Maine emergency responders learning patience and understanding are critical to saving lives.
It had all the elements of a situation that could end badly.
The man had a history of mental health problems, and in the wee hours of one morning last year he seemed out of touch with reality. His mother decided he needed to go to the hospital, now. He decided he wasn’t going anywhere.
She called 911.
Eric Samson, then a deputy with the Androscoggin County Sheriff’s Department, responded with another deputy. Samson had been trained to deal with someone who was mentally ill.
Listen. Don’t discount the other person’s thoughts or feelings. De-escalate.
“He was resistant, actively resistant, didn’t really feel the need for law enforcement . . . I had remembered the technique of how to deal just verbally,” Samson said. “He was saying things to me that did not make sense. But I responded with asking him to explain, and I just waited for that opportunity through the conversation, accepting what he was saying was reality and talking to him about that. He brought up how he wants to help law enforcement. So I explained, ‘Well, if you want to help us, for us to be able to do our jobs we need you to come with us. And if you’re willing to come with us, that would be a great help.'”
The night ended with him willingly going to the hospital.
Samson, now Androscoggin County sheriff, still thinks about that success.
“Everything turned from him sitting in a chair refusing to go, and something that could have ended up (with police ordering) ‘You’re going,’ to (the man saying) ‘OK! Let’s go,'” Samson said.
It’s the kind of call Maine’s first responders often get: Help someone who is mentally ill or in crisis.
They’re complex situations that can escalate quickly, sometimes with the potential for violence, risking the lives of both first responders and the person needing help.
Mental health advocates and mentally ill Mainers say first responders in Maine tend to handle such calls well, with sensitivity, a sense of calm and knowledge.
Though both first responders and advocates say more can always be done.
Samson, for one, has started sending his officers to a weeklong training program run by the Maine chapter of the National Alliance on Mental Illness, or NAMI. One of his first volunteers was the deputy who went with him during that middle-of-the-night call last year.
“He said ‘I want to go’ because he saw,” Samson said.
‘We run into it every day’
First responders — including dispatchers, police, firefighters and emergency medical personnel — get involved with an emergency call at the beginning. Their job is to gather information, stabilize the situation and get help to the person who needs it.
Any call can go badly, whether it involves someone who has mental health problems or not. And the vast majority of people who are mentally ill aren’t violent. But calls that involve someone who is in crisis or struggles with mental illness can be particularly tricky to handle because the person may not want help, may not understand what’s going on, may be difficult to talk to or may have had a bad experience that makes going to the hospital or dealing with police anxiety-provoking.
“You can’t paint mental health with just a single brush. It’s a very complex situation,” said Jay Bradshaw, who recently retired after years heading Maine EMS, the emergency medical services arm of the Maine Department of Public Safety. “Sometimes the person’s mental health may need just a comforting voice of somebody who’s calm and near. That’s one thing. On the other end of the spectrum you may have somebody who has serious psychological, behavioral challenges that require reaching out to, perhaps, law enforcement.”
First responders say that when they encounter people who are mentally ill or in crisis, often those people are hallucinating, feeling anxious or depressed, having a panic attack, considering killing themselves or no longer taking care of themselves. Drugs and alcohol exacerbate the situation.
Sometimes other issues — like autism, a diabetic crisis or a bad reaction to medication — can resemble a mental health problem.
“There’s any number of possibilities that fall into that realm of behavioral emergency,” said Auburn Fire Chief Frank Roma, whose department handles both fire and medical calls. “We respond to behavioral emergencies on a fairly frequent basis . . . certainly at least weekly.”
About 51,000 Maine adults and 13,000 children have a serious mental health issue, according to a 2010 NAMI state fact sheet. That doesn’t include Mainers who have a less severe mental health issue or who will find themselves in a sudden crisis.
“The reality is that you don’t know when the issue is going to matter to you until it matters to you an incredible amount,” said Jenna Mehnert, executive director of NAMI Maine. “It has no racial, no socio-economic, no educational barrier. Mental health challenges touch everybody.”
