"Take care of yourself so you can take care of others"
By Deputy Kurt Barbour
I have been a police officer for more than 20 years and as I near the end of my career and prepare for retirement, my heart is heavy with loss of good brothers and sisters. I started my career like most who read this, with a heart full of good intentions and proud to be able to serve and protect my community in the capacity of a police officer. It is a proud profession and for me a calling. I have seen people at their very best; I have seen people at their very worst. I have sacrificed much in the pursuit of my calling, but I have gained much knowledge and experience along the way and the desire to pass along what I have learned. For some, my words will hit home and strike a chord of recognition deep within. Yet for others, my words will seem of a cautionary tale that will elicit the internal dialogue, “it won’t happen to me.” Like when I was much younger and my father would advise me of something he learned through experience and I shrugged it off, maybe others will do the same with my experience, but a story left untold is wasted experience.
I have had the privilege of working with many excellent brothers and sisters of blue in my profession and have learned from every one of them along the way. I have seized the opportunities that were presented to me along my path to become a Detective working undercover, and in a specialized unit for Gangs, Guns and Drugs. I have been a police negotiator for over a decade and command one of the larger Crisis Negotiation Teams in Illinois. I instruct my department and the County on important topics such as Crisis Intervention Team (CIT) and De-escalation Techniques. I instruct nationwide to Federal, International, State and Local Law Enforcement officers and Military on various Law Enforcement Topics and therefore have the opportunity to hear stories of others in the field on a national level. As we share our stories, one thing becomes very apparent to me, with experience comes pain. The narrative might be slightly different for each story, but the emotion remains unchanged.
There is a lot of mental health awareness portrayed in the media these days and even some focus where it concerns first responders. Decades ago, when I started my career, focus on how the job affects us was certainly not brought to the forefront during my training. In fact, I recall that I was only told there was a high rate of divorce and substance abuse amongst the law enforcement community. I thought nothing more about it because that can’t happen to me. My concern at that time was how to keep myself physically healthy and not being shot while in the course of my duties. I never weighed the possibility that the very job I love could be the cause of many sleepless nights and social anxiety. In fact, I have advised many new recruits in the field, that to outlast this career and make it to retirement, one must consider their own mental health. As a negotiator and CIT officer, we must be able to consider someone’s mental status and provide meaningful dialogue to provide that person with proper help and resources for a successful resolution. How can we do that, if our very own mental health is compromised?
I often give this comparison to people I instruct in officer safety, every one of us have a different sized mason jar. Eventually, we pack enough feelings into that mason jar where it begins to overflow. It becomes essential that we unpack that mason jar as we go. The average police officer will experience critical incidents in their career exponentially greater than the average citizen in their entire lives. First responders see so many negative events that it becomes ingrained in them. I don’t believe we are de-sensitized by these events; we are damaged by them. Suicide by first responders has become a large reason for death among law enforcement. So much so, that an article by USA Today, June 10, 2022 authored by Cady Stanton titled “Police, firefighters die by suicide more often than in line of duty. Why rates remain high” states as a statistic that “In 2020, 116 police officers died by suicide and 113 died in the line of duty, according to researchers.” This to me is alarming. I have known many law enforcement officers who have taken their own lives and all of them were friends. I have also known law enforcement officers who were killed in the line of duty. And now that I contemplate the faces of those who have departed this world far too early, the number of those by their own hand exceeds those of in the line of duty. Of course, my argument here is that it is all in the line of duty. The only difference being that by one’s own hand.
There are many nights that I find it very difficult to sleep because for some unknown reason, an incident I had been part of haunts me. There are incidents I respond to which remind me of other incidents. I have one thing that keeps me on track that some not think of, and that is the ability to speak of these things with others and unpack my mason jar. This for me, however, has not always been easy to do. I began my career as a police officer in a police culture where I felt that showing emotions and feelings equated to weakness. There is no room for weakness in police work. Through my training as a negotiator and CIT trainer, I’ve learned a distinction; having feelings and emotions is natural and not a weakness, but a strength. It is through having feelings and emotions we can connect better to the community we serve as humans and create a positive impact in the community. Today, police officers face many challenges which create enormous stress with public and legislative scrutiny of police raised by the abhorrent actions of a few police officers, more restrictive legislation tying the hands of law enforcement to protect the communities we serve, police officers leaving the profession and numbers drastically reducing and even administration of police in many cases, not supporting their rank and file. While this last item does not evenly apply across the nation, there are some departments who talk about supporting their officer’s mental health needs yet apply further stressful practices and do not fully support their rank and file. There are still cultures in policing out there where favoritism play in the office politics and some administration and supervisors who rather than support their rank and file, see them as a threat to their position and create a hostile work environment more than the job itself.
