Does a ‘Code of Silence’ Among Students, Parents Abet School Shootings?

School shootings can be averted when parents, school authorities and students themselves take seriously the signals indicating potential violence from troubled youths, and communicate their concerns as quickly as possible, according to the Police Foundation.

School shootings can be averted when parents, school authorities and students themselves take seriously the signals indicating potential violence from troubled youths, and communicate their concerns as quickly as possible, according to the Police Foundation.

In two companion studies of 51 completed and 51 averted incidents of school violence that have occurred in the U.S. since the 1999 Columbine High School shooting, researchers found that the reluctance to break the “code of silence,” and tell responsible authorities about fellow students who openly make threats or display signs of mental instability is a critical factor determining whether a tragedy occurs or is prevented.

“Communication is the key to preventing mass attacks,” concluded Peter Langman and Frank Straub, the co-authors of one of the papers. “To improve communication, communities need to be trained to recognize warning signs and to know what to do when they encounter them.”

Langman, a psychologist and expert on school safety, and Straub, a former Spokane police chief who is now director of the Police Foundation’s Center for Mass Violence Response Studies, found that, although there was no typical school shooting, there were common factors connecting many of them.

The incidents studied—which were not intended to be a comprehensive list of all the school shootings in the US since 1999—were mostly committed by males under the age of 27, most of whom already had a “history” of mental instability.

“A majority of perpetrators who completed attacks had a history of being treated for one or more mental health issues or development disorders,” said the paper.

Often there were clear signals of homicidal intent long in advance that parents or students failed to take seriously.

In one example, a perpetrator was so obsessed with the Columbine shooting that he convinced his mother to drive him across country so he could see the site where the shooting happened.

“Despite knowing that he was suicidal and obsessed with Columbine and owned firearms, she apparently did not recognize these factors as warning signs for violence,” the authors wrote.

In several cases, students or parents ignored comments about proposed violence—especially when they were made in a joking manner, or failed to recognize signs of mental illness—underlining the need for a changed national approach to mental health, the paper said.

Ending the Stigma of Mental Illness

“Increased knowledge about mental health and the signs of psychological distress could have resulted in better intervention by parents, teachers, and others,” said the authors. “In addition, the stigma regarding mental health treatment has been a barrier that has kept people from getting help.

“Efforts to destigmatize mental health treatment should be a national priority, along with increasing available services and making sure they are accessible and affordable to all who need them.”

The second paper, by Jeff Daniels, attempted to identify the factors in the 51 “averted” incidents that prevented potential tragedies from occurring.

Daniels focused on two contrasting cases. In the first, a 17-year-old boy, his brother, and friends, calling themselves the “Trench Coat Mafia” in imitation of a group of students at Columbine, plotted to blow up their school and shoot any surviving teachers and students as they fled. But one of the conspirators disclosed the plot to a teacher, who then passed the information along to a school resource officer, who notified the local police. As a result of the investigation, five youths were arrested.

In the second case, a bright 15-year-old boy from a broken home who had begun to do poorly in his studies, talked repeatedly with friends about “pulling a Columbine” and bringing a gun to school and kill people. His friends largely dismissed it as a joke. When he actually announced he was going to “bring a bunch of guns” to school the next day, some of his friends were concerned enough to pat him down for a gun.

However, they failed to search his backpack, which contained the gun. He entered the school and shot 15 people.

“The primary difference between the two case examples is that in the averted shooting, multiple people reported their concerns, but in the completed shooting, no one who was concerned about a possible attack contacted either the school or local law enforcement,” Daniels said.

The reluctance to tell authorities or others their fears is a result of the “code of silence” that prevails among many young people who fear being called snitchers, the paper said.

According to the paper, school authorities can go a long way towards puncturing students’ concerns by helping them make “a distinction between ‘snitching’ (which is reporting to get somebody in trouble) and reporting a concern (which is intended to help others).”

