Shared from the 3/10/2017 San Francisco Chronicle eEdition


Training and treatment, not jail

On Mental Health

Violent encounters between police and individuals with mental illness — Sean Moore in San Francisco and Joseph Mann in Sacramento — have highlighted the use of lethal force. In both incidents, police were summoned to address dangerous or disorderly behavior of men who suffered from mental illness; both incidents ended with officers shooting the suspects, one fatally.

Public attention has focused narrowly on perceived police mismanagement of these tragic situations. Unfortunately, it may be difficult to defuse a dangerous situation especially when the officers feel that their lives are at risk or a civilian may be injured.

Violent encounters between police and the mentally ill however represent the tail end of a series of events. To prevent these types of incidents requires a broader view and a few key steps, beginning with:

Give officers the knowledge and tools to work with individuals with mental illness. Crisis Intervention Training is a team-based approach to prepare police to safely address incidents and divert individuals with mental illness to psychiatric and social services and away from county jails. San Francisco’s program, led by Lt. Mario Molina, began training police officers in deescalation techniques in 2001 . In 2012 , the program became mandatory: Since that time nearly 700 officers have been trained. The SFPD’s goal is to have all of the nearly 2,200 SFPD officers trained within the next four to five years.

Help individuals with

mental illness get treatment so police encounters can be avoided. One intervention is to use collaborative or “therapeutic” courts, including behavioral health, drug and veterans’ courts, to divert individuals whose infractions are the result of mental illness or substance use to appropriate psychiatric treatment. These types of courts improve compliance with treatment and lead to a decrease in future violence and arrests. State Sen. Jim Beall, D-San Jose, has introduced legislation (SB8)that gives judges the discretion to divert those with mental illness to behavioral health courts.

Use assertive case management teams to carry out the plans established in behavioral health courts, as well as supportive and stable housing units. The proposal for a Behavioral Health Justice Center in place of a new San Francisco County Jail addresses the needs of the homeless, mentally ill, and those with substance use disorders with four levels of care, ranging from a 24-hour emergency center to an inpatient transitional care unit.

Use Laura’s Law, named after a young woman who was killed by a person with untreated psychosis. The policy, also called assisted outpatient treatment, can work for individuals with serious mental illness who have had recurrent involuntary psychiatric hospitalizations or incarcerations and continue to refuse treatment. Since its initiation in San Francisco in November 2015, most of the individuals who were referred for evaluation accepted treatment voluntarily.

Develop more supportive housing in San Francisco for those recently released from jail. Organizations such as Brilliant Corners provide cost-effective, permanent housing for the city’s low-income and disabled population. But funding is scarce and physical space is limited.

It’s vital that we look at the changes that can prevent violent encounters with police and make our city safer as well as address the needs of mentally ill individuals. We need multiple kinds of interventions and public support to ensure that individuals such as Sean Moore and Joseph Mann get the care they need and deserve.

Dr. Matthew E. Hirschtritt is a psychiatrist at UCSF. Dr. Renee L. Binder directs the Psychiatry and Law program at UCSF and is the immediate past president of the American Psychiatric Association.

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