Since the murder of George Floyd by Minneapolis law enforcement, elected officials and communities across the country have engaged in impassioned discussions about strategies for reforming—and for some, abolishing—policing systems as they currently exist in the United States.
From calls to ban the use of chokeholds by police officers (which were already prohibited in Tampa and St. Petersburg), to defunding police departments, racial justice advocates across the country have proposed a number of ideas to address the stain of police brutality—and its disproportionate impact within Black and brown communities.
Many activists have highlighted calls to reallocate police department spending towards strengthening the social and economic welfare of communities, through investment in community health services, education, transit, affordable housing development, and mental health care.
As the St. Petersburg Police Department moves to reallocate more than $3 million in funding from the police department towards the creation of a community assistant liaison (CAL) team, it’s clear there’s a need to consider what can be done to comprehensively address the issue of police violence against people with mental illness.
According to the Treatment Advocacy Center, an estimated 25% of fatal encounters with police officers in the United States involve people with mental illness. The risk of being killed during interactions with law enforcement is 16 times higher for people with mental illness compared to the general population.
Over recent decades, families of people with mental illness have shared devastating tales of calling the police to assist their loved ones in crisis—only to have their loved one shot and killed by those sworn to protect and serve.
In 2015, Dallas police fatally shot 38-year-old Jason Harrison, who had schizophrenia and bipolar disorder. According to Harrison’s mother, he’d been refusing to take his medication and was experiencing acute mental distress. On the day of his death, Harrison's mother called 911 to seek assistance for her son. When police arrived, both Harrison and his mother stepped outside. Harrison had been holding a screwdriver in his hand. When law enforcement demanded he drop the screwdriver, Harrison, who was likely overwhelmed, possibly paranoid and delusional, did not comply.
Within seconds after police shouted demands for Harrison to drop the tool, the officers unleashed a round of gunshots, killing him.
In May of this year, Florida resident Tony McDade, a Black transgender man with mental illness, was fatally shot by Tallahassee police after being identified as a suspect in a fatal stabbing incident.
McDade had been arrested and incarcerated multiple times, and over the course of more than a decade had pleaded with authorities for mental health treatment, readily acknowledging his anger problems. McDade’s mother attested to the fact that Tony had been “psychologically scarred” by his experiences with incarceration and other traumatic events. There are dozens more stories like McDade’s, with many close to home here in Florida.
These intersecting issues of skeleton mental health care budgets and police brutality don’t exist in a vacuum independent of one another. The defunding of mental health care is inextricably linked to issues of housing instability, lack of health insurance, discrimination, and a crumbling public health infrastructure.
Addressing police violence against people with mental illness is also a racial justice issue. Serious mental illness (SMI) in Black and brown communities has historically been misidentified and mistreated.
The historical context of this is too complex to be fully captured here, but has been documented extensively.
A Brief History Lesson
Within the context of Black Lives Matter protests, the connection between mental health stigma, civil disobedience, and marginalization on the basis of skin color holds particular salience.
Over the past few months, BLM protestors have been wrongfully depicted as disruptive, hostile, and even certifiably insane. This kind of framing is not new.
Jonathan Metzl, author of “The Protest Psychosis,” documents how civil disobedience and threats to authority figures—including law enforcement—were explicitly pathologized as symptoms of schizophrenia during the Civil Rights Movement of the 1960s. This led to the disproportionate institutionalization of Black men over the next decade, who were characterized by the U.S. medical psychiatric community as violent, dangerous, and quite literally psychotic. Scholar Nadia Monique Richardson notes that this “continues to influence collective attitudes on mental illness in the Black community,” complicating the generic notion of stigma.
Another important connection between mental illness and law enforcement is the wave of deinstitutionalization that occurred in the 1960s.
This movement, fought for by many civil rights activists, drastically reduced populations in psychiatric hospitals, driving people with mental illness out of asylums—which had earned a horrific reputation—and back into their communities. This shift came in the wake of the Community Mental Health Construction Act passed by President John F. Kennedy in 1963.
This legislation was supposed to expand funding for community health services, supporting people with mental illness through community-based resources rather than requiring long-term, or even lifelong, stays in asylums.
Unfortunately, after Kennedy was assassinated, his successor did not carry out Kennedy’s original vision. This disruption significantly obstructed the process of expanding community health services, with devastating consequences. Among other things, this led to widespread houselessness and the diversion of people with mental illness into the criminal justice system.
