Maria Eva Dorigo

Public Policies to increase the access of mental health services for mentally-ill persons to

avoid psychiatric crisis due to lack of treatment and to reduce punitive approaches against

the mentally ill

Introduction

Mental illnesses are prevalent in the US, but there is little attention, poor funding to the fight

against these diseases and a tremendous stigma unlike other illnesses. According to National

Institute of Health one in six adults live with a mental disease (44.7 million in 2016). 1 Moreover,

10.4 million adults aged 18 or older in the United States are diagnosed with a severe mental

illness (SMI) (4.2% of all U.S. adults).

Unfortunately, there are a lot of myths, taboos, and stigma around mental illness. Some of the

most common mental illnesses are depression, bipolar disorder and schizophrenia. When the

mentally ill without proper treatment find themselves in a psychiatric crisis, family members or

people in the streets tend to call 911 because they interpret their erratic and violent behavior as

dangerous. In the NIH website on the topic of schizophrenia describes that “Most people with

schizophrenia are not violent; however, the risk of violence is greatest when schizophrenia is

untreated. It is important to help a person with schizophrenia symptoms get treatment as quickly

as possible. People with schizophrenia are much more likely to harm themselves than others.”2

On the same token the NIH describes that people with untreated bipolar disorder may try to hurt

themselves or attempt suicide.3

1 National Institute of Health website. Mental Illness section. 2 Ibid3 Ibid

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Lately, there has been an increase in police officers-mentally disable people interactions that end

up in the shooting and death of the mentally-ill person; a man in Brooklyn threatening people

with a shower head, a woman in the Bronx holding a scissors in her hands, or a teenage boy in

North Carolina threatening her mother with a hummer. In all these cases the police was called.

Unfortunately, these three cases ended up in the shooting of the mentally ill by the police. They

all have in common the lack of or discontinuation of treatment by the mentally ill and the

absence of police training on how to deal with a person who is having a psychiatric crisis.

One of the reasons why this encounters have become more frequent is closely related with the

dearth of access to mental health care for our population. Without treatment or proper diagnosis

people end up in psychiatric crisis and that is when police officers come in contact with them

with fatal consequences. According to The Baltimore Sun article “Hospital emergency rooms in

Maryland struggle with flood of patients with mental health, substance-use issues,” since the

1980s, the state run psychiatric beds had dropped by nearly 80 percent due to the efforts of

deinstitutionalize care.4 Deinstitutionalization5 itself is not a bad policy but the transition has not

run smoothly and is considered the biggest responsible of the mental health crisis that we are

immersed today.6

4 The Baltimore Sun. Hospital emergency rooms in Maryland struggle with flood of patients with mental health, substance-use issues. April 18, 2018.5 Deinstitutionalization is the name given to the policy of moving severely mentally ill people out of large state institutions and then closing part or all of those institutions.6 Frontline. “Deinstitutionalization: A psychiatric “Titanic.” 1997.

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When regular police officers encounter a mentally-ill person in the streets they have two options:

take them to the ER or to jail. Both institutions are ill equipped to properly treat patients with

mental illness to avoid new crisis from happening.

I. Mentally-ill in Jails and prisons

A PBS report on the issue of mental health and prisons, states that every year, approximately 2

million mentally-ill people are booked into county jails.7 According to Alisa Roth, author of

“Insane: America’s Criminal Treatment of Mental Illness,” indicates “We treat mental health as

a crisis.”8 She explains that we address the problem when the person is in the middle of a crisis

instead of preventing the crisis with the proper treatment. Moreover, the prison system locks up

too many mentally-ill people which provides poor or no treatment what leads to deterioration. A

2015 Human Rights Watch report points out that “Prison is challenging for everyone, but

prisoners with mental disabilities may struggle more than others to adjust to the extraordinary

stresses of incarceration, to follow the rules governing every aspect of life, and to respond

promptly to staff orders.”9 Besides, according to The Marshall Project’s article on this topic

