It’s been six years since the death of Yanira Serrano, the 18-year-old Moonridge woman who while suffering a mental health crisis was killed by a San Mateo County Sheriff’s deputy. In the aftermath, Sheriff’s officials promised change in how it responds to mental health calls. While there has been more training, there is scant evidence that it has made a difference in real-world situations.
The Sheriff’s Office reports increased crisis intervention training and the addition of the Psychiatric Emergency Response Team. However, there is little evidence of change in the rate of violent interactions between law enforcement and people with mental illness.
Crisis intervention team training is not new to police departments across the country. It took hold in the late 1980s, when a 27-year-old schizophrenic named Joseph Dewayne Robinson was shot and killed by police in Memphis, Tenn. His death outraged the community, and that outrage led to the formation of the first Crisis Intervention Team. The resulting methods became the foundation for attempting to reduce lethality from police encounters with people with mental or substance abuse disorders.
Today such training has been adopted in about 17 percent of all police agencies in the United States, including the San Mateo County Sheriff’s Office. While studies show the training often leads to referral to mental health services, the training has failed to make any measurable difference in the use of force. This has caused some advocates to question the effectiveness of CIT training.
The Journal of the American Academy of Psychiatry and the Law reported enough variability within CIT that it’s difficult to determine how effective the program is overall. Police officers who have had the training perceive a reduction in use of force and that they had reduced the stigma of mental illness, the study found.
All San Mateo County Sheriff’s deputies are taught how to respond to mental health crises from the day they start the police academy. They later receive the CIT curriculum while they are in field training. The weeklong course is mandatory. The training involves instruction from community mental health workers, people with mental illness and their families. It teaches how to assess mental illness, how to use communication and de-escalation techniques and how to speak effectively with mental health providers.
“Beyond the 40-hour course, the Sheriff’s Office does assign electronic-based training on an annual basis. Much of this is focused around de-escalation and crisis intervention,” said Sgt. Mike Tabak, who has helped launch psychiatric response efforts within the department.
About 98 percent of the Sheriff’s patrol deputies are trained in CIT. Those who aren’t are new hires who have not yet taken the training. Tabak said that means every deputy who responds to a 911 call has the basic first-response training.
“People are not calling 911 when there is a run-of-the-mill issue. People call 911 when it is an emergency and we are required to make sure everybody is safe,” he said. “We provide deputies with the CIT training and we know they will deal with these situations as best as they are equipped on a basic level.
“CIT is by no means a fix-all,” he said.
Many mental health providers would argue that the best response is preventing the crisis to begin with. That requires preventive services before an emergency arises.
“I have found CIT training to be effective,” National Alliance on Mental Illness San Mateo Outreach Coordinator Loren Shea said. “However, I think it’s definitely one of many options in terms of when someone is in a mental health crisis. It does not always have to be law enforcement.”
To assist in connecting people with mental health services in the county, the Sheriff’s Office formed a Psychiatric Emergency Response Team. Tabak helped launch the program in 2015, but has since been promoted to another department. PERT is now run by a team of two detectives and two San Mateo County Behavioral Health and Recovery Services clinicians who act as a secondary response, connecting patients and families with services and resources to manage mental health issues.
While the PERT can assist during an emergency, team members are mainly there to follow up with people and families and provide resources to get connected with mental health care.
“If it is determined that a person would benefit from some kind of follow up, that is what PERT does,” Tabak said. “People ask why is PERT not 24/7? It’s a staffing issue.”
In the last six months, 329 referrals were made to PERT either by patrol staff or community organizations. Of those cases, a detective and clinician followed up on 103. The PERT team can also offer support to patrol officers in the field and while not staffed 24/7 they are on call.
“The goal is to get people help and reduce police contact when someone is having a behavioral issue,” Tabak said. “We want to prevent an arrest or use of force. In any way, we want to prevent this outcome. “
Yet such outcomes remain all too frequent. People with mental illness are 16 times more likely to be killed by police officers, according to a report from the Treatment Advocacy Center.
Though the Sheriff’s Office acknowledges sending deputies to a mental health crisis is not ideal, they are required to respond to 911 calls.
Last year, the Sheriff's Office sent a pair of detectives to Portland, Ore., to learn more intensive mental health protocols. Now the model of “enhanced” crisis intervention team training, as presented by the Portland Police Bureau, may be implemented here, Tabak said.
The Portland Police Bureau has been criticized for how it handled incidents involving people with mental health issues. In 2012, the department was pushed by a Justice Department investigation to create a training program and establish protocols for how officers deal with people with mental illness. The Bureau already had patrol officers receiving the CIT training, but this new approach went a step further.
“We said we are going to develop a layered approach,” said Liesbeth Gerritsen, a mental health professional, who works and advises on the program with the bureau.
Here’s how the Portland model works: If a person calls 911, the dispatcher is trained to go through certain criteria with the caller to either divert the call to a mental health hotline or request that an “enhanced” crisis intervention team officer respond.
The police department set up an entire behavioral health unit, staffed with clinicians and law enforcement. Officers who have been on the force for at least three years can opt to take the enhanced training, which is an additional 40-hours.
“We have a lot more time in that training to talk about de-escalating these higher level events that often end up in shooting,” Gerritsen said.
Gerritsen, who was instrumental in launching Portland’s enhanced crisis intervention team program, said that the most important piece of the training comes down to de-escalation skills.
“If an agency just adopts this one thing and puts it in one program and it does not get supported by all the other disciplines, it will never stick the way it should,” she said.