First responders say they handle more mental health issues now than in decades past. Many believe that’s because the state — and the country — began shifting away from institutions in the 1990s, instead favoring outpatient care, which keeps people in their communities and, sometimes, in the path of first responders. Some say the long-running shortage of short-term and long-term psychiatric beds has also caused patients to cycle in and out of emergency care, stabilizing only for a short time before they need help again.
Whatever the reason, it’s become common to get calls involving someone with mental health issues.
“We run into it every day, from cars that we stop to well-being checks,” said Maine State Police Chief Robert Williams. “Mental illness or mental health is a huge problem facing law enforcement today. I read one study that said 80 percent of people we come in contact with has a mental illness. That seems kind of high, but we do deal with it a lot.”
Maine first responders have long been looking at ways to deal with people who are mentally ill or in crisis.
In 1996, after a mentally ill man killed two elderly nuns and injured two others in a Waterville chapel, police there began partnering with local mental health agency Crisis & Counseling Centers, having mental health workers ride along during some shifts. The program has since been adopted by a number of other police departments in Maine, including Augusta earlier this year.
In the early 2000s, Laurie Cyr-Martel, an experienced mental health worker, served as a dedicated crisis intervention officer tasked with working scenes with the Lewiston Police Department. She also wrote a book on dealing with people in crisis — “Responding to Emotionally Disturbed Persons: a Manual for Law Enforcement Personnel.”
Also in the early 2000s, NAMI Maine began offering Crisis Intervention Team (CIT) training to first responders and others. The 40-hour, weeklong course teaches them how to calm, contain and intervene in situations, and introduces them to people who have mental health problems so they can better understand the point of view of someone on the other end of a call.
NAMI Maine later added a more basic 8-hour “Mental Health First Aid” course for those who couldn’t commit to a full week of training.
Although many consider NAMI’s courses to be “the gold standard,” some first responders’ groups have their own specialized training.
“There’s a handling-suicidal-callers class that, depending on availability and funds, we’ll send students to,” said Phyllis Gamache, director for Lewiston-Auburn’s 911 communications center. “It’s good for new people who haven’t been exposed to a great deal. It’s nerve wracking. There’s a lot of responsibility for somebody who’s only been on the job for six months, or even three years, to have the responsibility to talk to someone who’s suicidal.”
Advocates, first responders and people with mental health issues say the training efforts have helped.
“They make you feel real comfortable,” said Judy Binnette, 66, of Auburn, who deals with anxiety, depression and PTSD and has had to call 911 for chest pains. “They try to calm you down so that you’re not getting overworked and getting more panicky and stuff. They’re really calm and very thoughtful with you.”
Paul Gauvreau, board chairman of Tri-County Mental Health Services in Lewiston and a Maine assistant attorney general who deals with involuntary hospital commitments, tends to hear about the most harrowing situations — like, recently, the man who was “obviously thought disordered” and found lying asleep on Route 202 in Greene. Police got him to the hospital without incident.
“It’s pretty stunning. There’s no other way to say it. People who are severely impaired put themselves in remarkable situations,” Gauvreau said. “I’m always impressed with the professionalism of first responders who go out of their way to make sure people are brought in to a secure setting.”
Attitudes have changed, too.
“The story I like to tell is when I first started at the (Lewiston) PD, the comments were ‘Oh, they’re just crazy or whacked out,'” said Cyr-Martel. “And then like 2006, 2008, I’d get officers saying, ‘Laurie, I think they’re de-compensating.’ It’s night and day.”
But while first responders, advocates and others agree that things have improved, they also say it could always be better.
Often, “better” starts with more training.
Listen
Although a few Maine departments have all or almost-all of their first responders CIT trained, most don’t. The program is free through NAMI Maine, but departments have to replace the trainee on the job for a week — often paying overtime — and that can be a financial barrier. It can also be difficult to push crisis training when departments have other training they need to prioritize, too.
And some first responders don’t know special training is available.
“It’s in the course of emergency training that you do (mental health training), but it’s just so cursory that it doesn’t give you anything in depth other than the fact that yes, this is mental illness, and this is what you shouldn’t do rather than what you should do,” said Donald Wormell, supervisor for United Ambulance Service in Lewiston. “Wouldn’t anyone want more training?”
