Systems in Crisis: Identifying Critical Issues in Response to Mental Health Crisis Calls

SYSTEMS IN CRISIS

Identifying Critical Issues in Response to Mental Health Crisis Calls

Executive Summary

Joseph Prude posed this gut-wrenching question on September 22, 2020, at the press conference where video footage belatedly revealed the circumstances of his brother Daniel’s death. As many of us now know, Daniel Prude was killed several months earlier when Joseph called 9-1-1 to get assistance for his brother, a person with mental illness in acute crisis. When police encountered Mr. Prude naked and unarmed on the street, they immediately used various forms of restraint to take him into custody, including the placement of a “spit hood” on his head that restricted his breathing. He vomited into the hood and lost consciousness. Tragically, he was pronounced to have suffered brain death later that day and was removed from life support ten days later.

Disability Rights New York (“DRNY”), the Protection and Advocacy System for individuals with disabilities in New York State, engaged in a searching analysis of why police response to calls for assistance with mental health crisis too often results in death, trauma and other adverse consequences to the person who needed help. In doing so, DRNY is proud to have partnered with the Mental Health Recovery Research Lab and Nadal Racial Justice Research Lab at John Jay College of Criminal Justice to form the RAASIC Project (Research and Advocacy Addressing Systems in Crisis). The Project jointly reviewed four recent cases in New York State where people with mental illness died as a result of action taken by police officers who were responding to a 9-1-1 call. The Project identified the numerous adverse legal consequences under New York law that regularly stem from a police officer’s response to such a mental health crisis event The Project also conducted a literature review to document the historical and cultural bases that appear to contribute to such tragic outcomes. Specifically, the Project considered the impact of persistent stigma imposed upon people with mental illness, the disproportional impact of police response on Black, Indigenous and other People of Color, and the impact on those whose identities must be viewed through an intersectional lens. And the Project conducted guided interviews with twenty shareholders from a broad spectrum of perspectives who have taken longstanding interest in this issue.

Based upon our findings, the Project has concluded that the case is firmly made for replacement of police officers as first responders in a majority of cases where calls are placed seeking

"How many more brothers got to die for society to understand that this needs to stop?”

assistance for individuals in acute mental health crisis. In fact, evidence supports the position that armed, uniformed police officers are uniquely inappropriate for this work, placing people with mental illness at particular risk of harm or death, and that training efforts initiated in the context of a Crisis Intervention Training (CIT) model do not significantly mitigate the potential for police to use excessive force and restraint against such individuals. The Project therefore strongly advocates for removal of police officers from the first response role in these cases.

The Project then turned to consideration of what issues must be carefully considered by policymakers in New York State who are currently developing models for an alternative response to mental health assistance calls. The Project reviewed available information regarding the successes and failures of alternatives to traditional police response implemented nationally in recent decades, and took into account the experiences and opinions of stakeholders interviewed. The Project monitored and analyzed current efforts to replace police-driven response models in New York City and Rochester, the cities that were the subject of our case reviews. Consensus was reached that a model currently operating successfully in one community cannot simply be duplicated for successful use in another community. To the contrary, each community must draw from local resources currently in place, identify critical additional resources that must be funded and developed, incorporate the needs and concerns of community residents, and earn community buy-in from those stakeholders whose daily work and sense of community safety will be directly impacted by the decisions being made.

Enlightened by this analysis, the Project provides people with mental illness, advocates, policymakers and the community at large with a set of fundamental guiding principles for reimaging response systems that currently place people with mental illness in danger. All of these principles are rooted in the conclusion that teams comprised of uniquely qualified and trained mental health and emergency response professionals and peer advocates, to be drawn from mental health systems serving the community of occurrence, constitute a sound model for alternative response. It is the hope of the Project that the analysis contained in this report will provide communities statewide with tools to envision a new approach to emergency mental health response, one that addresses the question posed by Joseph Prude and weighs with care its implications for a just society

REFLECTING ON FOUR LIVES RECENTLY LOST

The Project began its work by respectfully acknowledging four lives recently lost in New York State when police officers acted as first responders to assist people in mental health crisis.

Saheed Vassell, Died April 4, 2018

On April 4th, 2018, New York City police officers responded to several 9-1-1 calls about a Black man who “looked like he was crazy” in a brown jacket wielding a silver firearm at people in the Crown Heights neighborhood of Brooklyn Saheed Vassell, a 34- year-old Jamaican man and father of a teenaged boy, had been diagnosed with bipolar disorder. He was known in the community as being a person with mental illness and this was not his first interaction with the police. His previous interactions with patrol officers, who knew him as “emotionally disturbed,” were much less threatening; they would sometimes chat with him or bring him Jamaican food. Unfortunately, the five NYPD officers who responded to the 9-1-1 call did not know Mr. Vassell. Their cars came to a screeching halt, and Mr. Vassell pointed his pipe at them. Almost instantly, four officers fired several shots at him and continued shooting after he dropped to the ground. Mr. Vassell was pronounced dead upon arrival at Kings County Hospital (Mueller et al., 2018)

Deborah Danner, Died October 18, 2018

On October 18,, 2016, Deborah Danner, a frail 66-year-old Black woman, was shot dead in her Bronx apartment by a New York City police officer who was responding to a concerned neighbor’s report that she was acting “erratically.” About four and a half years earlier, Ms. Danner had written an essay entitled “Living with Schizophrenia,” in which she addressed her struggle with schizophrenia, described her experience with stigma, and advocated against the severe mistreatment of people with mental illness at the hands of police officers. In that essay, Ms. Danner stated, “We are all aware of the all too frequent news stories about the mentally ill who come up against law enforcement instead of mental health professionals and end up dead.” On the night of her death, neighbors reported that Ms. Danner, who was known and liked by members of her community, was actively symptomatic. She was seen naked in front of the building holding a pair of scissors. By the time the police arrived, Ms. Danner had returned to her apartment and was actively telling people to go away. According to the report of an EMT on

the scene, the police were eventually able to enter the apartment and persuade Ms. Danner to put down the scissors. Still actively symptomatic, Ms. Danner reportedly ran into her bedroom, where she grabbed a baseball bat and brandished it at Sgt. Hugh Barry. Sgt. Barry fired two shots into her stomach, causing her death. In February 2018, Sgt. Barry was tried before a judge on counts of murder, manslaughter and criminally negligent homicide and acquitted on all charges. (Goldstein, et.al. 2018).

Daniel Prude, Died March 30, 2020

On March 23, 2020, Joseph Prude called Rochester police via 9-1-1 because his brother Daniel Prude was acting erratically. Mr. Prude had a history of mental illness and drug use, and earlier that day had been assessed at Strong Memorial Hospital’s psychiatric unit after he told his brother that he wanted to die and that someone was out to get him. Mr. Prude had recently experienced a lot of loss, including the death of two of his brothers and the suicide of his nephew. On the date of the incident, Mr. Prude had used PCP. Rochester police officers found him walking around outside naked and bleeding. Mr. Prude complied with the police, lay down on the ground, and was handcuffed. A few minutes later, he became agitated and started yelling and spitting at the officers. They covered his head in a hood, referred to by Rochester police as a “spit hood,” and forcibly restrained him on the ground, causing him to vomit. Two minutes later he stopped breathing. Body-cam footage shows the officers casually chatting with each other while this happened. Although he was resuscitated at the scene, he died seven days later. The medical examiner ruled his death a homicide caused by "complications of asphyxia in the setting of physical restraint,” with “excited delirium” and acute PCP intoxication as factors in his death. (Gold, M. & Closson, T., 2021).