The Police Foundation studies were part of an Averted School Violence project that began in 2015 and was funded by the Office of Community Oriented Policing Services (COPS) at the Department of Justice and the National Institute of Justice (NIJ). The project selected an equal number of averted and completed incidents to establish a database from which it could draw conclusions and recommendations for law enforcement, community groups, parents and educators.

Both papers drew a number of other lessons from their study related to school security, first responders and strengthened community partnerships.

‘Punishment is Not Prevention’

One lesson was that expulsion of students who exhibit troublesome behavior was not likely to head off a shooting incident, noting that in several cases students who were suspended returned later to the school with a gun and committed murder.

“Punishment is not prevention,” the Langman-Straub paper said. “The lesson here is that when students are suspended and prohibited from being on school property and this is not communicated to school personnel, the students can return to the school, enter, and commit acts of violence.”

Other recommendations for school authorities, parents and law enforcement have frequently been made by other experts. Both papers notably stayed away from hot- button issues raised by advocates on different sides of the debate about preventing mass shootings in schools, such as stricter gun control or arming teachers.

The recommendations included:

  • Ensure that guns are stored and locked safely in the home;
  • Make an effort to secure the school grounds, even though metal detectors were shown rto provide little detection;
  • Develop effective first-response plans to hand potential school emergencies;
  • Maintain trusting relationships with students to detect potential signs of distress and physical aggression, and educate students themselves about warning signs;
  • Use trained security or school resource officers as a deterrent;
  • Parents should not hesitate to check diaries, papers or social media used by young people who have displayed problematic behavior.

But the overall conclusion of both papers is that early and transparent communication among all the players who are likely to be involved in a school shooting incident is a primary factor in keeping schools safe.

“Safety is a community concern,” said the Langman-Straub paper. “When more people take action to maintain safety, the more likely a community is to prevent an act of violence.”

Additional Reading: Stopping School Shootings: Is Colorado’s Safe2Tell Hotline a Solution?

See also: Today’s TCR newsbrief: ‘Silent Panic Alarms to be Installed in NJ Schools.”

Both papers are available for download. The Langman-Straub paper is accessible here.  The Daniels paper can be accessed here.


LA Sheriff Cites Mental Care Failings After Mass Killing

The case of Dakota Theriot, who is accused of killing five people last month near Baton Rouge, La., “is an extremely horrific example of what we all have known are the shortcomings of our national system of mental health care,” says St. Charles Parish, La., Sheriff Gary Champagne.

The case of Dakota Theriot, who is accused of killing five people last month near Baton Rouge, La., “is an extremely horrific example of what we all have known are the shortcomings of our national system of mental health care,” says St. Charles Parish, La., Sheriff Gary Champagne, reports The Advocate. Police and court records show he had beaten his wife and threatened to kill his family. He never faced a lengthy prison term or long-term hospitalization. For many offenses, he was never arrested. Theriot, 21, had threatened to burn the family house down. His ex-wife told police he once “snapped,” pulling the side mirrors off her car to use as a weapon. He was accused of choking her, knocking out her teeth, throwing her through a window and breaking her wrist. She said he had been diagnosed with schizophrenia.

The fact that someone is mentally ill rarely leads to homicidal violence, but the charge that Theriot killed five people in a rampage that spanned at least an hour is  is a tragic reminder of  a mental health system where treatment is little more than crisis stabilization. Champagne, former president of the National Sheriffs Association, says law enforcement conferences have become dominated by talking about how police have replaced asylums as the front lines for mental health care. “There are a lot of people …that fit that kind of bill,” Champagne said. “He ends up killing five people and everybody looks and says ‘Oh, well, what didn’t we do?’ Well I don’t know what could’ve been done more at this point in time. He’s going in to people who are supposed to be treating him and helping him.”


Oregon Wastes Millions on Pretrial Treatment: Report

A “deeply broken” system meant to treat criminal defendants who are deemed mentally unfit for trial has instead warehoused them in a costly state mental hospital for far longer periods than if they had simply served jail time for minor offenses, a newspaper investigation reveals.

