When It Comes to Dealing with the Seriously Mentally Ill, Both Sides Are Failing to Face Hard Facts

The recent spate of police shootings of the mentally ill has increased pressure on Mayor de Blasio to retool Thrive NYC, his beleaguered behavioral health program, and protocols for “emotionally disturbed person” calls.

Mental health is now being debated more vigorously in New York than it has been in many years. Anyone who believes in the need for reform has to find that encouraging.

In a city where the seriously mentally ill make up 17% of the jail population and about 40% of unsheltered homeless people, and an estimated 93,000 aren’t getting the treatment they need, clearly we have a system that merits great scrutiny.

But raising consciousness about an issue doesn’t guarantee authentic reform. The mental health debate, particularly as it pertains to police shootings, has missed a few huge points.

For one thing, hard cases make bad policy, in part because they come in more than one variety.

Saheed Vassell was a 34-year-old Crown Heights resident with bipolar disorder who was shot dead by cops in April 2018. Callers to 911 believed he may have been armed with a gun. Tragically, he turned out only to have been brandishing a small metal pipe.

Advocates who believe that mental-health-related-911 calls merit a mental health, not criminal justice, response, have focused heavily on Vassell’s case.

Their argument, though, applies less in the case of Kwesi Ashun.

Ashun was a 33-year-old man with serious mental illness. In October 2019, while cops were responding to a request for assistance near where he was peddling T-shirts, he assaulted an officer with a metal chair. After a taser failed to stop him, he was fatally shot by police. Subsequent press reports revealed that Ashun had a history of violence that included allegedly slashing a police officer in the face in 2004. The officer he struck with the chair was put in a medically induced coma.

Which incident should New York design its crisis response system around: that of Saheed Vassell, who was harmless, or that of Kwesi Ashun, who plainly was not? Which is more instructive as we think about distributing responsibility over EDP calls between mental health and public safety officials?

The Ashun incident took place only days after the mayor released the results of a NYC Crisis Prevention and Response Task Force convened in the wake of the Vassell shooting. The task force plan called for making more use of mental health professionals in certain precincts with high rates of EDP calls.

It would not have prevented Ashun’s death but it is certainly more reasonable than some of the more radical proposals circulating in the advocacy community. Indeed, upon its release, de Blasio’s plan was criticized by Public Advocate Jumaane Williams and others for not going further to minimize the police role in EDP calls (or, to use the new PC term instituted by de Blasio’s plan, “mental health calls”).

Much of the challenge with preventing unnecessary police shootings of the mentally ill lies in the fact that it is difficult to parse, in real-time, the distinction between a serious mental health disturbance and a public safety emergency.

The seriousness of any given EDP call can’t always be assessed at the outset and events can escalate fast. As alluded to earlier, the cops in the Ashun incident weren’t on the scene to respond to a call about him but an entirely separate incident of someone urinating in a nearby nail salon. The state attorney general’s March 2019 special report on the Vassell shooting noted that, of that incident’s two 911 calls fielded by dispatchers, one made no mention of any signs of mental illness. The second dispatcher did code the call as an “EDP,” but only on the basis of being informed by the caller that “[t]here’s a guy walking around the street. He looks like he’s crazy.” Both dispatchers were informed by callers that a gun may have been present.

There’s a neighborhood disturbance that some civilian believes needs immediate police assistance: often, that’s all that a dispatcher is going to be certain about. Calls that indisputably merit the attention of clinicians, instead of cops, are likely to be less-than-serious calls where the risk of violence is low.

The tendency for less-serious psychiatric problems to suck resources away from the more serious, such as untreated schizophrenia, accounts for much of our mental health systems’ current dysfunction.

To be clear, the de Blasio administration is on the right track in exploring some kind of role for mental health providers in how mental health-related 911 calls get handled. “Crisis Intervention Training” for cops is de rigueur in departments nationwide. It has been estimated that about half the U.S. population is covered by some form of CIT. The NYPD was long seen as a laggard in getting going with de-escalation.

But one reality we must face up to in the debate over police de-escalation techniques is we don’t really know what works.

The rate of police shootings of the mentally ill is too high. It’s higher than the rate of shootings of blacks and certainly that of the population as a whole. But these tragedies are still far too rare to offer proof of how policy may be driving the numbers.

The NYPD’s Crisis Intervention Training program began in 2015 and has been rolled out gradually. Since 2015, at least 16 mentally ill individuals have died in confrontations with police. In 2013, 2014 and 2015, not one EDP call resulted in a fatality, according to the NYPD.

Too much has been made of the administration’s slow progress in training the entire NYPD in CIT. The quality of such a program can’t be measured by the number of cops who have gone through the training. Sam Cochran, the former Memphis cop often credited with inventing CIT, has long urged departments to view it as an elite program whose integrity is placed at risk by making the training universal throughout a whole department.

Even the best-regarded programs haven’t been able to reduce shootings to zero. In June 2017, CIT-trained officers in Seattle fatally shot a mentally ill woman named Charleena Lyles who the officers said was coming at them with knives. Five months prior to that incident, a report by the NYPD’s Inspector General had hailed the Seattle program as a national model New York should do more to emulate.

As for Thrive NYC, all of the recent mental-health-related tragedies in New York pose just as many questions for critics of de Blasio as they do for the mayor himself.

For one: What would they have done to prevent Kwesi Ashun’s death?

Amidst all the criticism of Thrive, it has been encouraging to hear so many city politicians call for a greater focus on the seriously mentally ill. This message strikes at the heart of Thrive’s flawed premise that mental health policy should cast as broad of a net as possible since any mild mental disorder runs a risk of metastasizing into violent paranoia.

(In other contexts, administration officials have noted that 10% of all mental health-related 911 calls come from about 275 people and, over one recent five year period, about 400 people with behavioral health problems accounted for more than 10,000 jail admissions and 300,000 total days in jail collectively.)

We’re certainly going to have to focus more if we’re going to get anywhere on mental health reform. But policymaking is not just about who gets what and how much. The more critical question to answer is what’s the most effective use of available resources?

Making more “peers” and clinicians available to try to prevent unnecessary shootings of paranoid people stands to benefit the seriously mentally ill far more than the worried well. But so is funding psychiatric hospital beds and assisted outpatient treatment, known in New York as Kendra’s Law.

Either of those latter two options could have provided the supervision that, in retrospect, no one can seriously deny Kwesi Ashun needed. Vassell’s parents, who have been strenuously critical of the city’s EDP protocol, acknowledged that keeping their son on his meds had been a struggle. According to the state Office of Mental Health, Kendra’s Law has notched a more than 20% increase in program participants’ adherence to medication regimens.

De Blasio announced a review of Kendra’s Law in the wake of the early October killings of four homeless men, allegedly by a mentally ill homeless man named Randy Santos. But expanding access to inpatient psychiatric care remains controversial among city progressives.

However much we may disagree about handling EDP calls, everyone agrees that the only viable long-term solution lies in upstream reforms that provide effective treatment to those now at risk of falling through the cracks. Anyone serious about stopping the next spectacular tragedy must embrace an expansion of modes of supervision for the seriously mentally ill.

Chronic vagueness has been, and remains, the chief affliction of New York’s mental health system. More vagueness cannot be the solution.

This piece originally appeared at New York Daily News

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Stephen Eide is a senior fellow at the Manhattan Institute and contributing editor of City Journal.

This piece originally appeared in New York Daily News