Last year, United handled about 20,000 calls for help, 574 of them classified as “psychiatric, abnormal behavior or suicide attempt.”
When it comes to police, Mehnert at NAMI Maine said she’d like to see half of Maine’s officers go through the 40-hour CIT session.
State Rep. Richard Malaby, R-Hancock, would have been happy with 20 percent.
During the last legislative session, he introduced a bill that would have required at least 20 percent of officers in municipal and sheriff’s departments be CIT trained by 2017. The bill died in committee. Malaby wasn’t surprised.
“I knew that wouldn’t happen, to be frank. Nonetheless, I pushed the issue,” he said. “But I did end up with a good compromise by working with the head of the police academy.”
Starting this year, the Maine Criminal Justice Academy — which trains most law enforcement officers in the state, including wardens, marine patrol, municipal and state police — will require that all of its students take NAMI Maine’s 8-hour Mental Health First Aid class.
“Today, that’s kind of a critical piece of training law enforcement officers,” said training coordinator David Tyrol of crisis training.
The academy graduates 100 to 120 people a year. Previously, students got seven hours of NAMI’s time, but that was largely focused on involuntary commitment. They’ll now receive that information in three hours rather than seven.
Mental Health First Aid is not as intensive as the weeklong CIT, but advocates say it will be a good start for students who have little-to-no experience in the field. And they like the fact that training all academy students will mean that, eventually, virtually all Maine police will be trained.
Some departments aren’t waiting for students to graduate and move up through the ranks.
Samson, the Androscoggin County Sheriff, started putting his deputies through CIT this year and has spoken with NAMI Maine about designing training geared specifically toward his corrections officers.
Samson was trained in the 1990s and now serves as a board member for Tri-County Mental Health Services in Lewiston. His goal: train all the officers he’s responsible for.
As a deputy, he repeatedly saw how well his crisis training worked — including, two or three years ago, when a Wales woman got upset because she believed people were talking to her through her ceiling and wouldn’t leave her alone.
Rather than dismiss her claims and leave, Samson was trained to stay and listen. When the woman mentioned she had a mental health case worker, Samson called the worker and got her help.
“You see (training) is successful and you say, ‘This is something more people need,'” he said.
More ideas being tried
Some first responders are trying new things, in addition to training.
The Auburn Fire Department last year started offering an emergency registry for families with autistic children so first responders will know, for example, not to use lights and sirens because that will upset the child more. Autism isn’t a mental health issue, but someone with autism can fall into the same “behavioral emergency”category.
So far, about a half-dozen families have signed up. The Lewiston Fire Department is considering something similar.
The Maine State Police, meanwhile, is creating partnerships aimed at responding to mental health issues before they escalate.
The agency has some of the most well-trained first responders in the state, but its chief lamented that some situations still require force.
“I want to make sure the perception isn’t that when law enforcement gets called to somebody who’s in a mental health crisis that our first instinct is to shoot them, because that’s what we hear all the time,” Williams said. “In the last year or so, state police have been involved in two or three shootings where the person has had mental illnesses and that’s all we hear — why didn’t you have more training to de-escalate, why didn’t you this, why didn’t you that? Well, the bottom line is, in those situations where we had to use deadly force, we had to use deadly force.”
His officers often meet people who have obvious mental health issues; they’ve interacted with people who believe someone snuck into their house through an electrical outlet, people who labeled everything in their home with the date they first saw it — but there’s nothing for the police to do. Those Mainers may have mental health problems, but they haven’t committed a crime, they don’t want to hurt themselves or someone else, and they aren’t posing a danger.
However, mental health problems can intensify. One day police can’t do anything, the next day that person is in crisis.
“We want to try to prevent the case where nothing gets done — we’ve been there a dozen times and then the person escalates where the police have to intervene. If there’s a way to prevent that, we want to do that,” Williams said.
So the Maine State Police has started working on a new partnership with mental health providers across the state to connect people who have mental health issues with professionals who can help.
“We can refer them, then we can call that agency and tell them, ‘You need to do a follow-up on these people,'” he said.
Williams knows it won’t always work. Some people will still refuse help. But it’s something more.
“At least the people involved can say, ‘You know what? These are the things we did to try and fix this,'” he said.
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