NOTE: This is the first in a series on the challenges law enforcement faces in handling calls of people in a mental health crisis and the efforts being made to improve results through supportive response.
An estimated 26 percent of adults in America suffer from a diagnosable mental disorder, and many are dealing with more than one, according to the National Institutes of Health.
When those suffering with mental health disorders are in crisis and are unable or unwilling to seek treatment, law enforcement officials are often called in to help. Law enforcement agencies across the country are responding to more mental health crisis situations than ever before.
A training program developed by the Northwestern Community Services Board — a public mental health provider that provides services to residents of Shenandoah, Warren, Clarke, Frederick, and Page counties and the City of Winchester — is giving local officers more tools to approach those incidents effectively and empathetically, often leading to better results for everyone involved.
A nationwide study of senior law enforcement officers — 75 percent of whom have served for more than 20 years — shows across the board increases in the number of calls for service involving individuals with mental illness and an increased amount of time spent on those calls. Some studies show that 20 percent or more of police calls are related to mental health and substance use issues.
From January to mid-August, the Front Royal Police Department, for instance, responded to 62 incidents involving individuals for whom an emergency custody (ECO) or temporary detention order (TDO) had been issued. Under the orders, people are taken into custody for mental health evaluation.
According to Front Royal Police Chief Kahle Magalis, the department has spent 844 total hours so far this year on those incidents. In 2022, the Front Royal police devoted 918 hours to ECO and TDO calls, up from 591 in 2021, 529 in 2020, and 464 in 2019, according to the Front Royal Police Department’s 2022 annual report.
Northwestern’s Crisis Intervention Team (CIT) program helps better prepare law enforcement to respond to those calls.
Through improved, focused training, officers learn to recognize signs and symptoms of a mental health episode and respond with empathy and increased understanding of the community resources and options that are available, said program director Donna Trillio. Often this can mean that individuals have more direct access to mental health care and, in some cases, are diverted from potential incarceration to treatment options.
Since 2009, the program has trained hundreds of law enforcement officers from Northwestern’s service area to better prepare them when they come in contact with people with mental illness, said Trillio.
The 40-hour training program provides mental health education that translates to every interaction an officer might have, including managing their own trauma and stress from on-the-job experiences, she said.
“If someone is in a mental health crisis, they or their family should ask for a CIT officer,” said Trillio, who has been with Northwestern for 14 years. “We’ve trained 500 officers throughout the service area so chances are there may be one available.”
Magalis added that those in need of services can also call 988 to be connected with local resources.
Magalis, FRPD Major Jason Ryman and New Market Police Chief Chris Rinker sat down with the Daily recently to discuss the CIT program and its impact on their departments and the community.
“Before [CIT training], when we showed up to an incident where someone was being disorderly, we’d just lock them up. Now it’s understanding that there’s something more than just bad behavior and addressing the root cause and trying to get that person the help that they need,” said Magalis, who is a member of the Northwestern Community Services Board and is working toward having all of his officers complete CIT training.
Officers must have at least two years of experience before being eligible to attend, Magalis said, noting that about half of his officers have completed the training.
Rinker, who is a trainer for the CIT program, added, “CIT is a mindset. It’s new tools that we’re giving officers to improve their communication and to make that just a better process for the mental health consumer.
“When the police come to your house, most of the time it’s not for a good thing, so for us to build those relationships and be empathetic and walk with them through that journey of getting recovery and getting them back to their home, that’s our goal. That’s any law enforcement officer’s goal,” Rinker said.
Added Ryman, “It’s recognition. There are behaviors that are associated with mental illness and there are behaviors that are just straight, criminal disorderly conduct. And it really helps the officers in realizing what they may be dealing with. It’s not always a criminal situation.”
Ryman, who has been withn the FRPD for 20 years, noted that in many cases the training leads to dramatically different outcomes.
