?
Mary Zdanowicz: The key is to provide as much education as possible for your son so that he can effectively manage his illness and avoid relapses that would require police intervention. You should be aware that studies sho that nearly half of people with schizophrenia and manic-depressive illness (bipolar disorder) have moderate to severe impairment of their awareness of illness. This means that they may not be able to recognize their need for treatment. There is a wonderful book that describes this neurological deficit and methods to help a person develop awareness of illness. It is called "I am not sick, I don't need help", by Dr. Xavier Amador available at www.vidapress.com.
You should also introduce your son to the police in your district and educate them about your son's illness. I would also encourage your police chief to implement the Crisis Intervention Team program described previously.
Springfield VA:
Why is it that the police even get involved? Can't family members or loved ones get help for these people?
Mary Zdanowicz: One of the problems is poorly funded and/or ineffective community treatment programs. But, the most common reason that police get involved is antiquated treatment laws.
Thirty years ago, laws governing treatment of the mentally ill were radically reformed. The most significant change was the requirement that if a person refuses treatment, they must become dangerous before they can be treated. So what typically happens? A family calls the mental health professionals because their son stops taking his medication and they tell the family, “we can’t do anything until your son becomes dangerous.” Many state laws, including Maryland’s, allow the son to refuse treatment until he becomes dangerous, leaving the mental health workers unable to intervene. When he deteriorates to the point where he is dangerous, the mental health professionals say, “we can’t deal with it now, call the police.” That means that law enforecment agents are the ones on the front line when a person’s mental condition deteriorates to the dangerous levels dictated by state law.
Police are also called in when a person with mental illness is symptomatic but the mental health system cannot respond because the person is not yet “dangerous.” This has been going on for years. When Pennsylvania changed its law in 1974 to require the presence of danger, Philadelphia’s police chief issued a directive that non-dangerous people who could no longer be taken into custody under the Mental Health Act could instead be arrested for disorderly conduct. That practice continues today out of necessity.
One way to reduce encounters between police and the mentally ill is to change restrictive state laws that prevent effective referrals for mental illness treatment until a person is dangerous to themselves or others. This is crucial because, while the mentally ill who are treated are no more dangerous than the rest of the population, those who are not being treated are significantly more likely to become dangerous. Enacting and utilizing standards based on the need-for-treatment allows for intervention before tragedies occur.
Perhaps the most important reform to prevent repeated institutionalization and the consequences of non-treatment is assisted outpatient treatment, which fosters treatment through a court-ordered plan. Not only does the court commit the patient to treatment, but it also commits the treatment to the patient. In the most comprehensive study to date, long-term assisted outpatient treatment was shown to reduce hospital admissions by 57 percent. The results were even more dramatic for individuals with schizophrenia and other psychotic disorders. Their hospital admissions were reduced by 72 percent. While it has not yet been studied, it is likely that similar reductions in jail admissions could also be effected by assisted outpatient treatment. The same study showed that long-term assisted treatment combined with routine outpatient services reduced the predicted probability of violence by 50 percent. This has obvious benefits for both law enforcement officers and the public. The Treatment Advocacy Center’s Model Law for Assisted Treatment provides an example of possible legislative reforms. It can be accessed at .
Clinton, MD:
Do you know if the Prince George's County Police Department utilizes a "Crisis Intervention Team"?
Mary Zdanowicz: I do not know. But, many jurisdictions around the country are starting to follow the Memphis CIT model. I suggest contacting Major Sam Cochran, Memphis, TN who is a national expert on CIT. He can be reached by e-mail at: samc1419@aol.com
Bethesda, MD:
Are most jurisdictions able to discern the symptomology of various mental illnesses compared to someone that is say "high" on drugs? Aren't most officers woefully lacking in their skills when it comes to dealing with the mentally ill?
