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VOLUME 3, ISSUE 2     PSYCHNEWS INTERNATIONAL          July 1998
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SECTION D: FEATURE ARTICLE


                       A BETTER DISPOSITION
NOTES ON DECRIMINALIZING POLICE CONTACTS WITH THE MENTALLY ILL 

      Frank Mullnix, MHCRN and Officer Clint Grimes, MA 

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Mental illness as a social problem is one that by default has 
fallen, too often, to law enforcement to resolve. Throughout the 
years, the mental health related call has been both difficult and 
time-consuming for police. This remains so even though today's 
patrol officer is more sophisticated and better able to recognize
mental illness than the officer of decades past. This type of call
can require a more specialized response than many officers are 
prepared by either training or aptitude to provide. The patrol
officer may not have time to thoroughly investigate due to the 
constant demand of answering calls for service, the public's 
greatest demand of law enforcement. The inevitable result is 
that a significant number of people with mental disorders 
become unnecessarily incarcerated. 

Even with the protection afforded by the LPS law, there is still a
significant number of mentally ill individuals placed unnecessarily
on 72 hour holds. This is not because of a lack of good will on 
the part of the officers, but because a lack of investigative skill
in mental health issues, a lack of resources to investigate such
matters and the pressure to get back into service and "handle the 
beat." Sadly, the use of force could sometimes be avoided. Again,
this is not due to an overzealous officer that is out to hurt 
someone. This is due to lack of training and resources in dealing 
with problems that are being shunted more and more to law 
enforcement. As state hospitals close and funding shifts away from
care of the mentally ill, more and more mentally disordered people
are forced out of facilities and into situations where police 
contact is inevitable. 

Three law enforcement agencies in Los Angeles County, the Los 
Angeles County Sheriffs Department (LASD), the Los Angeles Police 
Department (LAPD), and most recently, the Long Beach Police 
Department (LBPD), the jurisdiction in which we work, are 
participating in a program that consistently strives to provide
a better disposition to this type of call. This concept called 
MET (Mental Evaluation Team) combines the skills and resources
of a police officer or deputy, and a Los Angeles County Department
of Mental Health worker, usually a licensed psychological 
technician (LPT), a registered nurse, or a licensed clinical 
social worker. This professional is cross-trained and works 
together with law enforcement personnel in two person teams that 
can be called out by patrol units needing assistance or the 
LBPD-MET can be directly dispatched. 

This synergy of assets brings forth a new, more powerful way of 
handling incidents than neither a black-and-white patrol unit 
nor a Psychiatric Mobile Response Team can provide. An MET 
represents a highly trained team that has new tools at their 
disposal. The clinician has access to the MIS system which can 
provide the team with information indicating if the subject has 
some kind of mental health history, immediately moving the realm 
of possibility away from incarceration and towards patient care. 
The clinician also has access to the Automated Eligibility 
Verification System (AEVS) to verify Medi-Cal eligibility. The 
cellular phone can also be used to verify any other insurance 
eligibility to route the subject away from the county system, 
lightening the burden on that system and providing the best 
possible care for the subject. The cellular phone can also be 
used to call doctors, board and care facilities or any other 
involved parties capable of giving the team useful information. 
Collectively, the availability of these resources allows for a 
far greater range of options from which to choose when making 
a disposition determination. 

The most important asset does not come from technology or the 
airwaves; it comes from a dedicated cross-trained team that has 
time to ask the right questions to determine the subject's 
needs. The team members can jointly assess an individual and
better determine what priority to give to law enforcement or 
mental health issues. We can often anticipate acting out 
behaviors and do not necessarily view them as non-compliance 
or resisting. A calm, relaxed, nurturing, but direct demeanor is
the order of the day. Force is a last resort and incarceration
only occurs if a felony has been committed. 

Since each team works together on a continuous basis, the 
team members know each other's mode of operation. As a team, 
they get to know the chronic subjects, their hang outs, and 
hang ups. They get to know which facilities have the smoothest 
admission process and where the subject can get the best care
if needed. The team will provide transportation to a psychiatric
emergency room unless there is a medical emergency. 

There is another winner in the municipality that is covered by 
a MET team. That winner is the mental health professional with 
a patient in crisis. From our experience, the crisis is most 
likely a manic episode or some type of suicide potential. 

Most often, this crisis happens in the patient's home. The doctor 
must, in many cases, count on a family member or neighbor to 
get the patient to the hospital. If the patient is acting out 
the possibility of injury to the patient and to the caregiver 
becomes more likely. Another alternative is the Psychiatric Mobile
Response Team(PMRT) from a hospital. But in Los Angeles County,
the PMRT response time may be hours.  Additionally, in 60% of PMRT 
responses, police assistance is required as is ambulance transport. 