George Zapantis, Died June 21, 2020

On June 21, 2020, George Zapantis, a 29- year old White man, suffered a fatal heart attack after being tased several times and forcibly restrained by New York City police officers in the doorway of his home in Queens. Mr. Zapantis, who worked as a security guard, was diagnosed with bipolar disorder and was taking medication for the condition at the time of his death. In response to an altercation between Mr. Zapantis and his upstairs neighbor, a passerby called 9-1-1 and reported a man with a gun. By the time the police officers arrived at his home,

the altercation between Mr. Zapantis and his upstairs neighbor had ended. Officers were told by neighbors that Mr. Zapantis approached their adult son carrying a sword, but also informed them that he had a mental illness and that they should wait until his mother got home before they attempted to approach him. Nevertheless, the officers approached Mr. Zapantis’ door and began knocking repeatedly until he emerged. Mr. Zapantis was wearing what appeared to be a gladiator outfit and a spartan hat, and was wielding a shield and a sword, which he soon abandoned. He told the officers that he was unarmed. Mr. Zapantis stated that he had the right to defend his home and pushed the door open The officers then tased him and continued to do so while on top of him, despite Zapantis’ shouting that he couldn’t breathe and that he was being choked. After a few minutes, Zapantis grew silent and his body went limp. Collective footage released several weeks later indicates that there were numerous junctures where officers could have chosen to employ different procedures, including more limited use of physical force. There were no documented attempts to de-escalate the situation. The police officers did not cease physical restraint until Mr. Zapantis fell silent. (Gonen, y. 2020)

The circumstances in which Mr. Vassell, Ms. Danner, Mr. Prude and Mr. Zapantis were killed illuminate many factors to be considered by all policymakers and community members discussing the issue of police response to mental health crisis calls. All four individuals had been diagnosed with mental illness and accessed treatment. Community members were either aware of their struggles with mental illness, or, in Mr. Prude’s case, the information was shared by the 91-1 caller. However, this available information appears not to have been considered or utilized by police who responded. Three were Black or People of Color; two were killed in their own homes. These circumstances also expose patterns of police conduct that placed these individuals at grave risk because police officers responded, failed to engage in de-escalation techniques, and were quick to initiate restraint and/or use force. The Project carried these observations forward as we engaged in a literature review to identify historical and cultural factors that appear to contribute to such tragic outcomes.

Policing of People With Mental Illness: The Necessary Perspective

People with serious mental illness are far more likely to be subject to dangerous police encounters than other individuals. People with untreated mental illness are “16 times more likely to be killed during a police encounter than other civilians approached or stopped by law enforcement” and “a minimum of 1 in 4 fatal police encounters ends the life of an individual with severe mental illness.” (Fuller, A. et. al., 2015). Between 2016 and 2019, 14 people with mental illness were killed by police in New York City alone. (Smith, G., 2019). Moreover, the danger to people with serious mental illness seems to be worsening. In New York City, for example “EDP calls” to 9-1-1 (calls for assistance for “Emotionally Disturbed Persons,” invoking the unfortunate term historically used by the New York City Police Department to describe people with mental illness who are in crisis) increased from 97,132 in 2009 to 179,569 in 2018. (Awal, K., 2019).

Factors Contributing to Failures in Police Interaction with People with Mental Illness

There is compelling evidence that police officers are substantially more likely to use force in their interactions with people with severe mental illnesses (SMI) than in their interactions with other community members, and that these interactions are significantly more likely to result in death. In a sample of 4,254 use of force incidents reported from three cities across the U.S., a study found that people with SMI were significantly more likely to experience police force than people without SMI when controlling for subject and officer variables (Rossler & Terrill, 2017). Further, a recent analysis of fatal use of force data compiled by The Washington Post and The Guardian indicated that the presence of mental illness is associated with a seven times increased risk for police interactions to result in death (Saleh et al., 2018). Additionally, a police officer’s propensity to sense danger to their individual safety while interacting with people with SMI was likely in place prior to receiving the call for assistance. Evidence establishes that police officers often perceived such calls for assistance as inherently dangerous (O’Brien, A. et. al., 2014).

Together, these studies demonstrate that having a mental illness is a risk factor for police use of force and death. These findings beg the question: why are police officers significantly more likely to use force against people with mental illness? It is therefore appropriate to consider studies addressing police perceptions of people with mental illness.

Police Stigmatization of People with Mental Illness

Studies conducted with police officers regarding their perceptions of people with mental illness indicate that stigma against people with mental illness is a factor contributing to use of force and restraint. For example, studies have found that officers perceive persons with the label of schizophrenia to be more dangerous than others without that label (Watson et al. 2004). Stigma is a term used to describe the attachment of negative stereotypes toward members of a labeled group, which typically leads to behavior such as microaggression, discrimination or social distance (see Yanos, 2018, for a review). The most commonly endorsed negative stereotypes about SMIs such as schizophrenia and bipolar disorder are dangerousness, unpredictability, and inability to recover (Pescosolido et al., 1999; Schomerus et al., 2012. Disturbingly, Soomro and Yanos (2019) found that endorsement of negative stereotypes, intended social distance, negative attributions, and intended micro-aggressions related to mental illness was substantially higher among police officers than the general population. The endorsement of negative stereotypes was roughly one standard deviation higher among police officers than members of the general public. Other studies conducted outside of the U.S. have found similar negative attitudes toward mental illness among police officers (Mulay et al., 2016). Additionally, negative mental health attitudes extends towards police officers’ own mental health difficulties, which are prevalent among officers. Over 90% of officers in a nationally representative sample reported that mental health stigma interfered with their own help-seeking (Drew & Martin, 2021).

Further research is needed to understand the role of stigma in outcomes of police encounters with persons with mental illness. As it is previously described, stigma represents individual attitudes. However, systemic factors in police departments, or mechanisms of structural stigma, are other factors ripe for sustained analysis and intervention at an institutional level.

Intersectionality as a Foundational Theoretical Lens

When considering police responses to people living with mental illness, social identity group membership based on race, ethnicity, gender expression, sexual orientation, religion, and socio-economic class must be considered as potential mitigating or exacerbating factors. Historically, most research has ignored the role of intersectionality as it relates to police and

overall criminal legal system contact (Potter, 2015). Intersectionality theory posits that people who are part of multiple oppressed identity groups experience unique discrimination based on the intersection of identities (Crenshaw, 1989). Although initially focused on Black women who faced social barriers based on their racial, gender, and gendered-racial identities, the theory has since been applied to a variety of intersecting systems of oppression and provides a multi-axis framework for dissecting nuanced experiences of oppression that is based on interlocking rather than summative experiences (Lewis & Grzanka, 2016; Potter, 2015).

Applying an intersectional lens to interactions between police and people with mental illness who are also Black, Indigenous or Other People of Color (BIPOC), research establishes that BIPOC who experience SMI are more likely to encounter police contact as a pathway to mental health care than White individuals who experience SMI (Prince & Wald, 2018). Being Black and having a mental illness is a significant risk factor for dying at the hands of police (Saleh et al., 2018), and older, unarmed Black men with mental illness are at higher risk to be fatally shot compared to their white counterparts (Thomas et al., 2021). In addition, whereas for white individuals SMI acts as a mitigating factor for perceptions of police use of force, people are more likely to support police use of force against Black individuals with SMI (Kahn et al., 2016). It is therefore clear that any comprehensive analysis of interactions between police and people living with mental illness must be grounded in intersectionality theory and account for factors above and beyond SMI that render people most vulnerable to dangerous, or even deadly outcomes.

Research on procedural justice, or perceptions of fairness in interactions with the criminal legal system (Radburn & Stott, 2019), has found that BIPOC lack trust in the criminal legal system in its entirety (law enforcement departments, prison system, courts, etc.). Research has found that people are less likely to cooperate or comply with law enforcement and other institutions when they do not believe systems to be fair (Johnson et al., 2017). When people hold multiple marginalized identities (e.g., BIPOC, queer or trans, lower socioeconomic status, etc.), they also show less trust in the system – diminishing their ability to seek help from police officers when they are victimized or are in need of assistance (Nadal, 2020). Given all of these factors, when BIPOC learn of incidents of police brutality or police violence, they are likely to increase their distrust in law enforcement and the criminal legal system.

Policing and Black, Indigenous, and other People of Color (BIPOC)

Research has found that BIPOC communities experience disproportionate police contact and are overrepresented in the criminal legal system (Alexander, 2012; Hawdon et al., 2017).

Neighborhoods with heavy concentrations of BIPOC experience an oversaturation of policing and police presence (Bandes, 2018), which may lead to the disproportionate number of causalities of BIPOC – particularly Black – civilians (Streeter, 2020).

Unarmed BIPOC are more likely to experience lethal police force than White Americans (Jones, 2017). Police have used excessive force on indigenous people defending their lands at Standing Rock in North and South Dakota (Estes, 2019), while also using violence to enforce immigration laws against Latinx and Asian undocumented immigrants (Armenta, 2017).

