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Eleven days before Jack Dale Collins was shot dead by Portland Police at Hoyt Arboretum, he visited the police bureau, confessed to a 42 year-old crime, and asked for help. He said he had molested a girl at his home when he was a teenager. He had forgotten many of the details, including the victim's name, but the police report shows that during this confession (which as a crime had passed the statute of limitations) he also asked for mental health care. The officer recommended Cascadia Behavioral Healthcare, but there is nothing to suggest that Collins followed up on this suggestion. According to The Oregonian, the officer said he would have driven Collins to Cascadia if he had been asked.
What would have happened if the process was different? If Collins had been taken to Cascadia, for example? Or perhaps if a crisis line had been called? What would have happened if he had received more mental health care long before setting foot into the police bureau?
Today we'll explore how homelessness and mental health issues overlap, and what role society (including the police) should play to help these people. What should happen when police and homeless people with mental health issues come in contact with each other — as they regularly do — long before a crisis situation? What responsibiity do the police have to help the homeless who are mentally fragile? And if the police are not responsible, who should be?
GUESTS:
- Chris Bouneff: Executive director of NAMI Oregon
- Brian Martinek: Assitant Chief in charge of operations for the Portland Police Bureau
- Phil Shapiro: Medical Director for Central City Concern 12th Avenue Recovery Center
- Joanne Fuller: Director of Multnomah County Department of County Human Services
24-hour mental health call center: 503-988-4888
Tagged as: homeless · mental health · police
Photo credit: Jeff Kubina / Creative Commons
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Parity was passed in '08, that goes into effect this July. The new health-care bill will expand the parity further, so, mental illness will be treated as, basically, commensurate with any other disease by insurance companies (hopefully!). These laws should at least expand the level of coverage, so perhaps more people can, or will, receive care. The mentally ill, of course, must first want the care. And mental illness, like any other disease, takes a certain amount of effort to ease its symptoms. Like Diabetes (and others) you can often control the disease, but you have to want to, and work to control it. With mental illness the challenges are even greater, because the viscous cycle that inherently occurs because it is a 'mental' condition, means the will to take, or to want to take, action may not ever exist. In some ways, though I would love to blame them, it is perhaps too much to ask of the police to take action. They are not medical professionals. But, if mental illness is a disease like any other, shouldn't the police at least have a 'mental' ambulance to call if someone is hurting?
But, things get tricky, because mental illnesses might be diseases, but they are certainly different from most other diseases. You are unlikely to be having an angina attack while wielding a knife at the officer coming to see to you. Officers must be empathic, and should exercise reasonable caution when pulling the trigger. Once the dangerous situation is under control, there should be some medical service the police can call to deal with the mentally wounded individual. Perhaps, as with some other diseases, there may be times when we can do nothing to stop, cure, or slow the progress of the illness. We can't save everyone. It is plausible that, at times, death may be the only relief for a suffering soul. Not pleasant, but maybe this is our reality.
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Mental illness is not a question of "wanting" to be cured. My daughter anguishes over her condition and is apologetic, but unable to control her thoughts. With diabetes, you at least have a measurable condition. With serious mental illness medical science cannot even fully explain it, much less effectively treat it. Until we can fully understand the nature of the diseases, we can only hope to help treat the symptoms, not the causes.
We do not choose who to treat for cancer and many ultimately die. At least they have the dignity of not being shot or beaten to death as a result of their condition.
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Dear advocate366,
That is not what my comment says. By 'want' I am saying you can't force the mentally ill to get help. They have to want the help, not for it to work necessarily, but for them to get it. You can't generally force care upon someone who is mentally ill unless they are a threat. Which is why I said, "the will to take, or to want to take, action may not ever exist." Which is why mental health care is a vicious cycle, because part of the solution in most other diseases can be the person getting help, going to the doctor, taking the medication, in mental health care the mind is ill, the very thing (the mind) you need to help you take action and seek assistance is hindered---so it is a terrible, harsh, battle. And, even worse, sometimes if you do seek medical attention it may not work.
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Mental health needs to have more weight in health care and other legislations, as it is often overlooked.
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Responsibility for mental health and homelessness lie in the hands of governments, corporations and citizens. Will we pay taxes that provide safety nets for those who can't fend for themselves or will we continue our effective practice of "everybody for them self"?
It is possible for the rich and the federal government to reallocate $100 billion dollars to strengthen those who mend and maintain mental health care, housing, and job creation for the chronically dispossessed.
