How to bring psychiatric training to law enforcement in your community:

1. How to bring psychiatric training to law enforcement in your community: AN INNOVATIVE APPROACH May 9, 2018 Presented by: Jennifer Earheart, MA; Nancy Martin, MD; Detective Benjamin Melendrez, MS; Nils Rosenbaum, MD; and Detective Matthew Tinney.

3. Learning objectives • Identify psychiatry’s role in promoting community well-being through partnerships with law enforcement • Understand the gaps in mental health training for law enforcement and current data on police interactions with people living with mental illness • Understand the practical utility of psychiatry-led training for law enforcement • Participate in and understand the process of law enforcement case presentations facilitated by a psychiatry team

4. Introduction to the panel

5. Panel presenters • Jennifer Earheart, MA • Nancy Martin, MD • Detective Benjamin Melendrez, MS • Nils Rosenbaum, MD • Detective Matthew Tinney

6. Audience polling

7. Have you ever had an interaction with law enforcement regarding a client/patient? • Yes • No

8. How would you rate the client outcome for that interaction? • Poor • Fair • Average • Good • Excellent

9. How would you rate the interaction with the police officer? • Poor • Fair • Average • Good • Excellent

10. Who receives more training before beginning their job, a cosmetologist or a police officer? • Cosmetologist • Police Officer

11. How much training do you think law enforcement officers receive in the area of mental health? • Less than 10 hours • 10 -20 hours • 20 - 30 hours • 30 - 40 hours • 40 - 50 hours

12. How can we improve interactions between law enforcement and mental health systems? • Training/education • Resources • Collaboration • Peer/consumer involvement

13. Law enforcement & mental health

14. Multiple Points of Interaction with Individuals with Mental Illness and Substance Use Disorders • 25% of people with mental illness have histories of police arrest. 1 • 12% of individuals have police involved in their pathway to mental health care. 1 Indicators of Mental Health & Drug Use Reported by Prisoners and Jail Inmates2,3

15. Prevalence of mental illness and substance use in new Mexico • Suicide deaths rates in New Mexico have been at least 50% higher than U.S. rates over the past 20 years. 4

16. Prevalence of mental illness and substance use in new Mexico • New Mexico's drug overdose death rate has been one of the highest in the nation for most of the last two decades.5

17. The local mental health landscape • In 2013, at least 53,000 individuals in Albuquerque who could have benefitted from mental health services did not receive them. 6 • A survey of mental health providers identified crisis intervention response as a major gap in the local behavioral health system. 6

18. LAW ENFORCEMENT & behavioral health incidents

19. The Number Of APD’s BH-Related CAD Calls Has Increased 72% Since 2010. It Is Very Likely Those Calls Will Continue To Increase. 7 APD CAD Classified As Behavioral Health Or Suicide Calls

20. In 2017, APD Field Officers Responded To About 700 BH-Related CAD Calls A Month. 7

21. Need for Specialized and Ongoing Mental health Training • Non-compliance may result in the use of force • Training historically focused on command/control and officer safety and no special training focused on interactions with people living with mental illness • A lack of guidance and training on how to apply police tactics to people living with mental illness resulted in highly publicized of uses of force

22. Crisis Intervention Team Model • CIT (Crisis Intervention Team) programs are local initiatives designed to improve the way law enforcement and the community respond to people experiencing mental health crises. They are built on strong partnerships between law enforcement, mental health provider agencies and individuals and families affected by mental illness.

23. The Albuquerque Model CIT programs are born when law enforcement, their communities, and mental health professionals build partnerships.”

24. Three core elements of the Albuquerque model INCLUSIVE COLLABORATION COORDINATEDRESPONSES COMPREHENSIVE TRAINING

25. Cit echo model

26. Grant Funding • $250,000 Three-Year Grant, 10/1/2015 – 9/30/2018 • BJA FY 2015 Justice and Mental Health Collaboration Program: Planning and Implementation

27. Cit echo model The goal of the CIT ECHO is to improve law enforcement interactions with people living with mental illness with the aim of increasing the safety of law enforcement and individuals in behavioral health crisis, fostering connections with the mental health system, and raising the level of community policing.

28. The ECHO Model Case based learning Demonopolizing knowledge Video-conferencing network

29. What is the CIT ECHO clinic? Connect to Zoom from 1:30-3:00(MST) on Tuesdays Brief didactic + Q&A for 30 minutes Debriefing cases/calls presented to network for feedback and discussion for 20 minutes Adjourn Certificates of participation given for each hour connected