Black suspects are more than twice as likely to be killed by police as those from other racial and ethnic groups, even when there are no other obvious circumstances during the encounter that would make the use of deadly force reasonable (Fagan and Campbell, 2020). The experience of Black Americans and police must of course be placed in historical context. Policing in the United States originally served as an apparatus to enforce and preserve the institution of chattel slavery. The first police forces originated in the 1700s; their primary tasks were to return runaway slaves and to create a culture of intimidation to effectively discourage slave revolts (Hasbrouck, 2020). In this way, the foundations of policing were created to preserve a culture of racism and White supremacy, while suppressing opposition to slavery. Even after the abolition of slavery, many police departments in the South continued to aid, abet, and actively participate in violence against Black communities – even supporting White terrorist organizations, such as the Ku Klux Klan (Castle, 2020).

The racial disparities in policing and police contact also have consequences that permeate after arrest. In addition to being overrepresented in the prison system, BIPOC youth are overrepresented in the juvenile legal system (Hawdon et al., 2017). BIPOC are more likely to be sentenced to death than their White counterparts (Fagan & Geller, 2018). Studies have suggested that Black defendants who exhibit more stereotypically Black features (i.e. darker skin) are more likely to be viewed as dangerous and culpable of crime (Levinston & Young, 2010), and that darker skinned Black people are more likely receive the death penalty than those with lighter skin (Eberhardt, Davies, Purdie-Vaughn, & Johnson, 2006)

Additionally, research shows that BIPOC people tend to view police more negatively than their White counterparts (Johnson et al., 2017; Nadal et al., 2017; Zhang, Nakamoto & Cerna, 2020). Taken even further, Black Americans tend to have more awareness of police misconduct (and hence negative views of police) than White, Asian, and Latinx Americans (Graziano & Gauthier, 2019). Evidence suggests that efforts to remediate community relationships with police (e.g., body worn cameras) have improved perceptions of police (Crow, Snyder, Crichlow, & Smykla, 2017; Saulnier, 2020). However, these studies primarily utilize White samples.

Racial Trauma and Policing

Racial trauma is defined as a form of race-based stress, refers to People of Color and Indigenous individuals' (POCI) reactions to dangerous events and real or perceived experiences of racial discrimination Comas-Díaz et al., 2019). Racial trauma can result from a variety of experiences, including witnessing racial violence, encountering race-based harassment at work or school, being targeted by race-induced violence hostility, or bullying. Studies have shown that when people experience a greater accumulation of racial discrimination, they may also report more symptoms of racial trauma (Carter et al., 2018; Williams et al., 2018).

Relative to policing, people of color - particularly Black Americans - may exhibit symptoms of racial trauma in multiple ways. First, if they have any negative, hostile, or violent experiences with police officers, they can develop a trauma response that may prevent them from trusting law enforcement, lead to anxiety or paranoia when around law enforcement, or prevent them from seeking services when they are targeted by crime. In a systematic review of 11 studies, McLeod et al. (2019) found significant associations between police interactions and various negative mental health outcomes among Black Americans. Additionally, when Black Americans hear of police brutality or violence towards unarmed BIPOC, they may also develop symptoms of racial trauma. In the same way that people develop traumatic stress in response to hearing about death or violence towards loved ones, BIPOC exhibit trauma symptoms when their loved ones or other community members encounter police violence. In this way, racial trauma is also a form of collective trauma, defined as psychological reactions to a traumatic event or series of events that affect an entire society (Hirschberger, G., 2018). Consequently, BIPOC people

who may not have any direct ties to people involved in police violence may still develop mental health problems as a result.

Police Experiences Based on Multiple Identities

Utilizing an intersectional lens and considering other factors beyond race and mental illness (e.g., ethnicity, skin-tone, immigration status, religion, and gender expression), research has found that other identities affect police interactions and perceptions of police. For example, immigrants unable to comply with police requests due to language barriers are penalized for noncompliance (Armenta, 2017); women of color who fail to adhere to traditional feminine norms are perceived as more aggressive (Potter, 2015); and Queer and trans people – especially queer and trans people of color (QTPOC) - are often targeted by police violence as a result of police heterosexist or transphobic bias (Nadal, 2020). Furthermore, beyond suspect characteristics, studies show that White police officers are more likely to make arrests compared to racial minority police (Todd & Chauhan, 2020), suggesting that officer identity may also play a crucial role in examining police responses to people with mental illness.

Adverse Legal Ramifications of the Police Response Model in New York State

Beyond the potential for death, injury and lasting trauma for people with mental illness, police response to mental health crisis calls in New York State also subjects people already in crisis to significant adverse legal consequences. The call that was made with intent to obtain assistance for oneself, a loved one or a neighbor on the street immediately becomes a criminal investigation when police arrive at the scene. The ramifications of these events proceeding down a criminal or civil commitment path can be long-lasting, and can far too often result in people with mental illness being subjected to immediate and prolonged involuntary confinement

Police Powers Conferred by the New York State Mental Hygiene Law

The New York State Mental Hygiene Law gives police officers a powerful role in the involuntary detention and potential commitment of individuals with serious mental illness. Section 9.41 authorizes all police officers in duly authorized departments to involuntarily place into custody any person who “appears to be mentally ill” and is “conducting themselves in a manner which is likely to result in serious harm to the person or others”. Additionally,

Sections 9.27, 9.37, 9.41, 9.45, 9.55, 9.57, and 9.58 authorize police officers to pick up people who are believed to have mental illness and transport them to the hospital. A person can be involuntary committed to a psychiatric facility under Sections 9.27 and 9.37 and can be subject to emergency commitment under Sections 9.39, 9.40, 9.41, 9.43, 9.45, 9.55, or 9.57.

The statute defines “likely to result in serious harm” as “(a) a substantial risk of physical harm to the person as manifested by threats of or attempts at suicide or serious bodily harm or other conduct demonstrating that the person is dangerous to himself or herself, or (b) a substantial risk of physical harm to other persons as manifested by homicidal or other violent behavior by which others are placed in reasonable fear of serious physical harm.” This determination is left to the subjective judgment of the officers. Thereafter, the police officer can take the person to a hospital or psychiatric facility or temporarily detain them in “another safe and comfortable place” pending examination or admission into one of these facilities. Involuntary admission into such a facility or involuntary transfer to another facility for ongoing treatment can result in extended confinement.

Section 9.41 emergency involuntary commitments often begin with a 9-1-1 call. Passersby, neighbors, family members, or the individual themselves may call 9-1-1 requesting either medical assistance or police officers. Jones v. New York, 16-CV-556 (AJN), 2019 WL 4640151, at *1(S.D.N.Y. Sept. 24, 2019) (police dispatched following a 9-1-1 call in which a building security guard called on behalf of an unknown individual); Mizrahi v. City of New York, 15CV6084ARRLB, 2018 WL 3848917, at *3 (E.D.N.Y. Aug. 13, 2018) (EMTs and police officers dispatched after plaintiff’s friend called 9-1-1 but could not originally tell the 9-1-1 dispatcher the correct address); Cruz v. City of New Rochelle, 13CV7432 (LMS), 2017 WL1402122, at *3 (S.D.N.Y. Apr. 3, 2017) (police dispatched to check on plaintiff after his estranged partner called 9-1-1).

Callers will often identify the subject of the call as a person with mental illness, leading the responding police officer to erroneously take the position that the statutory criteria for police action have been established. See Mizrahi, 2018 WL 3848917 at *21 (the court held that plaintiff was incorrectly transported to the hospital by EMTs and police officers under § 9.41 after an unverified 9-1-1 caller claimed that plaintiff was suicidal without determining if the plaintiff had mental illness or was a danger to herself); Kerman v. City of New York, 261 F.3d 229, 235 (2d Cir. 2000).

After a police officer takes a person into custody consistent with these powers, the police officer will routinely transport the person to a hospital or psychiatric facility for evaluation by a clinician. The further findings of such a clinician often result in temporary involuntary confinement and initiate the chain of events leading to involuntary civil commitment for an extended period of time. While those subject to a motion for involuntary civil commitment are entitled to representation, there is no one in place to provide legal advocacy on their behalf until the matter is formally brought before a court.