Are we collectively compassionate or do we merely talk about it?
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What all of you seem to overlook is this: We are a nation that is growing poorer and racial and ethnically fragmented and an increasing number of our diverse population is stumbling around stoked on dope.
We are becoming in America like the 13 underdeveloped countries I worked in...too many problems chasing too few resources. As things get tougher, people hunker down and insist on their taxes being spent in ways that directly benefit them. As in Brazil, and in Mexico, for example, bullets are cheaper than maintaining the mentally ill in a decent facility or housing the criminally inclined in a nice, well appointed prison.
We no longer generate the wealth and resources to maintain the public institutional infrastructure we once enjoyed. We are not going to spend more money on the mentally ill, the criminals and enforcement and incarceration than we are already doing. Taxpayers will simply NOT vote for more money going toward those problems.
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A person has to agree to receiving mental health care. You cannot force someone to get it unless A) they said they are suicidal B) they said they are hearing voices C) they committed a crime. These rules are due to past abuses where husbands committed their wives without much cause to mental institutions and people who were otherwise able to be on the outside world were kept locked up for years.
To expect police to be in charge of making sure people get mental help is ridiculous. This should be the responsibility of government sponsored health care and the individual. The police are not trained as psychiatrists and if they start bringing people to institutions, there will be another uproar. Why do we blame the police for everything? They are in charge of protecting the innocent. If that means shooting a mentally ill dangerous man who refuses to get mental health care, than that's what it means. Once a molester always a molester. A friend of mine was jogging on a nearby trail in POrtland and was forced at knife point by a mentally ill homeless man into the bushes. Luckily my friend got away. It really bothers me that these mentally ill people choose parks to live or hang out it. That is where my children plaly and where I like to run by myself. These should be safe places--not hangouts for people who choose to live outdoors, do drugs, or are otherwise mentally ill. I'm sure that man is in a better place right now--what was his quality of life like anyway? being out in the cold, mentally ill, knowing that he committed a crime for which he never paid but his victim is likely still paying? Why are we so afraid of death? For me, it is not the worst penalty for a child abuser
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By the way, I have called a crisis line and had patients call a crisis line before and they are practically useless.
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THis is a vital topic. A significant number of daily street arrests are of mentally disabled people who wind up without care and medication on the streets, or self-medicating with alcohol or street drugs. The area jails need to be holding areas for these people and that is not their purpose.
Budget cuts and closures of subsidized mental health providers have been an issue for a long time. We treat the mentally challenged as expendable and force the homeless among them to live without meds or counselling. When tragedies happen we pay attention for a while, but soon we treat them like they are invisible.
I suggest talking to a commander of one of the area jails as a starting point to get a handle on how large the mentally challenged jail population is. Custody officers are called on to do what medical/psychiatric professionals should be doing.
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Years ago when I was a Deputy Sheriff we had a great resource to help the mentally ill we came across on our tours: Dammasch State Hospital.
How it worked: we would come across the person presenting per radio call or just by rolling up on them in the street. Assessment starts out of the car immediately: is the person drunk/not able to navigate. Response: CHIERS summoned and the person is taken to detox.
If the person presented differently and was not "centered", posed a danger to himself or others? Off to OHSU on a cilvil hold for a psych evaluation.
If the afflicted person is deemed by an admiitin OHSU psychiatrist to be an AMIP (Allegedly Menatlly Ill Person or 12-34 in cop talk) we were off to Wilsonville and introduced the AMIP into Dammasch.
Many times the Dammasch staff knew who we we bringing in as we went through the door.
Reports were Special reports. Not custody reports. This was civil procedure.
Then Dammasch was closed. Budget. The Feds and the state were supposed to provide safe housing, treatment and other services in the communities. Never happened. Hence the streets are the dumping ground for these people. Walk around downtown and see the fallout.
Possible answer. Call CHIERS with a mental team. Let them take the AMIP up to OHSU and go through the process through and to Cascadia.
The system is in failure. The police are the providers of last resort. Open 24/7/365.
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I am a public defender in Umatilla County, and I think the state of mental health care in Oregon is poor and needs dramatic improvement despite the best efforts of those who serve on the front lines of this issue. I have had many clients with deep and serious issues in conflict with police, who often use a rough approach when dealing with the mentally ill.