30. Participating Agencies FLORIDA Pinellas County Sheriff’s Office MARYLAND Wicomico County Health Department/ Core Service Agency MINNESOTA St. Paul Police Department NEW MEXICO Alamogordo Police Department Albuquerque Ambulance Albuquerque Fire Department Albuquerque Police Department Bernalillo County Sheriff’s Department Bosque Farms Police Department Corrales Police Department Farmington Police Department Las Cruces Police Department Los Lunas Police Department New Mexico Department of Public Safety New Mexico State Police Portales Police Department Rio Arriba Sheriff’s Office Rio Rancho Police Department  San Juan County Sheriff’s Department Sandoval County Sheriff’s Office United States Probation and Parole University of New Mexico Veteran’s Administration NEW YORK New York Ambulance/ Mental Health America Chaplain Center for Urban Community Services OREGON Portland Police Department • TEXAS • Hale County Sheriff's Office • WASHINGTON • Comprehensive Healthcare • Everett Police Department • King County Washington Sheriff's Department • Kirkland Police Department • Washington State Criminal Justice Training Center • Yakima Police Department • WEST VIRGINIA • Huntington Veterans Affairs Medical Center • WISCONSIN • Stevens Point Police Department

31. Who is attending?

32. Curriculum

33. Curriculum

34. What are the benefits to law enforcement? • FREE • Training without travel • Certificates given after training • Decreasing variability in tactical responses • Identification of areas needing improvement/training/changes to SOPs • Live access to specialty consult with CIT experts, psychiatrists, law enforcement trainers • Development of CIT programs and infrastructure • Decreasing liability through peer review • Development of best practices

35. Preliminary data

36. Impact on officer self-efficacy

38. Impact on officer perceptions It is the job of law enforcement to link/connect people living with mental illness into treatment. N=55

39. Case presentations

40. Case Debriefings DEBRIEFING TEMPLATE • Debriefings give officers an opportunity to receive feedback and recommendations from their peers, experienced detectives, and a team of psychiatrists on on-going cases, or calls for service, involving behavioral health.

41. Case example 1. • Female mid-40s, no prior hx of mental illness or SUDs • Reason for contact: Subject has called the department approx. 60 times in last month making reports of stalking, harassment, and trespassing; states she is being followed by her neighbors and believes they have put a tracking device on her car. Officers followed-up on claims and found no evidence of criminal activity. • Field assessment: Subject has become so paranoid she has decided to move out of her house and into a shelter. She has not slept in four days. Officer has suggested she see a doctor but she refuses.

42. Case example 1. continued • Officer response to call: Case has been referred to Adult Protective Services but primary officer is concerned the case will be closed since the individual appears able to conduct ADLs. • Question for psychiatry hub: The primary officer is seeking advice on how to help this subject get treatment. Officer has suggested she seek medical treatment for her hallucinations but subject refuses.

43. Case example 1. continued Do you have any clarifying questions for the detective about the case? What are your recommendations for the detective on this case?

44. Case example 2. • 32 y/o male, self-disclosed schizophrenia, hx of SUDs including marijuana, heroin, and methamphetamine • Reason for contact: Subject has frequent interactions with law enforcement but has recently become more agitated. On a recent call the subject walked into a neighbor's home with a machete and demanded his spouse be released. Subject is not married. Subject left the residence but then began screaming that his spouse was being held in the house and slashing the window screens of the home. • Field assessment: Subject is increasingly aggressive, with pressured speech. During the arrest the subject bit an officer drawing blood. At time of arrest subject was found with methamphetamine in his pocket.

45. Case example 2. continued • Officer response to call: Officer was unable to speak with the subject as he was incoherent and unresponsive to questions. • Question for psychiatry hub: Presenting officer is concerned about the safety of future interactions with subject and would like to know if there is anything that can be done to get subject into mental health treatment.

46. Case example 2. continued Do you have any clarifying questions for the detective about the case? What are your recommendations for the detective on this case?

47. In Summary • What do we want our take away to be? • What is the major theme of our presentation?

48. Sandia Mountains, Albuquerque, NM THANK YOU!

49. CONTACT INFORMATION

50. SOURCES • Livingston J: Contact between police and people with mental disorders: A review of rates. Psychiatric Services 2016; 67(8):850-857 • Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-12(NCJ 250612) • Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007-2009 (NCJ 250546) • Suicide Death. Retrieved on March 28, 2018 from New Mexico Department of Health, Indicator-Based Information System for Public Health website: http://ibis.health.state.nm.us/". • Drug Overdose Deaths. Retrieved on April 11, 2018 from New Mexico Department of Health, Indicator-Based Information System for Public Health website: http://ibis.health.state.nm.us/". • Landscape of behavioral health in Albuquerque. October 15, 2014. • An Overview Of Behavioral Health Related Incidents In Albuquerque, Peter Winograd and Kylynn Brown • Plotkin M, Peckerman, T: The Variability in Law Enforcement Standards: A 42-State Survey on Mental Health and Crisis De-escalation Training (New York: CSG Justice Center 2017). • Rosenbaum N, Tinney M, Tohen M: Collaboration to reduce tragedy and improve outcomes: law enforcement, psychiatry, and people living with mental illness. American Journal of Psychiatry 2017; 174(6)513-517