Police officers currently charged with making the subjective call contemplated by the Mental Hygiene Law are largely immune from liability if their determination is subsequently found to be wrong. Section 9.59 of the Mental Hygiene Law states that police officers “acting pursuant to their special duties . . . shall not be liable for damages for injuries alleged to have been sustained by such person or for the death of such person alleged to have occurred by reason of an act or omission unless it is established that such injuries or such death was caused by gross negligence.” Policymakers seeking case law that interprets Section 9.59 will find that there is little, likely because the standard of gross negligence is based on the opinion of the police officer acting under their Section 9 powers. See Heller, 144 F. Supp. 3d at 627 n.15. (“Mental Hygiene Law § 9.59 provides that police officers who effect a mental health arrest are immune from suits arising from such seizures, unless the seizure resulted from gross negligence.”). As long as a police officer can show some evidence of their “belief” that an individual picked up under Section 9 has mental illness and potentially dangerous, they are able to claim immunity under Section 9.59.

Additionally, where a police officer is alleged to have incorrectly moved for commitment of a person with mental illness under Section 9.41, state and federal courts have interpreted the law to give officers and other officials wide discretion. In the case of Thomas v. Culberg, for example, the court found that the “New York Mental Hygiene Law does not require that the threat of substantial harm to oneself or others be evidenced by overt act, attempts or threats.” 741 F. Supp.77, 81 n.1 (S.D.N.Y. 1990). See also Higgins v. City of Oneonta, 617 N.Y.S.2d 566, 568 (N.Y. App. Div. 3d Dept. 1994) (“[D]etention pursuant to [the New York Mental Hygiene Law] does not require proof that the person presents an immediate danger to others.”); Project Release v. Prevost, 551 F. Supp. 1298, 1305 (E.D.N.Y. 1982), aff'd, 722 F.2d 960 (2d Cir. 1983) (“[P]roof of a recent overt act need not be added to the New York commitment standard.”);

Heller v. Bedford C. Sch. Dist., 144 F. Supp. 3d 596, 622 (S.D.N.Y. 2015), aff’d, 665 F. App’x 49 (2d Cir.2016) (unpublished) (requiring police officers to show “a probability or substantial chance of dangerous behavior, not an actual showing of such behavior”) (internal quotation marks omitted). One court found an individual with mental illness to pose a substantial threat of physical harm to himself or others by refusing or being unable “to meet his essential needs for food, clothing or shelter.” Matter of Carl C., 511 N.Y.S.2d 144, 144 (N.Y. App. Div. 2d Dept. 1987) (citing to Addington v. Texas, 441 U.S. 418; O’Connor v. Donaldson, 422 U.S.563; Matter of Harry M., 468 N.Y.S.2d 359 (N.Y. App. Div. 2d Dept. 1983)).

The conferring of this kind of power to police officers raises a litany of questions, not only in the minds of legal advocates, but also in the minds of people with mental illness and those who support them. What training, if any, does each police officer have to make a subjective determination that a person “appears to be mentally ill?” How does one distinguish the appearance of mental illness from the behaviors of a person experiencing a seizure, symptoms of traumatic brain injury, or other manifestations of physical disability? With regard to the determination that a person is “conducting themselves in a manner that is likely to result in serious harm to the person or others,” what are the factual criteria that each police officer is required to consider in making such a call? What if the conduct included initial possession of an object that could be used to harm someone, but that possession was thereafter abandoned? What if the conduct was elicited by the conduct of the responding police officer or other officers at the scene? And what if the 9-1-1 caller who reported the conduct was motivated to exaggerate or fabricate their account due to personal or generalized bias against the subject of the call, or simply made a mistake in interpreting or reporting on the behaviors of the person they observed?

Underlying concerns about the impact of a police officer’s subjective decision under the Mental Hygiene Law is the fact that New York State police departments regularly treat such matters as “mental health arrests.” Police continue to document their determination that an individual is eligible for a Section 9.41 emergency involuntary hospitalization in police arrest reports. In Disability Advocates, Inc. v. McMahon, a person’s involuntary commitment to the hospital by police officers resulted in a police blotter entry and a form titled “New York State Police Arrest Report.” 279 F. Supp. 2d 158, 160 (N.D.N.Y. 2003), aff’d, 124 F. App’x 674 (2d Cir. 2005). In a court decision reviewing this case, the United States Court of Appeals

for the Second Circuit of New York found that police are authorized under Section 9.41 to “arrest” an individual even though Section 9.41 uses the term “custody.” Id. at 164 (“As used in the law, the word ‘arrest’ is defined as ‘to seize (a person) by legal authority or warrant; take into custody.’”). Not only does the use of the term “arrest” stigmatize those with mental illness who are taken into custody by police officers, it also triggers imposition of other adverse consequences of criminal arrest. The arrest report will, for example, show up in background checks conducted on people involuntarily admitted to the hospital under Section 9.41, jeopardizing employment and other subsequent opportunities.

Where the subjective determination of the police officer precipitates a chain of events that can result in prolonged civil confinement, New York State policymakers are urged to reconsider the scope and consequence of the police powers conferred by this statute, and each municipality should consider the real world consequences of its use in their communities.

Criminal Law Consequences of Police Response

In addition to the ramifications of the Mental Hygiene Law, New York State police officers responding to mental health assistance calls often arrest people in crisis for one or more Penal Law offenses. As a result, people with mental illness are required to face criminal prosecution for misdemeanor or even felony offenses and are thereby exposed to detention in jail facilities. Depending on the behavior exhibited by a person in crisis, a police officer could establish probable cause for a variety of offenses, with no obligation at the detention stage to set forth in detail whether the person detained actually formed the required intent to be convicted of the offense. The list of offenses regularly charged against people in mental health crisis includes but is not limited to the following: Resisting Arrest (P.L. Article 205), Obstructing Governmental Administration and Obstructing Emergency Medical Services (P.L. Article 195), and Assault or Attempted Assault on a Peace Officer, Police Officer, Fireman or Emergency Medical Services Personnel (P.L. Article 120 and 110/120.00).

While New York State has recently enacted sweeping bail reform laws intended to ensure that people charged with low level offenses are released on their own recognizance pending prosecution, people with mental illness who have been previously charged with offenses can be held for extended periods of time on violations of probation or parole holds. While there is not yet data that reflects the impacts of the New York State bail reform laws, the results of surveys at

the national level published by the U.S. Department of Justice, Bureau of Justice Statistics published in June 2017 show a high level of mental health histories among people in jail. Fortyfour percent surveyed reported a history of a diagnosed mental health disorder, and 26 percent reported serious psychological distress within the prior month. Disability Rights New York’s PAIMI Program (Protection & Advocacy for Individuals with Mental Illness) regularly provides services and guidance to people with mental illness in jail settings who face decompensation due to isolation, improper restraint, and lack of access to prescribed psychiatric medicines and adequate mental health services

Persistent Lack of Police Accountability

In addition to each of the previously-referenced adverse impacts on people with mental illness when police respond, residents of York State and people across the nation have also been forced to accept another reality: the criminal law persistently fails to hold police officers accountable for acts of excessive force and restraints resulting in death or physical injury to people with mental illness. Police are rarely charged with criminal offenses committed against people with mental illness. When prosecutors do present these matters to grand juries for searching review of police officer conduct, grand juries regularly fail to return an indictment. This was recently the case in Rochester, where the grand jury failed to return an indictment charging police officers with criminal wrongdoing in the death of Daniel Prude. And when local prosecutors or Assistant Attorneys General take police misconduct cases to trial, the triers-of-fact (whether they be jurors or judges) often return verdicts of not guilty. Such was the case with the prosecution of Sgt. Hugh Barry in relation to the death of Deborah Danner.

Police officer practices are regulated by the Fourth Amendment’s protections against unlawful searches and seizures, and jurors are required to consider the “reasonableness” of a police officer’s conduct in determining whether the conduct was in fact unlawful. Case law does not provide instruction to police officers or courts regarding what conduct is reasonable for police officers to take, leaving the triers-of-fact with no substantive guidance in evaluating police conduct during the few consequential moments of police response. Where the person killed or injured is a person with mental illness exhibiting behavior associated with their diagnoses, one must consider the impact that stigma against people with mental illness plays in such verdicts.

Whatever the reasons for these outcomes, the loved ones of those who were killed or injured are afforded no accountability for the police officer’s conduct.