A former client (who was eventually civilly committed for schizo-affective disorder) was arrested for attempting to assault a police officer. The officer wanted to conduct a "field interview" of my client who had done nothing wrong. My client completely misunderstood the officer's intentions and mistook him for an assailant from several years ago in California. My client walked briskly toward the officer who tazed my client in the chest. Weeks later, my client had missed a court date, so the police went to arrest him on the warrant. The police learned he was sitting in his father's home with a loaded gun to defend it from intruders. My client was lucky that he did not suffer the same fate as the gentleman from Portland, even though it was apparent to all invoved with him that he was completely and totally bonkers.
I have had other clients who have spent more time in custody waiting to be evaluated to determine the extent of their mental illness than the maximum sentence they would have recieved had they simply pleaded guilty.
The state's mental health system is overloaded and underfunded. Instead of building more prisons, the state should spend money on new mental health facilities and personnel. Stories like the one from Portland will continue until this is changed.
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I work for Cascadia in a secure facility for chronically mentally ill. We work with the police when residents decompensate and become violent. The police that help us have been wonderful in the last year. I don't know if its just the North presinct, but they have been kind, gentle, and understanding with our people. It's unfortunate that the State Hospitals are so full that people are released before they are ready, decompensate, then end up interacting with the police. Too bad we are closing state hospitals. Things will just get worse.
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Could you take a moment to describe the continuum of mental illness, explicitly demonstrating the difference between a psychiatrist and a psychologist?
And would you explicitly describe how people with severe mental illness do not think they are sick and fear asking for help. This is how they fall through the cracks.
There is a law in california which allows a psychologist to hold a person longer than 72 hours if they have been in the system before and it's known that they are chronically vulnerable to falling through the cracks because they won't ask for help?
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Cascadia or some other clinic needs an ongoing therapist that csn see someone immediated so that the police or any other adency that is known by the theraputic commmunity can bring someone in when the officer detects a mental heath need not only a crisis. This may need a protective hold on the person and maybe a socialworker assign to police in the station. I am a retired caseworker from Children Services.
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FREE WILL. Part of our reluctance to deal with mental illness, is that, somewhat obviously, it occurs in the mind, and we believe that the individual conjures up everything that occurs in there, and are responsible for everything that comes out. We like to cling to the idea of free will---that people can will themselves to get better. We love this notion of free will, because it gives us the opportunity to blame the individual wholly and completely for their actions. We don't want to say that disease is part of the cause of someone's bad deeds, because then we feel we can't punish them.
This looking to blame is rampant all over our culture and perhaps the world. We have recently encountered this with the vitriol against the obese. We don't want to say the mentally ill can't always help themselves, because we feel they will not be held accountable and will escape responsibility. Partially because of these concepts we treat mental illness differently.
I, personally, have a very hard time realizing that people are not always to blame for what they do, and how to respond to that. How it all works out. Even though I know it intellectually. We are so programmed in the opposite way, it is so hard to overcome this. So hard not to resent people and despise them for their actions. Even if you are conscious and aware of these ideas, it is a lot of hard work to overcome the distaste. How do you show empathy towards people you can't stand? It is very difficult.
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Discover truth, wisdom and the true nature of reality for yourself. Buddhism might be a useful starting place.
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10 years ago (or so), the County ran the Crisis Triage Center -- a place on the Eastside to bring people experiencing mental health crises. Ask the County representative why the CTC closed.
I think the response will reflect the priority (low) that society places on dealing with mental health issues.
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For what it's worth I work in a methadone clinic. This relates in so much as we deal with a large number of co-occuring disorders. Addiction very rarely comes by itself. We have a large problem with parroll officers allowing their clients to be patients. We get patients to start working on their mental health issues as part of their treatment here. But they have to be patients for us to help them with that process. Stigma has always surrounded addiction but for those with co-occuring disorders it makes getting help twice as difficult.
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This is a situation crying out for philanthropy. Imagine if Phil Knight and others gave their millions to Cascadia and other crisis intervention and counseling services to create a national model for improving community mental health. That would do far more public good than college football.
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This is what I hate about depending on philanthropy instead of funding through taxing ourselves for the benefit of our fellow man.
The wealthy tend to choose thing that aggrandize themselves among their social equals, sports teams, art museums, concert halls, etc, and the needs of our fellow citizens just drop through the cracks. And the philanthropists just write off their self aggrandizement on their taxes, so they win both ways and society loses.
Sheesh!
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I justed commented but realise that at this time due to funding crisis a volunteer system might be needed. I would volunteer to do this either to spend time or be availabe by phone or email also to volunteer to help this set this up.
PS Of course,We need to used only gualified volunteers.
