Training Police for Mental Health Interventions

POLICE DISPATCHER: Uh, 131 [INAUDIBLE] cross over to 1 lima, 1 lima.

JAMES WILLIAMS: Mental illness doesn't discriminate. It infects all people of all walks of life.

[DISTRESSED SPEECH]

MAN: You're going to be safe right now. You're safe.

WILLIAM KASBERG: In the middle of the night, you're not going to call a doctor, you're going to call the police, when you need help.

SEATED MAN: I've been hearing some things from other people without seeing them.

MAN: What things do you hear?

WILLIAM KASBERG: We end up dealing with people that are in crisis, every single day, whether it be schizophrenia, bipolar, or depression. And our biggest weapon that we use is not on our belt. It's our ability to communicate. It's actually getting them to talk to me.

JAMES WILLIAMS: With the mental health unit, we'll take the uniforms off. And when you're dealing with someone who's in a crisis, you want the focus to be on getting them treatment. You don't want them to be the focus on the patch or the badge.

The vehicle that we drive, it's an all-black SUV. So we have the advantage, once we introduce ourselves, and we can put the badge away. No one has to be in their business.

We'll start looking for calls for service, on our laptop. And, if there's a mental-health-related component, we'll take that call.

POLICE DISPATCHER: Unit 131, here.

WILLIAM KASBERG: Hey, partner this is Kasberg at Mental Health. What's going on?

POLICE DISPATCHER: Uh, we've got a young female. I didn't get her age yet. She's—she's not even talking to her dad anymore. She's a cutter, and she's just freaking out right now.

WILLIAM KASBERG: OK, 10-4. Is everybody safe there? Is she safe right now?

POLICE DISPATCHER: Yeah, everybody's safe. We're good.

JAMES WILLIAMS: We cover a whole city of San Antonio, with just six people—two on daylight and four officers on night.

POLICEMAN: Right here. Hey, guys.

JAMES WILLIAMS: All of the officers in San Antonio police department are CIT-trained. We go to a 40-hour crisis-intervention school.

WILLIAM KASBERG: Hey, why don't you-all go over there, and I'll start talking to her, so she's not feeling alienated.

MAN: OK.

WILLIAM KASBERG: OK?

The crisis-intervention-team type of training originated because of a deadly-force type of situation—

Can I talk with you? Is that OK?

—where officers were called to a family member's house.

Would it be OK if I got you a blanket or something? Would that be cool?

But they ended up going to close. They ended up cornering the "consumer"—as we refer to a person with mental illness. He had a knife, and the only out that he saw was charging at the officers, with that knife,

POLICEMAN: Check it out. I got you a cool blanket, man.

WILLIAM KASBERG: That son was actually killed. Something needed to be done.

POLICEMAN: How's she doing in school right now?

MAN: Not good.

POLICEMAN: Not good?

WILLIAM KASBERG: And that's where this type of training came in place, of using good communication skills, using deescalation techniques—

Can you just tell me a little bit about what's going on, what's got you so upset? I really want to help.

JAMES WILLIAMS: Let me ask you, within the last 72 hours, to your knowledge, has she made any mentions of wanting to cut herself—

MAN: Yes—

JAMES WILLIAMS: —or any suicide—

[INTERPOSING VOICES]

WILLIAM KASBERG: Do you have one place that you typically cut yourself?

JAMES WILLIAMS: We're not doctors, we're not counselors, we're not there to diagnose, but we want them to be aware of what services we can get them connected into.

FATHER: I want her helped tonight. I'm not going to wait another minute. I want to—I'll go over to the hospital. I'll stay up all night, if I have to, but I want my daughter to get well.

JAMES WILLIAMS: What we'd like to do is what's called "emergency detention." It's basically a legal, civil hold saying that we get her to a hospital, get her to see a counselor or a doctor tonight.

WILLIAM KASBERG: We're going to let you talk to a counselor tonight, because it's just to keep you safe. You're not in any kind of trouble or anything like that. You understand that, right? OK? We work together and take care of each other. Is that cool? Let's do this.

OK, come on out here. Hop on in.

You know what was cool? Is, after talking to her, she was actually wanting to go.

JAMES WILLIAMS: Yeah! That was good, at the end—

WILLIAM KASBERG: Ah, man, I'll tell you what—

JAMES WILLIAMS: She said, you know what? You asked her, are you willing to go with us? And she said—she nodded yes.

WILLIAM KASBERG: Oh, I'll tell you what, that makes all the difference, man. That's the reason you come to work, right there.

So we're headed to police headquarters. The service agent working at the desk right there is calling in about a gentleman who seems very delusional. He believes that he was abducted at the age of two and that he happens to be the son of Janis Joplin and one of the drummers of the Beatles.

JAMES WILLIAMS: Right.

WILLIAM KASBERG: He said he seems like he's very out of touch with reality. Seems very scared.

JAMES WILLIAMS: Did you call the police, sir?

