A "Smart" Way To Help The Mentally Ill

Specially Trained Teams Of Police Officers and Clinicians Respond to Citizens in Crisis

From The Daily Journal by Pat Alston, February 4, 2009

Police officer Channing Lang had ended her shift in downtown Los Angeles and was walking to her car on the rooftop of a nearby parking structure when she spotted a stranger.

A tiny, red glow flickered as the man tried to light a cigarette in the dark.

"Can I help you with something?" Lang asked the man. "Do you work here?"

"Yes," the man responded. "I wash the cars [up here]."

She knew he did not.

Lang chatted with the man for a minute or two, then asked if he was thinking about hurting himself.

"No," he said.

"Come on," she said. "I'll walk downstairs with you."

On the way down, the man admitted he had thought about jumping when he went to the top of the six-story building.

Lang got help for him. That's what she does every day.

Lang is a member of the Mental Evaluation Unit, a joint project of the Los Angeles Police Department and the Los Angeles County Department of Mental Health. Through its Systemwide Mental Assessment Response Teams, commonly known as SMART, the unit provides crisis intervention to the mentally ill and psychological first aid to victims of trauma and disasters.

"It's a great partnership," Lang said.

The program, one of the few of its kind in the nation, has been so successful at prevention and intervention that it's used as a model by other cities, such as Houston, according to Lt. Lionel M. Garcia, who heads Los Angeles' Mental Evaluation Unit.

San Diego County also patterned its Psychiatric Emergency Response Team, which teams up police officers with mental-health clinicians, after the Los Angeles program.

"It's really collaboration at its absolute best," said Jim Fix, a licensed clinical social worker and executive director of the San Diego County program.

"These teams save lives and get people into treatment, instead of arrest and incarceration," said Mark Gale, second vice president of the California branch of the National Alliance of Mental Illness.

In 2008, the Los Angeles County SMART teams provided crisis intervention in 4,760 cases, including facilitating the April hospitalization of pop star Britney Spears. Their work accounted for roughly 3 percent of the cases handled by the LAPD last year.

Intervention by the SMART teams kept many of these mentally ill people out of custody and saved patrol officers 5,233 hours, or 436 shifts, "so they could focus on other critical missions," Garcia said.

Each SMART team has two members: a specially trained LAPD officer and a mental health clinician. The team offers a calming presence in a potentially volatile situation, said Charles M. Dempsey, one of the Mental Evaluation Unit's lead detectives.

"Early intervention is the goal to keep a situation from escalating," Dempsey said.

"It's a unique partnership between two bureaucracies," said J.P. "Rick" Guerin, vice chairman of the Daily Journal Corp. and an LAPD reserve officer who works in the specialized unit.

Guerin fields telephone calls from patrol officers who encounter a mentally ill person thought to be a danger to himself or others.

Under Section 5150 of the state Welfare and Institutions Code, such a person can be held for at least 72 hours for a psychiatric evaluation.

Guerin checks the unit's database to see if team members have had prior contact with the person. As a member of the unit, he also has access to both mental health records and criminal justice information.

"When you're dealing with somebody in crisis, you want to make sure you have as much information as possible," Dempsey said.

Based on that information, Guerin advises the patrol officer of a course of action to take until one of the unit's SMART teams arrives on the scene. "I primarily do triage," he said.

The Mental Evaluation Unit gets 800 calls to 900 calls a month. In addition to patrol officers on the street, the unit fields calls from concerned citizens, school administrators and business people reporting incidents involving a mentally ill or unstable person within the city's 468 square miles.

"You never know where it's going to happen," said Sgt. Ben Hetzler, one of the unit's supervisors.

"We respond to any call, any time, anywhere in the city of Los Angeles," said Mack Garland, a licensed clinical social worker and a SMART team member.

A SMART team's job is to assess the risk posed by a person, Garland said. "We try to determine ... does this person need to be hospitalized ... or are there other things we can do?" he said.

Situations involving out-of-control pop stars aren't the only unusual cases the teams are called on to deal with. Garland and his partner recently responded to a Norwegian cruise ship headed into Los Angeles harbor with a troubled newlywed couple.

"Things weren't going well," Garland recalled. The ship's staff believed the couple needed psychiatric evaluation, he said

SMART teams do not discuss the details of their cases because of privacy laws. But Garland did say that, when the ship docked, two SMART teams went aboard: one for the husband and one for the wife.

The team members immediately referred the couple to local mental health professionals, who helped them get beyond the stresses that nearly torpedoed their marriage.

The Mental Evaluation Unit got its start in the mid-1990s, after the county sheriff's department and Department of Mental Health teamed up to provide services for the mentally ill, Dempsey said.

"We mirrored their Mental Evaluation Team," the detective said.