Over the past six years, Oregon has sent at least 1,486 people with mental illness accused of misdemeanors to spend months at the state hospital to ready them for court in a “deeply broken” system that is wasteful and unjust, The Oregonian reports. Deemed incompetent to assist in their defense, people charged with minor offenses can languish in the hospital far longer than any jail sentence they might have served, and at hospitalization costs far greater than they might get at a small, secure residential facility offering better one-on-one treatment, the newspaper found.

Bob Joondeph, director of the advocacy group Disability Rights Oregon, said, “This is an issue that’s been around for many years now. All the players know about it.” But “enormous institutional inertia” has stopped attempts at reform, he said. Peter Courtney, president of the state Senate and a longtime mental health care reformer, said he has had trouble convincing the Legislature to vote for bigger mental health budgets. “Everybody cares about mental health. Every state senator and state representative does,” Courtney said. “The problem is when it comes to prioritization of funds, everybody wants to do something about mental health but just not today.”


ProPublica Made Errors In OR Insanity Defense Stories

ProPublica corrected stories  published with the Malheur Enterprise about Oregon’s handling of people found “guilty except for insanity.” The stories were prompted by the case of Anthony Montwheeler, who was charged in 2017 with killing two people soon after his release by Oregon’s Psychiatric Security Review Board.

ProPublica corrected stories  published in the last year with the Malheur Enterprise about Oregon’s handling of people found “guilty except for insanity.” The stories were prompted by the case of Anthony Montwheeler, who was charged in 2017 with killing two people soon after his release by Oregon’s Psychiatric Security Review Board. The stories triggered calls for reform by state officials. A reader’s inquiry from a reader prompted ProPublica to review the stories’ underlying data and assertions. ProPublica now says, “We found errors of fact and analysis that need to be corrected.” One of these stories was summarized in The Crime Report.

One key assertion in the series was that insanity defendants are charged with crimes after they are freed more frequently than people freed after serving prison sentences. Data provided in the stories were inaccurate, as is the assertion that insanity defendants have a higher recidivism rate than those released from prison. ProPublica says that, “In some instances, we incorrectly tallied misdemeanor charges as felonies. In others, we mistakenly included people charged with felonies outside the three-year window. We also misstated the recidivism rate among people released from Oregon’s prisons. The state does not track the number of people charged with felonies after they are freed. The rate we cited in the story — 16 percent — arose from a misreading of state records.” ProPublica recounted a number of other errors in its reporting.


Should Police Be Handling Mental-Illness Cases?

The majority of police officers in 45 percent of agencies surveyed haven’t been trained to handle mental-heath crises. In Eugene, Or., a nonprofit handles such cases, amounting to 17 percent of police service calls last year.

The calls come to police departments with growing regularity: a man in mental crisis; a woman hanging out near a dumpster at an upscale apartment complex; a homeless woman in distress. In most cities, police officers respond to such calls, an approach experts say increases the risk of a violent encounter because they aren’t always adequately trained to deal with the mentally ill. At least one in every four people killed by police has a serious mental illness, says the Virginia-based Treatment Advocacy Center. In Eugene, Oregon’s third-largest city, when police receive such calls, they aren’t usually the ones who respond, the Wall Street Journal reports. The first responders are typically pairs of hoodie-wearing crisis workers and medics driving white vans stocked with medical supplies, blankets and water.

They work for a nonprofit called Cahoots—which stands for Crisis Assistance Helping Out On The Street. Started by social activists in 1989, Cahoots handled 17 percent of the 96,115 calls for service made to Eugene police last year. In 2017, police officers spent 21 percent of their time responding to or transporting people with mental illness, found a survey of 355 U.S. law enforcement agencies by the Treatment Advocacy Center. More police departments are training their officers in techniques to deal with the mentally ill. Los Angeles, Houston and Salt Lake City pair officers with mental-health workers with police officers. Still, the center found that in 45 percent of the agencies polled the majority of officers haven’t received crisis-intervention training. Public anger over police killings has pushed law-enforcement leaders in California to discuss how to replicate Eugene’s program in their state, said Brian Marvel, president of the Peace Officers Research Association of California.