Stakeholder Experiences and Observations

The Project engaged in a series of twenty (20) guided interviews with a wide spectrum of individuals who have either experienced police response to mental health crisis calls in New York State or reviewed documentation and/or accounts of such lived experiences. Each of the individuals was selected based upon their specific and longstanding interest in development of a response model for acute mental health crisis calls that appropriately balances the legal, ethical, health and safety interests of people with mental illness with the safety interests of the community at large. The participating stakeholders, all New York State residents, self-identified to the Project as follows: two people living with mental illness; two attorneys who represent people with mental illness in civil proceedings; one peer support specialist; one peer support supervisor; one current member of a mental health response team; one emergency room psychiatrist; one member of a police complaint review board; one doctor of behavioral analysis; one veteran public defender; one police officer; one veteran civil rights prosecutor; one sociologist; one diversity, equity and inclusion educator; one clinical psychologist; one community organizer; one veteran emergency services professional; one administrator of a mental health advocacy organization; and one civil rights litigator. The interview responses of these stakeholders echoed many of the factors set forth in the above literature and legal reviews. Several of the stakeholders interviewed shared experiences and provided support for their positions, as reflected below.

Melody Harkness, a Black woman who currently serves as Program Manager at Albany Police Review Board and CEO of Harkness Consulting Solutions, reported that her current work, which includes work with people with mental illness, is impacted by her experience with Albany police when she was under the age of 18. Ms. Harkness said that she was one of several passengers in a parked car being driven by a person who police believed had an open warrant. Multiple police cars pulled up and surrounded their car, police officers emerged with guns drawn demanding that no one move, and a male police officer subjected her to a body search. She described the experience as “chaotic” and “confusing” and noted that she called up the experience several years later when the not guilty verdict was returned in the death of Trayvon

Martin. Ms. Harkness described a meeting she recently conducted with a woman with mental illness, who experiences a heightened adverse response when seeing or speaking of police officers based upon multiple traumatic experiences with them. Ms. Harkness also expressed concern about “former offenders who suffer from mental illness and have done their time, but now that’s solely how law enforcement sees them,” citing “the bias that come out when police officers fail to see (people with mental illness) as rehabilitatable.”

Veteran public defender Emma Stern and former chief civil rights prosecutor Marc Fliedner, who was also one of the authors of this document, both now work at Disability Rights New York. They reported having reviewed numerous cases in which the arrival of armed, uniformed police officers in response to mental health assistance calls escalated rather than deescalated the situations. They had in the course of their work been exposed to numerous recordings, generated either from neighborhood surveillance cameras or police bodycams, of interactions between police officers and people with mental illness in crisis. They reported that in the majority of the cases, police officers aggressively approached the people in crisis and made immediate attempts to restrain them, with no attempts to de-escalate the situation via verbal communication, non-confrontational body language or other tactical means. As a result, each situation escalated significantly, with the recorded movements of the parties becoming heightened and combative. Mr. Fliedner said that several of the people confronted by these police officers were not able to understand the commands the officers were shouting at them and reported experiencing immediate trauma when they observed uniformed police arriving at the scene. New York State residents diagnosed with mental illness and peer counselors interviewed also provided reports of instances in which the presence of uniformed police officers triggered a strong adverse response for people diagnosed with SMI.

An attending psychiatrist at a major New York City hospital system, who agreed to engage in a guided interview with the RAASIC Project under the condition that their identity or affiliation would not be included in this report, identified problems created when police officers bring people to emergency services based upon their perception that the person is a person with mental illness. Recent ingestion of several currently popular street drugs, including PCP and K2, a plant-based drug sprayed with synthetic compounds also referred to as Spice, stimulate aggressive behaviors that police often confuse with symptoms of SMI. Under such circumstances, a police officer may take a person into custody who is not in fact mentally ill. The

efforts of clinicians attempting to rule out mental illness are impeded by the fact that some hospital systems, including the reporter’s, do not conduct blood screening for K2. As a result, the person who has ingested K2 or other controlled substances is necessarily detained until it can be determined whether or not a person has mental illness and eligible for further civil detention. As this waiting game takes place, already taxed acute care facilities are required to hold and monitor those who are not mentally ill and should be released or directed to supportive addiction services.

Suzannah Iadarola, a pediatric psychologist at the Strong Center for Developmental Disabilities, University of Rochester Medical Center, has worked with a number of families of children with developmental disabilities and mental health diagnoses who have had interaction with police. She reported that parents have described calling 9-1-1 as a last resort when they were concerned for someone’s safety, including their child’s, their own, or the safety of someone else in the house. In many instances, parents reported that the police officers had limited background in behavioral de-escalation. In some cases, families perceived a lack of partnership between law enforcement officers and parents (i.e., not always accepting parents’ insights as experts on their own children). Dr. Iadarola expressed support for non-police response models in such circumstances, stating that those responding must be appropriately trained on the intersections between mental illness and developmental disability and techniques for interacting with children with a wide range of communication skills. She also reported that in her experience, families of color with whom she’s worked have expressed reluctance to call 9-1-1 and thereby initiate police response. In response to recent local events she noted an observation that police officers continue to engage in adultification of Black male and female children, to their detriment.

Thomas Verni, a retired NYPD Detective and current police trainer, engaged in and supervised many mental health crisis calls, and has conducted trainings relating to such calls for several years. He reported that police officers consider such calls to be one of the top three most dangerous situations they respond to, along with car stops and domestic violence situations. He described such calls as chaotic and unpredictable, presenting variables that cannot be anticipated in advance. He said that when officers get what have been historically referred to as “EDP calls for assistance,” their defined objectives are to isolate and contain the situation, preserve life, and get the subject help. He reported that many officers are adept at de-escalating the situation and meeting these objectives, while some officers initiate restraint and use of force before employing

de-escalation techniques. He also noted that some individuals who remain calm when police respond become agitated when they observe emergency medical services vehicles arrive on scene. Det. Verni emphasized the critical need for first responders to be provided with continuing training, to be created in collaboration with qualified professionals from multiple disciplines and regularly updated. He said that several areas of police procedure must be regular subjects of retraining, including use of force, de-escalation techniques, and factors relevant to the cultures each individual represents. He also noted that some police officers discussing current team response models express concern that other team members will “get in the way” or be harmed themselves

Matt Kudish, Executive Director of the National Alliance on Mental Illness of NYC (NAMI-NYC) and a member of the CCIT-NYC coalition, told the Project, “It’s time to remove the police from mental health related calls and allow mental health professionals and trained peers to engage, deescalate, and support those who need us most.”

Alternative Team Models Integrating Police Officers as First Responders

Crisis Intervention Teams (CIT)

Having set forth factors impacting police officer interaction with people with mental illness who are in crisis, the Project now turns to discussion of response models that incorporate police officers into a team of responders that includes professionals from other disciplines. Several initiatives have been enacted in police departments in New York State, nationally and internationally that shift the focus of response away from an entirely police-driven response to a multidisciplinary response where police officers are teamed with mental health professionals

The most well-known and widely disseminated approach in the U S is the Crisis Intervention Team (CIT) model. CIT began in Memphis, Tennessee after a 1988 incident in which a person with mental illness was fatally shot by a police officer. Uniform features of the model include 40 hours of specialized police officer instruction, including education about mental illness, and training in de-escalation strategies. Other noteworthy components of the CIT model include coordination with emergency dispatch workers so that mental health-related emergencies are referred to CIT officers and the development of designated emergency drop-off locations that can serve as an alternative to hospitalization or arrest.

Officers typically must “self-select” into the 40-hour CIT training program Unfortunately, even in departments with more developed CIT programs, only a fraction of officers typically receive the full training. Where CIT officers are not available to respond with the team, non-CIT trained officers are required to respond.

As of 2012, CIT had been implemented in over 3,000 jurisdictions internationally, and its implementation appears to be growing (Watson & Fulambacher, 2012; https://www.citinternational.org/). It is important to recognize that although many departments may implement certain core elements of the CIT model, with most including mental healthrelated officer trainings, many do not implement the full CIT model (Watson et al., 2017).

