 downtown Portland, Aug 6, 2020 Mary Ann Murk, an attorney in Astoria, Oregon, is probably the best and savviest advocate a person facing a mental commitment could have. She writes honestly about the cruelty that some allegedly mentally ill persons are subjected to, and the costs of and emotional burden to the law enforcement officers charged with finding some place for the person to land. These people haven’t been charged with a crime. Their victims are often family members who want them to get help, not spend time in jail. Oregon’s law on allegedly mentally ill persons (colloquially known as AMIPs) has nothing to do with legal insanity or being unfit to stand for trial. The mental commitment process isn’t part of the criminal code. It’s an attempt to provide a constitutional structure for people suffering such severe mental illness that they pose an immediate physical threat to themselves or others, or who won’t provide for such a basic need as eating.
These cases are heartbreaking. They are usually brought by concerned family members, rarely by the cops, never by the district attorney’s office. Here’s a fairly typical example: A family member repeatedly calls Clatsop Behavioral Healthcare (CBH) because their adult son is convinced outside governments are communicating with him through microwaves that only he can hear. One day he threatens to blow up a local government building to stop the voices. He yells, screams, takes out the kitchen knives and begins cutting himself. A crime hasn’t been committed. The police won’t engage, even if the family says they’re afraid of what the son might do. CBH will send one or two case workers to assess the situation and write a report. If they believe the son meets the qualifications, CBH will apply to the court for an order. If the judge believes the person qualifies under Oregon law, she will sign a warrant of detention. At this point the sheriff’s office is delegated the responsibility of transporting the person to whatever mental hospital between Coos Bay and the Idaho border is available. Let’s say the person is “decompensating” -- falling apart -- in a store. Making a terrible and frightening scene but not destroying any property. The store is likely to call the police. The police will likely come to ensure a crime hasn’t taken place. This is one of the social services we’ve come to expect the police to provide. They will try to “de-escalate,” or calm down, the person, and possibly suggest he leave the store. Police are trained in de-escalation. The officer is there to make sure no one is getting hurt and that the guy doesn’t have a weapon. Once the officer has assured that, she will call CBH to have that agency come and assess the person. Often CBH doesn’t or can’t immediately respond, so the officer has to stay around to make sure the person is safe and that the situation doesn’t escalate. If the officer can articulate an imminent danger, she can hold the person temporarily, usually in the back of the police car, until CBH arrives. There are many scenarios. Some are worse -- for everyone -- than others. The important point here is that police don’t investigate and make judgments about mental illness. Mental health workers do. The budget of CBH is larger than the sheriff’s office and the district attorney’s office combined. (All CBH funding comes from the state and some federal sources.) And yet we definitely need more funding for mental health. We also need the police, and probably more funding for them, at least in Astoria. I can guarantee you that if a family member calls CBH and says their son has lost his mind and is waving a butcher knife around, CBH is going to call the police, and wait for officers to respond before going in themselves. (That’s one other reason why officers wear 40-pound vests: to prevent themselves from being stabbed in the chest.) No mental health facility for those who need temporary commitment is available anywhere on the north coast. Semi-independent housing was closed years ago. Drop-in crisis services have been dramatically reduced. Neither our hospitals nor our jail have a room for people whose primary issue is acute mental illness (despite years of attempting to convince both CMH and Providence Seaside to do so.) The Oregon State Hospital was massively downsized over a decade ago. The only options are within a small patchwork of hospitals ranging from Coos Bay, Corvallis, Portland, and Ontario. A shackled 9-hour ride in the back of a sheriff’s patrol car is demeaning and terrifying, as most of the people are in active psychosis and believe they are being abducted by aliens or sent for medical experiments. They are clearly suffering and usually haven’t committed a crime, and certainly haven’t been charged as yet. Nor should the sheriff have to engage in this sometimes dangerous and almost always unpleasant duty. What can we do? Mandate that all hospitals have the ability to do psychiatric evaluations every day of the week. Create a treatment and evaluation facility close enough to avoid the long ride. Assign transport to a non-police agency. But consider what might happen when the allegedly mentally ill person attacks the driver or bolts the car on the Santiam Pass in mid-winter. Once social workers have the training, legal authority, and desire to run after and restrain someone in the grip of a psychosis, they might as well be police officers. There are many dedicated people working in the field, but we fail the profoundly mentally ill. The police are the least culpable of all. Some proponents of Defund the Police want to refocus how police work is done. Many police departments themselves might welcome this because many consider the proper work of police to be detecting and apprehending criminal suspects, not doing social work. Some proponents, like the city leaders in Minneapolis and Seattle, have made clear they seek abolition. In practical terms that will mean that unless an actual crime is underway, and likely a violent crime, police officers will respond only to purely criminal calls. That, of course, does nothing to avoid confrontations with robbers high on meth, and men with anger management problems who’ve beaten their girlfriend to a bloody pulp. A serious car crash might be ignored absent immediate evidence of drunk driving. Police reforms, treatment of the mentally ill -- these issues should go well beyond politics. The Great Cauliflower, as I’ve often called Reagan, didn’t open the mental institutions on his own. Nor did Nixon. The call to deinstitutionalize came well before either of these conservatives, and arose from more liberal outrage. Ken Kesey’s “One Flew Over the Cuckoo’s Nest” was published in 1962. In 1963 Kennedy proposed and signed into law the “Community Mental Health Act,” which would have built local mental health facilities to replace institutions. The Act was poorly funded due to the costs of the Vietnam War. Medicaid’s passage in 1965, signed into law by Lyndon Johnson, incentivized moving patients out of institutions. Just as former speaker of the house Tip O’Neill said, “All politics is local.” By extension, so are the solutions. ### |