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'An extremely vulnerable position': Mental health calls are common for police in the Poconos. Is there a better way to respond?

Pocono Record - 5/4/2021

May 4—Pennsylvania State Police responded to a call about a possibly suicidal person standing on a Route 80 overpass in Bartonsville on Dec. 30.

The caller, 19-year-old Christian Hall, paced along the cleared road with a realistic-looking pellet gun in hand. He was in between counselors at the time, his family said, and in a crisis.

Officers trained in psychology and crisis intervention negotiated with Hall for about 90 minutes before they said Hall disobeyed orders to drop the gun. He approached them with his arms raised over his head, gun in hand, and troopers shot Hall three times, killing him.

Monroe County law enforcement is no stranger to mental health related crises. According to the Carbon Monroe Pike Mental Health and Developmental Services, police responded to more than 250 of these calls in 2020 alone.

"Every officer that's out there on the road is, at some point, going to face somebody who's having a mental health crisis," said Chris Wagner, chief of the Pocono Mountain Regional Police Department.

It's a reality that forces police into the role of the mental health professional — the counselor, the negotiator and de-escalator — with regularity.

While many of these interactions end without casualty, those that don't are prompting law enforcement and mental health professionals to re-evaluate how officers respond to mental health crises.

This conversation comes at a time when viral videos of officer-involved shootings have sparked widespread distrust of police and calls for reform, when pandemic-related isolation has reports of mental illness at an all-time high, and when Pennsylvania State Police face scrutiny for the fatal shooting of Christian Hall.

The Pocono Record spoke with mental health and law enforcement experts to find out how officers assume the role of the mental health professional and what alternatives might exist. Here's what we learned.

Officers are taught to recognize the signs and symptoms of a person's mental state in short, digestible segments. Ruth Moore, director of the Pennsylvania Psychiatric Institute, called it "signs and symptoms for the layperson."

"I found that people didn't want an eight-hour training. It wasn't working well," Moore said. "People did not pay attention after the third or the fourth hour."

Instead, she fits her lesson into a three-hour PowerPoint presentation, which she has taught to Pennsylvania State Police for the last three years. Among the techniques she teaches for de-escalation: Keep your voice low.

"Law enforcement are trained to have this powerful command, and that isn't always the way it would work with somebody with a mental illness," she said. "They'll think that you're the aggressor. Then things can go wrong."

In addition to police academy and field training, state law requires that officers undergo mental health training annually. How an agency fulfills that requirement, or if they pursue additional training, is largely up to their discretion, police chief Wagner said.

Wagner enlisted the help of Carbon Monroe Pike Mental Health and Developmental Services to train Pocono Mountain Regional Police in 2020.

In one exercise offered by MHDS, trainees are told to fill out a job application while a voice speaks to them through a pair of headphones.

"You're worthless," it says. "You need to kill yourself. No one likes you. Shut up. Look down."

The voice might be incoherent and jumbled until one word comes out clearly, said Jennifer Williams, an administrator at MHDS. Other times, it makes clear demands as trainees try to carry out a routine task.

Exercises like this are aimed at helping officers understand why a person in crisis may not listen to an instruction the first time, or why they may allude to something the officers cannot see or hear. Moore's and MHDS training also encompasses things like active listening, implicit bias and displaying empathy.

Officers aren't evaluated upon completing MHDS training, Williams said, but they are expected to self-evaluate and ask questions when needed.

Wagner said officers who appear to struggle in training will go through the curriculum again, though this is rare. Many officers have post-secondary degrees, he said, and "this isn't the type of training the average person can't grasp."

Even so, the scenarios taught during training don't always mimic what officers encounter in the field. Moore said she gives cadets the tools and resources they need to be a successful de-escalator in times of crisis, but de-escalation isn't always an option.

"You're going in there to try to protect yourself and the individual. Unfortunately if there's a threat on your life, then you have to go back to your basic training," Moore said. "I don't get into that part of it."