Rural Jails Struggle to Cope with Rise in Mentally Troubled Inmates

The growing population of offenders with mental health or substance abuse issues is a nationwide problem, but it’s especially challenging in rural communities. One Wisconsin jail has risen to the challenge.

When someone is booked into Polk County jail in rural Wisconsin, the first step is a screening process to determine the individual’s medical and mental health care needs. The information from that screen is reviewed by the jail nurse and jail sergeant, who determine if the jail nurse needs to follow up.

Once in the general jail population, the inmate can submit a nurse call slip for non-emergency mental health concerns, and the nurse or jail staff member will follow up as needed. An urgent mental health need is handled through a request by call slip to a nurse or staff on regular rounds.

Many big-city jails, which are now the main source of medical help and counseling for the mentally ill, have used similar strategies to deal with a growing roster of inmates who need special medical help.  But the approach has now spread to smaller rural jails in states like Wisconsin.

“Our jail staff is excellent in recognizing symptoms of mental health and of untreated mental health issues, notifying me, and addressing those issues,” said Donna Johnson, the Polk County public health nurse, who has worked in the county jail for 20 years.

Rural jails often bear the brunt of what has become a growing national problem. A 2016 survey of 230 jail staff members across 39 states found that 96 percent reported having inmates with serious mental illnesses during the previous year.

Three-quarters of the jails reported seeing more or far more seriously mentally ill inmates compared to five to 10 years ago.

More than 80 percent of people incarcerated in the Polk County Jail have mental health needs, according to Johnson.

“For the people we’re seeing with serious and pervasive mental health issues in the jail setting, methamphetamine (addiction) is by far the greatest issue that we’re dealing with,” she said.

According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA),  the toxic effects of substances can mimic mental illness in ways that can be difficult to distinguish from mental illnesses.

Substance-induced mental health disorders involve psychiatric symptoms that are caused by using a substance. People can also have co-occurring mental disorders, where they have a mental illness and a substance use disorder.


The 160-bed Polk County Jail in rural Wisconsin has seen a rise in inmates suffering from mental health and substance abuse issues. Photo courtesy Leader-Register.

Rob Drew, captain of the Polk County Jail, estimates that around 70 percent of the county jail’s inmate population would benefit from some type of mental health care, be it from a counseling session or meeting with a psychologist.

“We have a fairly low number of people that rise to the level of being suicidal, but the number of people that could benefit from general mental health services is very high,” said Drew, who oversees the county’s 160-bed jail.

Drew said it is difficult to calculate the specific amount of people in jail with mental health needs due to the variation in inmate mental health needs, which aren’t tracked with jail records.

Polk County’s Johnson says that the mental health of those in the county jail has always been a concern, but it has dramatically changed over the years.

“It used to be a rare occasion when we had someone who displayed [suicidal tendencies] … (and was in need of) psychiatric services,” said Johnson.  “Now it is really the norm,”

Looking back to the first methamphetamine epidemic that occurred about 20 years ago, Johnson says that they had people in the jail displaying acutely psychotic behavior where they experienced both auditory and visual hallucinations.

“We see that on a chronic basis now,” said Johnson, who believes the mental health issues the county is experiencing right now are largely due to methamphetamine and alcohol use.

“Alcohol remains our Number One issue,” said Johnson. “It (alcohol) doesn’t get as much attention because it’s legal.”

The American Psychiatric Association reports that chronic heavy methamphetamine use can cause temporary paranoid delusional states that may last for weeks, months and even years. Symptoms can also include dementia, psychotic episodes, and evidence of “bipolar” disorder.

Heavy long-term alcohol use can cause brain damage that causes symptoms of dementia that are not entirely reversible even with sobriety.

However, most substance-induced symptoms begin to improve within hours or days after substance use has stopped.