“Research shows that the risk for suicide, self-harm and worsening symptoms increases the

longer a person is behind bars.”10 Furthermore, jails located in rural areas do not have mental

health professionals on site and for the suicidal, “law enforcement have few options other than

periodically stopping by the cell to check on the person and putting potentially violent

individuals in restraints and seclusion.”11

7 PBS. Giving vulnerable residents help before mental health issues land them in jail. April 9, 2018.

8 NPR. Marketplace. How mental illness has become a ticket to jail. April 3, 2018.9 Human Rights Watch. Callous and Cruel. Use of force against inmates with Mental Disabilities in US Jails and Prisons. May 12, 200510 The Marshall Project. When a mental health emergency lands you in jail. September 20, 2017.11 Ibid

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According to a Washington Post article psychiatric disorders such as schizophrenia and bipolar

disorder are ten times more frequent in an incarcerated person than a free person. While only 4

percent of the general population has been diagnosed with a serious mental illness, 20 percent of

inmates have the same diagnosis, “leading some to characterize prisons and jails as America’s

‘new asylums’.”12 Furthermore, when a person who is mentally-ill is released from prison/jail,

the discharge plan does not include services in the community, which can lead to a new

conviction.

A topic that is rarely touched upon is how incarceration pushes prisoners to develop mental

health issues that did not have before being imprisoned. United States has a pervasive use of

solitary confinement, which plays a big role in the development of mental illness. On the interim

report prepared by the Special Rapporteur of The Human Rights Council on Torture and Other

Cruel, Inhuman or Degrading Treatment or Punishment we can find the effects that solitary

confinement causes in the incarcerated. Among these effects we find: anxiety, depression, anger,

cognitive disturbances, perpetual distortions, paranoia and psychosis, and self-harm.13 Therefore,

the Special Rapporteur states in his report that “prolonged solitary confinement, in excess of 15

days, should be subject to an absolute prohibition.”14

Another topic that is important to highlight is that in the case of women incarcerated, most of

them have a history of trauma, such as psychological, physical or sexual violence perpetrated to

them. In a UN Report on Gender and Torture says that “Women and girls are at particular risk of

12 Washington Post, Virginia jails struggle to help mentally ill inmates. May 1, 201813 United Nations. A/66/268. Torture and other cruel, inhuman or degrading treatment or punishment. August 5, 201114 Ibid

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sexual assault by male prisoners and prison staff, including rape, insults, humiliation and

unnecessary invasive body searches.”15 All these amount toward the deterioration of incarcerated

women’s mental health.

The Marshall Project’s article mentioned above also explains the way Colorado has shift from a

punitive to a medical approach to deal with the mentally-ill. After a state task force

recommended to end the practice of incarcerate the mentally disable they found an innovative

way to implement this change, they use marijuana tax revenue ($6 million out of $9 million in

total) to pay for crisis centers, training for police officers and transportation programs.16

Lastly, a PBS Hour video shows an astonishing data that “in 44 of 50 states a prison or jail holds

more individual with serious mental illness than the largest remaining state psychiatric hospital

in those states.”17

II. ER and the burden of mental disable people’s visits

Another institution where people with mental health issues end up when in crisis is the

Emergency Room. A recent article in Baltimore Sun describes that Maryland ER physicians and

hospital authorities say that “they have become overwhelmed with such patients in need of

treatment for mental health or substance use problems.”18 Patients have to wait up to 24 hours for

hospital staff to locate a mental health institution for the proper care of the patient because most

15 United Nations. A/HRC/31/57. Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment. January 5, 2016.16 The Marshall Project. When a mental health emergency lands you in jail. September 20, 2017.17 PBS. Giving vulnerable residents help before mental health issues land them in jail. April 9, 2018.18 The Baltimore Sun. Hospital emergency rooms in Maryland struggle with flood of patients with mental health, substance-use issues. April 18, 2018

