How Atlanta, Fulton, DeKalb Could Stop Criminalizing Mentally Ill People (UPDATE 1)
(APN) ATLANTA — After DeKalb police officer Robert Olsen killed Anthony Hill, a young Black man suffering a mental health crisis, Atlanta Progressive News traveled to San Antonio, Texas, to report on a program that has changed how police deal with mentally ill people in that city.
In this follow-up, we look at how the criminal justice, law enforcement, and mental health systems in Metro Atlanta measure up to the San Antonio model; and how local jurisdictions could build on existing programs to emulate the model, should they so choose.
The focus of our initial reporting was the San Antonio Police Department’s Mental Health Unit. All SAPD officers undergo a 40-hour Crisis Intervention Training that prepares them to de-escalate situations involving a mental health crisis. Officers in the Mental Health Unit receive additional training and respond specifically to emergency situations where mental illness may be a factor.
APN has found that neither the Fulton County Police Department (FCPD) nor the Atlanta Police Department (APD) have a designated mental health unit. The DeKalb Police Department (DPD) does, but its hours and staff are limited.
Only one officer and one nurse staff the DPD’s Mobile Crisis Unit during a scheduled shift, and shifts are only scheduled Tuesday through Saturday, from 2:00 p.m. to midnight.
When Anthony Hill’s neighbors called 911, they reported that he was roaming the apartment complex naked, making strange sounds and movements.
An officer in San Antonio’s Mental Health Unit told APN this factor alone should have indicated to first responders that Hill was experiencing mental illness. But even if it had, no one in the Mobile Crisis Unit was available to help.
“The [Mobile Crisis Unit] was not working at the time of this incident,” Captain Steven Fore, a DeKalb Police Department spokesperson, told APN.
DPD officers are required to undergo mental health training as part of the state’s Peace Officer Standards and Training. Prior to 2012, all Georgia police officers had to have six hours of mental health training, but then it was reduced to only four hours.
Recently, DPD changed its policy to require that officers receive a full 40 hours of mental health training, on par with San Antonio PD.
Fore maintained that the change has nothing to do with the killing of Anthony Hill.
“Our Public Safety Director, Dr. Cedric Alexander, had already been working on implementing this additional training. Being a psychologist by trait [sic] he felt the training was important and the implementation had been in place for several months,” Fore said in an email.
As for APD, officers can voluntarily undergo the same 40-hour Crisis Intervention Training that all of San Antonio’s police officers are required to have. Approximately 650 officers have completed the training, out of a total 1,972 sworn officers.
Those who opt out receive little more instruction than what is offered by an eight page section of APD’s Standard Operating Procedure Policy Manual. The short section contains definitions of mental illnesses, information on mental health facilities, and a list of ten guidelines for responding to “mentally challenged” people.
The list instructs officers to “approach the victim in a calm, non-threatening, and reassuring manner;” “Treat adult victims as adults, not children;” and “If available, have a certified Crisis Intervention Team officer assist in the situation,” among other tips.
Crisis Intervention Training is also voluntary within the Fulton County Police Department. Officers are only required to undergo the state-mandated four hours of training.
For Atlanta to start catching up to San Antonio, establishing mental health units and making Crisis Intervention Training mandatory would go a long way.
But San Antonio’s reforms go well beyond these two measures: In San Antonio, and surrounding Bexar County, a series of changes spanning more than a decade have transformed the way law enforcement, the criminal justice system, and mental health service providers interact, effectively decriminalizing mental illness.
Treatment, not jail
The calm quiet that permeates Bexar County’s Restoration Center belies how much is going on there.
Just northwest of downtown San Antonio, the center is a mental health treatment hub. It houses a sixteen-bed Crisis Care center, a public sobering unit, a twenty-eight bed detox wing, a mobile crisis team headquarters, a methadone clinic, a primary care clinic, offices for follow-up care, and a day care for patients’ children.
