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Two cities took different paths in wake of tragedies

Editor’s note: Earlier this year, the Greater Albuquerque Chamber of Commerce organized a visit to Tucson by a group of business, health, judicial, political and law enforcement leaders to study its innovative approach to tackling mental illness and police response. Those attending included Mayor Richard Berry, County Commission Chairwoman Maggie Hart Stebbins and Chief District Judge Nan Nash. Today, Winthrop Quigley begins a three-part series on Tucson’s programs. Part 2 will be published next Sunday.

The case was shaping up like a repeat of the shooting of Rep. Gabrielle Giffords.

A military veteran attending Pima Community College in Tucson was experiencing delusions that he had been assaulted on campus. He demanded action from college officials. When they didn’t respond to his liking, he became more agitated. Acquaintances began to worry he was going to become violent.

Finally, he sent an email to then-U.S. Rep. Ron Barber saying that if Barber didn’t fix the problem, he would “go Loughner on you.” That was a reference to Jared Lee Loughner who had shot both Barber and Gabrielle Giffords, a congresswoman at the time, during a public event in Tucson.

Giffords’ injuries forced her to resign her seat. Barber, who had been her chief of staff, won a special election to Congress.

Loughner also had been a Pima Community College student. His behavior became more frightening and erratic until he was suspended in 2010.

He killed six people and wounded 13 during his attack on Giffords, who was his target. He was diagnosed with schizophrenia after his arrest.

The police were called once Barber was threatened, but the Tucson Police Department’s response was not what you might expect.

Instead of uniformed officers or a SWAT team, members of Tucson Police Department’s Mental Health Investigative Support Team were notified. These are cops. Sworn law enforcement officers.

But they specialize in dealing with the mentally ill. They use unmarked cars and wear civilian clothes. Their goal is to put people on a path to recovery, and to avoid violence and confrontation.

The unit was conceived in the Pima County Sheriff’s Office after the Giffords shooting. The sheriff’s chief of corrections, Byron Gwaltney, who at the time was in charge of the Loughner investigation, was looking for a way to prevent what are called mass-casualty events – an attack involving four or more victims. Two-thirds of all mass-casualty attacks since 2000 were committed by people with severe mental illness, according to Paul Sayre, the Tucson police captain who runs the department’s investigations division, to which the mental health unit belongs.

Law enforcement is doing “very little” to prevent such attacks, Sayre said. “Right now, most agencies teach active-shooter protocols.” If police can help keep mentally ill people in a recovery program, “they are not going to commit a mass-casualty event,” he said.

Tucson’s Mental Health Investigative Support Team is responsible for serving court orders issued when mentally ill people get on the wrong side of the law. If a condition of a man’s release from a criminal proceeding is that he get treatment, for example, officers from the unit are sent when the man doesn’t show up for treatment. The unit has handled 300 court orders since it was formed in January 2014. No MHIST officer has ever had to use force when serving an order, Sayre said.

Officers in the unit got the veteran who was threatening Barber connected with mental health services and check on him regularly. He is doing well, Sayre said.

Albuquerque comparison

In the Albuquerque area, we’ve come to equate mental health treatment shortcomings with our policing problems. I’d guess few of us spent much time thinking about mental health treatment until we saw the video of the homeless and mentally ill James Boyd shot and killed by Albuquerque police officers.

Part of the Albuquerque and Bernalillo County delegation that traveled to Tucson recently poses in front of that city's Crisis Response Center, which puts many mental health services under one roof. (Courtesy of Greater Albuquerque Chamber of Commerce)

Part of the Albuquerque and Bernalillo County delegation that traveled to Tucson recently poses in front of that city’s Crisis Response Center, which puts many mental health services under one roof. (Courtesy of Greater Albuquerque Chamber of Commerce)

County Commissioner Maggie Hart Stebbins said a major reason the Bernalillo County government hopes to raise $20 million annually for mental health services with a gross receipts tax increase is to keep the mentally ill out of the Bernalillo County lock-up, where the cost of treatment is high and the long-term chance of recovery is low.

Last year’s $6 million judgment against the city for the wrongful death of Christopher Torres, diagnosed with schizophrenia and killed in his own backyard by police officers attempting to serve an arrest warrant, is more proof that the human and financial price of failed policing of the mentally ill is too high.

The Tucson Police Department is known for successfully and nonviolently defusing crises brought on by mental illness. Tucson and Pima County have what appears to be one of the better mental health treatment systems in the nation.

Almost two dozen New Mexico governmental, community, business, police and mental health leaders visited Tucson in January on a trip organized by the Greater Albuquerque Chamber of Commerce.

Paul Hopkins, a veteran mental health counselor in Albuquerque and a member of the chamber’s mental health systems task force, said the key difference is that the Tucson area has a system with which to deliver mental health services and the Albuquerque area does not.

“Mental health resources are fragmented and profoundly under-resourced” in Bernalillo County, Hopkins said. “That is not a system.”

“If you’re going to look at police issues, you have to look at infrastructure issues,” he said.

Tucson built its infrastructure over a 30-year period, and not for entirely altruistic reasons. Pat Benchik is CEO of Connections AZ Inc., a company that has a contract to manage the Pima County mental health crisis system. He said the county lost a class action lawsuit in 1981 on grounds it violated a state statute requiring it to provide “a full continuum” of services to the mentally ill.

