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What options do police have when interacting with those with mental health issues?

Photo of police car
Jason Rojas | Flickr
St. Louis County Crisis Intervention Team officers respond to as many as 60 calls per week involving a person with a mental health issue, according to Sgt. Jeremy Romo.

Do police do enough to de-escalate encounters with people who may be mentally ill? Why do police use guns against a person with possible mental health issues who is armed with only a knife?

These are questions that seem to crop up after any incident in which police use deadly force against someone who seems to suffer from mental health issues. They arose last week after the fatal police shooting of a man with a history of mental illness in Jennings, and after the death of Kajieme Powell last year in St. Louis.

And they are questions police experts ask themselves.

Crisis intervention

St. Louis County Crisis Intervention Team trained officers respond to about 50 to 60 calls per week involving people with mental health issues. About 80 percent of those are for someone who is suicidal. — Sgt. Jeremy Romo, coordinator St. Louis Area CIT

De-escalation of encounters with the mentally ill — and getting them connected to resources — is the goal of the St. Louis Area Crisis Intervention Team, according to coordinator Sgt. Jeremy Romo of the St. Louis County police. Romo’s department is the only one in Missouri with a full-time employee dedicated to crisis intervention training, and it added a second one in January.

Crisis intervention training, one of the many recommendations made in March’s interim report from the President’s Task Force on 21st Century Policing, helps prepare officers for dealing with those with mental health issues.

The local CIT team trains officers in some 50-plus local municipalities who volunteer to undergo 40 hours of training by mental health professionals for just these situations.

“The goal is to educate officers … to look at someone’s behavior and differentiate between, ‘Is the behavior I’m seeing because of criminal intent or is it because of some sort of mental health disorder?’” Romo said.

It’s critical training, Romo said, given that county CIT-trained officers respond to about 50 to 60 calls a week involving people with mental health issues, the majority of whom are suicidal.

“Many of those situations are volatile, many involve weapons, but the general public doesn’t hear about that because 50 to 60 times a week, officers respond to those situations, they use their skills, they de-escalate that situation and get that person connected to resources,” he said.


 Slowing down and listening

The key is first slowing down a situation upon arrival to find out if mental health issues may come into play, said Chuck Wexler, executive director of the Police Executive Research Forum, which conducts policing research and consulting.

“Police departments are problem solvers, they think (about) what they are supposed to do and deal with it quickly,” he said. “In cases with the mentally ill, it’s almost counter-intuitive because you need to slow things down, get additional officers, get a supervisor to the scene.”

That gives time for officers to gather more information, talk to family members, and assess the level of danger– all of which Wexler says increases the probability of resolving a situation without the use of force.

That time also provides officers a chance to try to find out what is upsetting the person, Romo said, noting CIT training emphasizes listening.

“Empathizing with that person, validating how they are feeling, in doing so you establish rapport with that individual,” he said. “The ultimate goal is to develop the ability verbally to get to the point where you can start influencing them to change their behavior, so in cases like that, to go voluntarily in the back of ambulance and go to a hospital and get help.”

Establishing a rapport

Stabilizing the situation also gives officers a chance to bring in reinforcements in the form of mental health professionals. CIT officers can call in mobile outreach teams from Behavioral Health Response in St. Louis to provide assessments and suggestions for follow-up care.

But establishing a rapport with an individual suffering from a mental health crisis can be a long process, Romo said, and it can change quickly.

“We stress to officers: if the situation is stable enough to work the skills we taught in CIT training to communicate with someone, we don’t put a time limit on that. It takes as long as it takes,” he said. “But sometimes the folks we’re dealing with, because of the mental health issues they have, they make choices or do things that we have to respond to.”

Part of the problem is that many times, people suffering from mental health issues don’t respond the way police expect them to. For example, if that person is armed, he may not listen to police asking him to put the weapon down.

“There are people you can point actually point a weapon at them, and they have no awareness that you are pointing a weapon at them or the consequences of their behavior, nor do they care, and in these circumstances it becomes extremely difficult to influence them,” said Dr. Bill Lewinski of the Force Science Institute, which studies police use of force.

So if that mentally ill person charges with a weapon toward an officer, Lewinski said police must do what they can to protect themselves and the public — even if it means lethal force.