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ER are not equipped to treat this patients.19 The mother of a patient explains that as a

consequence of the lack of providers in the community who offer a continuous care, they end up

in crisis situations and have to resort to the ER. Moreover, even though some patients do have

private insurance coverage, there are no alternatives of behavioral care services in their

communities. According to Dr. Elias Shaya, senior associate executive director for behavioral

health services "For patients with mental illness, we moved them out of the hospital and straight

into the street.”20 Most patients who attend the ER are diagnosed with mood, anxiety or

substance use disorders. The U.S. Substance Abuse and Mental Health Services Administration

detected that 88 percent of drug addicts in Maryland do not have access to addiction treatment

and only 14 percent of the psychiatrists are accepting new patients.21 One of the problems that

the behavioral health care network in Maryland has, is that they are not opened 24 hours and

patients do need them at any time of the day and night.22

Kevin O’Rourke an ER doctor interviewed by PBS Hour on the assistance the mentally-ill and

addicted people can have at the ER responds “If they are having an acute emergency, an acute

mental health break…we are equipped to take care of them.”23 Although, he continues saying

that since these are chronic problems that need case management, housing, medication; the ER

do not have neither the human nor economic resources to deal with these patients. Moreover, Dr.

O’Rourke expands on the economic side, saying that sending patients to the crisis center reduce

costs between 50 to 75 percent, since ER visits are very expensive.24

19 Ibid20 Ibid21 Ibid22 Ibid23 PBS. Giving vulnerable residents help before mental health issues land them in jail. April 9, 2018.24 Ibid

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III. Homelessness and mental illness

According to a 2016 Housing and Urban Development report, 549,928 people are experiencing

homelessness in the United States. Of those half a million people 68 percent is staying in

emergency shelters, transitional housing programs, or safe havens, and 32 percent are in

unsheltered locations. The five major cities in the country with the largest homeless population

are: New York City (75,523), Los Angeles City and County (43,854), Seattle/King County, WA

(10,730), San Diego city and County (8,669), and DC (8,350). 25 Although this report explains

the term Safe Havens as those places which provide housing for people with severe mental

illness, it fails to provide statistics on how many people are housed in these establishments. In

New York City there are 13,900 severe mentally-ill of whom 1,833 are unsheltered; and 9,532

have chronic substance abuse, 1,645 of those are unsheltered. 26

Homeless Ethnicity and Gender in the US27

Ethnicity Gender

White African Am. Hispanic

s

Male Female Transgender

48.3% 39.1% 22.1% 60.2% 39% 0.3%

As we can see in the NYC statistics from HUD, a high number of homeless have a history of

mental disabilities which also includes substance abuse problems. Although, the percentage of

25 US Department of Housing and Urban Development. The 2016 Annual Homeless Assessment Report (AHAR) to Congress. November 2016.26 HUD 2017 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations27 US Department of Housing and Urban Development. The 2016 Annual Homeless Assessment Report (AHAR) to Congress. November 2016.

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homeless who are mentally ill ranges between 13 to 15% nationwide, there are places, such as

Los Angeles, where the incidence of mental illness among homeless people is higher (30%).28

At the same token, prolonged homelessness provokes mental and physical illnesses. According

to a National Coalition for the Homeless’ fact sheet “Mental illness may cause people to neglect

taking the necessary precautions against disease. When combined with inadequate hygiene due

to homelessness, this may lead to physical problems such as respiratory infections, skin diseases,

or exposure to tuberculosis or HIV.”29

IV. Policies to increase access of health services for the mentally ill, and to reduce

the punitive approach

The following interventions for dealing with mentally-ill people who are in contact with the law

enforcements are important models to follow to divert people who need and deserve to be helped

by mental health professionals and not caught in the criminal justice system which is not

equipped to treat them. Mentally-ill people who are caught in the criminal justice system are

sentenced to deteriorate or in the worst cases died.

Emergency call diversion

We, as a community, need to rely less on the 911 call for everything. People tend to call 911 for

absolutely everything. For instance: they call when they have a complain about a loud party next

door, or a person using charcoal barbecue in a non barbecue area, or when someone suffers a

28 Los Angeles Times. Mental illness and homelessness are connected. But not how you might think. August 7,

2017.

29 National Coalition of Homeless. Mental Illness and Homelessness. July 2009.

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minor cut or have flu like symptoms, or have a power outage, among other things. The

emergency number should be call only for real crime, medical or fire-related emergencies.