MAN: Yes, I did.

JAMES WILLIAMS: How are you doing, sir? My name is James. With the police department. This is my partner, William.

WILLIAM KASBERG: Hi, I'm William. Nice to meet you.

MAN: Nice to meet you.

JAMES WILLIAMS: Well, what's going on with you, sir?

WILLIAM KASBERG: Why don't you sit down and talk with us.

MAN: Sure. The mother who gave me birth is, uh, her name is Janis Joplin.

WILLIAM KASBERG: Her name is Janis Joplin?

MAN: Yes.

WILLIAM KASBERG: OK.

You know anything about the history of policing and things of that nature, dealing with persons with mental illness has always been considered kind of a stigma. It's somebody else's responsibility. It's because we had the least amount of training to deal with somebody that was in a full-blown crisis or having some kind of psychotic episode.

MAN: I was abducted at the age of two years old.

JAMES WILLIAMS: OK.

WILLIAM KASBERG: And you said you went to a psychiatrist. Tell me a little bit about that. Did they ever say you were diagnosed with bipolar, schizophrenia—

MAN: No, no.

WILLIAM KASBERG: Nothing.

MAN: They told me that he wanted to label me as a schizo, but, you know, I've been ignoring these voices from these other people who I cannot see.

WILLIAM KASBERG: Pete, you seem like you're going through a lot tonight, and we want to help you.

MAN: I'm going through a lot, and I've also been having some, uh, uh—

WILLIAM KASBERG: Are you hearing things that other people don't hear? Like voices?

MAN: —been hearing some things from other people without seeing them.

WILLIAM KASBERG: What things do you hear?

MAN: These things, this device—

WILLIAM KASBERG: A device?

MAN: I just recently find out, found out, that it's inside my—the, uh, in the ear. Uh, high-tech, little, small, little implants that are inside—

WILLIAM KASBERG: There's so many cases out there where people have inflicted such severe injury to their head, trying to get the voices to stop. And we take it very seriously—

MAN: Keep antagonizing, and I know this is not—these people who are not invisible. I know that they're just as human as you are.

WILLIAM KASBERG: So you feel like—do you feel like these people are out to get you? Or are they conspiring against you?

MAN: They wanted me to try to end my life, you know?

JAMES WILLIAMS: Did they ever tell you a plan on how they would want you to end your life?

MAN: Just stop breathing, and which—I'm not going to do that!

WILLIAM KASBERG: Law enforcement has a history only new to arrest and end up putting them in jail. So, therefore, most of your jails around the nation became the biggest mental health facilities around the world.

JAMES WILLIAMS: What we'd like to do we'd like to take you somewhere where you can also get something to eat, get some rest tonight, and talk to each other.

WILLIAM KASBERG: Someplace safe to be tonight.

MAN: I have a—

WILLIAM KASBERG: Our whole thing is what we refer to as a "jail diversion." If we can keep people out of jail and into services, it serves two benefits. The first benefit is, they're going to get healthier. The second benefit is, it costs so much more money to incarcerate somebody as opposed to getting them help.

What's going to happen here, like I said, this is this just a clinic, someplace to keep you safe tonight, to have somebody to talk to. When we go in, they're going to do your blood pressure, your temperature, make sure you're feeling well. Make sure you tell them about your ear kind of thing.

And then we'll have one more person to talk to. So you'll have one more person that wants to listen and hear what you're going through. OK? So go ahead and follow us in.

One thing that we've learned is, all these training, all this resource we've had, once you go out there and you actually experience the benefits, you actually get to live the cliche, you know, I joined the police department because I want to help people. Because we've seen the success stories.

You know, I mean, you want to help everybody out, here. And that's the whole goal, is you want to save the world mentality kind of thing. But there is limitations, and— But you have to go and stretch your arm out, across your side of the bridge, as far as you can, and just hope that somebody reaches out to meet you halfway.

We come down to the downtown area, portion of San Antonio is—we do have a large homeless population. Let's check on this gentleman. Just a second.

JAMES WILLIAMS: Let's check on this [INAUDIBLE].

WILLIAM KASBERG: How are you doing, sir? This is the San Antonio Police Department. Is everything OK?

JAMES WILLIAMS: Before I came over to the mental-health unit, I worked the street-crimes unit. And we were doing a full patrol downtown. And I heard someone call my name.

And I turned around, and it was a classmate of mine that I used to go to high school with. He just seemed really disheveled, really decompensated.

WILLIAM KASBERG: Is there anything we can do to help you?

JAMES WILLIAMS: Come to find out he was living on the streets of San Antonio, homeless. He had paranoid schizophrenia. And I couldn't believe it, because this is not the same person I knew from high school. And it really just bothered me. I said, what more can I do for him?

We'll walk with you.

WILLIAM KASBERG: Just try to stay out of the street, OK?

JAMES WILLIAMS: You see the cars, how fast they're coming, here.

