Brandon police responding to increased mental health incidents
BRANDON — There was a recurring item in the Brandon Police Log this spring.
“Mental Health Issue, Triangle Court. Subject transported by Brandon Area Rescue to Rutland Regional Medical Center.”
Brandon police and BARS were often called to the same residence on Triangle Court off McConnell Road two or three times a week.
The policing term “mental health issue” can cover myriad issues from a panic attack to a full-blown psychotic episode to attempted suicide. Like many local police departments, the Brandon police are called to handle mental health issues fairly regularly all over town.
The notion of community-based mental health care is not easy in a rural state like Vermont. The miles between towns and the nearest hospital, let alone psychiatric evaluation facility, often means there is no time to get a mental health counselor on-scene. Crisis intervention has to happen locally. Enter local law enforcement and emergency services.
The Reporter spoke with state and local officials for an in-depth look at how rural Vermont communities and state agencies bridge the gaps in caring for the mentally disabled in the modern age.
TROUBLE ON TRIANGLE COURT
In this case, the individual was under the care of the Department of Disabilities, Aging and Independent Living (DAIL), residing part-time on Triangle Court with 24-hour supervision. But when he got agitated, the client would self-harm, repeatedly banging his head against a wall, lighting his clothes on fire, or cutting himself with a kitchen knife. And when the client was agitated and threatening to self-harm, the caseworkers would call the Brandon police.
According to Brandon Police Chief Chris Brickell, his officers were called to Triangle Court for this client 24 times between Dec. 4, 2015, and June 1, 2016.
Each time, the client was transported to Rutland Regional Medical Center for evaluation. But because the client has been deemed competent and not “a danger to himself or others,” he has the right to make his own medical decisions and discharge himself from the hospital. He then returns to Triangle Court.
Not long after The Reporter interviewed Brickell for this story, the client was moved to another house in a different town in Addison County. But Specialized Community Care, the agency under DAIL that manages these clients and places them in communities, owns the mobile home on Triangle Court, which will continue to be used to house its clients.
“We’re not mental health professionals and we’re being forced to be experienced in many more things than we’re trained to do,” Brickell said. “(The client on Triangle Court) is taxing the services we have to offer because Specialized Community Care placed him here. It’s not their fault, but it’s a lose-lose situation.”
DAY IN THE LIFE
The Brandon police body cam video of the client is both telling and disturbing. In one encounter, Lt. Rod Pulsifer partially opens the door to a bedroom and is heard gently talking to the client, who is rocking in a desk chair. A 10-inch kitchen knife is visible on the desk next to the client’s hand. He does not respond to Pulsifer’s questions.
Pulsifer asks the man to please give him the knife so he can put it in another room. The client is clearly agitated, rocking and whimpering softly. Still, he does not respond. Pulsifer continues to speak gently to the client, who then picks up a cigarette lighter and lights the sleeve of his shirt on fire. Pulsifer implores the client, “Please don’t do that, please put the fire out,” and the client extinguishes the flame on his sleeve.
Suddenly, the client’s whimpers get louder and he picks up the kitchen knife and presses it to his own neck.
“Don’t do that,” Pulsifer is heard saying. “I care about you and I don’t want you to hurt yourself. I know you’re upset. Let’s work this out.”
The client weeps softly and then suddenly throws the knife at the wall in front of him, where it sticks, and Pulsifer enters the room.
In another body cam video, Brickell answers a call to the same location with Cpl. Adam Murach. They are seen entering the mobile home and calling the client’s name. He is not immediately found, then Cpl. Murach locates him locked in a bathroom. The officer asks him to please come out so they can talk, calling him “Buddy” and telling him it’s OK. The client unlocks the door and an officer asks him if he’s OK and if he needs a hug. The client nods and the two hug. Then the officer asks the client if he’d like to have the handcuffs on and if it would make him feel safe, and the client says he would like the handcuffs. Cpl. Murach then puts the cuffs on the client’s wrists in front of him with plastic zip tie restraints.
Brickell said that while each interaction with this client ended peacefully, there are no guarantees.
“Even though we’ve dealt with him successfully 24 times, that could change any time,” Brickell said. “And then you have a worse situation for everyone involved.”
But the issue is not just the danger of these situations to all parties, Brickell said. It’s that repeated mental health calls tax local law enforcement and emergency services, potentially pulling them away from other emergency calls and costing money.
Years ago, Brickell said, a client who repeatedly triggered 911 calls would be arrested and incarcerated or committed to psychiatric facility. But with the increasing loss of mental health beds in the state, only the most mentally ill are involuntarily committed.
“They want us to come in and fix it, but we’re just a temporary plug to resolve the safety issues,” Brickell said. “We have no place else to go with this guy. As much as I want to, a person has a right to live where they like and be part of the community.”
It is that belief that was the driving force behind a systemic change 25 years ago in the way the mentally and physically disabled were treated in this country, and particularly in Vermont.
The state closed the Brandon Training School in 1993 and moved toward a model of integrating those with emotional and mental disabilities into local communities. The idea was part of a nationwide shift in the treatment of the mentally disabled, away from institutionalization and into supervised independent living. The real-life skills some clients were learning in the Brandon Training School were rarely if ever used outside the institution’s boundaries.
The goal was to stop marginalizing the physically and mentally disabled and instead teach them to live independently and challenge them to improve their life skills.
