Past Issues :: 2007 June 15 :: Cover Story
Mindful of Trouble
Lt. Sara Westbrook’s badge says Portland Police Bureau, not mental-health service provider. But in her 22 years on the force, she has seen her job change as funds and services for the mentally ill declined. Today, she is the coordinator for the bureau’s Crisis Intervention Team, or CIT, which trains officers to work with the growing population of people living with mental illness and without proper care. Its mission is to provide the most effective and compassionate response to police situations involving people in a mental-health crisis.
The CIT partners with Project Respond and other organizations working with the mentally ill to train, consult and assist officers, but there aren’t enough to go around. The shortage applies to education, funding and commitment from a public that still views the mentally ill through a stigmatized lens of fear and misunderstanding, according to Westbrook.
When the program started in 1995, Westbrook was one of the first to enroll. This month, Westbrook hands the post over to its first civilian coordinator, Leisbeth Gerritsen, formerly with Project Respond. In the wake of the death of James Chasse, a mentally ill man who died in police custody last year, the CIT program has gone from a voluntary offering to a mandatory training for all officers. Westbrook would like to see it become mandatory for everyone in the community. Then maybe society would support a network for preventing the crisis, and police officers could go back to being police officers.
Street Roots: What was happening with regard to police and the mental-health community that led to the creation of the Crisis Intervention Team more than a decade ago?
Lt. Sara Westbrook: In our state, as in most states in the nation, the police are the ones who have the authority and responsibility to put a hold on someone if they are a danger to themselves or someone else imminently due to mental illness. Think about that. That’s weird. The reason for this is because it’s really a civil-liberties issue. I’m making a decision to handcuff you and take you some place against your will. If I do that without probable cause, that’s kidnapping. … It’s a legal decision, not a medical decision.
For years that’s been true. And for years, we never got much training. We got training on meeting the legal criteria, but we didn’t get any training, when I started, as to anything else about a mental illness.
Then there were the deinstitutionalization of mental health all around the country, which pushed people with mental illnesses into our communities where they were not properly supported or cared for, so now they’re on our streets, which makes it a police interaction.
That’s where it was bone on bone frustration. We’re not mental-health workers; it’s not what I’m trained to be; we don’t want to be. It’s a setup for so many bad interactions.
That kind of created the CIT.
S.R.: You went from a voluntary program to a mandatory one for all officers. Why?
Westbrook: We started in February with our new training. It’s once a month now, instead of just a couple of times a year. We do 30 people a month. It’s going to take us two years to get (every officer) through. We’re only training the ones who haven’t been trained in the past. Every police officer, sergeant and detective is going to be trained.
And that’s partly a response to James Chasse, but also partly because of this gradual change over the last 20 years of more and more mentally ill people being on the street and less and less resources for them. There’s no place to give them services, even when they’re requesting them. So that creates people in a higher level of crisis, and more of them. It’s becoming even more of a law enforcement job than it ever was in the past. Our calls for service involving the mentally ill have significantly increased since I started 22 years ago. It’s huge. Particularly if you’re not working downtown. You get outside of where the social-service core is, (and) before, you could go for months and have maybe one call in six months. And now everybody goes on calls all the time, all over the city.
S.R.: What specifically are CIT officers learning?
Westbrook: Knowledge is power, and it’s not just police officers who don’t know anything about the mentally ill. We as a society don’t know anything about the mentally ill. And police reflect the society. I wish that what we’re learning was in every high school health class. It just should be standard. How different our society would be if our neighbors, our gasoline attendants, our school teachers, our librarians, our parents, our medical doctors, lawyers, judges learned about medical health.
We’re learning that your brain is an organ and it can get sick just like any other part of your body can get sick. There’s thought disorders and mood disorders, and what they might look like, what might cause them, where the medical community is in treating that and how far behind we are in treating mental health. How to get enough information about what’s happening in the person, that it’s an illness, and get out of that mindset that this person could change if they wanted, that there’s some choice involved in this, and that’s ludicrous. I think that we give enough information that they’re really starting to see how this happens, who it happens to – it’s cross-culture, cross-class, cross-gender. We talk about how to talk to someone who is having auditory hallucinations.
The premise of the training is if I can show up on the scene and reduce someone’s fear, it makes this a safer situation for them and for me. Which is always a goal for us.