With all these factors, it is not difficult to see how despair becomes the only reward to some who have dedicated most of their lives in the service of others. Divorce, substance abuse and loneliness become more prevalent in some than the pride of serving the community. The feeling of putting yourself in harm’s way every day for citizens who seem to be against police, a department who cares little about you, and a government who sees police as the problem and not the solution plus more and more responsibilities for little pay replace the feelings of being part of the noblest order to protect those who need to be protected. The thin blue line has much meaning in the law enforcement community, but for some, the darkness of our mental well-being is closing in on that thin blue line making it a diminishing line, until the darkness completely fades that line of mental health to nothing. Some see suicide as the final and only resort, thus ending their career in by horrific means.
How can we help those in need when we have lost our own way? It is akin to not being able to get to a call on time if along the way, we crash our vehicle. There is much more attention now in reducing the stigma often associated with first responders reaching out for help. There is much more emphasis placed now on looking out for one another when we recognize those signs of darkness closing in. There is hope at the end of the tunnel to save those who save others. It is time for us to have one another’s back not only when we are answering a call as back-up, but also in the repair of one’s mental state. Additionally, there is always a hand there for us to help one another. I am never to busy for a brother or sister in blue to listen to them.
Resources for help are there: bluehelp.org, copline.org and weneverwalkalone.org are just a few. Our own “BLUE HEALTH” is important because we DO matter.
Deputy Kurt Barbour
By Detective Mike Walton
What’s over 3000 years old and means “action through thought”? Here’s a clue, “Sticks and Stones will Break my Bones, but Names will Never Hurt Me.”
That child’s saying, a relatively modern-day version of “action through thought” or “MANTRA”, has been around for nearly 200 years. While most agree, names can hurt. This simple MANTRA builds that little something special within our minds called, MENTAL RESILIENCE. Unfortunately, I can’t remember the last time I heard a child say this, and I hate to admit it, but I don’t think I taught it to my children… It’s definitely worth re-visiting.
Children develop so quickly, from completely incapable beings to walking, talking little people. Their simple lives, void of clear understanding and communication, are worth examining and appreciating. It provides perspective of who and what we are, and where we came from…and if nothing else, they demonstrate in real time, a long list of challenges that we have overcome. A child’s life is filled with adversity. They are expected to take life’s challenges head on and continue working…and the amazing part, they do. Sure, they complain, cry, fuss and whine, but they live up to the expectations through mimicking and constant encouragement (even if they don’t know what is being said).
It wasn’t so long ago that I was reminded of childhood lessons. For a time, I had all the strength and energy I ever needed, that is until I didn’t have it anymore. Within a split second of that car hitting me, my strength and energy vanished. My life was altered and I began a downward spiral with a negative inner MANTRA… and like any MANTRA, action through thought was being realized. Instead of creeping towards my goals, they remained ever distant. It wasn’t until I changed my internal monologue/self talk/MANTRA when things started to turn around.
Curious how to start? The task is fairly simple, but when things are at its BLEAKEST, even simple things can be difficult. Write out 20 things that you are grateful for. That’s it. These don’t have to be big ticket items. Start small, with things that might even make you smile thinking how simple this exercise is. Ability to read, could be one, ability to write could be another….walk, talk, listen, see, hear, smell, taste…whatever you can think of. It may sound too simple to work, but it does. Want to improve the results, write the list every morning before the day begins. This sets mental actions into motion that draw upon positives, which produce positive action. Yes, life is full of adversity. Bad things will still happen, such is life, but it’s up to us how we deal with that. Like the child in the playground being teased, repeat to yourself a positive MANTRA.