At first, he said, it was a Monday-through-Friday operation. Teams would respond to crisis calls that ranged from a barricaded subject threatening a resident to somebody walking aimlessly in traffic.

The unit, which has evolved into a 20-hour-per-day, seven-day-a-week program, maintains a homeless outreach program, with a SMART team based in the heart of downtown Los Angeles.

"They actually walk Skid Row and try to engage people they believe suffer from mental illness," Dempsey said.

"It's a voluntary type of engagement to see if [the team] can refer them to services," he added.

The teams also respond to community crises, such as deadly accidents and natural disasters. For instance, they went to the scene of the Chatsworth Metrolink accident in September that killed 25 people and injured 135. And they offered "psychological first-aid," Dempsey said, to evacuees of the Oakridge Mobile Home Park in Sylmar that went up in flames in November, destroying 80 percent of the park's 608 homes.

"What greater crisis to experience than losing your home," Dempsey said.

Several years ago, the Mental Evaluation Unit responded to a murder-suicide, where a man shot his estranged girlfriend. When her 12-year-old daughter came into the room, the man shot himself.

"Who takes care of the little girl ... [who had] to witness this tragedy?" Dempsey asked.

That afternoon, the child's three siblings returned home.

"We worked with the kids, talking it through," Dempsey said.

The Department of Children and Family Services then stepped in to find temporary care for the youngsters.

"We're not going to solve everything in a day," Dempsey said, but the teams do provide "a bridge to services."

If a person needs more intensive case management, the unit's Case Assessment Management Program, or CAMP, takes over. Team members work with people who repeatedly call 911. They also try to establish rapport with those who have a potential for violence.

The purpose of the program, Dempsey said, is to free up critical emergency-response services for true emergencies by redirecting high-frequency users to appropriate mental-health services.

"About 10 percent of the clients use about 90 percent of the [emergency] services," said Linda Boyd, mental health clinical program manager for the Department of Mental Health. Boyd oversees all the mental health programs in the county that involve law enforcement.

Dempsey recalled the mentally ill man who repeatedly called 911 "because he liked to hear the sirens." CAMP arranged for a conservatorship for the man.

And then there was the savvy, health-obsessed veteran who knew that patients delivered to a hospital by ambulance receive preferential service. He frequently called 911, feigning medical issues, so paramedics would drive him from his Los Angeles home to the Veterans Administration Health Care Center in West Los Angeles.

"He was averaging four or five calls a week," Dempsey said.

CAMP hooked him up with transportation to the VA and helped reconnect him with his family, the detective said.

The specialized follow-up program responds to "jumpers" and barricaded subjects, Dempsey said. Team members provide intelligence on the mindset of people involved in these incidents and work with negotiators and behavioral scientists to ease tensions at potentially violent scenes.

They also work to identify and treat mentally ill students to prevent school violence, such as the 2007 massacre at Virginia Tech.

"Our unit is about peacefully resolving the situation and minimizing the risk," Dempsey said.

"There are few jobs that ... when you come to work, you save a life," Dempsey said. "Every single call's like that."

One of those calls came two years ago from Wes Walraven, an executive in the finance industry. Walraven, the legal guardian of two brothers, sought help from the police after one of the brothers, who had been diagnosed with paranoid schizophrenia, tried to kill himself. It was the latest in a string of suicide attempts by the young man, who by then was in his early 20s.

"Around Christmastime, I caught him trying to cut his wrists ... late one night," Walraven said.

"We got him stabilized, but the only way you can get someone committed, if not voluntarily, is to call the police," he said. "They can put them on a three-day hold ... during which time they can try to stabilize them at the hospital."

The next day, Walraven made that call.

About 15 minutes after a squad car arrived at Walraven's home, a SMART team pulled into the driveway.

"They were very calm in talking with [him]," Walraven said. "They explained what they were going to do, where they were going to take him."

Lang was the officer.

"He was a sweetheart," she recalled of the young man.

The team found a public hospital that would take the uninsured patient, and the doctors changed his medication.

"He's had a dramatic improvement," Walraven said.

He is now living with his brother and looking for a job. Walraven credits the SMART team for turning the troubled young man's life around.

"Communication is everything," Lang said. "Sometimes you can get through to somebody; sometimes you can't."

Lang describes herself as an "extreme optimist." Even when she cannot help someone, she said, "you can plant a little seed, and maybe that seed will grow.

"You may not see the results right away, and you may never see the results," she said.

But the thought she may have planted a sliver of hope in someone, she said, "keeps me going."

"It fuels us," she said.

In the case of the stranger Lang met on the rooftop of her building, "It was just one of those moments where you're at the right place at the right time," she said.

When that happens, Lang said, "it's magical."

Copyright 2009 Daily Journal Corp.

Source: The Daily Journal

Link: http://www.dailyjournal.com/