Mary Zdanowicz: This is clearly an area where training is essential. While there may be some similarities between someone who is psychotic and someone who is experiencing a drug reaction, police can be trained to recognize differences. But, this also points to the importance of police having knowledge about individuals in their communities who have a history of mental illness. It is very important for the mental health community and law enforcement to work together to protect citizens with mental illness.
Greenbelt, MD:
I read today's news article and kept thinking how fortunate my family is. For 13 years, my brother has been diagnosed mentally ill and has been on the frightening treadmill of abandoning medication, aberrant behavior, commitments, forced hospitalizations, and recuperation, to be followed by his decision to quit meds one more time.
As I read these heartbreaking accounts, I wonder how many families know of the County Commissioner's Office in PG County. That office is open 24 hours and I have gone repeatedly to seek an emergency commitment for my brother when he's been a danger to himself or to someone else (the legal standard for emergency psychiatric commitment).
The Sheriff's department, which is dispatched by the Commissioner's office once the commitment has been granted, has been very effective in helping to defuse the situations and safely get my brother into the hospital for treatment.
As a family, we have called the Greenbelt police to advise them of my brother's condition, knowing that he would be one of those that would antagonize the police to kill him as his suicide attempt. They have been compassionate and firm and have helped my brother the treatment he needs when he's sick.
Why don't more families of the mentally ill know of the resources that exist in their county to assist their loved ones?
Witnessing the mental decline that is preventable with medication is very difficult. Knowing where to turn for additional resources is important for families that want to advocate for their loved one. This does not excuse accountability for the patient, and sometimes, personal responsibility is beyond their ability. I wanted very much to comment to highlight a different angle. Does your oganization have a website?
Mary Zdanowicz: Thank you for reminding us that many law enforcement officers are particulary adept at helping the mentally ill in crisis. I also agree that it is essential that families learn what resources are available and how to use them. Knowing what your state law allows in a crisis is also imperative. Please visit our website www.psychlaws.org for more information.
Mt. Rainier:
My roommate is a paramedic and frequently is confronted with people who are emotionally unstable. So I have some understanding of how volatile the situation can be. It is very difficult to know what a 'crazy' person will do next. That said, it is just astonishing to me that with prior warning that they need to deal with someone emotionally unstable but NOT a hostage situation, not with someone else in danger, that the Prince George's police are not -prepared- to deal with non-lethal means. It is desolating that the SWAT team seems to be their only alternative to the beat cop.
Mary Zdanowicz: You are correct that, when possible, less than lethal methods should be used. But, we really need to focus on preventing police interventions by keeping people out of crisis.
There is some evidence to suggest that incidents of police shootings occur at higher rates in states that have the most restrictive mental illness treatment laws. For example, 6% of the mentally ill shot by police in 1998 occurred in Maryland, 3 times more than would be expected based on it having less than 2% of the nation’s population. Maryland has one of the most restrictive mental illness treatment laws in the country, limiting intervention to situations in which a person is “dangerous” and not allowing court-ordered community treatment. The two other states with the highest rate of these incidents in 1998, California (31% of incidents with 12% of population) and Florida (20% of incidents with 6% of the population) have similarly restrictive laws.
washingtonpost.com:
Thanks for joining us today, Mary Zdanowicz.
Mary Zdanowicz: I appreciate the Washington Post investigating the tragedy of people with untreated mental illness being killed in altercations with police. The Treatment Advocacy Center is working to prevent such tragedies. We encourage readers to contact us at info@psychlaws.org or 703-294-6005 or visit our website at www.psychlaws.org.
Thank you all for joining us.
washingtonpost.com:
That was our last question today. Thanks to everyone who joined the
discussion.
Stay tuned to Live Online for more on the Prince George's police
shootings series:
Criminal
Justice Professor James Fyfe Tuesday at 3 p.m. EDT
Prince
George's NAACP Thursday at 11 a.m. EDT
Police
Training Methods Thursday at 11:30 a.m. EDT
Political Activist Alvin L. Thornton Thursday at 1 p.m. EDT
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