A “MANTRA” is like the angel on your shoulder, reminding you of all the historic challenges that you have overcome, and convincing you that you can overcome the challenge facing you today. So, if there is something that you’ve been wanting to do, there’s no time like the present to start performing mental action to make it happen. STICKS AND STONES WILL BREAK MY BONES, BUT NAMES WILL NEVER HURT ME.
Until Next Time,
Detective – Policing Ontario
Author of the APOK novel series – www.michaelwalton.ca
Michael Walton has been a Police Officer since 1999. Initially, he started working in the Region of Peel, where he gained valuable experience. Sought after, he brought his enthusiasm and work ethic to various units such as Drug Enforcement, Guns and Gangs, Homicide, Internal Affairs, and Intelligence. In 2011, a near death accident sidelined Michael and doctors weren't sure if he was ever going to wear a badge again. In that down time he completed a dream that he had put off for far too long; he released his 1st novel titled APOK. The sequel to the novel that started it all is was released Thursday October 10th, 2019. It is sure to delight faithful fans and excite new readers. Get ready for a crazy ride. **Foreword Clarion Reviews calls APOK Derailed a blockbuster.**
Detective Mike Walton
By Police Officer Vance Row (Ret.)
Vance Row is a former Police Officer who currently works as a Police/Fire Dispatcher for Ocean City, MD Emergency Services. In his spare time, he teaches yoga at several local studios along the Eastern Shore of Maryland plus "pop up" events for Public Safety/Military Professionals. Vance lives in Ocean City, MD with his wife and their three dogs.
"I'm not one to fail. Whatever I put my name on will be a success." I'm not completely sure where that logic came from because I was a terrible student throughout my grade school life. When I went to college, something changed inside me. I found drive and initiative. I began to care about what I did, and it showed. Not just in the classroom, but also on the football field.
At the end of my college career, I was an Academic, All-American, multiple year All-Conference honors football player. I also received a Bachelor's Degree in Criminal Justice. I found that I like to break stereotypes and didn't want anyone to regard me as a "dumb jock." I decided that if I were to do something, I would give it my all and strive to be the best in the business, no matter the odds.
I found early success in my law enforcement career when I was asked to be part of specialty assignments. Even though I didn't have any administrative talent that I knew of, I was able to adapt. In my off-time, I volunteered to serve on the Local Fraternal of Police Chapter as an Executive Board Member.
While many people would say that I wasn't a "typical" cop, I spent most of my working and non-working hours in law enforcement activities. If something needed to be accomplished, I did it. No matter the task, I believed that I could learn it, create it, earn it, and deliver. I took considerable pride in being the person who "got sh*t done." At work, if extra work, stay overs, or additional responsibilities were needed, I was the "go-to" person.
On October 1, 2016, I was injured, and my life changed forever. It was a silly accident. My police bicycle hit a sidewalk crack and the impact sent me flying over the handlebars and tearing my patella tendon.
My recovery was a lengthy process that included extensive rehab. I never made it back to who I was prior to the accident. The accident not only tore my patella tendon, but also took my sense of self-work and my value to the Police Agency. I was able to manage administrative duties; however, Commanders decided that they no longer wanted me to do what I knew how to do. With no disability retirement, I survived in a tortured existence for the better part of five years.
Despite my arduous work, and years of accomplishment, I felt thrown away by the Police Department. During this time, my alcohol consumption skyrocketed. There were multiple days per week where I woke up on the living room couch, remembering nothing. I could deal with the physical pain from injuries; however, I was unsure how to manage my mental health. I spoke with a therapist regarding the frustration of dealing with difficult individuals, but never considered that I had any personal difficulties.
Late in 2019, my wife told me that "we need to talk" about my drinking. This directly followed an antic-filled afternoon where she took videos to show me what I looked like while intoxicated. At that moment, I knew I needed a change. The first change was to "pause" my drinking. That change remains in effect today, three years later (November 2019).
For so many years, I was the one who maneuvered tough situations. How does one help themselves? Though I appeared fine on the surface, I was troubled inside. I had no idea how to help myself. Then, I found a studio Yoga practice. I may never know why I decided to go one Saturday morning, but I discovered a powerful connection with the folks in the room.