The heart of basic training is what Stroud Area Regional Police Lt. Scott Raymond calls the "Priority of Life pyramid."

At the top of the pyramid is the hostage. Raymond said officers have a moral and ethical obligation to prioritize their safety first. Next is the private citizen, and third is the police themselves. The suspect falls at the very bottom.

It's a clean and easy tool, but it's riddled with gray space. Consider a person in a mental health crisis who is armed and threatening to hurt themselves.

"They're not really bad guys, because they haven't committed any crime," Raymond said. "It's kind of hard to put them in a category other than as a citizen — but at times, a suspect as well."

In 2017, a 17-year-old boy placed a call to 911, then pulled out a handgun and pointed it at the police who responded. Standoffs like these put police in "an extremely vulnerable position," Wagner said.

"When somebody is intending to commit suicide by cop, they're forcing a police officer into a shoot/don't shoot situation," he said. "At the end of the day, that officer is trained to go home safely."

In the case of the 17-year-old, officers didn't shoot. The boy was taken into custody after a brief standoff, yelling for officers to kill him.

Not all standoffs are resolved as peacefully — the most recent being the case of Hall.

"Any officer, at any time, if they feel that their life or the lives of others are in immediate danger, has the authority to utilize force," Wagner said. "Whatever that force may be."

Even Moore said police encounters with potentially volatile and armed individuals are not the time to be looking at signs and symptoms: "This is the time where you have to go back to your basic training and decide what is the best thing to do."

It's often a split-second decision, Wagner said.

"No officer out there wants to take anybody's life. As a matter of fact, that's maybe one of the worst things that can happen to an officer," Wagner said. "They have to live with that the rest of their life. No officer wants to have to live with that on their conscience."

The consequences of these decisions are often final and tragic, but experts say a solution is within reach.

As numerous law enforcement agencies across the country embrace training for mental health situations, those in the field of academics are still curious as to whether it works in the end.

Authors of the report "The Deafening Demand for De-escalation Training: A Systematic Review and Call for Evidence in Police Use of Force Reform" provided an extensive look into police use of force in various scenarios, including mental health crises.

The report suggests that while de-escalation training is "a promising practice" and a "valuable tool for individuals responding to incidents of crisis, aggression or violence," research remains "relatively weak" as to its effectiveness.

"Recommendations that de-escalation must be used as a primary tool should await additional evidence regarding its effectiveness and any unintended consequences that may impact officer and public safety," the report states in its conclusion.

The authors of the report note that police agencies need to gather and analyze data to evaluate changes in use of force related to policies and training. "To do otherwise could unnecessarily place officers and citizens at increased risk for injury or death," they wrote.

Holona Ochs, an associate professor in Lehigh University'sDepartment of Political Science, has been researching perspectives on policing throughout the Lehigh Valley over the past five years, interviewing over 100 officers and community members about a variety of topics, including mental health care and crisis intervention.

"Officers are telling us that they are getting more mental health calls; they anticipate getting even more of them," she said. "They do understand that this has a lot to do with the closing of the state hospitals and the increasing sort of pressures in society. So they do understand it, but they don't often feel well prepared to deal with it."

They are not mental health professionals, Ochs said, and they are asking for additional support.

Raymond is among those officers exploring alternative ways to respond to mental health crises. He gave a recent example of a man threatening to commit suicide. When Stroud Area Regional Police arrived at his house, he barred the door and threatened to shoot.

So, officers retreated, Raymond said. They referred the case to mental health professionals within the community instead.

"I can tell you 10 years ago, we probably would have kicked the guy's door down to the ground," Raymond said.

It's the way conflicts like these have been handled for years, he said, and it isn't working.

In a report using data from The Guardian's publicly sourced database on lethal encounters with law enforcement, Ochs and her co-authors found that "collaborative teams are more likely to offer better assessment and treatment options than the current punitive responses."