Through the use of a MET, mental health professionals could call 
the police and request a MET response. The MET team is already in 
the field so the response time is a lot faster. The MET team can 
converse with the doctor or counselor in route to the call, verify 
insurance coverage, as well as safely restrain the patient if necessary.
The response will be both safe and compassionate. The mental health 
professional in his/her office will be speaking directly to another 
mental health professional, the MET clinician.  

As members of the LBPD-MET, we have seen, first hand how the MET 
concept consistently provides a better disposition of the so-called 
mental health call. We would like to relate an actual call that serves 
to illustrate how this occurs. 


CASE 1 

Eddy (pseudonym) is a large young man 6'-5'' 300 lbs. plus. He is in 
his late 20s and has a chronic, severe mental illness. As a result 
of the many calls to his residence he has become something of a 
legend in the division where he lives. Rookies have been warned 
about him as an informal part of their training. Seemingly every 
veteran officer in the division has been to his house multiple 
times. Eddy is also a bit developmentally disabled. He has been 
diagnosed as "Bipolar" and will tell you how he goes to church in
one breath and how he gets favors for protecting hookers. For the 
most part he is harmless, though his size alone is intimidating. 
The moniker "Baby Huey" could describe him because he truly is a 
gentle giant. 

The first time we met Eddy was in the first week we were in service. 
A call that originated at Eddy's house said that he was afraid of 
being hurt by Eddy. When we arrived on scene, patrol officers, Eddy's 
mother and Eddy were in the living room. Eddy was explaining how he 
was manic and how he had been taking medication. When we asked him 
if he had taken it today he said yes and that he was due to take 
some more right now, and took it right in front of us. 

He was a little agitated and we shortly found out why. Behind him 
came voices from the kitchen taunting him and calling him names 
like 10 year-olds might on the playground. It was the boyfriend of 
Eddy's mother and one of the boyfriend's friends. Both men were in 
their early 40's. I let my partner continue the evaluation, walked 
to the kitchen and suggested to the two men that they could be more 
helpful by shutting up or leaving. I concluded by telling them that 
they were the ones with the intellectual advantage over Eddy. They 
should use their heads and not provoke him. 

We determined that Eddy did not meet 5150 criteria (1) and, 
accordingly  did not hospitalize him. We offered to take him to 
a hospital of his choice for voluntary treatment but he declined.
Our intention was to protect Eddy's rights and not allow him to
be railroaded from his home. Though the conclusion of this story 
is positive, when we reviewed this call we realized that we had 
been naive in assessing the risk to the client. We had focused
instead on his (negligible) risk to others. Eddy did not fit 
5150 criteria. He was a danger to no one and he had a mother 
that loved him and took care of him. However, his mother's 
boyfriend and his friend were provocative towards him. Eddy's 
mother agreed that they should leave. We left him at home and 
went to back into service. 

Later, as we left dinner and got in our car, we just happened 
to be listening on the same channel as Eddy's part of town. We heard 
a 245 (assault with a deadly weapon) being dispatched. We heard 
unit after unit en route to a familiar address, Eddy's house. We 
got on the freeway and headed for Eddy's house as fast as we 
possibly could. At that time we drove a black and white so it
was lights and sirens all the way. We could hear a sergeant 
arrive, then the helicopter, then finally the beeping tone of a
"code red" meaning the radio channel was to remain clear for that 
CRITICAL incident. I got on the radio and asked if Eddy was the 
suspect or the victim. The answer came, "the suspect". We were 
afraid Eddy might be shot. Then we heard that Eddy was lying on 
the ground "having a seizure". 

When we arrived at the street, there were at least five black 
and whites, a fire unit and paramedics. I asked one of the 
Officers where Eddy was and we headed in the direction that 
he had pointed. On the way we saw the mother's boyfriend sitting 
on the hood of the sergeant's car, being tended to by paramedics. 
He was bleeding very heavily from the bridge of his nose. As we
walked further we saw this mountain of a man lying on the ground
motionless. We approached him and called his name, he moved a 
little bit. 

"Eddy, what happened? " we asked. 

"Oh, hi guys," he said. "Reggie (pseudonym) hit me in the head 
with a hammer, so I bit him." 

"He hit you with the hammer?" I said. "Did you tell this to 
any of the officers?" I asked. 

"No, I didn't," said Eddy. 

It was dark so I shined my flashlight on Eddy's head and he 
literally had no less than nine distinct impressions in his scalp. 

We went to the sergeant and explained to him that Eddy was not 
the suspect. He was the victim, who had bitten the real suspect 
because he was being assaulted with a hammer. Eddy's mother 
confirmed that she was trying to get Eddy in their pickup truck 
to take him to the hospital when Reggie had attacked with 
the hammer. 