In 2017 the Leader-Register reported that Polk County leads the state of Wisconsin in per capita criminal prosecutions of methamphetamine. That year there were 184 individuals arrested for methamphetamine alone with 393 drug charges against them.

The Polk County behavioral health unit pychiatrist, Dr. James Rugowski, visits the jail once a month for about five hours to handle medication assessment, management and to assess individuals’ mental health needs.

Crisis workers connect incarcerated individuals with behavioral health services before they are released from jail, so there is a continuation of care. Before their release individuals who are identified in need get help processing their (medical assistance) BadgerCare application from a county health department staff member.

“When they walk out of the jail doors, they can have their BadgerCare application already processed so they have insurance to cover their mental health services, medications and medical needs,” said Johnson.

Stark and Johnson also provide suicide and mental health training to jail staff.

“From administration all the way down to the line staff, we all strongly believe that it’s equally as important to care for [inmates’] mental health as it is to care for their physical health,” said Johnson.

The county offers a crisis call line through Northwest Connections, a third-party organization contracted by the county’s mental health unit to handle the county’s crisis call work. This allows the county 24/7, 365-day coverage for crisis calls and is used in the jail.

“The officer can bring the inmate to the phone and give the call taker a synopsis of what’s going on and the inmate will speak to the crisis call person and they determine the appropriate care for them,” said Drew.

Challenges they still face include serving non-county residents, and a lack of resources for proactive care and the continuation of care outside of jail.

“I do think we are doing a really good job of managing what we have with the resources that we have available,” said Drew.

“More resources would be nice, but you can only play with the cards you’re dealt.”

Johnson has found connecting individuals from outside of Polk County to services once they leave jail a challenge, because not all counties have the same services or resources.

“I can’t always have an appointment scheduled for them when they walk out the door, whereas I can if they are a Polk County resident,” she said.

Barriers for individuals continuing their mental health care outside of jail include finding housing and transportation to appointments. Those that are enrolled in BadgerCare can access the state’s nonemergency medical transportation services.

However, in Johnson’s experience, that extra step of organizing transportation can become a barrier for some people.

Polk County has one transitional housing facility for those returning to society after incarceration called the Serenity Home, but its future at its current location, in the old county jail, is uncertain.

“It has been a godsend to have them where they are, but unfortunately the county board opted not to renew their lease when it is up,” said Johnson.

The Serenity Home, operated by the Salvation Army, is located across the street from the Polk County Jail and neighbors the county’s behavioral health unit.

Looking to the future, Johnson and Drew are hopeful about the potential to better serve individuals incarcerated in the county jail who have mental health needs.

Recently, the county’s community services unit proposed two positions to expand behavioral health services. The positions are an additional half-time jail nurse, specializing in mental health services, and a full-time nurse practitioner for the behavioral health unit.

Drew supports both positions.

“If that comes to fruition, which I am hoping it does, I think it will be a really good model for other counties to provide more preventative care,” said Drew.

Danielle Danford, a staff writer for the Leader-Register, is a 2018 John Jay Rural Justice Reporting Fellow. This is a condensed and slightly edited version of a story written as part of her Fellowship project. The full story is available here.


Oregon Hid High Recidivism Among Criminally Insane

Oregon releases people found not guilty by reason of insanity from supervision and treatment more quickly than nearly every other state in the nation, but they commit far more crimes after their release than the state has previously led the public to believe, a news investigation has found.

Oregon releases people found not guilty by reason of insanity from supervision and treatment more quickly than nearly every other state in the nation, but they commit far more crimes after their release than the state has previously led the public to believe, according to a joint report from ProPublica and the Malheur (Ore.) Enterprise. The speed at which the state releases the criminally insane from custody is driven by both Oregon’s unique-in-the-nation law and state officials’ expansive interpretation of applicable federal court rulings. Release decisions are made by the Psychiatric Security Review Board. The five-member panel of mental health and probation experts has custody of defendants found not guilty by reason of insanity and oversees their treatment. On its website, the board assures Oregonians that repeat offenses by people it supervises are exceedingly rare events, with only 0.46 percent of defendants committing new crimes each year.