Today, the three largest inpatient psychiatric facilities in the United States are the Los Angeles County Jail, Rikers Island Jail, and Chicago’s Cook County Jail. In 2018, the Orlando Sentinel wrote that Florida's Orange County Jail was the "largest mental health institution in five Central Florida counties."
Beyond lack of access to care
Lacking access to mental health treatment is a huge problem, especially in Florida. According to Mental Health America, Florida ranks 40th in access to mental health care for adults, and more than 60% of Florida adults living with mental illness do not receive treatment. Even worse, the state is ranked last nationwide in mental health care spending per-person.
But it’s important to look at the broader picture. Lack of access to treatment for mental health issues is a problem, but it’s not the only problem.
The causes of various mental illnesses are the subjects of ongoing research and are widely debated. There’s evidence to support that there are biological and genetic bases for several mental illnesses, including psychotic disorders like schizophrenia. However, what’s also important to recognize is the influence of interpersonal, social, and economic conditions. Experiencing discrimination on the basis of race, ethnicity, sexual orientation, gender identity, or socioeconomic status (SES) can affect mental health.
Having an unstable or abusive housing situation, having little social support, struggling with drug and alcohol abuse, or being a survivor of trauma affects mental health and can worsen existing mental illness. Poverty, food insecurity, and oppression are known links to mental health. If you’ve ever experienced job loss, lacked health insurance, been homeless, or struggled to pay your bills—you don’t have to use your imagination to wonder why.
Police violence and mental illness: What can we do? What’s already been done?
From everything discussed above, it should be apparent that mental health care deserves a leading role in our collective discussions about race, systemic oppression, and policing in Tampa Bay.
While some people who are experiencing a psychotic episode may appear hostile, severely agitated, and possibly resistant to help, they should never be at risk for becoming a target of deadly force by police. Not when the care of trained mental health workers and community advocates could—and arguably should—be provided with the resources to properly evaluate and de-escalate situations of acute mental distress.
Across the country, plenty of things—from de-escalation training to community-based programs led by mental health workers— have been proposed to address the intersection of police violence and mental illness, with varying degrees of success. More on that later.
Here in Tampa, one strategy that’s been championed to address police violence against mentally ill populations is crisis intervention training (CIT).
CIT is a 40-hour training program for law enforcement that is designed to inform interactions between police officers and people with mental illness.
The National Alliance on Mental Illness (NAMI) describes CIT as an “innovative, community-based approach” that creates a partnership between local law enforcement, mental health workers, people with mental illness, and advocates.
The curriculum for Hillsborough County’s crisis intervention training program includes, but is not limited to:
- Mental health crisis awareness training
- Verbal and physical intervention techniques
- Mental health “first aid”
- Crisis intervention training, which prioritizes de-escalation tactics and jail diversion, comes from the “Memphis model” of crisis intervention.
The Memphis model was developed in the wake of a fatal encounter between Memphis police and a young man with mental illness in 1987. Variations on CIT programs have since been implemented in at least 40 states nationwide.
Crisis Intervention Training in Tampa
For years, the Hillsborough County Sheriff’s Office (HCSO) has maintained a community outreach team of crisis intervention-trained deputies. A 2019 report from the U.S. Department of Justice shows that as of 2015, the HCSO had equipped at least 1,000 officers with this specialized training. Local Tampa Bay chapters of NAMI have fought to expand crisis intervention training throughout Hillsborough and surrounding counties.
Last year, in 2019, NAMI Hillsborough achieved what they believed to be a major victory, as CIT became mandatory for HSCO officers rather than simply voluntary.
In December of 2019, the Tampa Police Department announced the launch of its own crisis intervention training program, making crisis intervention training mandatory for all sworn-in officers. Other types of workers in the department are also required to attend a variation of the program.
Tampa police chief, Brian Dugan, who has been the subject of sharp criticism in recent months, had stated his hope for having all officers complete the training by June 1.
Creative Loafing Tampa Bay reached out to the TPD to see whether or not that’s come to fruition, especially in light of obstacles imposed by the coronavirus pandemic.
Does crisis intervention training actually help?
If you’re no stranger to news of the trail of fatal interactions between Tampa law enforcement and local residents over the last decade or so—you may be surprised to learn that there are programs in place to deter the use of excessive force by police.
Crisis intervention training has received significant praise from NAMI and organizations that operate within the criminal justice system as an effective model for law enforcement.
