Not enough

How mental health resources impact public safety

By Kirsten Swann

When someone called the Anchorage Police Department from Player’s Choice Bingo to report a possible shooting one night in late January, a Facebook group dedicated to monitoring APD scanner traffic overheard and promptly posted the call online.

According to police, a man had claimed he was shot while walking through Mountain View earlier that evening. He said his injury was hidden by a bulletproof vest he was wearing; that he didn’t know who shot him because he was blinded by lights at the time.

On social media, speculation ran wild.

Some people wondered what Anchorage is coming to these days. Others said they weren’t surprised: After all, it is Mountain View, and isn’t Mountain View supposed to be really dangerous? They might as well give out bulletproof vests to passersby, one man suggested.

But there was more to the call than first met the ear. There was no shooting in Mountain View that night, according to police reports, just a man struggling with mental illness.

That happens more than you might expect, police say.

Officer Ruth Adolf, a seven-year veteran of the Anchorage’s police force and five-year member of APD’s Crisis Intervention Team (CIT), said the majority of calls she’s seen here have some kind of relationship with mental illness.

It plays a prominent role in public safety and police work citywide, yet it’s often overlooked and the resources to cope with it are stretched thin. 

The Department of Corrections, which ultimately cares for more mental health patients than any other entity in the state, is operating at 101 percent capacity, according to a 2015 DOC recidivism reduction plan. The need for mental health services within DOC has increased steadily since 2008 and these days, roughly two-thirds of the state’s prison population has a mental illness, substance abuse disorder or other cognitive impairment. On the other hand, recidivism rates also hover above 60 percent—generally even higher for the mentally ill.

“We all know that putting somebody in jail is not the solution,” Adolf said.

The CIT aims for better outcomes, providing an immediate response to mental health crises and reducing violent physical encounters. It’s comprised of more than 80 patrol officers, dispatchers and supervisors who voluntarily complete 40 hours of instruction with more than two dozen teachers from the mental health community.

The Alaska Mental Health Trust Authority, the National Alliance on Mental Illness and local mental health care providers are all involved with the effort.

“It’s very nontraditional police work,” said Adolf, who now coordinates CIT work for the department.

Through specialized training, team members learn about the different mental illnesses and medications, how to approach someone in crisis and how to develop a rapport. Patience is key, Adolf said; so is thinking outside the box. CIT members practice active listening skills, empathy and a calm approach.

In one activity, team members use Skittles to replicate medicine sets for different mental illnesses and practice spending a week in compliance. It can be tricky, Adolf said. Now imagine remembering those complicated routines when you already have trouble coping with day-to-day tasks. That’s just the beginning.

Mental health problems are complex, she said, and often compounded by a lack of stability. After years of living with mental illness, many people can find themselves with no family, no friends, no health care or no place to live. Sometimes, it’s all of the above.

The CIT can do a variety of things to help, from connecting people with service providers to performing seemingly mundane tasks that make a world of difference to deescalating potentially violent confrontations.

In one case, Adolf said, two Anchorage women living with mental health problems found themselves repeatedly calling 911 and having issues with “some other things.” APD was able to work with the women and their care providers to put together a checklist of ways to handle those situations when they arose, and it worked. The calls to 911 “decreased tremendously,” Adolf said.

In other cases, though, there’s not much police can do.

Some people have undiagnosed mental health issues, or won’t acknowledge their situation and refuse to engage with service providers, Adolf said. If a person is deemed “gravely disabled” and a threat to themselves or those around them, they might be involuntarily committed under the authority of Title 47.

The CIT coordinator recalled one recent case that began when a man stopped taking his medications—something that can be easy to do when you feel healthy, she said. But then things began to spiral out of control. His housekeeper, scared away by his shouting and threats, stopped coming by. Then, he stopped engaging with his health care providers, refusing to let anyone in to his home. You could see the trash piling up inside through the windows, Adolf said.

Finally, after about two months, a judge granted an ex parte order, paving the way for involuntary committal at API.

When that happens, according to state statute, doctors have 72 hours to evaluate patients and determine whether their condition warrants a longer commitment. Adolf said she often sees people released after a much shorter period of time, only to be replaced by somebody else.

Outside the DOC, there are only 96 psychiatric beds in Anchorage, according to the department. People can go to the Alaska Psychiatric Institute, which has 80 beds, or the Providence Crisis Recovery Center, which has 16.

The existing resources are often not enough, Adolf said.

At first, the connection between mental health and public safety activity isn’t always obvious.

People might self-medicate, obscuring an underlying issue with alcohol and other drugs, Adolf said. Once you gain more insight into the situation, though, you begin to realize how prevalent mental health problems really are—so prevalent that the police department’s CIT members make up approximately a quarter of the force.

The calls to which the team responds run the gamut, she said. Sometimes it’s a neighbor reporting a disturbance; other times it might be someone suffering from a delusional disorder calling 911 to report something seemingly suspicious. On other occasions, people call for police help “just to talk,” and the problem is temporarily solved with five minute’s of a CIT officer’s time. Sometimes the call is much more serious. It all depends on the person and the situation, Adolf said.

In Mountain View alone, the Player’s Choice shooting report was one of 10 mental health-related calls over the month of January. Last year, the neighborhood saw 92 such calls for service.

But mental health problems are hardly contained to just one single community, Adolf said. CIT officers respond to all parts of town.

Meanwhile, the state’s largest community mental health provider continues to grapple with persistent wait lists and insufficient manpower to meet Alaska’s needs.

“This issue is not a law enforcement issue,” said Jerry Jenkins, executive director at Anchorage Community Mental Health Services. “The issue is human services.”

Twelve years ago, ACMHS cared for around 3,200 seriously mentally ill adults and severely emotionally disturbed youth, according to its executive director. These days, the organization serves fewer than 2,000 people.

“It directly relates to the resources we have,” Jenkins said.

Between fiscal years 2009 and 2013, ACMHS annual reports show revenues increasing by more than $5.2 million. The devil’s in the details: In FY 2013, the organization reported providing $6 million worth of charity care. The majority of clients are covered by Medicaid, which reimburses approximately 70 percent of the actual cost of care. More than 40 percent rely on Medicare, which reimburses less than 33 percent of the actual cost of psychiatric care, according to ACMHS.

Compared to the cost of residential psychiatric treatment or incarceration, community mental health services are the least expensive options. Each ACMHS client costs about $25 per day, according to the organization, while spending a day in residential psychiatric treatment costs approximately $157. A DOC prisoner in special population costs roughly $1,500 per day.

In Anchorage, Jenkins said his organization serves about 1,400 adults and employs around 165 people. It aims to ensure food, clothing, shelter and medical care. Mental health conditions get a lot better when those three things are in place, Jenkins said. Building trust is important, he said, and health care providers have to be in it for the long haul. Recovery doesn’t happen overnight.

Most clients come from API and DOC, he said, “Because those are the most vulnerable and the most in need.”

People are also referred to the community mental health service from Crossover House, a street outreach program for seriously mentally ill adults, and Pathways, another outreach program serving chronic inebriates.

But on any given day, the organization’s adult waiting list hovers around 150 people, Jenkins said. It’s a difficult situation. CIT members watch people cycle in and out of Anchorage’s limited mental health care facilities, and ACMHS—operating at capacity—is unable to connect them to the services that could make a lasting different.

“(CIT members) know somebody needs help, but they can’t get it: They can go to the psychiatric emergency department, they can go to Providence, then to the emergency room then to API, then I get involved,” Jenkins said. “Ideally, I’d be able to get involved a lot sooner.”

It could have lasting effects for community health and police resources alike.

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