The state Office of Mental Health estimates a third of those incarcerated in New York have some type of mental illness. So why are they locked up instead of in a mental health program? Actually, Erie County has become a leader in diverting these offenders from prison. Progress has been slow, but steady, using a national model of law enforcement called Crisis Intervention Teams.
"Mary's" brother first starting showing signs of his brain disorder in the 1970s, at age 16.
"With my brother's illness, it was difficult for him to realize that he had an illness," Mary says, "so he would go off his meds and he would act out in different ways that were either somewhat violent or questionable in different ways that we really didn't know where to turn and we needed an intervention."
With no other option, Mary says the first point of contact usually became the calling police...over and over, for more than 30 years.
"He was arrested so many times. It was such upheaval in the family," she says. "Usually it ended up where my brother would be hauled away in handcuffs and treated like a criminal. I don't blame the police officers for doing that a lot of times because they just were simply unaware that my brother had this condition that he could not control."
Mary says her brother's behavior did not stabilize until he was was about 50 years old. He was admitted to a long-term facility, which has forced him to remain on his medications.
"Jane's" son has a similar history with law enforcement.
"My son has bipolar with some schizoaffective symptoms and what they do is, they don't always have good choices," Jane says.
Her son, too, has been arrested more times than Jane can count.
"The judicial system is very hard to navigate. They know very little about mental illness and we've had bad experience," Jane says. "Nobody tells you anything. Just like mental illness, nobody tells you anything unless you go out and look for the answers and in the criminal system, they're far and in between the answers. They're treated like everybody else: truly criminal."
However, both Mary and Jane say their loved ones are not criminals, they are ill individuals who should be treated as such.
"Every person is so unique in how their illness presents," says Mary. "The most important thing for my brother is, number one, to be treated with dignity. When they come out to the house and he's in a state of disarray due to his mental illness, to please look at my brother and give him some dignity to try to de-escalate the situation."
That is what a national best-practice model called Crisis Intervention Teams aims to do.
"Some of the things they'll tell you is, approach the person very cautiously, don't in their face, don't get in their space," explains Ann Venuto, president of the local chapter of the National Alliance on Mental Illness. "Be very gentle in the way you talk to them. Try to explain to them that it's safe."
Venuto says CIT gives law enforcement additional tools to handle a call non-violently and requires a change in traditional police procedure.
"They're trained to look at suspicious activity and respond in a way that puts their safety first and, you know, to shoot to kill. They're nervous. 'Who are you? What are you doing here? Do you have a weapon? Are you going to reach for something?'" Venuto says. "So if you're mentally ill, you're more nervous and you're more reactive and, if you're psychotic, you're not in reality at all. And you kind of get in their face or you have a threatening voice, you're going to ratchet them up. That's like a recipe for disaster with a police officer with a gun."
Jane says she now knows to specifically ask for a CIT-trained officer to be dispatched when her son acts out.
"In fact, one time I was in Depew and I was on the border in a car with my son, who was not well, and that's when I called for the police and they told me they had not been trained yet in Depew," Jane says," and I said, 'Not a problem. I'll drive two more blocks and I'll be in Cheektowaga and I will call on Cheektowaga's help' and that's what I did."
In 2013, Cheektowaga Police became the first in Western New York to train their patrol officers in CIT. They and Crisis Services - which has been training law enforcement about mental illness for years - created a CIT program tailored to Erie County road patrols. Later it was revised to pilot at the Erie County Holding Center, the first jail to adopt the change.
In fact, Erie County has become a leader in what New York State sees as the future of policing. Traditionally, law enforcement have been trained "to arrest their way out of a situation," but there is increasing evidence that offenders with special needs - like a mental illness - respond better to Crisis Intervention Teams.
"We want this to be a new way of policing, a new way of law enforcement and mental health working collaboratively together," says Rana Meehan, a mental health programs specialist with the state Office of Mental Health.
OMH brings together parties who want to participate in CIT, sets goals and identifies gaps. Meehan describes CIT as a systemic change in how New York thinks about and treats those with mental illness.
"Maybe the outcome isn't jail. Maybe it's a diversion into a mental health treatment program rather than incarceration - and that's really the key to CIT," Meehan says. "It's looking at how do you specifically identify individuals that you can divert from the criminal justice system into more appropriate treatment, not only for the individuals suffering from mental illness, but for the criminal justice system, as well. Where is the best use of our resources?"
NAMI - which helped outline a national CIT training curriculum - says resources across Erie County have become especially strained and entangled. As institutions downsize, continuity of care is fragmented, and an opioids crisis takes a heavier-than-expected toll on both the health care and criminal justice systems, first responders are often the first point to contact for a mental health intervention.
"A lot of times when people are absorbed into the criminal justice system, they're often not diagnosed with a mental illness," says Crisis Services' Kristin Aducci, Erie County's CIT coordinator. Aducci and Cheektowaga Police Lt. Brian Gould lead CIT training for local law enforcement.
"So what we hope is that officers do is that they catch that in the beginning, so if someone has to be arrested, but they're noticing those signs and symptoms, to be able to pass that along," she says.
That is why a strong CIT program has to reach out and gain the commitment of a variety of community stakeholders. Aducci says, if everyone along that chain understands mental health, an offender is more likely to avoid the criminal justice system, get treatment and remain stable.
"One of the things that we've seen in some of the departments across Erie County is that we've had people that have had frequent interactions with law enforcement," she says, "but because they've implemented CIT, they either have zero interactions with law enforcement or now they have a better outlook, so when they do go into crisis, they call the police and say, 'Hey, I'm in crisis right now, I need someone.' They send a police officer out there, they work with them for a little bit and they're okay."
Fundamentally, Aducci says, CIT is about building trust that law enforcement is there to help, not necessarily handcuff.
That training, developed for road patrols, was later tailored for county corrections officers.
"When an individual gets arrested and they get remanded to the custody of the Erie County Sheriff's Office, they go through a screening and they're booked into our system and then they're then seen by medical," says Sgt. Michael Knezevic, the Sheriff's supervisor of inmates with special needs. "If they're flagged to see forensic mental health, those inmates then are given an extensive interview to determine what services they'll require while they are in our facility."
"One of the problems that we get is that this information that we get, sometimes, comes from the individual that we've arrested," he says. "They may not want to be tagged as someone with a forensic mental illness, so they may not give us the information and when that happens, they go into the general jail populace."
At only five years old locally, Crisis Intervention Teams are still young, but always advancing, Aducci says. For example, she says a grant-funded case management team is now refining discharge strategies for those released from incarceration.
The state praises Erie County's CIT program as "quite intense and successful," as does NAMI's Venuto.
"I hear from families in a support group and on a helpline that we get in the office, where people will call in, and there's no question that people who have experienced police coming to their house report a big difference with an officer who is CIT-trained and really being compassionate and understanding with the family."
Overall, however, only about 500 Western New York law enforcement officers have been trained in CIT - a small number, given about 800 total members of the Buffalo Police Department alone.
That is why for 2018, Meehan says the state - including Erie County - is stepping up its train-the-trainer program: officers receive CIT training, then go back to their departments and train others...and so on and so on.
Credits: Part 1 music is Aimee Mann, NPR's Music Tiny Desk Concert; Memphis Police Officer Christopher Ross from PBS Newshour. Part 2 Officer Steve Grant from NYS OMH training. No person mentioned in this story appears in the photographs.