Research on C IT has consistently indicated that it improves officer attitudes and reduces police officer preferences for using force in encounters with people with SMI (Watson et al., 2017). In several studies that use self-report data obtained from officers in police departments in Georgia and Florida, CIT participating police officers have expressed more positive and diverse attitudes toward mental illness, greater knowledge of mental illness and treatment, lower social distance stigma, and greater self-efficacy in de-escalation and referral decisions relative to nonCIT officers (Ellis, 2014; Compton et al., 2014a; Bahora et al., 2008; Hanafi et al., 2008). Similarly, another study looked at the impact of CIT on schizophrenia specific related changes in officer attitudes and knowledge (Compton et al., 2014b). Compton and colleagues found that immediately following CIT, officers reported improved attitudes, specifically about aggressiveness of persons with schizophrenia, were more supportive of treatment programs, had greater knowledge of schizophrenia, and less social distance toward persons with schizophrenia. In a review of the CIT model literature, Watson et al. (2017) determined that the CIT model can be considered an evidence-based practice for officer cognitive and attitudinal outcomes, but that more research is needed to determine the efficacy of CIT for improving other outcomes, such as use of force, arrest, and referral to services.

While a potential benefit of CIT is a reduction in police officer use of force among people with mental illness, the literature has yielded inconsistent findings on this outcome. Morabito and colleagues (2012) interviewed 216 police officers, both CIT and non-CIT trained officers, from the Chicago Police Department and asked them about their most recent professional experience involving a person with mental illness. Findings revealed that overall, CIT officers were actually more likely to use higher levels of force. However, when subject demeanor was

considered, CIT officers were more likely to react with less force for an increasingly resistant demeanor compared to non-CIT officers (Morabito et al., 2012). Another study provided officers with a response booklet and asked them to record information about every duty-related encounter with a person with mental illness over a 6-week period. Researchers found no difference in physical use of force between CIT and non-CIT officers. However, CIT-officers were significantly more likely to report their highest level of force as verbal engagement/negotiation than non-CIT trained officers (Compton et al., 2014b). Both studies demonstrate the effectiveness of CIT in de-escalation. However, due to methodological limitations, it remains unclear what the overall impact of CIT on use of force may look like across an entire department and when more inclusive and reliable data is utilized.

Although the implementation of CIT may have an impact on trained officers, its implementation may still fail to prevent tragic incidents in interactions with people with mental illness because there is no guarantee the CIT trained officers will respond when mental health crises occur. Notably, the Rochester Police Department was an early adopter of the Crisis Intervention Team (CIT) model and Daniel Prude nonetheless died at the hands of Rochester police officers. Saheed Vassell was also killed after New York City had implemented a CIT model. Although it is unclear if the individual officers who responded to these incidents were CIT trained, the clear failures of their responses indicate definite limitations to the CIT model, either in the deployment of trained officers to warranted situations, or in the ability of officers to implement CIT principles in their work.

Co-Response Teams

There is a now a growing consensus that while CIT has been successful in a number of ways, other options need to be considered to reduce the unnecessary use of force in encounters with people with SMI, and particularly BIPOC with SMI. One alternative approach is the coresponse team model, which originated in Vancouver, Canada in the late 1970’s (Cotton & Coleman, 2017). The key element of this approach is that there are designated trained mental health staff who assist police in responding to incidents involving persons with SMI, either by riding along with officers, or through remote communication (Puntis et al., 2018).

One potential benefit of the co-response model is that in some jurisdictions, participating officers are required to complete more training than CIT officers. In New York City, co-response

officers complete two additional weeks of training, and there is also the opportunity for stigma reduction through the extended collaboration between mental health professionals and coresponding officers. Morabito et al. (2018) described an example of a co-response program in Boston, Massachusetts: four master’s level mental health clinicians were assigned to designated areas of the city, responding to emergency calls involving mental health crises and providing onscene crisis de-escalation, alongside police officers. Based on administrative data from this program, roughly half of interactions that involved co-responders appeared to have resulted in successful de-escalation, with 36% resulting in the person being “left at scene” and 22% resulting in follow-up and referral.

A review of the research literature on the impact of co-response models found no controlled studies evaluating their effectiveness. However, it does establish that co-response models were associated with reductions in arrest and hospitalization in three studies, along with other positive findings such as positive perceptions from service users and officers (Puntis et al., 2018). Both Puntis et al. (2018) and Cotton and Coleman (2017) concluded that there is a need for more rigorous research on the effectiveness of co-response models.

Many departments provide at least a portion of officers with CIT training or co-response models. However CIT International, whose primary mission is to implement and provide information on CIT, concluded that police should be removed from mental health crisis responses and that even co-responder models are insufficient as they still involve police in the response (CIT, An open letter, 2020).

Mobile Response Teams

Another frequently cited model for response to mental health crisis calls is commonly referred to as the “mobile response team” model. The model is typically designed to respond to on-site calls within 60 minutes of the reported crisis. It is notable for its valuable follow-up services, which can include next day creation of behavioral health care plans, screening and standardized assessments, creation of a safety plan to prevent future crisis, and inclusion of family members in the support process. However, programs in some cities that identify as mobile response teams cannot respond quickly enough to qualify as first responders. In New York City, for example, it takes an average of 17 hours for mobile crisis to respond to calls, demonstrating that they are not fully equipped to respond in immediate crises (Smith, 2019).

Using Crisis Stabilization Centers As Component of Existing Response Models

A positive development in community-based health services has been recognition of the value in providing safe spaces for people with mental illness to interact with supportive parties during crisis. These include Crisis Stabilization Centers, generally defined as facilities where people experiencing mental health crisis can voluntarily go to obtain help as an alternative to emergency rooms, detention centers, or remaining untreated in their personal living environments.

In New York State, draft legislation calls for utilization of Crisis Stabilization Centers by police officers invoking their powers under the Mental Hygiene Law. Use of these centers to facilitate de-escalation for those in mental health crisis as an alternative to hospitalization or detention may be a sound component of existing emergency response models. However a coalition of legal advocates for people with mental illness, comprised in part of Disability Rights New York, New York Civil Liberties Union and New York Lawyers for the Public Interest, calls for amendment of the draft legislation to include a requirement that police officers advise the person suspected of requiring mental health assistance of the availability of a Crisis Stabilization Center before invoking the Mental Hygiene Law to involuntarily detain the person.

RAASIC Project Conclusion Regarding the Role of Police Officers in Mental Health Assistance Calls

Based upon the information and analysis set forth above, the RAASIS Project has concluded that the case is firmly made for replacement of police officers as first responders in a majority of cases where calls are placed seeking assistance for individuals in acute mental health crisis. In fact, evidence suggests that armed, uniformed police officers are uniquely inappropriate for this work, placing these individuals at particular risk of harm or death, and that training efforts initiated in the context of a Crisis Intervention Training (CIT) model do not significantly mitigate the potential for police to use excessive force and restraint against such individuals. The Project therefore strongly advocates for removal of police officers from the first response role in these cases.

Having reached this conclusion, the Project now turns to the challenging question of what criteria should be used by communities who are motivated to replace police response in

development of a model that is not only smarter, safer and more humane, but also feasible in light of current cultural and political dynamics.

Developing The Right Alternative Response Model For

Each Community

Beginning with CAHOOTS

The uprising of outrage against police brutality during the summer of 2020 and the wellpublicized police killings of both Daniel Prude and Walter Wallace, two Black men experiencing mental health crises, have culminated in a nationwide call for crisis-response models that do not involve any police officers. For over 31 years, Springfield and Eugene, Oregon have an established non-police response for mental health calls, Crisis Assistance Helping Out on the Streets (CAHOOTS). CAHOOTS is widely recognized as the most successful non-police model and is therefore the starting point for municipalities in New York State to develop their own nonpolice model

In his September 2019 report entitled Improving New York City’s Response to Individuals on Mental Health Crisis, New York City Public Advocate Jumaane Williams identified the CAHOOTS model as “an extremely valuable case study in how a system for non-police response to non-criminal emergencies can be successfully implemented.” (Williams, J. 2019). In the model, residents can call 9-1-1 and have a medic and crisis worker dispatched to a mental health crisis in lieu of a traditional police response. CAHOOTS workers are the default responders if there is no reason to believe the call involves a weapon or is violent in nature (What is CAHOOTS?, 2020). This approach requires that dispatchers make a rapid determination regarding whether the mobile crisis unit or police should be sent in response to the crisis call

Despite the considerable enthusiasm for CAHOOTS, there is to date little research available on its effectiveness. However, internal data does indicate that in 2019, CAHOOTS responded to 17% of dispatch’s overall call volume and on average from 2014 – 2019, saved their cities $8.5 million annually. Importantly, out of the 24,000 calls CAHOOTS responded to in 2019, police backup was requested in less than one percent of calls (n = 150) (What is

CAHOOTS?, 2020). This is good news, and the Project is hopeful that further research will be developed to evaluate outcomes in CAHOOTS encounters.