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Chris Bohnoff is absolutely correct in his view that this is a very large systemic failure. The failure is not limited to crisis intervention. It is incredibly difficult to live in recovery from mental illness. We will have thousands of mentally ill citizens living on the streets until we have adequate systems to provide housing, income and heath care (including mental health) care resources. Access to services for poor people is largely dependent on eleigibility for Social Secrurity disability benefits (either SSD or SSI). This is not an easy gate. It often takes years of complicated and contentious self-advocacy to gain this determination. Individuals with a cognative impariment are often unable to navigate these process alone.
Even with a Medicare or Medicaid card, there are precious few providers who will accept the benefit as payment for services. It is a self-defeating system. Without access to medical services, medications are not available. Without medications, individuals ofen decompensate, and lose the insight into their own situation that can help lead to recovery.
Until we look at the problem from a community level through the eyes of the consumer, we will never provide a humane path to recovery. There are many parts to the problem. We must address them all together in a way that solves the problem, not just dumps it on some other budget.
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Yes, this issue needs to be addressed on a community-level, but to trash the Crisis Triage Center (CTC) and say that the staffing and quality of care was incompetent, is insulting. I do not think it is NAMI's position that the CTC should have been closed. Chris Bouneff should know that the (former) staff of the CTC are the current staff of the in-patient and out-patient facilities throughout Multnomah County. To reference lobotomies (?!) was an unnecessary and insulting. I was not impressed with his comments.
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About lack of funding:
A few years ago I was talking with a Conservative and he said that their strategy is to drive the government so far into debt that they have to cut funding and get rid of social services because social services are "socialism". Ronald Reagan did that and Conservatives have done it ever since.
He told me that Conservatives are for what they (mis-) interpret as Darwins "survival of the fittest", rugged individualism, and the least fit should just be left to die off.
And so funding has been cut and cut and cut, in favor of tax cuts for the wealthy and to the detriment of what Jesus called "the least of these".
So the lack of a safety net can be directly attributed to Conservatives and their lack of "Compassion" for their fellow Americans.
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About 25 yrs ago our economic and political elites decided for us to rid the nation of manufacturing and to police the world with our declining wealth. It is still happening.
We are becoming poorer and the poor have less influence than the rich. Generally speaking the rich are less troubled by crime and crazies in their gated communities than the rest of us. That stated, it is obvious that their taxes and clout are going to target issues that directly affect their quality of life. Unless the homeless and loonies are sitting on their front porches and the burglars are breaking in their doors they are unlikey to see greater percentages of public revenue diverted to handling the crazies and violent criminals.
It is a matter of priorities and shifting political power in a nation in economic and social decline.
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I misspoke: we didn't have civil commitment info on our site. But here it is now:
http://www.oregoncounseling.org/LawsRights/CivilCommit.htm
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I work with mental health clients in west Portland, and Phil is right about getting patients/clients in the door. Compliance with treatment is paramount, and we see non-compliance every day. Seriously mentally ill clients, those who may need to be protected by committing them to a state hospital, are less frequently committed because freedom (or their "right to folly") is seen as more important at this time. These are the clients who are spinning/floating, perhaps; we say "circling the drain." As for the police, they have been great, though they could always use more training, as we always can. Mr. Collins, despite his attempt to enter mental health treatment, was a danger to others (he was threatening people with a weapon). I have no doubt that he knew how to go to the ER or to Cascadia/CCC, etc. I hope the officer involved learns from the experience and returns to work.
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I am a local Emergency doctor. We see hundreds of mental health crisis patients per year, arriving by ambulance, police and helpless family members. They stay in the ER for days, awaiting psychiatric bed assignment. There are woefully few outpt psych services for people who do not meet the bar for involuntary hold.
Those who do meet involun hold criteria are often released before a psych bed assignment is made, because we medicate them while in the ER to "keep the peace" (to not have to use physical restraints). They then do not get outpt followup, do not continue to take meds, and then are back.
Also, many homeless people use the ER for shelter, food and medication, as they are "kicked"out of the shelters in the early morning. They then develop suicide ideation and then appear in the ER.
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My name is Cathy Horey and I was one of the original creators of the CIT training and Crisis Triage Center. In 1996 this system work for both individuals with mental illness and police. We felt it was the right direction in creating a system that would respond to thoses who needed services as well as thoses who were impacted by the crisis.
I worked in Multnomah County long enough to watch the system become compromised as funding was diverted to a more managed care insurance system. The up and donw fudning stream for those in need of services impacts the entire community. The individual experienciuing symptoms, the loved trying to help and those who are on the front lines whether it be social workers, ER or polce.
