Deborah Danner coped with schizophrenia for more than three decades, describing it as a "curse" and a "nightmare" whose only "saving grace" was that it was not fatal. But she knew that an encounter with police could change everything.
"We are all aware of the all too frequent news stories about the mentally ill who come up against law enforcement instead of mental health professionals and end up dead," Danner wrote in a 2012 essay, "Living With Schizophrenia."
Last year, on Oct. 18, police arrived at her apartment after her neighbors — not for the first time — called 911 about a "disturbance" in the Bronx building. Sgt. Hugh Barry of the New York Police Department convinced the 66-year-old Danner to put down the scissors she'd been wielding but when she lunged at him with a baseball bat, he fatally shot her, according to police accounts.
"She was not a monster," said Wallace Cooke Jr., Danner's cousin and a retired New York police officer. "She was mentally ill."
How police respond to persons with mental illness is an issue that law enforcement agencies have grappled with for decades.
"Police are the front responders to people in crisis," said Ron Honberg, senior policy advisor at the National Alliance on Mental Illness. "Why are so many people reaching this point? What can we do to reduce the burdens on police, and what can we do to prepare police to respond to these situations?"
PUSH FOR POLICIES
Police unions from around the country came together in June to try to improve officers' responses. They call their effort Compassionate and Accountable Responses for Everyone, and are focused on implementing mental health policies laid out in the 21st Century Cures Act, signed by former President Barack Obama in December.
The law includes changes to federal mental health policies regarding law enforcement training, coordination among multidisciplinary response teams and clarification of the medical privacy law, the Health Insurance Portability and Accountability Act, which protects the information of patients.
Police officials would like to remove obstacles to retrieving that information on medical history, such as a record of past contact with the mental health system. The law calls for a review of HIPAA to eliminate ambiguity in what information can be shared.
The 21st Century Cures Act authorizes the Department of Justice to appropriate $50 million each fiscal year from 2017 to 2021 to cover the large number of reforms included in the section of the law regarding mental illness.
"The vehicle is there, but it needs to be funded," said John George, president of the Fraternal Order of Police in Oklahoma City, where calls for mental health crises have increased by 88 percent in the past four years. "This is a crisis."
The coalition of organizations includes unions from Los Angeles, San Jose, San Francisco, Oklahoma City and Omaha. At its inception, it also included organizations from New York and Chicago, according to The Los Angeles Times.
The police efforts come against a backdrop of an under-resourced mental health system and the absence of quality, consistent care.
"I don’t think there's enough resources provided for mental health throughout this country," Cooke Jr. said. "Debbie was confused and had her issues, but she still was a very intelligent young woman … and didn’t have to die in her bedroom."
About 43.4 million adult Americans live with mental illness, 9.8 million of them with a severe illness. For those Americans whose serious illness goes untreated, an encounter with law enforcement is 16 times more likely to be fatal than for other civilians, according to a 2015 Treatment Advocacy Center study.
"The real story is the failure of the mental health system," said Louis Dekmar, the incoming president of the International Association of Chiefs of Police. "There's just not a large political constituency for the mentally ill, unless law enforcement or family members advocate."
The national attention to the opioid epidemic could spur some improvement. As studies emerge that overdose death numbers are higher than previously thought, President Donald Trump has declared the crisis a national emergency.
"A lot of times, if you read profiles of people who overdosed on opioids … there's an underlying mental illness," Honberg said.
EDUCATION IN DE-ESCALATION
Funds provided by the 21st Century Cures Act would allow police departments to send more officers to receive training in mental illness — and enable them to pay overtime to other officers to cover their shifts. According to Rebecca Skillern, an officer in the Houston Police Department's mental health division, just 12 crisis intervention response teams are available for the city's population of 2.3 million.
"We're terribly understaffed," Skillern said. "While we do try to provide the training to as many personnel as possible, we constantly have officers asking for more units."
Training to deal with these types of crises differs from traditional police protocol, according to Amy Watson, a professor at the Jane Addams College of Social Work at the University of Illinois at Chicago.
"Standard police training is to come into a situation and take control, gain compliance very quickly and resolve it. That doesn't necessarily work when you're responding to someone who's in crisis," Watson said. "If they're really agitated, they're not processing police officers' commands as quickly as officers want them to … and may be very frightened."
In the case of Deborah Danner, Barry, an eight-year veteran, was charged with second-degree murder in May. He has pleaded not guilty.
Danner herself addressed the importance of the issue of training, writing that "teaching law enforcement how to deal with the mentally ill in crisis," was a "very serious problem" that warranted attention.
Though the 21st Century Cures Act just became law last year, some law enforcement and mental health professionals recognized the need for improved training in the late 1980's and established a model with a lasting influence.
Crisis Intervention Team International, an organization that began in Memphis, Tennessee, in 1988, developed a 40-hour course that incorporates expertise from mental health professionals and law enforcement. It works to build empathy for persons with mental illness and to prepare police officers with real-life scenarios, according to Michael Woody, president of CIT International.
"When the officers leave, they seem to have the confidence to handle these mental health calls more compassionately," Woody said.
In Woody's home state of Ohio, 65 percent of law enforcement agencies have officers who have received CIT training.
"They're able to recognize [mental illness], and they have learned communication skills, both verbal and non-verbal, to engage the person more effectively … accessible body language, speaking in lower volume, lower pace, being a little more patient, knowing how to not confirm false beliefs but be respectful," said Mark Munetz, chair of psychiatry at Northeast Ohio Medical University.