The reality is that about 35 percent of those let out of supervised psychiatric treatment were charged with new crimes within three years of being freed by state officials. Between Jan. 1, 2008, and Oct. 15, 2015, the state freed 220 defendants who had been acquitted of felonies because they could not tell right from wrong or control their actions. About a quarter of them, or 51 people, were charged with attacking others within three years. Twenty-five were charged with lesser crimes. Eighteen others were charged more than three years later, including 12 people for violent incidents. They were charged with felonies about as often as people freed after serving prison terms — both 16 percent — according to the news organizations’ analysis and the Oregon Department of Corrections. The review board made similar findings in an internal report almost three years ago, but never shared it with the public or with other state agencies.


Media Called Out on Linking Shooting to PTSD

Did the mass shooting in a California bar stem from the shooter’s combat-related post-traumatic stress? Too many reporters jumped to that conclusion, a media critic writes.

In a rush to explain the unexplainable, journalists have written multiple stories that draw unfounded conclusions linking the combat experience of last week’s Thousand Oaks, Calif., mass shooter to post-traumatic stress disorder, Columbia Journalism Review reports. In an opinion column, CJR‘s Andrew McCormick cites stories published by CNN, Reuters, the New York Daily News, the Los Angeles Times and The New York Times that took unconfirmed reports about the shooter’s mental condition and broadly suggested a causal link to the shootings at a country bar in which 12 were killed.

“Even if the former Marine had been diagnosed with PTSD,” McCormick wrote, “it would offer little explanation for Wednesday’s events. PTSD is not a guaranteed pathway to violence, much less homicide; while PTSD can result in increased anger and aggression, those suffering from PTSD are more likely to to withdraw than to lash out at others, according to the American Psychiatric Association. The image of the veteran as a haunted killer, stamped indelibly into the zeitgeist, is a myth. As Elspeth Ritchie, a retired Army colonel and psychiatrist with experience in treating the condition, told The Washington Post, something like a mass shooting usually results from a psychotic episode, in which the perpetrator loses touch with reality, not PTSD.”


‘Kindness of Strangers’ a Last Resort for the Rural Mentally Ill

In rural Nebraska, police and medical providers have teamed up to divert troubled individuals from the justice system, but it’s still a struggle to get adequate resources.

Even though more services are becoming available to divert the seriously mentally ill from the justice system, rural communities are struggling to find the resources they need to bring those services to the people who need them.

Transportation, for instance, can make the difference between success or failure.

“We have no public transportation here,” said Pamela Hopkins, a Fremont, Neb., lawyer who is running for Dodge County Attorney. “Many of these people are unable to drive, for one reason or another, whether it’s because they use alcohol as a substitute for their treatment and they lost their licenses because of that, or they’re too poor to have a car.

“They’ve got to depend on the kindness of strangers.”

Without ready access to counseling or treatment often located far from their homes, defendants might otherwise find it hard to prove to judges that they are serious about addressing their problems.

Nebraska, like many states with large rural populations, is at the sharp end of the challenges of dealing with mentally troubled individuals. Most of the state is experiencing a shortage in mental health and psychiatric providers, according to the state’s Department of Health and Human Services (DHHS) Office of Rural Health.

Linda Witmuss, deputy director of the DHHS Division of Behavioral Health, acknowledged that the system needs to undertake a “richer review of data” to better determine how the state’s finite resources should be allotted to meet the need.

But she argues that mental health reforms launched by the state in 2004 have led to more services at the community level.

“There’s always room for more services—don’t get me wrong there,” she said. “ (But) all of our rehab options (and) services, including expansion of medication management, came about as a result of that reform.”

In 2004, the Nebraska legislature passed Bill LB1083, which was designed to reduce the use of inpatient psychiatric services at the state’s three Regional Centers in Lincoln, Norfolk and Hastings, and invest more in outpatient and community-based services that could help those struggling with mental health in their own communities.