This beautiful practice gave me the ability to release negative emotions and to find a calm, peaceful mind for the first time in years. It was within a month of regular studio practice that I knew I wanted to instruct people like me. I wanted to teach yoga to First Responders and Military personnel.
Mark Twain said, "The two most important days are the day you are born and the day that you find out why." I had unknowingly stumbled into my "purpose" through training to be a Yoga Teacher. I initially enrolled because I wanted to provide a beneficial way to take care of public safety personnel who take care of everyone. My primary motivator was the growing number of suicides in the First Responder and Military communities. When a person suffers in silence and doesn't know what to do with heavy burdens, they tend to make unsound decisions in order to escape pain.
I completed my initial yoga teacher certification (200 hr.) in 2021. This past year, I have additionally completed yoga teacher training programs through Veterans Yoga Project and Warriors at Ease. These programs gave me tools to utilize researched-backed methods that provide students techniques to quiet the storm in their mind and achieve a peaceful existence both on and off the mat.
"The meaning of life is to find your gift. The purpose of life is to give it away." - Pablo Picasso
Connect with Vance and his work on social media!
Facebook: Yoga Rescue
Police Officer Vance Row (Ret.)
By Retired Sergeant/Detective & current Psychologist Adam Pasciak
I worked with Redford PD (next to Detroit, MI) from 1987-2006 in a variety of roles from road patrol, undercover narcotics, road sergeant, and finally as detective assigned to major crimes. I was involved in an on-duty shooting in 1998 and received purple heart for injuries. I was able to return to full duty for a few years, but ultimately received a medical retirement due to injuries. I went on to get PhD in Psychology and am currently working with first responders dealing with PTSD and job issues. I am the author of an article and book on police issues including peer support and dealing with a shooting. I am currently a member of crisis response team often called to help after officers experience traumatic events.
The role of peer support in law enforcement varies from department to department. In some agencies it is non-existent, in others it is somewhat vilified, and then in rare cases you will find that it is a thriving and necessary part of the department. What accounts for the difference? I think there are two main factors: administrative support for it, and ability of the workers to embrace it.
In the law enforcement culture mental health is largely something that is not discussed. It is rare to see it in any of the academy trainings, and I would be surprised to learn that many FTO’s make it a part of the training. Most administrations seem to view it as a thing to use only after something goes wrong, or worse—as a form of discipline. When I transitioned from my role as a police officer to a psychologist wanting to work with police officers, I was not immediately successful. I think somewhat due to a general distrust of mental health workers.
As I have been around longer, it appears I am getting a positive reputation, and this has led to being somewhat embraced by some departments.
I think the last statistic I saw online said the profession is still 80%+ male. As a general rule, males in our culture are not socialized with an emphasis on emotions or learning emotionally supportive behaviors. Consequently, we are not good at recognizing emotions or offering adequate support. Many wives will attest to this, especially those married to police officers.
It gets especially bad for officers because we learn two things early in our careers: if we show weakness, it is grounds for being teased by peers, and there is an expectation that we develop a stoic response to any scene we encounter and not let emotions interfere with our ability to deal with things. This is an example of how our biggest strength can become our biggest liability.
Not only are we bad at offering adequate help to others, but we often do not recognize the need for help for ourselves. It is our role to fix problems for everyone—as men and as police officers. How do we handle things when we cannot sort out our own issues? The number of police suicides each year is a staggering and sad figure. Especially because it is the one area of officer safety we have direct control over. Self-care and an ability to be supportive to peers should be an automatic part of our daily routine.
I recently met with a first responder who told me his department’s idea of support was to ask, “You good?”, with a tone that seemed to imply the expected answer was yes. Even when there was a response in the negative, it was met with how one might respond to someone when we ask the standard greeting of “How’s it going?” and they start to tell us how it really is going. Meaning, it is not meant to be answered truthfully, just a matter of small talk. We generally tune out answers that go beyond a simple response of, “Good thanks. You?”
So we are not good in recognizing emotions in others (other than anger and a few basic other ones) and we are not good at recognizing or getting help when we need it. How can we be effective at peer support? Is peer support even important? From my own experience, following my shooting, I discovered that contact with most of my co-workers was non-existent. This included administration. As a result of this, I felt abandoned and disheartened.