MANY ARE SUCCESSFUL, SOME ARE NOT
Ray Hathaway is the executive director of Specialized Community Care in Middlebury. He reinforced the notion that independent living and learning life skills is the goal with all of his clients. He also confirmed that SCC purchased the mobile home on Triangle Court in Brandon to house DAIL clients. He also said that he and DAIL officials were aware of every 9-1-1 call made regarding that client in the last six month, and that a critical incident report is generated for each incident.
“Everyone up and down the line is aware of the situation,” Hathaway said. “Some individuals are extremely challenging and resistant to treatment. This case is well-known throughout the system, and it is a particularly challenging case.”
Hathaway added that some clients, like this one, also receive all of the benefits of Vermont’s mental health and disability programs and work the system to their advantage. In this case, the client reportedly did not like one of his caseworkers and would act out when challenged.
“There is more than one individual in the state that knows how to work the system,” Hathaway said. “They are protected within the system and it allows the individual to behave in a certain manner.”
Much like the police definition of the mental health issue, so it goes society. Anyone with an addiction, depressive tendencies, anger issues, seasonal affective disorder, even those in substance abuse recovery, technically have some form of mental illness.
And so the following statistic, while jarring, must be taken with a grain of salt: According to the Vermont Department of Corrections, 60 percent of men and 60 percent of women currently incarcerated in the state have been diagnosed with some form of mental illness.
And jail is not where someone with a serious mental illness wants to be, Hathaway said, because the state’s prisons are not equipped with the personnel trained to handle those prisoners.
“Generally speaking, no, there are not services available,” he said. “Either the individual doesn’t go to jail, or they don’t go for very long.”
One reason is the lack of psychiatric personnel and facilities in prison, but more importantly, it’s that punishment and confinement fly in the face of the integration model of therapy for mental health patients.
“We are always doing progressive development for everyone we serve,” Hathaway said. “We’re always trying to teach, educate, change behavior, and change the way the individual interacts with the world. We explicitly do not use punishment models. Our job is to do our best to make sure those (criminal) situations don’t happen again.”
NOWHERE ELSE TO TURN
Every individual that enters the state system of care brings with them their life’s baggage, their issues, their fears. Some are on medication, others on the wrong medication or not medicated enough. Many have alienated their families, or their families have given up on trying to help them. It is often when people have nowhere left to turn and no one left to advocate for them that the state steps in to help.
Hathaway acknowledged that while local law enforcement and emergency services are considered partners in the quest to help the state’s mental health clients who may get off track, the onus is on him and his team of case managers at SCC, DAIL and other state agencies who are working to improve the quality of life for these individuals.
“It’s a tough job but we are committed to it,” Hathaway said. “We believe in it. Generally speaking, everyone we work with improves over time, and we are able to resolve the issues that drive the ineffective behaviors and make their lives more enjoyable.”
Hathaway said the emphasis is on conflict resolution, problem solving and coping skills.
He went on to say that Vermont’s mental health and disability services are some of the best and most progressive in the country.
“The folks in this state are very lucky to have these services,” he said. “Some folks who have come from other states and other systems describe some pretty horrendous conditions. Vermont is very progressive regarding integration and also treatment.”
WE’RE IN THIS TOGETHER
Mourning Fox is the mental health services director for the Vermont Department of Mental Health. He said he is well aware of the tightrope the state must walk when dealing with clients who are stretching local services so thin. He said that was the main reason behind the Team Two program, which was implemented this year. It’s a collaboration between the Department of Public Safety and the Department of Mental Health to help bridge the gap between mental health professionals and local law enforcement and emergency service personnel in handling mental health cases at the local level.
“It’s a collaborative process and a coordinated response,” Fox said. “The goal is to reduce the amount of time where law enforcement is needed. It’s not unknown that law enforcement in general tends to be on the front lines as first responders to mental health crises. It’s not what they are trained to do, so it just made sense to develop something where mental health and law enforcement work together.”
In 2014, mental health training became mandatory for all Vermont law enforcement officials under Act 80. The Team Two training is voluntary, and offers a level of instruction in dealing with mental health individuals in crisis beyond the mandated program.
The goal of the Team Two program is to help build relationships among regional responders, while simultaneously meeting the needs of clients and ensure public safety.
Police Chief Brickell is a Team Two instructor, which may be why his officers are so effective in dealing with mental health cases in crisis. And while he says the program is worthwhile, Brickell said it falls short in rural communities.
“It’s designed for law enforcement, mental health professionals and dispatchers to team up and respond to situations together if possible,” he said. “So, in places like Rutland, it’s great, because everyone is right there. But for me to call Rutland Mental Health and get them up here in 30 minutes to deal with a mental health issue is unrealistic.”
But Fox countered that the Team Two program often urges phone consultations over in-person aid in more rural areas where personnel are not close by.
“We’re such a small state that we need to pool our resources and use them the best way possible,” Fox said. “And to make sure we’re doing things safely and we avoid the negative outcomes when people are communicating.”
That said, even Fox agreed that a situation like the one on Triangle Court in Brandon is unacceptable for all parties.
“It’s not working when EMS and law enforcement are coming out three or four times a week,” he said.
COMMUNICATION IS KEY
DAIL Deputy Commissioner Camille George said the goal of her team in any mental health issue within a community is to foster communication between law enforcement, mental health caseworkers, state agencies and the client. She echoed Ray Hathaway’s assertion that each case requires constant oversight and adjustment.
“My hope is that law enforcement would reach out to the agency and if they are not having success, we would welcome a call from them to work out some kind of solution,” she said. “As people change and develop, and as circumstances change, we can look at a case at any time and make adjustments.”
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