Psychiatric and suicide emergencies, though, should not be handled by the police department or

if taken care of those, a team of trained professionals should be in charge.

“What if somebody called 911 and we had [the person speak to someone] who could de-escalate

[the situation] or talk to them in an appropriate way to get them the help they needed, instead of

sending a police car?”30 What Lieutenant Brian Bixler from LAPD is suggesting is to divert

emergency calls to the appropriate mental health professionals who can handle the person in

crisis, avoiding sending the police to assist a person with a psychiatric crisis, something that they

were not trained to do and do not know how to manage.

Crisis prevention and the use of diversion (Kansas City case)

According to Judge Joseph Locascio from Kansas City Court “Typically, the people that we see

on the custody docket, they have just a complex array of problems. It is not just behavioral

health, not just mental health and substance abuse issues, but also homelessness, a history of

trauma, no family or social support whatsoever, no job skills, no social skills.”31 Judge Locascio

estimates that a third of the people in custody have a mental problem. He explains that in many

cases is quite obvious when a person has mental issues. Lawyers do not know how to handle

their mentally-ill client, police officers in court, in most instances, use force to make them

30 Los Angeles Times. Mental illness and homelessness are connected. But not how you might think. August 7,

2017.31 PBS. Giving vulnerable residents help before mental health issues land them in jail. April 9, 2018.

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comply with orders. He says “that’s sort of symbolic of the entire community. We don’t know

what to do here.”32

Police officers have the opportunity to catch a person in need of mental health and help avoid his

or her involvement with the criminal justice system. To make this reality, they need to be able to

count with mental health facilities in the community to take the person for evaluation and

treatment. The Kansas City Assessment and Triage Center run by the non-profit organization

ReDiscover, is financed with money from the city, local hospitals, and the Missouri Department

of Mental Health and State legislature. Stephany Boyers, the program manager, explains that

when police officers do not know what to do with a person who does not behave normal, they

have a place to bring her/him to be evaluated and see what kind of services besides medication

they might need.33 The PBS article tittle Giving Vulnerable Residents Help Before Mental Health

Issues Land Them in Jail describes that three quarters of the clients are homeless men, most with

both mental health and drug abuse problems and no health coverage. In this outpatient center

they can stay for up to 23 hours with the assistance of nurses and social workers, they can sober

up, have food, sleep, and take a shower. The crisis center professionals assist them with long-

term care such as medication, housing or employment.

John Young a PBS Hour journalist interviewed James Butler, a homeless person treated at The

Kansas Assessment and Triage Center who was placed in a transitional house. Mr. Butler says “I

was worthless in the streets. One police officer called me a bottom-feeder. That hurt.” 34 Mr.

Butler is a sixty-one year old man who has lived in the streets for 35 years. During that period he

32 Ibid33 Ibid34 PBS. Giving vulnerable residents help before mental health issues land them in jail. April 9, 2018.

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suffered from undiagnosed schizophrenia, was addicted to cocaine and had a drinking problem as

well. About 10 months ago a police officer picked him up from the streets and Butler though he

was going to take him to jail again. But instead he was taken to a crisis center and his life was

turned upside down and his recovery began.

Access to mental health services after incarceration

The Marshall Project’s article “Out of Prison, Uncovered” 35 describes the case of Ernest who

killed his two-year-old daughter in the midst of a psychotic delusion. When he was released, he

felt desperate because he only had a month worth pills to control his delusion and mania. He had

no insurance and he needed to see a doctor to continue his treatment. The article explains that

“Most of the state prison system in the 31 states that expanded Medicaid have either not created

large-scale enrollment programs or operate spotty programs that leave large numbers of exiting

inmates –many of whom are chronically ill—without insurance.”36 Therefore, those former

prisoners who live in those 19 states which did not expand Medicaid are in the worst position to

get health coverage. The article mentions that in Florida and Washington State Medicaid access

has reduced recidivism among the mentally ill by 16 percent. Nationwide, 16 state prison

systems have no formal procedure to register prisoners in Medicaid as they reenter the

community, according to a survey by the Marshall Project. Nine States have only small programs

in select facilities or for limited groups of prisoners, like those with disabilities.37

Nontraditional crime prevention: The Crisis Intervention Team (The Memphis Model) 38

35 The Marshall Project. Out of Prison, Uncovered. December 6, 2016.36 Ibid37 Ibid38

Information for this section was taken from the following article: PBS. Memphis police take specialized approach to mental illness. November 9, 2015.