I had always heard about how cops had each other’s backs and I fully expected to have this type of support when I needed it. To realize that having someone’s six was really only related to physical safety was a disappointing eye-opener. I did consider that it was possibly more a statement of my general likeability than anything else. While I am sure that played something of a role, the sad thing is that in talking with many of the officers I see in therapy, this has not been an uncommon occurrence. Some of them even seem like decent, likeable people. I think some of this experience played a role in my ultimate early medical retirement. The physical injuries were a large part of things, but the piece where I felt disconnected and undervalued played a huge role in the energy level I was able to bring to doing the job.
I understand why some departments are reluctant to invest in mental health care. I think there is a view it would be abused and they might be on the hook for costs related to care and potential benefits. That said, it would seem the costs of keeping people who are barely hanging on in roles where they are dealing with stressful situations daily is inviting even greater costs. Greater still if the officer is unable to be salvaged due to poor judgement resulting in injury or death to others, or simply poor attitude resulting in minimal performance. Even worse is loss of the officer due to suicide.
I have been fortunate to see a couple are departments engaged in healthy responses for officers. In one situation, they initiated care for the officer, showed support throughout for him and his spouse, and had a plan in place for his return to the job. To my knowledge, after he completed therapy, he had gone on to have success with his job. That was a rare, happy ending. In another agency, I have seen resources put into finding good therapists, and actually checking in with officers to see how they are doing—meaning really listening when they go on to say they are not doing okay.
In an article I co-wrote with Thomas Kelley (Pasciak & Kelley, 2013), we discussed how critical incident debriefings for officers might be better if they included some sort of hand-on/interactive piece as officers (and men in general) would find it easier to discuss emotional issues better while engaged in some sort of task. For the most part, I continue to see departments using Critical Incident Stress Debriefings (CISD) as more of a CYA, one-time event rather than an opportunity to bring everyone together and make sure we are actually okay. This also means checking in weeks and months afterward, since this is where most of us will typically start to experience the bigger problems as everyone else has gone on with their lives and we are still living with the aftereffects of the event.
It is not a given that men and cops cannot develop healthy emotions and supportive behaviors. It is simply that most of us do not get much education in these areas early in our lives. Luckily, just as we have been able to pick up other skills and knowledge during out lives, we can do the same in this area. We just have to recognize and admit it is worth the effort. The payoff is that not only do we develop closer bonds with others around us, but our overall health is generally improved.
Pasciak, A., & Kelley, T. (2013). Conformity to traditional gender norms by male police officers exposed to trauma: Implications for Critical Incident Stress Debriefing [Electronic Version]. Applied Psychology in Criminal Justice, 9(2).
By Ret. Lt. Rick Arrington
Richard Arrington is a retired police lieutenant from a mid-sized city, crime prevention expert, published author, and retired Virginia prevention subject matter expert and program manager. He has more than 40 years of experience in law enforcement, crime prevention, community policing and as an instructor. He is the owner and lead instructor of the Crime Prevention Center for Training and Services, LLC, which focuses on proactive policing solutions. He serves on several national advisory boards regarding crime prevention, including the International Association of Chiefs of Police.
On July 9, 2021, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) announced that they would be suspending new admissions of five of the eight state institutions for the mentally ill in Virginia until further notice. They cited a lack of capacity to meet the growing need. Nearly 30 percent of all positions in the state institutions were unfilled, with vacancies at almost 40 percent in some hospitals. Virginia already ranked 41st in the nation for their mental health workforce. Virginia’s governor at the time, Ralph Northam (D), a pediatrician, well known for his pro-abortion stance, had just unveiled a statewide initiative supposedly designed to enhance access to mental health services in May 2021. The state’s answer regarding mental health was evidently to accept no more patients, instead of investigating the mass exodus and filling the needed positions.
The Virginia Association of Chiefs of Police quickly responded to the closure. In their response they said:
“Law enforcement does not have a viable choice: if an ECO/TDO (Emergency Custody Order/Temporary Custody Order) is ordered and there is no psychiatric bed, the only option is street release. This is not a viable or responsible option for the treatment and care of an individual in mental health crisis. More than 25 years ago, Virginia made a verbal commitment to community-based mental health care to eliminate the use of state institutions. The verbal commitment has never been realized. The mental health system says it lacks capacity to meet the needs of the mentally ill. Law enforcement cannot answer this lack of capacity nor meet the expectations of the public when it comes to mental health care. Virginia is in a state of crisis, and no one is listening.”