The reduction of inpatient beds was consistent with nationwide efforts to move away from institutionalizing the mentally ill and instead treat them in their communities. But those interviewed by the Tribune say that the infrastructure for community care was slow to materialize, and it still isn’t adequate for those who may be in need of more intensive care.

“There’s a lot of people who aren’t even leaving their homes to get the services that they need because they’re just homebound because of their anxiety,” said Hylean McGreevy, a licensed mental health practitioner and alcohol and drug counselor at Methodist Fremont Health’s Behavioral Outpatient Services.

“They’re not functioning well and they fall through the cracks.”

According to numbers provided to the Tribune by the Nebraska Jail Standards Board, of 1,225 individuals discharged from the Regional Centers in a four-year period following mental health reform, nearly 500, or around 40 percent, ended up in the county jail system at least once.

About six percent ended up in the prison system.

Collaboration Between Police and Health Providers

The challenges often begin at the street level, where rural law enforcement encounters individuals in desperate straits.

“There is a lot of stress on the community,” said Fremont Police Lt. Kurt Bottorff. “Times are hard for certain people — the stress builds up and that’s where some mental health breakdowns can take place.

“Their behavior ends up being a law violation and they’re sometimes jailed because of it, instead of addressing the core problem.”

Under a pilot program that started in July, the Fremont Police Department became one of only two departments in the state to hire a crisis response co-responder—a licensed mental health practitioner who works directly in the police department two days per week, responding to 911 calls alongside officers when she believes mental health is an issue in the complaint.

The pilot program, funded by a two-year grant from the Behavioral Health Support Foundation and operating in collaboration with Lutheran Family Services, aims to help keep those struggling with mental health issues out of the criminal justice system or avoid involuntary hospital stays, and to connect them with community resources.

Until recently, even the nearest medical services were a 40-minute drive away, in Omaha.

Now, mental health practitioner Rachel Wesely can respond at her own discretion instantaneously, from within the department, and can follow up with callers after law enforcement leaves.

‘When people are released (from jail) into the community, and they don’t have the supports in place, it becomes a revolving door.’

But as concern mounts about a growing number of mentally ill individuals entering the criminal justice system and winding up in county jails, local stakeholders are taking a more focused approach to line those individuals up with more appropriate services.

“There’s a need for access to treatment in jails and when individuals are incarcerated, it’s not getting filled,” Wesely said. “Sometimes when people are released back out into the community (and) they don’t have the supports in place, it kind of becomes a revolving door.”

Medication and services can be expensive. Many lack insurance to help cover costs, though some programs offer sliding fee scales, which can adjust payments based on income and family size. In recent years, co-pays and deductibles have become more expensive even for those who have insurance, providers say.

Additionally, treating mental illness is more complicated than treating physical ailments, and ensuring compliance to treatment plans poses challenges, providers say. Psychiatric treatment requires significant “trial-and-error” to find the right medications, doses and strategies. That means lots of time spent taking medications that may ultimately need to be adjusted or changed, and that may carry unpleasant side effects that deter compliance.

It’s a process that requires patience and follow-up. And ensuring that patients comply with their treatment plans, remain stable or avoid self-medicating with illicit drugs and alcohol is a challenge that’s only exacerbated by barriers like access and affordability.

“Let’s just use a hypothetical,” said Dodge County Attorney Oliver Glass. “I can’t afford my medication, my medication makes me feel strange anyway, but I do know that when I self-medicate with street drugs or alcohol, that’s going to make me feel better at least.

“And that’s when, at least in my experience here, a lot of crimes are committed.”

Intensive Care Challenges

The Regional (Health) Center has some space available to the regions for more intensive care. It houses individuals who have been ordered by a court to receive a competency evaluation or restoration, as well as individuals committed by a local mental health board. The latter process only occurs if an individual in crisis refuses to be voluntarily committed and is put under an emergency protective custody.