The stabilization of funding is key to providing servics at all levels and there will be no change until funding is stabilized.
Thanks for your time CAthy
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I'm currently dealing with a huge system breakdown in regards to mental healthcare in conjunction with policing in Multnomah and Washington counties. My brother (age 21) in the last 6-8 months has experienced symptoms of psychosis and at times has refused treatment due to his paranoya, which is a symptom of the psychosis. (Technically he is not yet diagnosed with a specific mental illness.) He is currently in county jail and we (his immediate family) are unable to get him the help he need, possibly a civil commitment, due to the the law enforcement's inappropriate response to his mental state. When he has been eligible for a civil committment the police and the mental health professionals from Wa. Co. are called. When the police responded and are requested by my mother or by his mental health providers to have an evaluation done the police (Portland and Wa. Co. Sherif) refuse and arrest and booked him instead. As I see it the major problem is in the police system. Because in my brother's case as soon as the police become involved the possibility of a mental evaluation goes out the window and because of that my brother sits in jail without the proper help or support from a mental health practitioner. I'm not sure exactly how this can change, but maybe we need to start by looking at both the training and the ideologies that the law enforcement in our community hold before real positive change can happen.
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I'm sorry that I haven't been able to participate today due to schedule conflicts. I am director of FolkTime (www.folktime.org), a non-profit peer support program for people with chronic mental illness. FolkTime has an office in NE Portland and one in Oregon City. Both sites offer people peer-directed programming four days a week and a nourishing meal on three days.
Peer directed services are backed by substantial research in their effectiveness at reducing hospitalization, reducing contact with law enforcement, and improving quality of life for both the member (client)and their caregivers.
There is no charge to attend, but a referral is required. Unfortunately, despite the millions spent on expensive treatment, no local mental health systems provide payment for services at FolkTime, yet they do provide all of the referrals. We have to raise every dollar.
FolkTime is not a crisis center. It is a place many call home and we have members who have backgrounds that include jail time and criminal activity. They all credit attendance at FolkTime with their current well-being.
In other areas, peer-directed support services are considered a low-cost, funded part of the mental health services continuum. Why not here?
Tom Brady
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Time was, the Fire Department responded only to fires. Today, 67% of Portland Fire & Rescue's calls are Emergency Medical Services (EMS) related -- heart attack, etc. Over time, to address a growing need, society has decided that the scope and mission of PF&R needed to be expanded.
Is time that the scope and mission of Portland Police Department gets expanded so that they DO become the first responders to mental health calls because PPD are the folks on the street?
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My daughter has bi-polar illness. She can often tell when she is dropping into an episode. She has health care insurance through Medicare. Yet often when she gets sick, no one, including our public health agencies such as Cascadia and Project Respond which we tried, want to see her and help her keep from spiraling down. She did not have the right kind of insurance for them. And she was willing to get help. She quickly became so sick that she no longer was willing to get treatment. Her sickness had taken over and she no longer thought she was ill or needed treatment or medications. Even with me as an advocate, it took us two years and her losing her home for someone to take her serious enough to provide the treatment she needed, which by that time took six months of in-patient treatment. She has also gone from a homeowner to subsidized housing, costing the tax payers hundreds of thousands more than if she could have found services early on. Until we have a system where everyone, regardless of insurance or lack of, can get the ongoing help and medications they need, we are going to have incidents like this one. Lives will be literally lost, even though many have "lost" their lives long before.
We need to make sure services are available early on for everyone. We need to have a way to get both emergency and ongoing treatments for those who have fallen through the cracks before they become "eminent" even if that means forced commitment. (My daughter is thankful that we finally got her civilly committed.) Until we do, this will happen again and again.
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i hope your daughter will recuperate soon.
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why should the most people of us suffer the illness,in especial,the children. -
Comments are now closed.
Since the 1950's the U.S. has decreased populations in mental institutions by 90% and sent them packing to live in communities without adequate support. Most just changed to a new residence in our ever-increasing jail populations or live without homes. When will we address the need for adequate treatment and support for mental illness?
The police have been asked to work with a situation that they did not create and are not trained to handle safely. The result is a disastrous mix where our community is fractured and everyone loses.
We need to deal with the problem on many fronts but I sense a lack of will to take the steps to fund solutions that can be effective. Community Mental Health was promised with deinstitutionalization but was never given a chance to succeed.