S.R.: Is there any tangible measure of improvements that you see happening?
Westbrook: I don’t know if you can measure them in numbers, in a quantifiable way. What I can say – how do I say this well – police officers are a very difficult audience to teach. Because we get a lot of training and a lot of it is not very good. It’s hard for us when someone comes in from the outside and says you should blah, blah, blah. We’re always being critiqued. And often the person coming in is hired contractually and means well – but they were all therapists, working in an office or in an environment that was safe and controlled in a manner that is way different from ours. We’re contacting people who haven’t knocked on our door asking for help. It’s a really different deal.
The tangible piece is the cops are listening. They’re saying this is some of the best training they’ve received. They’re giving good feedback. It’s amazing.
S.R.: From law enforcement’s perspective, what are some of the things the city can be doing to reach the tough cases that are out there?
Westbrook: Well, I would be inclusive of the city, county, state, business community, education community: I think a huge piece of this is education. What changes an officer’s behavior is not that we tell them that they should change. What we say is here is the information, and frankly, this could be you. And we’re finding out that we’ve created an environment in which we’re saying in our classes, ‘I have a sister who has schizophrenia," "My mother is bipolar," or "My child is bipolar and this is my experience." They weren’t talking about that before. Cops are learning enough about it that they’re changing their behavior because of knowledge, not because they’re told to, and that’s key.
So I would ask that the community to give knowledge. We have to have a class in our high schools that talks about this. Statistically, if we got people help right away, the first break of the illness, the chances are the disease will not progress to be nearly as devastating as it would be otherwise. Medicines are much more likely to have an impact and be effective. The person has a more fulfilled life and it costs us less as a society. And the only way that’s going to happen is if more people know about it. I’d like that to be a key part of education in the Portland Public Schools.
We need to start having something other than crisis services. As a community, we’ve got to help people out before they get to this point. It’s costing us a lot of money, it’s ineffective for people, it’s just awful. That needs to be funded. I think the funding is going to follow the education.
S.R.: The Mental Health/Public Safety Initiative was formed by Mayor Potter in the wake of the death of James Chasse in September 2006. The mayor has said the purpose is not to produce another report, but rather to take immediate actions to improve how the local and regional mental-health and public-safety systems work together. How’s the initiative going?
Westbrook: We all know what the problem is, and frankly, everyone is on the same sheet of music on what to do about it. Everybody agreed on what we need to do and the city is trying to take a lead and make some things happen. But it’s hard because the funding stream has always been that it’s a county responsibility. So the city is starting to fund some things that it doesn’t traditionally fund.
There was a real sense of urgency that we need to figure out a different way to do it. The 10 things that came out of it are starting to happen. One is a 16-bed facility for police and Project Respond.
(Currently) you either have to have personal insurance, or get into the system, which is very difficult to do. There’s no room at the inn. You have to be incredibly ill to get to enough of the front of the line to get some help. It’s far more than what you think of usually as an emergency situation. It’s so hard to understand. There are no beds. They’re all full. There is nowhere to go. So when I put somebody on a hold to try to start this process and get them on a commitment, it is so bad that essentially it means that if I succeed, then somebody else has got to come out. Then who am I helping?
S.R.: How can people and organizations in the community work with the bureau to help in this effort in their neighborhoods?
Westbrook: Do what we can to get people to allow drop-in centers or respite-care centers in their backyards. How hard is it to find a place for a drop-in center because people don’t want it here? They want it; they just don’t want it here. Not in my neighborhood. The more we can encourage people to allow that for services to occur.
Again, it’s education. If we understood more, we wouldn’t have so much fear. We have an incredible fear in our society about the mentally ill. What we know is what we see on TV. We make this assumption that the mentally ill are dangerous people. The fear has paralyzed us. It’s not based in good knowledge. So the more we know about it, and we start acknowledging that it’s not them, it’s us. They are us. It touches all of our lives. The numbers are staggering.
Even if you don’t care, it makes sense financially. For a society, it is cheaper for us to pay for services and for places for people to live and get care for immediate crisis, before they get put into some system, because the system costs a lot of money. As soon as you get law enforcement involved, we’re incredibly expensive service. You don’t want us being your primary care providers for the mentally ill. That’s not saving anybody any money. If you’re a person who just looks at the bottom-line dollars, this is an incredibly inefficient and expensive way to do it.