Across the street is Haven For Hope, a homeless shelter with a beautiful, sprawling campus that one could easily mistake for a college.
People who complete the Restoration Center detox program (one of few in the area that takes patients without health insurance) have the option of entering a 90-day rehab program and living free-of-charge at Haven For Hope.
There, they can receive assistance in everything from finding a job to learning how to garden, receive three meals a day, and take advantage of amenities like a gym, a library, and even a kennel for pet cats and dogs.
But that wasn’t always the case. I n 2001, neither the Restoration Center nor Haven for Hope existed. Instead, the Bexar County Jail was the de facto institution for people suffering from mental health and substance abuse problems.
It was hardly alone. As large state mental hospitals have been systematically defunded and shuttered, jail and prison populations have swelled nationwide.
According to the National Alliance on Mental Illness (NAMI), 24 percent of state prison inmates and 21 percent of local jail inmates have a recent history of mental illness.
That is compared to about six percent of the general population in the United States.
In 2001, things had gotten so bad in Bexar County, that the jail was cited for overcrowding. An audit recommended 1,000 new beds.
“We were sitting at a crossroads. Do we put the money into this jail system or try to find another way?” Brittany Lash, Director of the Restoration Center, recalled in an interview with APN.
At that point, the Center For Healthcare Service (CHCS), Bexar County’s mental health authority, had been training local police in responding to mental health issues for about one year.
The conundrum of the overcrowded jail presented an opportunity to take that collaboration further and overhaul the way that the mental health and criminal justice systems interacted altogether.
“I wanted to do something about the criminalization of the mentally ill because I was painfully aware of all these people in jail who shouldn’t be there,” Leon Evans, CHCS Director, told APN.
Evans was instrumental in bringing together city and county officials to devise an alternative plan.
“They never built those extra beds,” Leon Evans, Director of CHCS said.
Instead, the county invested in CHCS to ramp up police training, build the Restoration Center, and work with the jails and courts to create systems for diverting mentally ill people from incarceration.
The investment has paid off. According to CHCS, the county saved 50 million dollars on booking, jailing, and emergency room visits between 2008 and 2013, and 17,000 mentally ill people have been diverted from jail and emergency rooms into treatment.
The Bexar County Transformation
The key to Bexar County’s success is not in one program, but in tackling the problem at multiple points while fostering strong communication between the various players.
Upon first contact with someone exhibiting mental health issues, police are trained to de-escalate the situation and can, if necessary, take the person to the Restoration Center.
There, the Crisis Care unit is designed to enable police to drop off the patient and spend no more than fifteen minutes filling out paperwork.
Previously, police faced hours-long waits in the emergency room, because they are legally required to stay with a detainee until the person is admitted. This inconvenience created a perverse incentive for police to take mentally ill people to jail instead of hospitals.
When mentally ill people do end up getting arrested, Bexar County now has a Magistrate screening process to identify those who can be released on a cost-free mental health bond and transported to a treatment facility instead of jail.
Bexar County also established a special Mental Health Court where judges have more options than a traditional court for channeling mentally ill people into treatment.
Similarly specialized courts exist to meet the needs of people arrested on drug charges, people arrested for driving while intoxicated, and even veterans.
Then there are programs to reduce recidivism for mentally ill people upon their release. These programs ensure that parolees and probationers get continuous care, including psychiatric services, medication, and establishing family support and life skills training.
One such program targets people with history of repeated hospitalization and incarceration by making house calls and working with the client’s family to make sure the individual remains stable. Case workers, nurses, community support specialists and legal advocates, are all part of the collaboration.
CHCS also has a dizzying array of programs and services that serve a preventative role, ensuring that people with mental illness and substance abuse problems get the help they need before they ever have a run-in with the law.
The Restoration Center and Haven For Hope are a centralized hub, but a CHCS map shows 16 facilities located within a twenty mile radius; and those are just facilities run by the agency. Dozens of private businesses, nonprofits, religious organizations, and other partners are also part of the safety net that has developed over the past decade.