Two other identified jurisdictions are now proposing implementation of similar programs. In June 2020, Albuquerque, New Mexico announced a new Community Safety Department, which will be a third dispatch option in addition to police and fire. This department planned to dispatch social workers, housing specialists, violence prevention experts, diversion experts, and mental health professionals instead of police. The Director of the Office of Equity and Inclusion explained, “The establishment of this new department acknowledges a mismatch between the social needs of people experiencing non-violent crises in our community and the existing infrastructure that attempts to respond to those needs. A social work response, rooted in social justice, gives us a much better chance of connecting people with the help they need and getting better outcomes for people of color without involving law enforcement.” (City of Albuquerque, 2020). This demonstrates the commitment of officials to address mental health needs and the needs of communities of Color in their city.

Full Engagement of All Critical Stakeholders

Lessons from New York City

In November, 2020, the New York City Mayor’s Office announced plans for a non-police pilot response program for mental health crisis in two neighborhoods identified as high need. The program, modeled after CAHOOTS, has EMS personnel and mental health crisis experts replacing police officers as the dispatch team on 9-1-1 calls. In subsequent testimony before the City Council, an official elaborated, stating that each response team would consist of two Fire Department EMTs and one social worker, available 16 hours a day, and would begin in spring 2021 when team members had been trained. No specifics were provided about the scope or content of the training.

The plan has faced criticism from stakeholders on all sides. Correct Crisis Intervention Today NYC (CCIT-NYC), a coalition of advocates for people with mental illness who worked with the city for several years in development of a new first responder model, expressed concern that the pilot plan relies on 9-1-1 dispatchers, also known as Police Communications Technicians, who work under the direct supervision of the NYPD. In the words of Ruth Lowenkron, CCIT-NYC member and Director of the Disability Justice Program at New York

Lawyers for the Public Interest, "Mental health crises are health issues not law enforcement issues, and must be treated as such. Any crisis response system must entirely eliminate the police. Period." (CCIT Press Release dated November 11, 2020). Several advocacy groups, including Community Access, the first organization in New York City to provide a crisis respite center as an alternative to emergency hospitalization, objected to the absence of peer advocates on the pilot response team.

The inclusion of peer support on the response team and the need to create a dispatch system that is outside the supervision and control of the NYPD, were concerns that had been frequently communicated to the Mayor’s Office during stakeholder discussions. However, none of these stakeholders were advised of the bases for their exclusion in the final pilot plan. They were provided with no information about the final model for the pilot program until its surprise announcement in November 2020 with a (now extended) February 2021 start date. Several people with mental illness who spoke with the Project expressed their personal concerns about these issues based in large part on their own experiences and those reported to them by other New York City residents.

The Project conducted a guided interview with retired FDNY Paramedic Lieutenant Dave A. Gill, who now provides advanced life support training for hospital personnel. Lt. Gill stated that announcement of the pilot project was met with great concern by emergency services personnel and union members who represent their interests. He advised that his colleagues have expressed concerns for the safety of all parties at a response scene if police are not present. He noted that emergency services personnel have not been trained to effectively interact with people with mental illness who are in acute crisis, and that the pilot program does not appear to provide for appropriate training. He also noted that he had, during the course of his career, worked with specially-trained, hospital-based transport personnel who were comprehensively trained and were adept at interacting with people with SMI. These programs that have since been eliminated.

The reactions of critical stakeholders to the rollout of this pilot program establish how imperative it is that policymakers consistently seek and incorporate the input of those directly impacted, not only during preliminary community debate, but also during every critical step in development of an alternative response model. Professor of Sociology Alex Vitale coordinates the Policing and Social Justice Project at Brooklyn College and regularly consults with communities nationally and internationally who are striving to develop alternative response

models. During a guided interview with the Project, he stated the dynamics of this debate as follows: “Don’t put three experts in a room, no matter how high up they are in the community, and then come up with a great plan and go around with it and try to sell it to people. Start with a needs assessment that the community is a participant in. Ask, ‘What is the level of need? Let’s do some concrete data collection, like how many emergency room admissions are you having every year and how many 9-1-1/3-1-1 types of responses you have and what are the existing circumstances? Bring the community in to talk about how their needs are being met and how they’re not being met. It’s a two-way conversation.”

The Update from Rochester

The City of Rochester continues to face scrutiny for its handling of Daniel Prude’s death. Understandable community unrest was recently exacerbated by not one but two disturbing developments. In January 2021, a 9- year old Black female child displaying what were construed as indicia of mental illness was handcuffed, pepper-sprayed and taken into custody by Rochester police officers. And in February 2021, a grand jury failed to return any criminal charges against the police officers responsible for Mr. Prude’s death. These incidents suggest that the culture many believe contributed to his death has not substantively changed since the video depicting his death was brought to light.

However, a multidisciplinary team of professionals has set forth a pilot plan for nonpolice response. The program, recently announced by the Department of Recreation and Human Services, highlights formation of a Person in Crisis (PIC) team consisting of emergency response social workers assigned to work in teams of two. During peak periods of time, two teams will reportedly be on duty and response will be provided 24 hours a day.

Responses to the calls will be determined by what is referred to as a 9-1-1/2-1-1 dispatcher employing a three-tiered approach. Calls indicating the lowest safety risk, referred to as low acuity calls, will be directed to a telephone support service, Low to Mid-acuity calls will be directed to the PIC Team, and Mid to High acuity calls will be directed to a co-dispatch system. This dispatch system will be comprised of personnel from the PIC team, a family crisis team and the Rochester Police Department. No detailed information has been provided regarding which dispatch team members will drive decision-making on the Mid to High acuity calls.

A presentation announcing the program in broad terms indicates that the model is thoughtful and comprehensive, with elements intended to build in each of the following objectives: cultural responsiveness and a diversity of support options to better align with community needs; acknowledgement of the mistrust among Black and Brown communities that have not been well-served by the current system; reduction in mental health stigma; leveraging of peers and activation of informal support; and transparency in evaluating results and sharing them with stakeholders (Rochester PIC Pilot Overview January 2021). As with any blueprint for a pilot program still in development, the level of commitment by city leadership to meet these objectives will be borne out by the manner in which it is implemented.

Also noteworthy was the announcement in late February 2021 of draft New York State legislation, aptly being referred to as “Daniel’s Law,” which would replace police response with a team model consistent with the Rochester plan. The draft legislation was introduced by a Rochester based assemblyperson and a Rochester state senator and is being supported by New York State Attorney General Letitia James.

Considering the Peer Component

As indicated above, many advocates are calling for the inclusion of peer providers (or persons with lived experience of mental illness) in non-police crisis response teams. The Project notes that several large cities including San Francisco, Portland and Los Angeles, currently incorporate peer support into their response models. Although there is no research examining the effect of peer providers in crisis response teams, there is considerable evidence that peer providers can play a key role in engaging people with SMI in follow-up mental health services (see Cabassa et al., 2017, for a review).

The Cabassa review notes that peer navigator interventions, which play the explicit role of helping to facilitate service engagement, show the greatest promise for impacting health outcomes among people with SMI. There has also been increasing interest on the application of forensic peer support to help engage persons with SMI and criminal justice involved in appropriate follow-up services (Adams & Lincoln, 2020). Although research findings on the specific impact of forensic peer specialists are lacking, there is considerable community enthusiasm about the potential of forensic peer specialists to facilitate engagement of people who might be particularly mistrustful of the mental health service system.

