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It's takes a village to respond to mental health crises

A police officer points his gun at a suspect.
Screenshot from Body Camera Video
Buffalo Police
The moment before Dominique Thomas is shot by Buffalo Police March 14, 2022.

Dominique Thomas is due in court Wednesday on charges he ran at Buffalo Police with a knife at his Hertel Avenue address. His appearance may be delayed, however, as Thomas recovers from gunshot wounds at Erie County Medical Center under the care of mental health doctors.

The case has renewed questions about the role of police in a mental health crisis, but the larger question seems to be the role of the community.

A man in mental health crisis

Erie County District Attorney John Flynn raised the dilemma last month, when he announced the officers in the case had been cleared and Thomas was being charged.

"I'm not here to hurt him. I'm not here to persecute him here. I'm here to prosecute him. And in the course of prosecution, as I do every day, I get people help who need help. And so I will do whatever I can to get him help," Flynn said. "But obviously, he had a knife in his hand and he lunged at two police officers. Not even lunged, he ran at them. So, obviously, I have to do what the law tells me to do and he has been charged."

As Flynn indicated, there's been a move toward treatment instead of punishment in recent years, but the community needs to be kept safe, as well.

"People say, 'Well, where was the behavioral health team?' I don't know if they understand how this works," said Capt. Amber Beyer.

Beyer, head of the Buffalo Police Behavioral Unit, said a clinician would not be safe interacting with a man wielding a large survival knife, as she said Thomas did on March 14.

"I think everybody is quick to blame the police, obviously, in this situation, because it came down to a police officer using lethal force against somebody," Beyer said. "But this individual had multiple police interactions prior to this incident where he was transported for mental health attention and, you know, treated and then released back into the community, where he was still obviously unwell."

Cheektowaga Police Chief Brian Gould agreed, there's an inherent danger in mental health calls for which police will always be necessary. Gould said the community needs to understand police are working hard to be part of the solution.

"Nobody wants to be involved in a situation like that. It's a last resort and we need to continue to make sure that we're doing everything in our power to prevent the situation from reaching that level, where the police are the only option and force, up to and including deadly physical force, is the only option," he said.

Cheektowaga created the first Crisis Intervention Team in Western New York in 2013 and the model has spread across the region since. CIT is a partnership among police, mental health professionals and advocates in the community to respond to mental health crises in the safest and most effective way possible.

Officials WBFO talked with agreed, most people with mental illness are not violent, but untreated mental illness can result in violent events. The ultimate goal, then, is to prevent a crisis from occurring in the first place. CIT may be the best tool currently available, but there are gaps in the system.

The CIT Model broken down into Inputs, Outputs and short-term, intermediate-term and long-term Hypothesized Outcomes.
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
The Crisis Intervention Team model.

Gaps in the system

"We have many different agencies in Western New York that have the ability to provide assistance," Gould said. "I think our lack, really, is just that coordination of all the resources and making sure that the highest utilizers are getting the most attention."

"This [the Thomas shooting] is an occurrence that will continue as long as there are no appropriate places for treatment for people with serious mental illness," said Michelle Brooks, executive director of the National Alliance on Mental Illness for Buffalo and Erie County.

Brooks said the team approach has made crisis interventions safer and service referrals more frequent, but the state — as a matter of policy — continues to eliminate the more expensive resources needed by the most seriously ill, who tend to be the people having a crisis.

"In the ideal situation, a person in a crisis should have access to some type of crisis stabilization. So not necessarily the emergency room or inpatient hospitalization, but someplace where they can go on a very short term for crisis stabilization," she said. "And then they need to be also linked to appropriate care. And that can be either community-based or, in some cases, they need an inpatient, more intensive, supervised type of treatment and care. That's really how the system should work."

Brooks said there are other gaps, as well.

"It's hit or miss," she said. "Towns, they are getting on board with CIT and it's improved, but it's not standardized for all police departments and they're implemented differently."

Gould agreed, sharing information is a challenge.

"Dispatchers can run the person's name and see every contest we've had with a person. One of the things when we talk about improving is how well are we sharing that across town lines," he said. "So we border the City of Buffalo. The person may have many contacts in the City of Buffalo. How quickly can my officers see that data, if they're dealing with the same individual? It's available, but not as easy as if they were in Cheektowaga."

Gould said sharing information between police and mental health providers is another area in need of improvement. He said it's a touchier subject due to HIPAA and privacy laws that are particularly strict when it comes to mental health, but can help prevent a police encounter.

Beyer said funding is also an issue.

"You know, the whole discussion is around removing money from the police budget. But if we want clinicians embedded in the police department, it costs money. If we want the behavioral health team running 24 hours, it costs money. If we want every officer CIT-trained, it costs a lot of money. And we want officers equipped with tasers, those things cost money," she said.

Jessica Pirro, president and CEO of Crisis Services, which provides CIT training regionally, said to remember the original caller in crisis.

"Are they going to call Crisis Services first? Are they going to call 911 first? Are they going to call a neighbor who happens to call one of us first? So it's understanding the access points people are coming into the system is that coordinated effort," Pirro said.

Pirro said CIT training is not as far along with 911 dispatchers as it is with police, but there is a "system on the horizon" where the different regional dispatch systems would divert mental health 911 calls to Crisis Services hotline counselors instead of police, as appropriate.

Pirro said Crisis Services handles close to 360 "suicide-level" calls per month and about 60 of those require police intervention.

"We have had families begging to have their loved one arrested and brought to the Holding Center, because they would be safer there than just be left homeless and untreated on the streets," Brooks said. "We had three of these situations in the past maybe six months, because that is the only alternative they see to keep their family members safe. And you can't request somebody to be arrested. So that doesn't occur. That is not really an option."

Still, nearly a quarter of suspects shot or killed during an encounter with police are people with mental illness, according to national data tracked by the Washington Post since 2015. It's prompted legislation like Daniel's Law, named after Daniel Prude, who was experiencing a mental health crisis when he died in the custody of Rochester Police March 23, 2020.

Nothing is as constant as change

All this comes as the New York State Office of Mental Health in February expanded the criteria allowing police to involuntarily transport people with mental illness to treatment.

"We are already taking over 100 individuals, 100 to 150 individuals involuntarily to CPEP [Comprehensive Psychiatric Emergency Program at Erie County Medical center] each month. If we're going to broaden that criteria in order to be able to take more individuals, we need to have the appropriate resources available to serve those individuals who need assistance," Beyer said. "I think that we can all agree that there are gaps in system, but we really need to all focus on collaborative efforts to advocate for community-based changes that support mental health and the safety of the community and all of the individuals within it."

Also coming online nationally on July 16 is 988, the new three-digit dialing code that's been designated for the National Suicide Prevention Hotline. The current phone number (1-800-273-8255) will also remain available to people in emotional distress or suicidal crisis, even after 988 is launched nationally.

Officials likened it to an ever-changing puzzle: a team of community partners are working together on finding and linking its many pieces, but the full picture isn't known yet.

"It's regular, collaborative meetings, it's regular conversations to say, okay, what are we working on? What do we need to do? What can we look at? What data can we evaluate to see where we can have immediate impact? And then what are some longer-term things we're going to have to advocate for?" Pirro said. "It can't always just be we're responding after an incident, because it's just a snapshot of time and it's hard to capture all of the day-in and day-out work that's happening behind the scenes."

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