This stripping of mental health treatment facilities is not isolated to Virginia. It was also reported that Wyoming legislators cut $7.5 million from the Wyoming Department of Health funds, which serve mental health and substance abuse services across that state. Those cuts led to the closure of a residential facility for those suffering from severe mental illness. According to a USAFacts Report, Wyoming and Utah were among the hardest hit mental health shortage areas in the United States. Just over 96 percent of Wyoming residents and 83 percent of Utah residents already lived in a mental health shortage area. Nationwide 37 percent of the population lived in mental health professional shortage areas in March of 2021. An additional 6,398 mental health providers were needed to fill the void, according to the report. Perhaps instead of defunding the police and mental health facilities, politicians should focus on prevention.
The Mental Instability Connection to Violence
Focusing on violence from the approach of prevention, I always begin with an attempt to understand the underlying cause, rather than simply the result or reaction to violence. Criminologists and my colleagues in the crime prevention community have known for years that the problem of violence is not one caused by the instrumentalities of violence such as, knives, guns, etc. being more available. In 2019 there were forty-one mass killings and thirty-three were with guns, but California, with some of the strictest gun laws in the country, had eight such mass slayings. To focus on the instruments rather than the root cause is at the very least counterproductive. It should be clear that without a cause there can be no effect. Something led up to the act, and I would assert that the increase in such violence is related to the mental health of the offenders. Surely, we can all agree that a person that sets out to kill groups in a school or a church is not in their right mind.
Many of those serving in a public service capacity encounter persons with mental health diagnosis, or those who are in crisis, and are often ill equipped to cope with their crisis. Law enforcement nationally have moved toward crisis intervention training as the norm to help to address this problem, as have others in the public service field. Some results are being seen. According to a Minnesota news article, “mental health crisis calls reported by Minnetonka police fell by almost a quarter in 2018, after officers took part in a crisis intervention program developed by two Twin Cities criminal justice professors.” The training was a single day training, as opposed to the weeklong course offered by others. The fact that a single day of training may impact those leaning toward violence because of being in crisis is very telling. In the Minnesota example the police department ensured that all staff attended, including non-sworn staff. Training in identifying persons under stress and in crisis, as well as appropriate reaction to them, is particularly important to law enforcement but can also be critical to those in a workplace where interaction with angry or upset citizens is frequent.
The anti-police crowd often cite that since 2015, almost quarter of all people killed by police officers in America have had a known mental illness. While they mean this statistic in a negative way against the police, it reveals the difficult position that law enforcement finds themselves in. These critics like to blame the police, even officers trained in crisis intervention who did everything to avoid the use of deadly force but, due to the mental state of the person, were forced to use force to save themselves or others.
While mental illness is not a sole measure or cause for violent attacks, those with severe mental illness are more likely to engage in violent encounters. In the U.S. mass killings (four or more, excluding the killer in a single incident) in 2019 hit the highest in a single year since the 1970s. Forensic psychologists who studied mass killers discovered that they often suffer from mental illnesses ranging from chronic psychotic disturbances and schizophrenia to paranoid disorders. These were not people who suddenly went on a rampage, but they are individuals who suffered mental incapacity and poor or no treatment for years. In 2018, the FBI released a report from their examination and research into mass shooters. In, A Study of the Pre-Attack Behaviors of Active Shooters in the United States Between 2008 and 2013, the authors examined 63 cases on which records contained the most complete information. They reported that 40 percent of those on which such information was available had received a psychiatric diagnosis; 70 percent had “mental health stressors” and/or “mental health concerning behaviors” prior to the attack; and 86 percent on which such information was available had suicidal ideation or had made suicide attempts prior to the attack. Another report, this one by the U.S. Secret Service released in 2018, reported that 64 percent of the mass attackers they examined experienced mental health symptoms, 32 percent were psychotic, and 25 percent had been hospitalized or prescribed psychiatric meds prior to their attacks. There are numerous other reports prior to these indicating the connection of severe mental illness to violence.