“The reality is that a lot of times we get diverted from the criminal justice system. Sometimes there are situations where technically you could make an arrest, but what have you really done with that? Because the person gets back out, the underlying cause still hasn’t been addressed, there’s still nothing done with that, it’s going to happen again and again and so you’re trying to guide them to resources, for one, to help them, but for another, to actually prevent the second call, the third call, the fifth call, and the person just escalating not because they’re criminal, but because of their illness,” he said. “It just keeps escalating up to the point where they do commit a criminal act. We’re trying to actually be the intervention that cuts in between that.”
The CIT program, which was developed in Memphis, Tennessee, after the fatal shooting of a man suffering from a mental health episode, is now offered in more than 2,700 communities nationwide, providing mental health education to law enforcement, Trillio said.
“They’re going to get an overview of clinical states — the ones they’re most likely to run into,” Trillio explained about the training, which is led by mental health professionals as well as officers trained in crisis intervention.
Through role-playing exercises and experiential learning, officers build empathy for the mental health community, she said. For instance, participants learn about the most common psychiatric medications they might encounter. In a module called “Why Don’t You Just Take Your Meds?” they learn how complex that issue can be.
“One of the core elements of CIT training is to impart empathy in law enforcement. This is one of those modules we teach that helps with that. And we get to show to the officers through this block of education that there are side effects, like sexual functioning, weight gain, flatulation. There are so many side effects that can be reduced with another pill so before you know it, we have people who take 17 pills a day,” Trillio said, adding that they also explore the expense and the challenges inherent in finding the right medication and dose, which can take a year for some people. “And then they start to feel better and are like, well, I don’t need it anymore and they stop taking it.”
As part of the training, officers are tasked with keeping a pill box with them all week and taking medication (candy) as directed, to simulate the challenges, Trillio said.
“We really hit them hard with that just to show them it is a pain in the butt. It’s a great exercise that is empathy-building,” she said.
A session on dual diagnosis is valuable since officers often encounter people who are high or intoxicated. It helps them to understand that “most of the time, underneath that, is a mental health issue or trauma,” Trillio said.
Peer recovery specialists offer another perspective and an opportunity to connect with the community, she said.
“By and large, these are folks who have substance use disorder and mental health diagnosis. They come in and tell their story,” Trillio said, noting that in many cases peer recovery specialists have been in jail, experienced homelessness, and perhaps lost custody of their children. “And now, here they are standing in front of this class of law enforcement and they have, maybe a degree, they have their certificate from being a peer. They’ve gotten their children back. Law enforcement sees people on their worst day and jailers see the same people going in and coming out and so they can see there are actually people who are successful.”
Participants also take site visits, for instance, to Sunshine House in New Market, where they eat lunch with NWCSB staff and clients who operate and attend the program for people with mental health issues who are in recovery.
Building relationships in the community is a key takeaway from the program, Trillio said.
“We often say it’s for the mental health consumer, but these skill sets that we’re teaching help to deal with any individual to build empathy,” said Rinker, who has been with NMPD for 24 years. “For my agency, we are only a six-man department, but we’re 100 percent CIT certified and I can easily say that CIT has changed how we do police work and has made a difference in our small community. We have mental health consumers that know that they’re not feeling well mentally and physically and will call us. Sometimes, it’s just a conversation, but sometimes it’s that they need to go to the local hospital to receive care.”
In law enforcement for 25 years and with the Front Royal police for six years, Magalis added, “It helps with everything. Our officers that are CIT certified have more tools in their toolbox to be able to de-escalate someone that’s not suffering from a mental illness, they’re just angry and upset. I’ve had officers that have gone to CIT training that have talked to me about how it doesn’t just help when they’re dealing with mental issues or if even if they’re dealing on the street, they communicate better with their shift mates, even in their personal relationships. They receive benefit from the training outside of just dealing with the mentally ill population. I think that’s a big deal.”
Rinker leads a presentation on officer wellness, discussing vicarious trauma and encouraging participants to get the help they need. He said that there has been a significant rise in suicides by first responders across the country in recent years.
“It’s the job in general — the magnitude of the trauma that is experienced on a daily basis,” said Rinker. “It’s OK not to be OK. Just because you’re a law enforcement officer or emergency responder, doesn’t make you a superhero. We’re human beings. And eventually you have the potential for your bucket to overflow and you have to have resources.”