WILLIAM KASBERG: It's not that it's bad for tourism, seeing homeless, but also we see them as human beings. And they're part of our community.

Have a good night, sir!

POLICE DISPATCHER: Uh, 131, [INAUDIBLE] cross over to 1 lima, 1 lima.

WILLIAM KASBERG: Hey, partner, did you just hear that call come out, man? We're going to head over to the restaurant, downtown. 10-4. And did he say that she was actually undressed?

POLICE DISPATCHER: Yeah, 10-4, he said she was naked out there.

WILLIAM KASBERG: 78-20, we got a call for that, and we're already heading that way.

POLICE DISPATCHER: OK, 78-20 [INAUDIBLE].

WILLIAM KASBERG: Do me a favor—go ahead and start EMS for us. Could be an excited delirium deal.

[INTERPOSING VOICES]

POLICEMAN: Might want to start EMS, also. She just has been really wild, out here.

POLICE DISPATCHER: OK. I'm starting EMS.

WILLIAM KASBERG: OK. What happened?

MAN: They told me to come out here, and he already had her down.

WILLIAM KASBERG: OK. She's naked.

JAMES WILLIAMS: The first thing we thought of, when we heard the call, was it's a possible excited-delirium case.

POLICEMAN: We've had several fatalities due to this. Typically, they'll end up having some kind of cardiac arrest, and we end up losing them.

[DISTRESSED SPEECH]

WILLIAM KASBERG: You're going to be safe right now. You're safe.

JAMES WILLIAMS: She kept mentioning someone was trying to attack her. So it could have been some hallucination she was experiencing.

WILLIAM KASBERG: Stay still, ma'am. Stay still.

JAMES WILLIAMS: Stay still! Stay still! Relax, relax, relax, relax!

WOMAN: One of you—

[INTERPOSING VOICES]

WILLIAM KASBERG: —stay with us!

JAMES WILLIAMS: —relax—

[INTERPOSING VOICES]

JAMES WILLIAMS: Just relax. Keeping her calm, talking with her, keeping her focused is going to be the main objective, at this point.

WILLIAM KASBERG: We're going to keep you safe.

JAMES WILLIAMS: Yeah, relax.

WOMAN: [INAUDIBLE]

WILLIAM KASBERG: We're going to keep you safe.

WOMAN: Oh my god—[WAILING]

WILLIAM KASBERG: You got any gloves? Some gloves? Would be really nice.

WOMAN: [WAILING]

WILLIAM KASBERG: Thank you, [? partner. ?]

WOMAN: [WAILING]

WILLIAM KASBERG: Can I get a pair of those, too, partner? I'm sorry.

POLICEMAN: She's real hot, man.

JAMES WILLIAMS: Her body temperature was increasing. That's usually a pretty dangerous sign.

WOMAN: [WAILING]

WILLIAM KASBERG: You're not in trouble, OK?

JAMES WILLIAMS: If she doesn't get immediate medical attention, she could go into shock.

WOMAN: [WHIMPERING]

WILLIAM KASBERG: Could you-all hold her head? There we go. You ready?

WOMAN: [BABBLING DELIRIOUSLY]

WILLIAM KASBERG: OK? Go?

WOMAN: [BABBLING DELIRIOUSLY]

WILLIAM KASBERG: Just relax. OK, OK, just try to breathe.

JAMES WILLIAMS: She'll get transported to the nearest hospital, for further medical treatment, and get her stabilized, make sure that she's going to be OK tonight. By working together, we were able to keep her calm. One of us riding in the EMS unit, with EMS, helps keep the patient focused while EMS can do their job and get the accurate vitals before they arrive to the emergency room.

WILLIAM KASBERG: Had we not had this training, with the fire department, our paramedics, and had the knowledge of what excited delirium is, it's probably saved her life That collaboration is just priceless. I'm glad the EMS was close. We were able to communicate and get her to the hospital that quick. I'm glad that ended like it did, I really am.

JAMES WILLIAMS: Could have been worse, but it wasn't. That's all you can hope for for.

[POLICE RADIO CHATTER]

WILLIAM KASBERG: One thing we found is, a lot of people don't need me. They don't need me, they don't need James, to solve their problems. They just need somebody to listen to them. Somehow, they've fallen off the road that they're on, and they lose direction. And it's just really, honestly, our job is to sit down, listen, care for them, and get them back on the highway, get them back onto the path of their life and where their family's going.

Whether somebody's suicidal or homicidal, the only one true element and foundation that they're all missing is one thing, and that's hope.

JAMES WILLIAMS: Good job, tonight, partner.

WILLIAM KASBERG: You, as well, partner.

JAMES WILLIAMS: It was good.

WILLIAM KASBERG: It really ended up well, man.

JAMES WILLIAMS: People can survive and have a great quality of life, own businesses, and work jobs, and have relationships, with mental illnesses. And so that's our goal, is to see them back to that quality of life that they need, to keep going and have that hope for the next day.

[MUSIC PLAYING]