Evans said that safety net didn’t materialize out of nowhere.
“Law enforcement and mental health professionals, we have nothing in common. We don’t speak the same language,” he told APN.
He described all government agencies as “territorial” as a result of being under-funded and over-worked.
This presented an obstacle to creating changes across multiple agencies and systems. Nothing would have changed, Evans said, without a monthly stakeholders meeting.
“You’ve got to get everyone to sit down on a regular basis to communicate and break down those barriers.”
Over time, mental health professionals, law enforcement, the courts, the public schools, the fire department, and others from both city and county agencies found common ground and built the relationships necessary to work together.
Even now, with all these successful programs in place, those monthly stakeholder meetings continue.
This is perhaps the biggest difference between San Antonio and the metro Atlanta area when it comes to the criminalization of the mentally ill.
An Atlanta Transformation?
Fulton and DeKalb Counties have some similar programs to the ones in place in Bexar County. But there is little cohesion between the various agencies, and many of the programs are operating at much smaller, sometimes ineffective scales––DPD’s Mobile Crisis Unit being a prime example.
The DeKalb Community Service Board, the county’s mental health agency, collaborates with DPD on training, and staffs the Mobile Crisis Unit with nurses who accompany officers. But the agency didn’t respond to a request for comment on how the collaboration could be more effective.
Neither did Lynn Copeland, the Region Three Coordinator for the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD).
Region Three oversees county health agencies in six metro Atlanta counties: Clayton, DeKalb, Fulton, Gwinnett, Newton, and Rockdale.
Though Copeland was unresponsive, the 2016 Annual Plan of the Region Three Planning Board reveals troubling details about the state of mental health care in metro Atlanta.
According to the 2013 data included in the report, 41,283 adults in Region Three were identified as needing public mental health services. But only 28,851 received those services.
When it comes to adults in need of addiction treatment, the numbers are much worse. Out of 64,982 adults in need, only 5,730 were served.
For adolescents in need mental health and addiction treatment, the numbers served compared to those in need were even lower.
In total, there are over 100,000 people in Metro Atlanta who need mental health and substance abuse treatment, but there are only two Crisis Stabilization Units with a total of 52 beds. These facilities are critical because they offer psychiatric stabilization and detoxification for patients whose symptoms are not acute enough to warrant hospitalization.
For more serious cases, there is only one state psychiatric hospital with 360 beds in Region Three. There are also three private psychiatric hospitals, but these serve a comparatively low number of indigent and homeless people.
In the Fulton County Jail, there are nearly as many people with mental illnesses as there are in Region Three’s state psychiatric hospital.
“This year there has been an average of 300 inmates with serious mental illness,” George Herron, Director of Health Services for the Fulton County Sheriff’s office, told APN in an email.
According to Herron, sixty to eighty percent of the daily jail population suffers from mental illness. That’s about three times the national average.
“The County Jail is the new mental health hospital,” Herron said.
The Region Three Planning Board report recommends expanding many services: more Crisis Stabilization Units, more housing and employment services for people with mental illness, and more detoxification services are needed.
But more of these services will not necessarily mean more costs to taxpayers.
As Bexar county has shown, investing in public mental health services can create huge savings in other areas.
That part is a no-brainer, Evans says. The hard part is planning and coordinating across departments in municipal and county governments to come up with a system that works.
“What’s important is you come up with your own community solution. It’s not the method, it’s that these people designed the method and they believe in it so much. That’s the magic, the active ingredient is that belief,” Evans said.
UPDATE 1: We have updated the title to read How Atlanta, Fulton, DeKalb Could Stop Criminalizing “Mentally Ill People” rather than “the Mentally Ill.” We prefer the latter for multiple reasons and usually would have caught it in the editing process, but in this instance, it was missed.