We worked it out with the sergeant so we could transport Eddy 
to the hospital, and Reggie would be arrested. All the pieces 
of the puzzle had been there. However the wrong conclusion was 
almost reached. Yes, there was an assault. Yes, one of the 
subjects was a giant of a man with a mental disorder. But the 
assumption was incorrect. The "big crazy guy" didn't do it. 
MET had done what it was designed to do; sift through the
circumstances, recover the truth and prevent unnecessary 
incarceration of a person who is not a criminal, just a 
person with a mental disorder. 

When examining the problem of criminalizing the mentally ill 
we accepted at face value a somewhat narrow portrayal of the 
problem as one resulting from failure to identify the consumer 
as mentally ill or from inappropriate management of the 
consumer once identified. In each case the break down in
the system could be seen as resulting from a deficit in 
either the officer's knowledge or sensitivity. While 
incomplete, this portrayal served to provide us with a 
minimum standard below which we would not venture. 


CASE 2 

We were called to evaluate a 28-year-old man who had reportedly 
jumped from a third story balcony after police were called to 
his home to investigate a domestic violence complaint. After 
jumping the man fought with police and was subdued. The 
officers described him as highly agitated and incoherent.
He was taken to an emergency room for medical clearance and 
we were asked to evaluate him. We soon learned that the 
client had two prior felonies and that at the moment when 
the police knocked on his door he was beating his wife 
(his "third strike"). He denied any psychiatric history. After
evaluating him we did hospitalize him but after much conversation 
with investigators, under arrest, at the county jail ward. In 
this case the client's escape behavior was probably misinterpreted 
as a suicide attempt. Apparently this jump was so dramatic that 
the investigators were temporarily diverted from the originating
event. Had he been "5150'd" by patrol officers and later 
released from the county hospital one wonders what would 
have become of his wife. 

This was the first of only two arrests we were involved in out 
of over 500 contacts. 


CASE 3 

The second arrest occurred as a result of a 2am "possible 
jumper" call on one of the local bridges. The client was a 
34-year-old woman whom a passer by had called to report as 
"looking very depressed". The client admitted to prior 
treatment for depression but did not wish any referral 
for treatment. She did not meet criteria for involuntary 
hospitalization. As we were trying to see if we might be 
able to help her further the client began to state 
repeatedly "You don't want to help me you just want to 
run my warrants and take me to jail". After several 
failed attempts to persuade that her possible warrants 
were not our concern we acquiesced and determined that 
she had a "no bail" warrant for serious crimes. We think 
that perhaps the stress of having these outstanding warrants 
may have contributed to her being on the bridge that night. 
She seemed almost relieved by the time our car reached the 
station. It is interesting to note that both of our arrests 
for the year were of people not considered as part of the 
L.A.C.D.M.H. target population, that is chronically mentally ill.
They are rather exceptions that prove the rule that the 
mentally ill people are usually not criminals. 


Certainly in our attempts to produce a "good disposition" 
by providing what has been called a more compassionate response, 
we have been successful in preventing incarceration of many 
of the mentally ill people we have contacted. However, it 
should not be a forgone conclusion that avoidance of
incarceration is always desired by all concerned. 

A "better disposition" involves allocating the most appropriate 
resources to resolve a given problem. For as long as these 
problems fall to law enforcement to resolve we all benefit 
when the mental health related call favors resolving the 
client's immediate needs rather than solving the crime. 



(1)  5150 of the California health and safety code allows police officers
and other designated individuals to hospitalize individuals that are
determined to be a danger to themselves, or to others, or who are gravely
disabled, due to a mental condition.  The person can be held up to 72
hours.  From there, a psychiatrist examines them and the hold may dropped
or extended, sometimes up to six months given proper psychological
conditions and legal channels.



Clint Grimes has been a Police Officer for Long Beach Police Department
for the past four years.  In addition to his assignment with the Mental
Evaluation Team, Clint is currently applying to be a SWAT ?Hostage
negotiator.  He spent two years in patrol where he began a master's
degree in Marriage, Family, and Child Counseling, which he completed in
December 1997.  Clint did his undergraduate work at Villanova where he
met his wife of 12 years, Cheryl, a nurse.  The Grimes family lives in
Lake Forest, California. They have two sons. Clint is also a Lieutenant
Commander in the U. S. Naval Reserve. e-mail: ccgrimes@juno.com

Frank Mullnix has over twenty years in nursing.  He has been with the Los
Angeles County Department of Mental Health for two years.  Frank started
out in pediatrics but, after a few years, moved to psychiatry.  He has
spent the bulk of his career as a nursing supervisor on locked
psychiatric wards and welcomes the variety of calls, and the environment
that working with Long Beach Police Department provides.  Frank lives in
Los Angeles with his wife Dorian, a Licensed Psychiatric Technician, his
four year old son, and infant daughter.  He is also a doctor of
chiropractic.  e-mail:  frankmx@earthlink.net


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