“If the officer has already tried communication, tried ballistic or impact tools in some way, whether projectiles or something else, and the person still insists on coming at them, the officer isn’t left with a lot of tools beyond that,” he said.

The danger that knives pose

Lewinski said he takes issue with the idea that knives aren’t as much of a threat as a gun, saying that police body armor and stab plates don’t protect an officer from wounds to the neck, head, face or forearms.

“For instance, if an officer’s forearm is cut, if they put their arm up to defend themselves and it’s cut, it means their hand is now useless because the tendons that operate hand are no longer functional; they cannot grab a weapon or shoot a weapon. So they are rendered quite defenseless,” he said.

Dr. Bill Lewinski of the Force Research Institute said knives are more dangerous to police, even when armed with guns, than people think.
Credit Mr. Smashy | Flickr
Dr. Bill Lewinski of the Force Research Institute said knives are more dangerous to police, even when armed with guns, than people think.

On top of that, Lewinski said it doesn’t take very long for a person with a knife to be a lethal threat. Most people can slash a knife faster than an officer weighed down in gear would be able to step out of the way. Additionally, Lewinski said his Institute has produced two journal published studies investigating the so-called “21-foot rule,” the idea that a person with an edged weapon within that distance is a deadly threat to officers that some police departments use as a guide.

“At 1.7 seconds, the average person can charge 25 feet, and 1.7 seconds is usually quicker than most officers can get their guns out of their holster, so it seems like it might be an unfair battle when you say someone has ‘just’ an edged weapon and an officer has a gun, but in close enough proximity, the edged weapon can slash or stab an officer and they can be more effective than a weapon,” he said.

In fact, Lewinski advocates for a wider distance between individuals armed with a knife and police.

Alternatives to force

Wexler of PERF agrees on increasing the distance, but disagrees that a knife or other edged weapon is as threatening to officers as a gun. He said officers need to learn how to “pull back from a situation” at a moment of crisis and learn not to “feel you have to resolve a situation."

Additionally, Wexler said police need to be aware of the growing problem of so-called “suicide-by-cop,” where individuals in a mental health crisis will put themselves in circumstances to appear menacing or threatening and making officers feel they should use force.

Sgt. Romo of the St. Louis County Police said he is aware that many people think police will automatically use force against someone who is armed, even if they are mentally ill. But Romo said police will take many factors into account before using force, such as the individual’s intent and whether the person is at a safe enough distance to try to use verbal de-escalation techniques.

“A lot of these folks, people with mental health disorders, or family members of people with mental health disorders, are afraid to call the police because they are afraid we are going to show up and immediately go to trying to arrest their family member or arrest them, or use some type of force,” he said. “But what we find is the more we educate people about the level of training that we give officers too, they feel comfortable calling us.”

More training, or changes?

Still, Romo said the CIT team will continue trying to improve its training. The CIT Coordinating Council also offers special crisis intervention training for dispatchers, on dealing with veterans, and an advanced course.

CIT officers are also increasingly working with the relatively new statewide community mental health liaison program to address “frequent utilizers.” Together, police and these mental health professionals visit with people in the community with a mental health issue they frequently come in contact with in order to better connect them with services.

Sgt. Jeremy Romo coordinates the St. Louis Area Crisis Intervention Team program, which trains officers how to best handle situations with people who suffer from mental health issues.
Credit St. Louis County Police Department
Sgt. Jeremy Romo coordinates the St. Louis Area Crisis Intervention Team program, which trains officers how to best handle situations with people who suffer from mental health issues.

“Officers who had contact with these individuals felt more comfortable with them, and hospital mental health staff who participated with the officers had more positive views of law enforcement,” according to the interim report of the President’s Task Force on 21st Century Policing.”

But Wexler said more crisis intervention training is needed, and his organization, PERF, is hoping for a “re-engineering” of how police get taught about use of force. PERF reported that it has heard from police executives that the training on use-of-force is “fragmented.” For instance, de-escalation skills might be taught on a different day from handling encounters with mentally ill people.

“This makes it difficult for officers to comprehend how all these elements fit together,” PERF said on its website. “Instead, chiefs told us, all of these use-of-force issues should be integrated into a comprehensive scenario-based training format so that we can give officers meaningful guidance on the types of situations they will often face on the street.”