"This is a policy matter as much as it is a matter of police practice," with law enforcement officers playing too many roles to effectively deal with mental health crises.

In the report, the authors state that movements like Defund the Police — which have been misinterpreted as an initiative to eliminate law enforcement funding completely —aim to redirect money to "social service workers who deal with domestic violence, homelessness, drug addiction, gang interventions, etc. ... so that de-escalation and public health experts can be first responders when these incidents happen."

Throughout the pandemic, Ochs said in an interview, many individuals have experienced a variety of crises — mental, health, economic, and others — that compound and create a formidable problem, one that is not evenly distributed amongst the population. This can lead to a feeling of apprehension in trusting law enforcement, especially in incidents where a mental health crisis is underway, potentially leading to deadly results.

"And these are the impacts of which are not evenly distributed across the population — people who are of color watching people of color being repeatedly killed by police ... is very traumatizing, and more traumatizing to some than others," Ochs said.

Opening up mental care to all, as opposed to just populations of privilege, could prove to be an effective strategy in reducing police standoffs with patients suffering from a mental health crisis, Ochs said. While people with high-quality health care coverage and greater income can access mental health services, those in underprivileged communities and communities of color tend to have little to no access.

"It's the mental health professionals who need to be the first responders in those cases," Ochs said. "The police shouldn't be tasked with doing something that then they're not well trained for. It sets them up for failure."

Hall's family is launching the Christian J. Hall Foundation in hopes of embedding dedicated mental health professionals into law enforcement agencies, Hall's cousin Nicole Henriquez said.

"We believe that if a mobile crisis team was called out for Christian on that day, he would be alive," she said. "They were on the bridge for 90 minutes, but I believe that our psychologists would have waited 90 minutes more — or even five minutes more, or found a different way to speak with him."

Among those on the bridge with Hall was a state trooper with a bachelor's degree in psychology and a master's degree in clinical psychology, who attempted de-escalation tactics before Hall was shot. An officer with an undergraduate degree in psychology is not the same thing as a licensed medical professional, Henriquez said.

"We know that we can never have Christian back," she said. "I know. We just want to make sure that his death was not in vain."

Police can still play a valuable role in assisting in mental health crisis situations when they do happen, Ochs said, by providing "that safe space for mental health professionals to do the work that they do."

"Police are very good at setting up a perimeter and keeping a safe space. Why don't they do that? Let's have them do the thing that they're really good at," she noted, adding that when police serve to secure the situation while following the lead of mental health professionals can lead to better outcomes.

Even in situations like that of Christian Hall, who police assumed at the time had a firearm, a psychologist or other mental health worker could play an integral role to maintain safety for both the patient, the public and police by "slowing down the situation," as Ochs put it.

Building connections between the police and the communities they serve could also help to create a relationship that may de-escalate situations before they turn deadly.

Ochs recently was in a trust-building exercise featuring local police forces and community members that was hosted at a local Hispanic Center in the Lehigh Valley.

Police chiefs from across the region, including Wagner, attended the event, and many expressed an interest in learning about 911 alternatives — programs that focus more upon mental and behavioral health crises over crimes.

Ochs found at least 29 such programs operating across the country, "from Chicago to Flatbush to Washington, Eugene, Oregon, Denver, Portland ... Houston," and more, while cities including Philadelphia are "toying around" with similar methods.

Utilizing mental health workers and involving them in these situations and other endeavors can greatly benefit the police, Ochs said, as standoff situations that turn deadly do, in fact, have a strong effect on those officers. Continued collaboration with those two fields could also help law enforcement officers deal with their own mental health issues, such as post-traumatic stress disorder, depression, anxiety, or other conditions.

By working with a blended force of mental health professionals and law enforcement officers to evaluate these situations, the team can focus on prevention.

"What were the mistakes that were made? How do we prevent them from happening again? These are all things that should be done (since) we're going to keep confronting these things. And we really need to start trying to address prevention," Ochs said.

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