According to those supporters of CIT, effects of this training include:
- Improving officer knowledge and attitudes about people with mental illness
- Increasing referrals to mental health units
- Major cost savings, as a result of diverting people with mental illness into community based treatment programs as opposed to jail or prison
- Reducing the amount of time police officers spend on mental health-related crisis calls
- Increase officer confidence in their management of mental health-related crisis situations
And all of these sound well and good—within a reformist framework, that is. However, a growing body of research demonstrates that the effectiveness of CIT for reducing police violence is questionable, and is more complicated than simply mandating that officers receive this training.
In his book, “The End of Policing,” author and professor Alex Vitale asserts that the broader issue that goes unaddressed with CIT is the lack of mental health care services available in communities where this training is being implemented.
“This [CIT] model has shown signs of success in cities that have embraced it, but only when there are meaningful mental health care services available for police to rely on,” Vitale wrote.
It follows then that an underfunded mental health care system may severely limit the utility of improving interactions between law enforcement and people experiencing mental health crises—assuming that does occur.
A study published in the Journal of the American Academy of Psychiatry and the Law also found little evidence to support CIT’s effect of reducing injuries and the use of force. The study reported mixed results concerning a reduction in overall arrests. In addition, if you’re supportive of police abolition, the fact that remains is that CIT is still a reform that operates as a police-centered model.
And for those who are opposed to the ever-increasing City of Tampa and Hillsborough County police budgets, it’s quite possible requiring additional training would also result in further increases—with, again, questionable results insofar as better protecting public safety.
There are variations on crisis response teams that might better fit the kind of support systems abolitionists envision, however. For instance, there are some crisis intervention models that aim to reduce police involvement by having trained mental health workers respond to crisis calls.
A local example that might be likened to this is Gracepoint’s Mobile Crisis Team. This program, which operates 24-hours a day, seven days a week, appoints licensed mental health workers as the primary responders to urgent mental health crisis calls.
While led by mental health workers—a concept considered ideal by many of those calling for police reform—the program currently operates on a limited budget, restricting its utility within the county.
Developing crisis response teams that reduce police involvement, moreover, opens the possibility that police officers, who may still be on stand-by within current programs, might eventually be rendered unnecessary within the crisis response partnership.
According to St. Petersburg Mayor, Rick Kreisman, their city’s upcoming CAL team will consist of “community and social working professionals”. This might put St. Pete well on its way towards creating a mobile crisis team that can more effectively respond to mental health crises in the county, although crisis calls will still be monitored by the police department.
Is St. Petersburg’s victory going to be the huge step forward that so many of us desperately want it to be? Only time will tell. Having some level of police involvement appears to be non-negotiable in handling mental health crisis calls at this time.
If not crisis intervention training, then what?
Crisis intervention training and even mental health crisis response teams aren’t capable of addressing all issues related to the intersection of mental illness and the criminal justice system. De-escalation and crisis intervention tactics may improve some interactions with law enforcement—don’t take this for granted as an absolute—but they don’t get at the core of the issues such as poverty, income insecurity, and housing instability that are commonly associated with mental health issues.
“Crisis response teams, specialized [mental health] courts, and improved training can reduce the impact of the criminal justice system on the mentally ill,” Vitale wrote, “but these are not replacements for a rational, functioning mental health system.”
And even still, acknowledging how mental health institutions have historically failed communities of color is also necessary. Now and moving forward, it’s critical to prioritize the adoption of anti-oppressive treatment approaches for mental health and to value the input of those with lived experience.
From a policy standpoint, many criminal justice advocates across the country, reformist and abolitionist alike, have fought for changes to address the various systems that are complicit in the over-policing and over-incarceration of people with mental illness.
Some alternatives to better support people with mental illness that have been proposed include:
- Supportive housing
- Community-based treatment models like assisted outpatient treatment (AOT)
- Creating collaborative community care networks decoupled from law enforcement
- Community re-entry planning for those who have been incarcerated
According to the Vera Institute of Justice, incarcerating people with mental illness costs two to three times more than community-based treatment.
Researchers in Central Florida found that providing chronically homeless people with supportive housing could save Florida taxpayers as much as $149 million in spending on health care and jails.
Diversion programs, which serve to divert people away from incarceration, may offer some benefit, as may specialized mental health courts for managing cases involving people with mental illness—but these also ultimately still rely on punitive sanctions. Which begs the question: What should we be fighting for?
Crisis intervention training, for its part, is a reform. Is it the most effective reform to address the criminalization of mental illness and eradicate fatal encounters between police and people with mental illness in Tampa Bay and beyond?
Well, that’s an argument to be contested. Crisis intervention services within law enforcement have existed in some form for years in Tampa Bay, yet concerns about the role law enforcement plays in responding to mental health crises remain.
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This article appears in Jul 16-22, 2020.