But wait times to get into the often crowded Regional Center have gone up, officials say.

Witmuss of the DHSS said that the state is looking into the need to increase capacity, but cautioned that opening new beds alone wouldn’t solve the problem.

“We have a lot of complex cases,” she said. “When you can’t discharge folks, then you can’t admit folks, either.”

Mental health programs and services are funded through Medicaid as well as the state’s behavioral healthcare regional system. Providers contract with one of the six regions, which then funnels funding from DHHS’ Division of Behavioral Health, federal block grants and county-level matching funds.

But grants and pilot programs, like the Lutheran Family Services’ co-responder program, are only guaranteed for fixed periods of time. Agencies and organizations are always shifting their appropriations to keep up with where the demand is highest, which can lead to changes in program availability.

Meanwhile, at the local level, stakeholders are giving new focus to the issue. Providers are exploring more innovative solutions to staff shortages, such as Telehealth, which would allow for remote counseling or med management.

Last year, Behavioral Health Care Region 6, which encompasses Douglas, Dodge, Cass, Washington and Sarpy Counties, hired Vicki Maca as a full-time employee, dedicated to trying to keep mentally ill individuals out of the criminal justice system.

That hiring decision was spurred by a nationwide initiative involving the National Association of County Officials, the American Psychiatric Association and the Council of State Governments known as the Stepping Up Initiative.

The initiative is a data-driven effort to reduce the number of people with serious mental illness booked into jail, shorten their average length of stay, increase the connection to care for those individuals in jail and reduce rates of recidivism.

While other behavioral health care regions are engaging with the Stepping Up Initiative, Region 6 is the only one that’s hired a full-time employee devoted to the topic.

But officials and providers remain optimistic. Rachel Wesely, the co-responder at the Fremont Police Department, law enforcement’s enthusiasm and willingness to cooperate with the co-responder model has led to success, she said.

Lt. Bottorff agrees.

“What I’m seeing now is reduced calls for service for the same problem,” he added. “There are times when we get so bombarded with the same situation—they didn’t have the tools to fix their problem.”

James Farrell, a staff writer for The Fremont Tribune, is a 2018 John Jay Rural Justice Reporting Fellow. This is an edited version of  Part Two of a series exploring the intersection of mental health and the criminal justice system in rural Nebraska. To see the full version, click here. Part One can be accessed here. Readers’ comments are welcome.


Experts Link Mental Health Issues to Spike in Honolulu Police Shootings

The number of police-involved fatal shootings in 2018 has doubled to six, the most ever in recent history, prompting concern among criminal justice experts about whether they’re seeing an overall trend of more violence in the Aloha State. 

When  Hawaii’s new police shooting board began its work this summer, it already had a full plate.Four fatal shootings were waiting to be reviewed by August, with three of them involving the Honolulu Police Department  (HPD). 

Two months later, the number of HPD-involved fatal shootings in 2018 has doubled to six, the most ever in recent history, prompting concern among criminal justice experts about whether they’re seeing an overall trend of more violence in the Aloha State. 

It is not known if any of the six men killed were using drugs or alcohol at the time of their deaths. HPD has declined to provide details because the cases are still under investigation and they declined requests to be interviewed about the shootings for this story.

For years, the police department has tried to address encounters officers have had with mentally ill and drug-addicted individuals. In 2006, the HPD began consulting with three on-duty psychologists when encountering someone who appeared to be mentally ill. By 2008, HPD officers had placed about 26,000 calls to the on-duty psychologists. This year, the department has been part of a new initiative to divert the mentally ill who have not committed a crime but appear to be in crisis.

Launched in April, the Law Enforcement Assisted Diversion program has yet to divert anyone. Out of the HPD came the Crisis Intervention Team (CIT) training. The concept has worked well for police departments that had growing numbers of officer-involved shootings. In Miami, for example, fatal shootings have gone down since 2010 and the number of mental health-related calls resulted in far fewer arrests, also saving millions of dollars for taxpayers.