In truth, most citizens with mental health diagnosis function well within society. It was reported that in 2016 nearly 1 in 5 adults in the United States, aged 18 or older (44.7million people) reported mental illness. Obviously we are not suggesting that all individuals diagnosed with mental illnesses are going to become violent attackers. What we are asserting is that the percentages which mental incapacity and crisis plays in mass attacks by violence or weapons are sufficiently high enough that it warrants research and solutions that are realistic and not politically or economically based.
Identifying the Errors Leading to the Problem
One important examination should be re-examining the policy that led to releasing persons into the public who really required a structured environment in which to safely function. The practice of deinstitutionalization is a government policy that started in the 1960s to supposedly better treat the mentally ill, while also saving money. Between the mid-1950s and 1994, roughly 487,000 mentally ill patients were discharged from state hospitals. Was it the treatment of their mental health that was the driving force, or saving of money?
One result of the deinstitutionalization policy was the closure of many mental health facilities, thus fewer facilities were available when needed. This is the dangerous history that Virginia and other states are repeating with their recent actions. Many argue the failure of this effort to “mainstream” mentally ill persons led to a large contingent of the homeless population. One interesting, but little known legal hurdle to assisting these individuals is the Medicaid Institutions for Mental Diseases (IMD) exclusion rules. The law prohibits the use of federal Medicaid financing for mental health and substance abuse residential facilities to a degree. Medicaid law excludes using federal financial participation (FFP) for beneficiaries under age sixty-five who are patients in a Mental Health Institution, other than for psychiatric services provided inpatient beneficiaries under age twenty-one. What was reported to have been designed to give persons with mental illness a better life, resulted in many being homeless, unable to seek mental health care and unable to obtain their needed medications. There are few in the law enforcement or emergency medical field that have not encountered a homeless person suffering from mental illness and for whom services are only temporarily available. The result is that within a month they are again back on the street and wandering aimlessly, uncared for and unable to care for themselves, it is not about their health!
Beginning in the 1970s in the United States, incidents of violent behavior, including homicides, committed by untreated individuals began to be increasingly reported. Such incidents became more numerous in the 1980s and 1990s and have further increased since. Existing studies suggest that individuals with untreated severe mental illness are responsible for at least 10 percent of all homicides and approximately half of all mass killings. These studies have also shown that when these individuals are treated, the incidence of violent behavior decreases significantly. One study revealed that severely mentally ill incarcerated persons were more likely to be violent while incarcerated. The research showed that their violence was the result of inadequate available treatment, along with stress associated with incarceration. This indicates that many severely mentally ill individuals committing violent acts and those incarcerated are the result of their not receiving their needed psychiatric treatment or medications. Approximately 16 percent of all inmates in our prisons are severely mentally ill. Did their inability to receive adequate care in a structured environment lead them there?
Few would suggest that imprisoning mentally ill persons with criminals is appropriate, yet that is exactly what the result of deinstitutionalization has been. Law enforcement has been given few tools with which to assist persons in mental crisis. Often the only option available is to take the individual to a hospital emergency room where they can receive temporary care and be evaluated for any danger that they may pose to themselves or others. This endangers medical staff, who are ill equipped to address the violent mentally unstable patient and it does not help the patient. The U.S. Bureau of Labor Statistics data points to an increasing workplace concern for healthcare workers are five times more likely than other professions to experience workplace violence. The research data also reports that most injuries from assaults at work requiring days away from work occur in the healthcare and social services settings. Much of this is related to the state of mind that an attacker is in, or the sense of crisis or frustration they feel at the time of the encounter.
It is easy to see that a problem leading to incarceration is the lack of available mental health facilities in which to house or treat these individuals because of the failed money saving policy of deinstitutionalization. While destigmatizing serious mental illness is a noble and compassionate goal, to deny its link to violence is not only endangering the public, but also endangering those who need mental health treatment in a structured environment. The question remains, is the cost savings worth it?