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The Crisis Intervention Team (CIT) was created two decades ago in partnership with the

Memphis Police Department, the Memphis Chapter of the National Alliance for Mental Illness

(NAMI), and other area mental health experts to bring a better response to emergency calls that

involve mentally-ill persons. It became which is known as CIT Memphis Model that is being

implementednationwide with chapters all over the country.39 “The Memphis Crisis Intervention

Team (CIT) is an innovative police based first responder program that has become nationally

known as the "Memphis Model" of pre-arrest jail diversion for those mentally illness crisis. This

program provides law enforcement based crisis intervention training for helping those

individuals with mental illness. Involvement in CIT is voluntary and based in the patrol division

of the police department. In addition, CIT works in partnership with those in mental health care

to provide a system of services that is friendly to the individuals with mental illness, family

members, and the police officers.”40

Randolph Dupont, a professor at University of Memphis and psychiatrist, who helped to create

CIT Memphis Model, explained in an interview that police officer are trained to respond with

force in case of non-compliance, although “people in crisis often act out of fear and an untrained

officer could interpret such behavior as defiance or non-compliance,” which might be fatal.41

A police officer who served in the CIT for eight years said that the first thing you have to have to

work in this team is compassion, patience and care, and also to understand is that one individual

behavior is not his/her fault but due to a chemical imbalance in his/her brain. 42 The PBS article

39 See US map at http://www.cit.memphis.edu/citmap/ 40 CIT Center. University of Memphis41

PBS. Memphis police take specialized approach to mental illness. November 9, 2015.42 Ibid

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shows high rates of success in reducing the use of force in mentally-ill-police encounters. From

14,125 emergency calls in 2014 handled by CIT, only 19 people with mental illness resulted

injured and the majority of those ended without the person being detained. Of the totality of

cases, 4,410 were diverted to mental health institutions, and 618 were taken to jail.

Interview with Lt. Cavanaugh (Montclair Police Department and CIT Essex County

trainer)

Lt. Richard Cavanaugh who kindly spent an hour of his time answering to my questioner, told

me that he is a CIT Law Enforcement Coordinator for all Crisis Intervention Team (CIT) training

in Essex County, New Jersey. He is not only the driving force behind the CIT Memphis Model in

this county but also is helping with the implementations of it in other counties in New Jersey as

well as internationally. He, along with a team of Mental Health professionals, plans, facilitate

and instruct all the CIT training in the county, and have trained over 500 police officers, Mental

Health screeners, Correction Officers and Social Workers from every Police Department and

Mental Health Facility in Essex County as well as members from NJSP, Secret Service, Postal

Police and the Department of Corrections to name a few agencies. Unfortunately, all of this

important work towards the CIT training is volunteer, which means he not only does not receive

any pay but also has to take his days off to do it. Moreover, he is retiring soon and do not have a

person assigned to replace him as a CIT Coordinator, which put in risk the continuation of such

an essential training for law enforcement in the benefit of those who suffer from mental diseases.

Lt. Cavanaugh explained that, unlike other counties in NJ that have only one screening center in

each county, Essex County counts with three. He says that all of the screening centers are

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attached to an acute care hospital and the patients have to be medically cleared before they can

be admitted to the behavioral health unit. In Essex County the screening centers are located at

Clara Mass Memorial Hospital, Newark Beth Israel Hospital and Rutgers University Behavioral

Health Care at University Hospital in Newark. On the other hand, he believes that the mental

health system is broken. He says “there are a lot of times that we, as law enforcement have our

hands tied. It is easier for me to put the person in jail than to get them committed.” Even though

that the police department communicates with the judges or prosecutors to arrange someone to

screen the person held in jail, and even have a bed waiting for the person in a psychiatric unit,

there are miscommunication and logistics problems that frustrates the process.

