James had been up all night pacing and cursing, and was becoming increasingly angry at me when I suggested he take his medication. I was getting scared. When his father was alive we could manage him together, but now that he’s gone and I’m in my 70’s, sometimes it is just too much. So I called the police. I just wanted them to take him to the hospital, so he could get back on his meds and get stabilized. But when the police came, they had their guns drawn and tackled him to the ground and handcuffed him. I’ll never forget the look he gave me as they yanked him out the door, there was such pain and betrayal in his eyes. - James’ mother

The police are often called by family members like James’ mother to intervene with individuals during mental health crises. In fact, “nearly 1 in 10 police encounters involve individuals with mental disorders.” (GAP, 2016) Yet, many law enforcement agencies are ill prepared to deal with the complexities involved when intervening with a person with active psychiatric symptoms, such as paranoia, hallucinations or despondency to the point of having suicidal thoughts. In some cities, such as Cleveland, it has been determined that there was a pattern and practice of excessive use of force, and persons with a history of mental health issues were overrepresented in those on the receiving end of this excessive use of force.

As a result of this finding by the Department of Justice, the Cleveland Community Police Commission (CCPC) was formed as stipulated in a consent decree between the US Department of Justice and the City of Cleveland in May, 2015. In September 2015, ten members chosen by a selection panel as well as representatives from three police organizations, were sworn in to serve on the Commission for four years, representing civil rights advocates, youth or student organizations, underrepresented minorities, faith based communities, academia, business, and individuals with expertise in the challenges faced by in people with mental illness or experiencing homelessness. As a community psychiatrist, I am on the Commission as a representative of the latter two groups.

The mandate of the Cleveland Community Police Commission is:

• “To make recommendations to the Chief of Police and the City, including the Mayor and City Council, on policies and practices related to community and problem-oriented policing, bias free policing and police transparency;

• To work with the many sub-communities that make up Cleveland for the purpose of developing recommendations for police practices that reflect an understanding of the values and priorities of Cleveland residents; and

• To report to the city and community as a whole and to provide transparency on police department reforms.”

In order to work toward the restoration of trust of the police by the community, efforts are being made to create opportunities for ongoing community input and to make the process as transparent as possible. Therefore meetings of the full Commission, town hall meetings and topic specific work groups meetings are all open to the public. Meeting times and locations are publicized in a number of venues and meeting minutes are posted on the Commission website. Areas of inquiry and recommendations by the Commission will include recommendations for redesign of the existing Cleveland Police Review Board, which investigates citizens’ complaints against police officers. They will also include policy review on areas that relate to Bias Free Policing and Use of Force, as well as the training of police officers. The latter will include special “Crisis Intervention Team” training preparing officers to respond appropriately and empathically when responding to mental health crises.

In addition to the Cleveland Community Police Commission, a Mental Health Response Advisory Committee( MHRAC) was also formed in order to foster relationships and build support between the police, the community, and Cleveland’s mental health providers, and to help identify problems and develop solutions designed to improve outcomes for individuals in crisis. This group has made specific recommendations regarding the Crisis Intervention Team training, so that there will be a cadre of highly trained police officers to respond to calls involving a mental health crisis. I play a liaison role between this group and the CCPC, keeping the Commission informed about the work of the MHRAC and advocating for the recommendations of this group to the CCPC.

My work on the commission has been challenging due to the enormity and urgency of the task we face. It has been all the more challenging due to an ambitious schedule of mandated reports that was imposed on us. These included early, successive recommendations pertaining to the Police Review Board, Bias Free Policing and Use of Force, all of which needed to be based on and heavily guided by community input generated at the above mentioned public meetings, held across the city, our own careful review of policies, and our review of best policing practices, nationally.

The committee that selected Police Commission members focused on the range and diversity of backgrounds of members, which is our biggest strength. But as you might imagine, it also poses challenges in reaching consensus and decisions about recommendations.

Each meeting is open to the public. And we usually allow 30 min at the end of each meeting for public comment. We continually strive to balance adequate time for citizens (many of whom have been quite understandably frustrated , angry and fearful for years) to be heard, with adequate time to do the policy review and crafting of recommendations that is the mandated work of the Commission.

We are very hopeful about a pilot project which will allow mental health workers to ride along with police in the police district found to be receiving the highest volume of calls related to mental health issues or crisis situations. The impact of this pilot project will be closely monitored, and success will be defined as an increase in the use of de-escalation techniques, a decrease in the use of excessive force and the diversion of individuals experiencing a mental health crisis from the criminal justice system to a medical or social service setting for appropriate intervention and treatment.

Being on the Cleveland Community Police Commission is allowing me to use my expertise as a community psychiatrist to shape recommendations for a process that should make it possible for mental health clients, like James, to avoid involvement with the criminal justice system, as much as possible, and have effective compassionate interactions with police officers when they do intervene. James’ mother should someday soon be able to ask for a CIT trained officer when she does call the police for help, in an attempt to obtain competent, compassionate support when she needs it most in her daily struggle to help her son.

People with Mental Illness in the Criminal Justice System, Group for the Advancement of Psychiatry Committee on Psychiatry and the Community, American Psychiatric Association Publishing, 2016.