An Ounce of Prevention
While some localities are content to expend their energy blaming law enforcement and mental health professionals for harming the mentally ill, others are establishing partnerships to creatively address the mental health of residents in the most humane and effective way. For example, some one hundred miles south of Portland, Oregon is Eugene, a city of about 176,000. While neighbors to the north in Portland were rioting, the Eugene population was working closely with the police to solve problems. To address mental health concerns and divert those in crisis, the Eugene Police Department (EPD) and the White Bird Clinic formed “CAHOOTS.” Cahoots is an acronym for “Crisis Assistance Helping Out On The Streets.” According to the EPD website, “Cahoots is a mobile crisis intervention program staffed by White Bird Clinic personnel using City of Eugene vehicles.” Perhaps most interesting is that the program is not new, it has been in place for nearly 30 years and is well embedded in the community. The City has funded CAHOOTS through the police department long before there were screams from other communities to divert police funds and to lay off officers. They seemed to have recognized that collaboration is needed, not angst. The concern is a community concern, not just a police concern. The program continues to provide support for EPD personnel by taking on many of the social service type calls for service to include crisis counseling. Trained CAHOOTS personnel often provide initial contact and transport for people who are intoxicated, mentally ill, or disoriented, as well as transport for necessary non-emergency medical care. In 2019 they handled 18,583 calls for service and are a great model for collaboratively addressing persons in crisis or suffering from minor mental illness episodes, but what of the chronic severely mentally ill which require a structured environment?
Perhaps it is time to re-examine the cost benefit of investing, rather than divesting, in mental health facilities which can assist those severely mentally ill individuals that are incapacitated or dangerous due to their mental illness. Should we also not examine alternative means of assisting those who only need a structured environment which assists them through providing counseling, psychiatric treatment, and ensuring that medication schedules are followed, and the medications are available? This assisted living-type facility will cost taxpayers something, but the cost will certainly be less than incarceration and will give those diagnosed with manageable mental illness an ability to work and contribute to society, while institutionalizing only those that pose a threat for harm to themselves and others. The lives saved from mass attacks and deadly force by law enforcement to protect others would justify it, but only if concern of those suffering from mental illness and the safety of the citizenry is real and not just an excuse for economic or political gains.
Richard “Rick” Arrington is a retired police lieutenant, published author, trainer and consultant in proactive policing strategies and crime prevention at the Crime Prevention Center for Training and Services.
2Wheeler, Catherine. State Budget Cuts Lead To Closing A Gillette Mental Health Facility. Wyoming Public Radio. May 21, 2021. Retrieved July 26, 2021.
3Over one-third of Americans live in areas lacking mental health professionals. USA Facts Article. June 9, 2021. https://usafacts.org/articles/over-one-third-of-americans-live-in-areas-lacking-mental-health-professionals/ Retrieved July 26, 2021.
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7U.S. Secret Service National Threat Assessment Center. Mass Attacks in Public Spaces. 2018
8National Institute of Mental Health. Mental illness website. https://www.nimh.nih.gov/health/statistics/mentalillness.shtml. Retrieved March 2019.
9Kimberly Amadeo Deinstitutionalization, Its Causes, Effects, Pros and Cons- How Deinstitutionalization in the 1970s Affects You Today. June 25, 2019. https://www.thebalance.com/ Retrieved Dec. 19, 2019
10Legal Action Center Website. https://lac.org/wp-content/uploads/2014/07/IMD_exclusion_fact_sheet.pdf
11Torrey, E. F. Deinstitutionalization and the rise of violence. 2015. CNS Spectrums 20(3), 207-214.
12A. M. Schenk & W. J. Fremouw. Individual characteristics related to prison violence: A critical review of the literature. Aggression and Violent Behavior, 2012. 17, 430-442.
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14Kimberly Amadeo Deinstitutionalization, Its Causes, Effects, Pros and Cons- How Deinstitutionalization in the 1970s Affects You Today. June 25, 2019. https://www.thebalance.com/ Retrieved Dec. 19, 2019
15Cited in the U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics report, Workplace Violence, 1993-2009 National Crime Victimization Survey and the Census of Fatal Occupational Injuries. March 2011. (www.bjs.gov/content/pub/pdf/wv09.pdf) and reported in the U.S. Department of Labor Occupational Safety and Health Administration document, Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. OSHA publication 3148-06R 2016
16CAHOOTS | Eugene, OR Website (eugene-or.gov)
Ret. Lt. Rick Arrington