He explains that there are a lot of reasons why people fell into the cracks of the system. Although

there is a court diversion program in Essex County which is done at the superior court level,

most of the arrests are at the municipal court level. Another issue is that Cedar Grove Township

has a mental health facility with 180 beds that was built after the old facility with 3,000 beds was

torn down. He says “where those 2,800 people go? Out on the streets.” Lt. Cavanaugh explains

to me an exercise he uses in his CIT training. The first day of training he hands out to

participants several prescriptions bottles with placebo pills inside and instructions on how to take

them. At the end of the week he collects the bottles back, counts the pills that are left and on

average only 10 percent are med compliance. “These are normal people. Could you imagine if

you have some form of psychosis? You have a voice saying to you ‘Don’t take the

medication!’.” Moreover, there are other cases where people start taking the medication and

when they feel well, they stop taking them. People with mental health issues may not have

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family members who make sure they take the medication, or do have family members but suffer

from burnout caused by years of taking care of a mentally ill.

Lt. Cavanaugh explained that only 25% of the police officers in the Montclair Police Department

have been trained under the CIT Memphis Model, although all of them have received the

mandatory 8-hour training on de-escalation techniques to individuals with special needs/mental

health issues. He recommends that all police departments go through a basic mental health

training for all their officers but only a few in each department should be trained under the CIT

Memphis Model.

He is hopeful though. He thinks that people are more aware and more sensible to the issue of

mentally ill people. He believes that a fluid relationship amongst the different actors (police

department, court and screening centers) needs to be in place for success. Coordination is

fundamental. The ideal way of working would be to bring the person to the jail unit, have a

mobile outreach unit go to the jail and assess the person and take the individual with them if that

is the case. Going to the ER to take a mentally ill could take the whole shift of a police officer

which police departments cannot afford when they are understaff. Another thing that can be done

to work more efficiently is to have a central registry to compile the information and create

statistics around the mentally ill that come in contact with the police. Currently, every town in

the county has its own police department with their own dispatchers and they do not centralize

the information.

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When inquiring about the intersection of homelessness and mental health, he explains that the

incidence of mental health among homeless is very high. People call the police because a

homeless has been sitting in Starbucks for 4 hours with one cup of coffee to take them out of

there. “We are moving the problem, we are not solving the problem,” says Lt. Cavanaugh. After

a lawsuit and complaints from Montclair neighbors, Mental Health Association has built two

houses with 6 units each to place homeless and they work well.

When asking if knowing the location of people with mental disabilities in the town could help

police officers when call for assistance, he responded that it would definetely help.

Unfortunately, mental health illness is strongly stigmatizing issue and no one wants to recognize

having this problem or that a family member does.

Conclusion

Mental illness is a very serious problem in the US and the lack of access to mental health

services it makes it impossible to address it properly. There are many alternatives to increase the

access of mental health services to patients in need and many others to avoid innecesary

punishment such as incarceration. It is fundamental and urgent to divert from the criminal justice

system the mentally ill to treatment facilities.

Prisons are the worst place for a person with mental disabilities to improve. Not only because

their oppressive nature but also due to the lack of willingness and resources to properly treat the

mentally disable. Prisons should never be the replacement for mental health facilities; therefore,

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it is imperative to avoid the use of imprisonment, especially for those who have a history of

mental health issues and parole those who are in need of mental health care.

It is urgent to change our legislation to stop criminalizing homelessness. The United Nations

Report called “Handbook on Strategies to reduce overcrowding in prisons,” recommends to re-

categorized (if not decriminalize) offences such as petty theft, or public order offences, among

others, the most common crimes that a homeless person can commit.43

It seems that we are not acting as a community which takes cares of the most vulnerable. If we

know each other we can take care of each other. What I mean is that neighbors and the police

department members should know the residents of the town/neighborhood they serve very well.

If they have the knowledge of where people with mental disabilities, or elderly or disable people

living by them are located, they would be able to serve them better.