A situation that could have escalated and become dangerous is instead defused into someone willing to go for help, he said.
As CARE calls for an increase in CIT and similar training across the country, some officials caution against shifting from voluntary to mandatory training without considering individual officers' passion for handling crises.
Julie Solomon, the chief administration officer at CIT International, believes that states and communities moving to require CIT training for all officers should build a voluntary component, where officers who are passionate about responding to crisis calls would receive advanced training.
“As a parent, the last thing I want is someone who was just forced to go through the 40-hour training to be the one to respond,” Solomon said.
The International Association of Chiefs of Police called for greater attention to the issue in 2016. The One Mind campaign asks agencies to sign a pledge that commits departments to train 100 percent of officers and selected staff, such as dispatchers, in mental-health first aid and 20 percent of officers in CIT training.
By the 2017 follow-up, 139 out of about 18,000 agencies had signed the pledge.
Dekmar cites a widespread lack of funding as a reason for the underwhelming pledge numbers, but believes improving marketing efforts through partnerships with mental health organizations could improve results.
"We expected that there would be more," Dekmar said. "Everywhere that we go, this is an interest."
ALL HANDS ON DECK
The 21st Century Cures Act also calls for a report to Congress on the progression of coordination efforts between law enforcement and relevant agencies, such as behavioral health providers.
"We have to be able to talk to each other … and have a mutual sense of compassion. Law enforcement is asked to be the first responders to a medical crisis," said Charles Lennon, a program manager who oversees joint efforts between the Los Angeles Department of Mental Health and the Los Angeles Police Department.
Experts say that police often do not have sufficient options once they have de-escalated a situation besides arrest or an emergency room visit, so the individual involved may not have the opportunity to receive further mental health support.
"We need to have other options at that point of contact with police," Watson said. "A crisis isn’t a crime."
The mental health crisis in the U.S. can in part be traced to a broad movement in the mid-20th century referred to as "deinstitutionalization." The introduction of the first antipsychotic drugs in 1955 and the implementation of Medicare and Medicaid under former President Lyndon B. Johnson precipitated the widespread closures of mental health hospitals. Individuals receiving inpatient care were left lacking clear support systems in their communities, contributing to more encounters with law enforcement.
"The jails and prisons have become the mental health hospitals," said Kathy Forward, executive director at the National Alliance on Mental Illness chapter in Santa Clara County.
Sgt. Paul Kelly, president of the San Jose Police Officers' Association in California, recognized the need for action after six people with mental illness were shot by city police officers this year, including 35-year-old Francis De La Cruz. Police officers took non-lethal measures to diffuse the situation before fatally shooting De La Cruz, who had picked up an axe and pointed it at the officers on the scene. De La Cruz had previously spent time in mental health institutions.
"When we realized what was going on across the nation, we needed to do something … not only on a local level, but a national level," Kelly said. "But it can't just be police unions knocking on D.C.'s door … I think you're going to have the local elected leaders hold hands on this."
After Danner’s death, New York City Mayor Bill de Blasio and NYPD police Commissioner James O'Neill condemned the shooting.
"Something went horribly wrong here," de Blasio said immediately afterward. "It's quite clear our officers are supposed to use deadly force only when faced with a dire situation and it's very hard for any of us to see that that standard was met here."
"Deborah Danner should be alive right now, period," de Blasio added. "If the protocols had been followed, she would be alive. It's as simple as that."
Presidents of the five unions involved with CARE recently attended a press conference in New York in July, joining other union officials in protesting Barry’s indictment.
"The scapegoating of police officers for the failing mental health system ends today," Jamie McBride, director of the Los Angeles Police Protective League, said at the press conference.
The "accountable" in Compassionate and Accountable Responses for Everyone refers to responsibility across the board, not just for police officers but also the support systems of the persons with mental illness.
The unions plan to launch public service announcements intended to show what goes through the minds of police officers and the protocol they follow when, for example, they pull a driver over.
The police efforts follow years of outcry —and accusations of racial discrimination — over the deaths of unarmed black men shot by officers. Often the officers were not charged in the deaths or if they were, they were acquitted after trials.
The Washington Post reported 643 police shooting deaths this year. Mental illness played a role in a quarter of the shootings, according to the Post.
In the case of mental illness, police officers say they are particularly frustrated with the public's lack of understanding of the difficulties they face when they respond to crises and they want their side of the story known. They say they will hold politicians accountable if they over-politicize police encounters.
"These encounters are being filmed, [with] more and more tragic outcomes," Honberg said. "All of that has escalated the visibility of these situations. What happens is that the police get blasted ... and sometimes it's justified and sometimes it may not be as cut and dry."
Union officials say that they plan to lobby local city officials and congressional delegations to implement and fund the 21st Century Cures Act policies.
"When the mental health system is not funded properly, it's a danger to the citizens, puts a strain on law enforcement and it hurts the quality of life in any environment, any city," George said.
One sign of progress was the Senate confirmation earlier this month of psychiatrist Elinore McCance-Katz to a position created as part of the legislation, an assistant secretary for mental health and substance use disorders.
John Snooks, executive director at the Treatment Advocacy Center, believes police unions' support can only help.
"If you can have law enforcement making the case for implementing the programs … that's going to be really powerful ... and changes the conversation for the public," Snooks said. "And lawmakers always listen to law enforcement because they're the ones on the ground."