Pima County was forced to work with a court-appointed monitor to build a system and it had to spend a great deal of money to do it.

Benchik said that, over time, the citizens of Pima County “coalesced around concepts of the need for a crisis system to respond to less-advantaged citizens and to promote the concepts of recovery – that people can get better.”

Ten years ago, Pima County voters approved a $64 million bond issue to build the Crisis Response Center. The center was completed four years ago in the southern part of Tucson on a campus that includes a psychiatric hospital, a mental health center, the county health department, a University of Arizona medical school facility and a number of outpatient programs. The local National Alliance on Mental Illness chapter is planning to move there.

The center is the door through which anyone can access the county mental health system, no matter how ill or whether he or she can pay for treatment. Before the center was built, police officers either tried to get someone they picked up into an emergency room, a process that could take eight hours, or book him into the jail, a one-hour exercise.

These days, a cop can drop someone at the crisis center and be on his way in an average of eight minutes. Police drop about 600 people a month at the center. Another 400 people a month come to the center on their own to get help.

Treatment and discharge planning both begin as soon as the patient walks in, Benchik said. A nurse begins a medical screening. A social worker asks about services the patient already receives, contacts family members and starts a case management plan. A physician begins a clinical interview.

If hospitalization is required, the center finds a bed. Most patients are discharged in less than 24 hours with a plan for follow-up care, appointments for services, a medication plan and, if necessary, a plan to obtain job training and housing. A case manager, and sometimes one of Capt. Sayre’s team, follows the patient’s progress and helps him access the care he needs.

It costs $15 million to $20 million to run the center, much of it provided by Medicaid, Benchik said, but cost savings abound elsewhere in the mental health system. For one, in-patient admissions were cut in half because the police had somewhere to take mentally ill residents other than an emergency room, he said.

Hopkins said Albuquerque-area practitioners and health policy advisers to local government have been saying for at least 10 years that a triage and crisis response center should be built in Bernalillo County. More important, he said, patients need a way to find and pay for the right kind of services after they leave such a center. The services are hard to find and there aren’t enough of them, Hopkins said.

Call center supervisor Richard Watchman reviews calls at the Crisis Response Center in Tucson, Ariz. Tucson's more centralized approach to mental health care is being considered as a model for Albuquerque. (A.E. Araiza/Arizona Daily Star)

Call center supervisor Richard Watchman reviews calls at the Crisis Response Center in Tucson, Ariz. Tucson’s more centralized approach to mental health care is being considered as a model for Albuquerque. (A.E. Araiza/Arizona Daily Star)

Elizabeth Simpson, of Bernalillo County’s public safety division, said the University of New Mexico psychiatric in-patient facility is too small and is set up to take only certain patients. A patient dealing with substance abuse, for example, is often not admitted. Kaseman Hospital has a psychiatric unit, but it, too, is small and can admit only certain patients. Officers and deputies often find that they haven’t even left the hospital parking lot when the person they picked up comes walking out of the building without receiving help and with nowhere to go to obtain it, Simpson said.

John Hyde

To get a sense of how things could work better in Albuquerque, let’s revisit the tragic case of John Hyde.

Hyde had been diagnosed with schizophrenia but, with medication and mental health support, he did well for 15 years, according to his family.

However, in 2004, Hyde began seeing a new therapist who questioned the diagnosis of schizophrenia and changed his treatment to include herbal remedies, guided imagery and therapies designed to treat post-traumatic stress disorder, family members said. Hyde told his family that his psychiatrist changed the medications he took.

By the end of the year, Hyde was trying to get a new doctor. He began making almost daily phone calls to Kaseman Presbyterian Behavioral Health Care to complain of his treatment. His family believes he stopped taking medication around March 2005. He began asking family members to provide him with weapons. Family members and neighbors were frightened by his worsening behavior.

Hyde’s brother Robert tried for weeks to contact John’s psychiatrist. He sent letters to practitioners at Presbyterian. In April, Presbyterian officials admitted John Hyde to the hospital, but released him four hours later. According to Hyde’s criminal defense lawyer, hospital records say the medical staff knew that Hyde owned a handgun.

In August, Presbyterian asked Albuquerque police to pick up Hyde for another evaluation. Hyde shot and killed the two officers dispatched to his home. Earlier that day, he had killed three other people.

Tucson approach

The Tucson approach would have allowed Hyde or his family a single crisis center to approach for help. The center would have evaluated him quickly. A case manager would have communicated with everyone involved in Hyde’s care, including his therapist and psychiatrist. The team would have identified services Hyde required.

APD’s MHIST officers would have kept in contact with Hyde to make sure he was doing well. If Hyde needed to be picked up by police, an MHIST unit would have been dispatched and the officers would have been completely aware of Hyde’s difficulties before they left the police station.

By default, many of Bernalillo County’s mentally ill people end up in the county jail, where about 40 percent of inmates are receiving some type of mental health service, Simpson said. When the prisoner is released, he is given three days worth of medication and the phone number of a mental health practitioner or agency he can contact for follow-up care, Hopkins said.

No one makes sure the pills are taken or the follow-up care is sought. If the inmate was receiving Medicaid benefits to pay for care before his arrest, he lost them while in jail.

It isn’t a bad system, Hopkins said. It is no system at all.

Next Sunday, comparing the two cities’ policing approaches.