We urgently need to implement more human ways to deal and taking care of the most vulnerable

in our society. We need to behave as a community and do not forget that we all need to be taken

care. And finally it is urgent to implement universal health care services to avoid people with

mental illnesses slip through the cracks of our actual system which does not guarantee this type

of service for everyone.

John Young PBS Hour’s journalist finalizes telling that “Everyone we talked to, the judge, the

doctor, the police, the head of the crisis center, the patients, say treating people with respect is

43 United Nations. Handbook on strategies to reduce overcrowding in prisons. 2013.

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key to changing behaviors.”44 The former homeless person mentioned before, Mr. James Butler,

closes the interview with PBS Hour saying:

“…It feels good to have people smiling at you instead of step out of the way. I

couldn’t have done it without this place, without help…That’s what turns people

around, like me, is finally seeing that people out there do have a heart. And I have

found out I’m still searching for who I am, because I have never known me. I have

never been clean and sober, or wanted to be. It is amazing. It puts a smile on my

face every day, and I have got a future coming.”

Policy Recommendations (listed in no particular order)

1. Decriminalization of minor/non-violent offences committed by the homeless

2. Police training and Crisis Intervention Team Memphis Model implementation in Police

Departments

3. Emergency call diversion

4. Court diversion programs

5. Creation of Ambulatory Community Crisis Centers and Psychiatric Units within hospitals

6. Follow Special Rapporteur recommendation on reduction or avoidance on the use of

solitary confinement in general and in particular to mentally-ill individuals.45

7. Revise sentensing and/or parole mentally-disable people to get proper treatment in their

communities.

8. Expand Medicaid to include former prisoners.

44 PBS. Giving vulnerable residents help before mental health issues land them in jail. April 9, 2018.

45 Also recommended by Human Rights Watch: See Callous and Cruel 2015 report.

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Annex I: Map of CIT Memphis Model implementation in New York State

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Map of CIT Memphis Model implementation in New Jersey

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Annex II: Interviews:

Questionare for Lieutenant Rich Cavanaugh (Montclair Police Department/Trainer for CIT Memphis Model in Essex County) (See audio attached)

1. Do you regularly have encounters with mentally-ill people while doing your job?

2. Have you had any encounter where a mentally-ill was in crisis?

3. Is there any community facility where you can take a mentally disable in crisis?

4. Is there any police officer in your Department trained with the Crisis Intervention Team

training (The Memphis Model)? Have anyone at your Department trained in any way to

deal with mentally-ill?

5. How you evaluate the program. Do you think is working? Why or why not?

6. Has Essex County or the Police Department statistics on how many people are sent to jail

and how many are sent to crisis centers?

7. Can you explain to me how do you proceed with a person who is having a psychiatric

crisis, when are they sent to jail and when are they sent to a crisis center?

8. Is a "screening center" (how you called it) a place where the person is not only stabilized

but also a case manager makes sure that he/she will need housing, medicines, food, job

training or other services? 

9. How is the intersection of homelessness and mental illness? What can you tell me about

this?

Questionare for Rafael Barilari (ER doctor-St Joseph Hospital Paterson, NJ) (Could not

contact him)

1. Do you receive patients homeless and mentally-ill? How many per day?

2. Who brings them?

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3. What do you do with them?/Do they receive treatment in the ER? Where do you transfer

them once they are released?

4. Are there any mental health facilities within the hospital where you work or in the

community?

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Bibliography

Baham, Darby. From “What If” to Real Results: U.S. Police Departments Explore Innovative, Collaborative Ways to Address Growing Mental Health Crisis. March 29, 2018https://csgjusticecenter.org/mental-health/posts/from-what-if-to-real-results-u-s-police-departments-explore-innovative-collaborative-ways-to-address-growing-mental-health-crisis/

CIT Center. University of Memphis. Department of Criminology and Criminal Justice.http://www.cit.memphis.edu/aboutCIT.php

Frontline. “Deinstitutionalization: A psychiatric “Titanic.” Excerpt drawn from Chapter 1, 3 and Appendix of: “Out of the Shadows: Confronting America’s Mental Illness Crisis” by E. Fuller Torrey, MD, 1997.https://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html

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