Public Education & Policy :: Mental Health Services Act

Role of Law Enforcement in Relation to the Mental Health Services Act

Policy Paper on the
Role of Law Enforcement in Relation to the Mental Health Services Act

Introduction

The California Network of Mental Health Clients (CNMHC) strongly supports the core values of the Mental Health Services Act (MHSA) that are clearly stated in Section 7, 5813.5 (d):

d) Planning for services shall be consistent with the philosophy, principles and practices of the Recovery Vision for mental health consumers.

(1) To promote concepts key to the recovery for individuals who have mental illness: hope, personal empowerment, respect, social connections, self-responsibility, and self-determination.

(2) To promote consumer-operated services as a way to support recovery.

(3) To reflect the cultural, ethnic, and racial diversity of mental health consumers.

(4) To plan for each consumer's individual needs.

In our own words, the CNMHC has articulated the following core values:

• Choice and self-determination in treatment.
• The need for mental health services that do no harm and protect and respect the rights of mental health clients.
• The need for social and rehabilitative community mental health services that address the real life needs of persons with psychiatric disabilities - affordable housing, income supports, jobs, friends, substance abuse issues.
• The need for client-run (peer) programs and mutual support groups (programs run totally by the recipients of the services) as well as clients as providers within more traditional mental health programs.
• The need to end stereotyping and discrimination of people with psychiatric disabilities.
• Overarching all of these principles, the need for client involvement in all decision making of the mental health system as it directly affects our lives, on every level of policy-making and program-monitoring.

It is within the context of these values that the CNMHC develops all of its policy positions, including the role of law enforcement in MHSA services.

Opposition to MHSA Funds for Psychiatric Emergency Response Teams (PERT)

The funds that would go toward PERT programs should be invested in the array of community services that will decrease the crisis situations that lead to police intervention. The MHSA is specifically designed to address the lack of voluntary, community-based rehabilitative and recovery-based services which has caused the over-use of law enforcement and jails. The MHSA percentage of overall mental health funds must be reserved for recovery-based, transformative services. Involuntary treatment looks backwards, not forwards. Whereas the conventional system has used coercion and force in its attempt to solve problems, a transformed system would create alternative options that maximize client self-determination and autonomy.

The CNMHC believes the most effective crisis teams are composed entirely of clients, or secondarily, clients and family members or clinicians. Police can be intimidating to a person in crisis, promote fear and convey enforcement, not support. We believe that these teams should not have involuntary commitment (5150) powers. It could be argued that using law enforcement in crisis situations criminalizes clients in such situations.

Proposed Guidelines for Funded Mental Health and Law Enforcement Collaborative Programs

Firstly, if PERT programs or other collaborative programs of mental health and law enforcement are funded under the MHSA, MHSA funds can not go to the police functions of the collaborative project, such as the salaries of police officers, police cars, equipment, or operating costs.

The DMH's requirements for Community Services and Supports (CSS) General System Development Funds clearly state, "This funding may only be used for mental health services and supports to address the mental illness or emotional disturbance. … In collaborative programs, the cost of the mental health component only is allowable." The Department has since clarified this requirement:

"All of the mental health costs [of PERTs] for staffing and providing new or expanded services are allowable under the MHSA. In addition, costs for training of law enforcement personnel and for evaluation of new or expanded services are also allowable. Costs for the law enforcement officers themselves are not allowable costs and are usually paid for by the law enforcement jurisdiction, consistent with their existing responsibilities. In addition, other costs usually born by law enforcement when responding to police calls, such as police cars, radios, administrative costs, etc. cannot be funded under MHSA."

This statement, in addition to clarifying that MHSA funds must be used for mental health services, underscores the Act's assertion that funds cannot be used to supplant or reduce a county's (or the state's) existing obligations under other entitlement programs or existing funding streams.

Allowing one local instance of the use of MHSA funds to support non-mental health functions will set a precedent throughout the State, and open the funding coffers to any system other than mental health that intersects with the lives of people with mental health disabilities.

Secondly, if PERT programs or other collaborative programs of mental health and law enforcement are funded under the MHSA, clients must be meaningfully and substantially involved in every aspect, from planning to implementation to evaluation. Clients must not be tokens, with minimal roles and inequitable pay. In the collaborations that we have investigated, clients were marginalized. For example, in a PERT program submitted as part of a county's Community Services and Supports plan, the roles of the consumer and family member are non-essential to the program: they are not in the field interacting with people in distress which is the substantive work of the project. In addition, while 1.3 million dollars is allocated for this PERT program, only $28,000 is apportioned for a part-time consumer and family member position, a sum which is proportionately out of alignment with the salaries of the other "partners." If there are to be collaborative mental health and law enforcement programs they must truly be collaborative, equal partnerships, with clients.

Transformational Approaches

It is a mistake to tout hospitalization or coercion in the community as an answer to the criminalization of people with mental disabilities. Decriminalization should not mean the choice between jails or hospitals/community coercion. Both of these outcomes are unacceptable. The MHSA gives us the opportunity to create new possibilities and raise the standard for outcomes with transformative approaches.

The CNMHC supports the creation of safe, voluntary, community places for people in crisis - "safe houses" where trauma-informed support is available at any time and individual choice is respected.

In addition, the CNMHC supports mobile community outreach teams led by clients, whose purpose is to address problems before becoming a crisis without police, to prevent rather than to contain. These outreach teams should be culturally appropriate and include peers who are members of the community in which they are providing services as well as persons who share the cultural background of that community.

Training and Education of Law Enforcement

CNMHC strongly supports client and survivor led training and education for law enforcement. Law enforcement has a long and well-documented record of abuse, excessive use of force, including lethal force, and mishandling of situations involving persons with mental disabilities. Police and sheriffs' departments use a command-and-control protocol, and few have received any training on client culture, crisis prevention and de-escalation techniques. In the words of psychiatrist Steven Lamberti of the American Psychiatric Association, "Unfortunately, police often lack the training necessary to handle such individuals [people diagnosed with mental illness] without resorting to unnecessary and sometimes lethal force." The Web page of the City of Memphis Crisis Intervention Team (CIT), a law enforcement training and education model, concurs, "Traditional police methods, misinformation, and lack of sensitivity cause fear and frustration for consumers and their families."

The CNMHC supports law enforcement training led by consumers, inclusive of families who have been the victims of police violence. More specifically, in all law enforcement trainings, consumers must not only have meaningful and substantial involvement, but control over the training processes and materials. It is our concern that what law enforcement may be learning could be discriminating attitudes about us held by others in the mental health community. In a recent CNMHC sponsored study entitled, "Normal People Don't Want to Know Us: First Hand Experiences and Perspectives on Stigma and Discrimination" by Delphine Brody, clients identified mental health professionals, family members and the criminal justice system (primarily law enforcement) as major groups that displayed stigmatizing attitudes about clients. This training should be extended to the criminal justice system, including public defenders, prosecutors and judges.

Once we have achieved a transformed mental health system, today's focus on risk, crisis and force will be replaced by an array of voluntary, self-directed options, for people of all ages, backgrounds and geographic regions. When clients are able to voice their needs and concerns and be heard, direct their own paths to wellness and recovery, have their needs met and determine the course of their lives as others do, this will truly be a health care system not a social control system. Law enforcement has been the default response to a system that lacked an array of voluntary, community services. As these services grow and multiply, they will become the default response and law enforcement will no longer be needed. As clients see it, in a fully transformed mental health system, all parties would get the services they needed when they asked for them thus leaving law enforcement personnel to protect and serve all citizens in the community and not involve themselves in health care matters.