In Chasse Case, a System That Lost Its Way

From EnzymePDX.com, August 6, 2010

Cathy Horey can remember a time, in the 1990s, when the articles in Portland newspapers about encounters between police and the mentally ill had positive outcomes. She recalls one in particular when cops responded to a call about an apparently disturbed man wandering naked through a large sewer pipe. An officer managed to talk the person out of a potentially volatile situation using skills learned through the police bureau’s then newly introduced crisis intervention training.

“The officer said, ‘Wow, this stuff really works,’” said Horey, a former program development specialist for Multnomah County.

Flash forward to July 28, the morning in which Mayor Sam Adams and three city commissioners voted unanimously to approve a $1.6 million settlement – the largest in Portland history – in a lawsuit brought by the family of James Chasse Jr., a mentally ill man who died in police custody in 2006. Later that afternoon, the council heard recommendations from an independent investigative board about improving the police bureau’s internal review process. That particular meeting featured impassioned testimony from the public, but the most significant comment came from Commissioner Amanda Fritz – not about police procedure, but about Portland’s mental health system.

“We don’t have a system,” she said bluntly.

That’s not entirely true: Multnomah County funds a mental health call center, a mobile crisis response team and a 24-hour walk-in clinic. But many advocates believe the system currently in place is fractured, and that the Chasse killing and recent police shootings involving people said to suffer from mental problems prove it’s not as effective as it should be. And the frustrating part, they say, is that Portland knows what works.

“We know how to provide services for people that cause them to behave significantly differently,” says Jason Renaud, a volunteer for the Mental Health Association of Portland, “but we don’t provide those services.”

It hasn’t always been that way. The story of Portland’s mental health system over the last 20 years is defined by numerous shifts in approach and discussions about “changing the culture.” Why hasn’t any of it stuck? Part of it is funding. But the deeper problem, according to Horey, is the continual “reinventing of the wheel” when it comes to dealing with the mentally ill. Every new official brings a different agenda, she says, when the most effective methods are already understood.

“Crisis is crisis,” she said. “It doesn’t change.”

Horey would know. She helped roll out Portland’s initial Crisis Intervention Team (CIT), a multilayered system patterned after what some experts refer to as the gold standard of community mental health programs. Known nationally as the Memphis Model after the city that first implemented it, the program brings together the police department and health care infrastructure to form a web designed to keep the sick out of prison and in treatment. At the law enforcement level, that involves creating a specialized task force to respond to mental disturbance calls. Officers receive 40 hours of training that includes not just de-escalation techniques but one-on-one interactions with the mentally ill in a stabilized environment.

The ultimate goal, says Sam Cochran of the CIT Center at the University of Memphis, is to foster within officers an understanding of what a person in the midst of a mental crisis is going through and dissolve the stigma associated with the illness.

“You can introduce training to officers, but that doesn’t necessarily mean they’re going to make some of those heart-changes that are necessary,” said Cochran, who helped develop the Memphis Model in the late 1980s in the aftermath of a police shooting involving a 27-year-old schizophrenic. “The CIT program brings about some benchmarks that help ensure a better response.”

The Portland Police Bureau adopted the CIT program in 1994 after a streak of fatal encounters between cops and people suffering from mental disorders. Bolstered by cooperation with the Multnomah County Behavioral Health Division, the local branch of the National Alliance of the Mentally Ill and other groups, by 1995 some 60 volunteer officers had received CIT certification. The officers would respond to calls in which the suspect was thought to be undergoing a psychiatric emergency, and instead of transporting them to jail or a hospital emergency room – where they are quickly cycled back onto the street – they were brought to a 16-bed mental health triage facility at Providence Medical Center that can hold a patient for up to two weeks for evaluation. According to a 2001 report by the American Psychiatric Association, because of the facility’s no-refusal policy for police drop-offs, officers were able to get in and out of the center within 30 minutes, as opposed to the hours potentially spent in an E.R.

Horey says the overall results were “unbelievable.”

“It created a bond and a partnership,” she said. “When you have a partnership where there’s a format to listen and figure out how to fix problems and make things work, it keeps the system open and more honest.”

But then, resources started to dry up. The triage center closed in July 2001, greatly weakening the impact of the CIT model. And when the mental health infrastructure disappears, the pressure falls on police to become, in Renaud’s word, “default social workers.”

Jump to 2006, when Chasse – a 42-year-old with a history of schizophrenia – died of injuries sustained in a struggle with police. In response to the outcry over Chasse’s death, then-Mayor Tom Potter allocated $500,000 to give all Portland police officers crisis intervention training. Although some advocates, such as Renaud, agreed with the move away from a concentrated CIT task force, others – including Sam Cochran – believe specialization is crucial.

“Why don’t we train everyone to be a SWAT Team officer? Because not everyone is suited to that,” Cochran said. “Many CIT officers see themselves in that role. Putting someone who doesn’t see themselves in that role is counterproductive to what you’re trying to do.”

Liesbeth Gerritsen, the Portland Police Bureau’s current CIT coordinator, says that a specially trained officer is not going to be able to respond to every potential mental health crisis. But having to train all 640 officers on the force means less time for hands-on training. Though police still do interact with the mentally ill during training, more of it is now done through videotaped interviews. Gerritsen says that the technique leads to “very honest, very candid discussions,” but that it’s impossible for her to know if the message is being absorbed by each individual officer.

“Most of the class is engaged, sure, or at least interacting with the material,” she said. “Do they get it? Do they use it? That’s not something I have control over.”

The question of whether or not the information is getting through – and causing those “heart-changes” Cochran mentions – may have been answered this year by the deaths of Aaron Campbell and Keaton Dupree Otis, men who were said to suffer from mental disorders and were both shot in altercations with Portland police. Those incidents have caused new Police Chief Mike Reese to talk about the need for a “mind shift.” And some strides are being made in that direction. Reese has voiced support for a pilot program started by his predecessor Rosie Sizer pairing officers with members of Project Respond, the mobile health care crisis response team run by Cascadia Behavioral Healthcare. The county recently received a grant from Washington, D.C.’s Bazelon Center for Mental Health Law to study police encounters with the mentally ill and how to improve the system. And August marks the scheduled groundbreaking for a new $5.3 million Crisis Assessment and Treatment Center to finally replace the triage unit shuttered nine years ago. It is set to open next year.

But the question remains: Can these strands congeal into a truly efficient mental health system? And with the state experiencing a $577 million budget shortfall, how long can it last? For advocates such as Renaud, the answer is relatively simple: “It’s just a matter of doing it. It’s a matter of making it a priority.”