Robert Lettieri, who serves on the Advisory Council for Disability Rights New York’s PAIMI Program, is employed as Long Island Regional Youth Partner at Families Together New York State and regularly facilitates training and coordination of peer specialists. During a guided interview with Mr. Lettieri, he addressed the merits of peer response. He stated that he and his colleagues uniformly see inclusion of Certified Peer Specialists as a valuable component of a first response model. However, he voiced his concern that all members of the response team must be provided with comprehensive and ongoing training, supervision and supports. He stressed that this training must include clear definition of each team member’s role in relation to the others and clear protocols for how to coordinate these efforts in a manner that best serves the needs of the person in crisis and others impacted. He also expressed his professional opinion that, “it would be beneficial to have a clinician on the team as well. I think that peers need clinicians and clinicians need peers. We complement one another in order to create a more holistic approach to valuable services.”

Debate continues in the mental health advocacy community regarding whether teams should include both peer specialists and clinicians. CCIT-NYC, which includes many people with disabilities, has taken the position that clinicians are predisposed to guide those in acute crisis toward hospitalization and/or imposition of involuntary treatments. Some advocates interviewed note that peers operating under current models are not in a position to facilitate deescalation of people in acute crisis, in that they cannot be familiar with behaviors associated with particular mental disorders and how these might present if impacted by dangerous substances. This concern was supported by several lawyers who represent people with mental illness, who stated that it took them several years interviewing clients in various states of crisis to develop deescalation techniques that resulted in constructive communication.

This debate highlights a question that must be posed by every community discussing what kind of model will work for them: what mental health resources do we have available that can feasibly be dedicated or enhanced to meet our agreed-upon community objectives?

Commitment to Development of Adequate Community-Based Mental Health Resources

The tragic reality underlying all discussion about acute mental health crisis calls in New York State is that they many of them could have been prevented if adequate neighborhood resources had been available for people with mental illness to seek assistance before they

experienced acute crisis. Uniformly and across disciplines, stakeholders who spoke with the Project took the position that every community considering alternative responses to mental health crisis calls must begin with a commitment to develop and enhance community-based mental health support services. The current paucity of such localized services demands that municipal, state and federal policymakers provide funding and other incentives for creative and compassionate community services providers to develop and maintain such services.

Guiding Principles for Development of Police-Replacement Models

Based upon its analysis of information contained in the available literature and the information and professional opinions shared by stakeholders who were interviewed in guided interviews, the Project has developed the following twelve (12) fundamental guiding principles for developing or modifying response systems that currently place people with mental illness in danger.

1. Replacement of Police Officers as First Responders

Review the legal, ethical and cultural factors that support replacement of police officers as first responders in the majority of circumstances where a call for assistance for a person in acute mental health crisis has been made.

2. Engage Community Stakeholders

Engage diverse stakeholders to discuss a non-police response model. Communities are urged to take the time required to accomplish such engagement and digest the information gained during the engagement process. Stakeholders must be kept apprised of all critical benchmarks in the development process. Communities should not succumb to demands for identification of a model and plan for implementation by federal or state entities which provide an inadequate timeline in which to make critical decisions.

Stakeholders must avoid the “us vs. them” distinctions between the community at large and people with mentally ill. It should be recognized by all stakeholders that people with mental

illness are members of the community that members of the community may have current or past mental illness, and that police officers also develop mental illness. By breaking down these barriers, and acknowledging that mental health crisis can occur to anyone, stakeholders can consider what kind of crisis response they would want for themselves or their loved ones.

3. Utilize Data

Utilize a data-driven approach to develop alternative response models. Consider patterns of response outcomes in individual neighborhoods and particularized impact on BIPOC individuals. Where relevant data is not immediately available, every effort should be made to access such data before critical determinations are made regarding the models being considered.

4. Create the Model That is Right for Your Community

Evaluate the unique cultural dynamics of the community to develop a model for respond to community members needing mental health assistance. This includes attaining stakeholder input about community goals and priorities, examining other successful models, and exploring new creative solutions and the means to attain them.

5. Work for Consensus on Community Safety

Seek consensus, based on feedback from diverse stakeholders, about what factors will be used to determine when dispatchers shift from initiating a presumptive non-police response to initiating a high-acuity response that includes police officers. Community discussion must consider the harms that result from addressing mental health crisis from a criminal perspective.

6. Carefully Consider Mechanism of Dispatch

Careful consideration should be given to how a caller places a request for assistance. Where the traditional 9-1-1 system is being considered, stakeholders must acknowledge that the police department, using traditional dispatch protocols within its purview, may maintain a high level of control over response determinations. Where an alternative number and/or platform for

communication is being considered, a protocol for collaborative evaluation of some calls for assistance will be required. Where stakeholders are considering an alternative number/platform, they must consider the need for a robust public education campaign to inform the public when and how the new system is to be accessed. Stakeholders must consider developing the right professional profile for dispatch personnel, and the need for robust and continuing training which integrates dispatch personnel into training provided to response team members.

7. Identify the Right Professionals for First Response

First response should include a multidisciplinary teams of professionals who are uniquely suited to the important task of safely assisting people in acute mental health crisis. Team members may include mental health professionals, emergency services professionals and peer specialists whose skills compliment and support those of other team members. Communities should not rule out creation of team positions for individuals who combine elements of these disciplines and others, providing for development of a specialized vocation ideally suited to the agreed-upon standards of community stakeholders, including people with mental illness.

8. Incorporate Robust and Sustained Training

Training must be comprehensive and reinforced to regularly incorporate information derived from stakeholder experiences. Training should be culturally competent and explicitly trauma informed, including the implications of vicarious trauma. Training should place the work in a historical context, encouraging understanding of how police culture and the experiences of BIPOC community members’ impact on behaviors exhibited during response. Wherever practicable, team members should be trained together to enhance the value of multidisciplinary exchange and support team cohesion. Training should adhere to the principles of “recoveryoriented” services that de-emphasizes coercion and emphasizes participant choice whenever possible, so that crisis workers are not used as de-facto police officers.

9. Revise Training for Police Officers Responding to High-Acuity Calls

Where police officers in new response models will respond only in designated high-acuity situations and in the context of a team response model, police officer training should be revised to reflect the role of the police officers in relation to other team members. Police officer training

should also be immediately adapted to incorporate information (as set forth above) regarding the intersections of mental health and race, the unique impacts of such events on BIPOC communities, the impacts of such events on children with mental illness, and the need to view all people in crisis as representative of multiple identities. Police training must be regularly updated and, to every degree practicable, integrated into the training of other team members and dispatchers with whom they will partner.

10. Adopt A Presumption Against Non-Confinement

Communities should develop a model that embraces a presumption against nonconfinement, including emergency admission into acute care facilities, where other available options are appropriate. Inherent in this presumption is a community commitment to develop and cultivate mental health services and supportive housing options. Response team training should consistently emphasize this presumption.

11. Incorporate Localized Mental Health Services

Stakeholders should examine existing neighborhood mental health services, and cultivate and support expansion of creative new services by highly localized providers that support objectives of the chosen model. Where commitment of resources to a new response model is matched with commitment to highly localized non-acute mental health services, the potential for acute mental health crises, and the potential for tragedy, will be reduced.

12. Commit to Transparency and Adaptation

Communities should commit to full transparency in reports back to the community on model successes and failures. This commitment must include addressing any deficiencies in modification of original policies and procedures, with priority given to those which directly impact on the safety of people in mental health crisis and response team members.

CONCLUSION

As communities throughout New York State commit to envisioning a response to mental health crisis calls that does not result in death or harm, the stakes are high for people with mental illness. A clear-eyed view of the issue establishes that police officers were never the appropriate parties to provide such assistance, and the systems that have conferred this responsibility on police officers require change. Fortunately, the movements sparked by the deaths of George Floyd, Daniel Prude and so many others have led us to this specific and rather extraordinary opportunity to make great change.

For communities in New York State who are just beginning to discuss alternative response models, the Project is hopeful that the information provided here is useful to frame the discussion. For communities who have been engaged in a dialogue about the issue for some time, the Project urges care and creativity in developing a model that reflects the values and concerns of all community members who will be impacted. The time-sensitive work of the Project does not purport to be exhaustive, nor does the Project suggest that we have uncovered every piece of relevant literature or informative stakeholder account. However, it represents the work of those who stand at the intersection of mental health and law and are dedicated to consideration of all factors impacting the rights of people with mental illness in relation to the community at large.

Disability Rights New York and partners at the John Jay College of Criminal Justice will continue to monitor developments around this issue, and are committed to continue our reporting and analysis in the months and years to come.

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