People with untreated mental illness are 16 times more likely to be killed during a police encounter than other civilians, with race and gender compounding those risk factors. The Black Lives Matter movement in San Diego was galvanized in 2016 when Ugandan refugee Alfred Olango was killed by police after his sister called for emergency psychiatric aid.
The board approved a pilot program last year to respond to behavioral health calls in North County. After months of delays due to North County lacking behavior health facilities for the crisis team to take people to, that pilot program is close to launching. The pilot program is supported by District Attorney Summer Stephan and Sheriff Bill Gore to bring new options to address nonviolent situations.
Supervisor Nathan Fletcher’s proposal expedites bringing the program to the entire county, which was the long-term goal of the pilot program. Supervisor Kristen Gaspar, who spearheaded the pilot program, questioned why Fletcher was circumventing the phased in and targeted process the board initially planned on but ultimately voted in favor of the motion.
The current system for responding to suicide calls, psychotic episodes and other behavioral health calls is the Psychiatric Emergency Response Teams (PERT) which pairs a clinician with a member of law enforcement. According to Fletcher, of the 54,000 mental health-related calls in the county in 2018, PERT responded to 10,000 of them. Half of those responses concluded with the person going to jail or the hospital.
Law enforcement even being present can escalate a situation, make it unsafe and can add to the traumatic nature of the event.
“When I had a friend in mental health crisis, the PERT clinician was mostly observing during the interaction. The mere presence of police sirens and a police car escalated the situation. I could visibly see my friend becoming less comfortable and less interested in talking through her feelings. She was handcuffed, searched and put in the back of a police car for expressing suicidal thoughts during a psychiatric crisis,” Chrissy Croft, a mental health professional, said about a time she needed emergency care for a friend who was eventually taken to a psychiatric hospital.
“The mental health care she received likely saved her life, but I can’t help imagining other possibilities that would have eased her into receiving help that night instead of simulating arrest,” Croft said.
For people who have interacted with PERT and law enforcement mental health responses regularly, they noted the difference between someone being booked for assault or being checked in to a hospital is usually left to the officer’s discretion — which can lead to bias playing a role in the decision.
“Are they 5150 — a danger to themselves and others — where they go to the hospital or is what they're doing criminal and they go to jail seems in so many instances such a judgment call,” Luke, a social worker specialized in homeless care, said. [Editor’s note: Luke is remaining anonymous so he can speak openly about his interactions with PERT.]
He explained that when someone is yelling and spitting at people whether that is treated as assault or a mental health episode too often depends on who made the call and where the person is. For instance, law enforcement officers responding to call from a business about a homeless person are incentivized to get the person out of the business district as fast as possible. However, when a similar call is made from a shelter or community meal area where the only people who are being affected are also homeless, the response is usually much slower.
A staff member at a local college library explained that while she was not told directly, officers insinuated that whether a homeless person having a mental health episode was booked in jail or received a different response largely depended on whether the person “pissed off” enough people.
“That’s really subjective,” said the staff member.
Many of the people at the library show up again as soon as they are released from jail or the hospital. The lack of long-term care and shelter makes the law enforcement interactions a recurring issue for the police, library staff and homeless people.
“The police hate doing it too. They get annoyed. It's just a bad system. It's a bad system for everyone,” the staff member said.
During the supervisor’s meeting, many members of the public called in support of Fletcher’s package of racial justice and law enforcement realignment proposals. Bishop Cornelius Bowser called to oppose them because they did not do enough to address the major police reforms needed.
While Luke sees having a non-police emergency response team as a necessary move to better serve the communities he works in, he believes more is needed because there is very little that can be done during a psychiatric episode in the first place other than going to the hospital or jail or the police leaving because there is nothing they can do.
“It just sucks that those are the options we currently have available to us as a mental health system,” Luke said.
Luke wants the county to invest in street psychiatric medicine teams so homeless people can be connected to ongoing care that prevents major psychiatric episodes. Without robust mental health care and wraparound services, people with recurring mental health issues take up a huge portion of police, emergency room and hospital resources.
The details of how the new Mobile Crisis Response Team (MCRT) would be deployed are still foggy, but the teams would not replacePERT as law enforcement would still be utilized to respond to violent situations. The number of PERT units could be cut in the future if they are less needed.
Supervisor Jim Desmond questioned whether there would be a separate phone number for the non-violent calls or if the system would be simplified with only one number for PERT and MCRT. Clinicians would then decide if they felt safe enough to send a response team without law enforcement.
Luke and Croft both support having a designated phone line for the MCRT so they can ensure a response from mental health professionals rather than law enforcement.
“We don’t need people weighing the pros and cons of getting help for their loved ones. When police brutality is a real issue, we have to think twice before getting emergency psychiatric help for loved ones under the current PERT structure,” Croft said.
PERT could not be reached to comment on this article.
—reach contributing editor Kendra Sitton at firstname.lastname@example.org.