(2-16-21) Recommendations by a Trump appointed commission studying ways to, among other things, improve law enforcement interactions with those in a mental health crisis are well-worth reading – despite heavy criticism aimed at the panel for being politically partisan and apparently violating federal open meeting requirements.
Shortly after the President’s Commission on Law Enforcement and Administration of Justice was appointed in January 2020, I warned in a blog that then-Attorney General William Barr was putting partisan politics above common sense in stacking the commission with pro-Trump officials or those who came from strong Trump voting districts rather than drawing from a wider swath of experts. A federal judge appointed by former President George W. Bush ruled last November that the panel was bias and had not notified the public about its meetings. He issued an order requiring it either to broadened its membership or include a disclaimer in its final report acknowledging his complaints. The panel chose to add the disclaimer.
Because of the political dust-up, the commission’s December report has been largely dismissed.
That’s a shame because several of its recommendations about mental illness are spot on.
Among them: create drop off centers rather than hauling those in crisis to jails and emergency rooms, make certain everyone booked into jail is screened for mental illnesses, increase police training about mental illnesses, do a better job triaging emergency calls, and create more treatment dockets.
The commission also called for ending the IMD exclusion, that prohibits federal Medicaid dollars from being used to reimburse facilities with more than 16 beds.
Those recommendations should sound familiar given the panel’s choice of witnesses. While he was still executive director of the Treatment Advocacy Center, John Snook was invited to testify and participate in a panel discussion. D. J. Jaffe also submitted written testimony before his death. On page 41 of its report, the commission quotes from his book, Insane Consequences.
“The IMD Exclusion precludes states from receiving Medicaid for adults in state hospitals which forces states to close the beds. . . . When an officer wants someone admitted they sometimes sit in the ER for hours only to have the hospital overrule the officer or discharge the person before they are stabilized because of the lack of beds. They ’”158 become ‘round-trippers’ and ‘frequent-flyers.”
The commission also relied heavily in its footnotes on Dr. E. Fuller Torrey’s writings and former TAC Executive Director Doris Fuller’s findings. (There was little input from mental health consumer groups.)
Others who submitted public comments or written testimony included several familiar names. Jerri Clark from Mothers of the Mentally Ill; NAMI national and several of its state chapters; Ron Bruno from CIT International, and local Virginians: Fairfax County Police Chief Edwin C. Roessler Jr., and Arlington Judge Louise DiMatteo.
Many of the commission’s findings are duplicates of what the Interdepartmental Serious Mental Illness Coordinating Committee has recommended.
The problem is getting worthy recommendations turned into action and policy.
Sadly, the partisan grumbling about the commission and its lack of interest in viewpoints other than law enforcement’s has diminished the impact of its report. I fear its mental health recommendations will join a stack of other well-intentioned mental health studies gathering dust in Washington.
From the report:
Chapter 3: Alleviating the Impact of Social Problems on Public Safety
3.1 Recommendations for Rebuilding Behavioral Health Treatment Services in the Community.
3.1.1 State and local governments should implement or enhance co-located, comprehensive, one-stop-shop systems of care to screen, assess, and treat people with mental illness and substance use disorders that meet the demand of the community, including criminal defendants.
3.1.2 State and local governments should develop multi-service centers to provide triage and connections to longer-term care for people with mental health disorders, with substance use disorders, and who are homeless.
3.1.3 Congress should eliminate Medicaid’s institutions for mental disease exclusion and Medicaid’s inmate exclusion policy.
3.1.4 Local government leaders should develop and implement a formal data-informed collaboration of criminal justice, public health, and social service agencies to reduce the communities’ unmet behavioral health treatment and homeless service needs.
3.1.5 Congress should fund the Department of Health and Human Services to increase the awareness capacity, quality, uniformity, and coverage of 211 and 988 services nationwide to reduce the burden of call response in situations involving the police.
3.2 Law Enforcement’s Role and Responsibilities to Address Social Problems.
3.2.1 States should develop policies and baseline training for local call takers for all N11 codes (e.g., 911, 211, 411, or 311). These policies should include procedures to effectively triage calls for individuals experiencing mental illness, substance use disorders, and homelessness during a crisis or a non-crisis situation.
3.2.2 Law enforcement agencies should have policies and procedures specifying officer response protocols for calls for service that involve individuals with a mental health disorder or substance use disorder or those who are homeless, including the integration of behavioral health professionals and other community services providers.
3.2.3 Law enforcement agencies should develop a training program for contact with individuals with a mental health disorder or substance use disorder or those who are homeless.
3.3 Improving State Court Responses to Social Problems.
3.3.1 States should expand their use of treatment courts, provide oversight to ensure adherence to the model, and provide funding for treatment and service specialists.
3.3.2 States should adopt programs to reduce the bottleneck of the process for competency restoration to stand trial.
3.3.3 The Department of Justice should examine how local laws and policies that decriminalize or reduce sanctions for drug use or activities related to homelessness impact law enforcement and public safety.
3.4 Prioritizing Treatment in Corrections.
3.4.1 Jails should screen every individual booked into the facility for substance use disorder and mental health disorder. Jails should follow up with a full assessment for anyone who screens positive.
3.4.2 Correctional facilities should provide evidence-based treatment for inmates with behavioral health disorders while they also address the inmates’ criminal behaviors and trends.
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