In many parts of the United States, including here in Gainesville and Hall County, law enforcement agencies have become de facto mental health care providers.
“Law enforcement is often the first responder to incidents involving individuals with mental health issues,” Hall County Sheriff Gerald Couch said. “Twenty years ago, law enforcement had little to no formal training in this area, nor was any training readily available.”
New training and funding to deal with mentally ill individuals has resulted, but the challenge is growing.
For example, between 20 and 25 percent of inmates in the Hall County Jail have a diagnosed mental illness, according to local officials, and that’s a costly expense to manage.
“This percentage has increased over the years,” Couch said. “This is not just a local issue, but one facing correctional institutes throughout the country.”
The consequences are pronounced for the mentally ill and local law enforcement agencies.
Individuals with untreated mental illness are 16 times more likely to be killed by police, for instance, according to a report last year from the Treatment Advocacy Center, a Virginia-based nonprofit.
And about 15 percent of men and 30 percent of women in jails across the country have serious mental health disorders, according to National Alliance on Mental Illness, with about 4 in 5 lacking access to medication and treatment.
Though families supply some medications for mentally ill inmates, the local sheriff’s office estimates a $25,000 medication expense this year to serve those in need.
Georgia lawmakers have identified the crisis faster than others, with increases to the state mental health budget of 22 percent between 2009 and 2012, according to NAMI.
And the Peach State is also one of leading states supporting crisis intervention teams.
But pushing forward begins with looking back.
How did we get here?
Many factors have come to represent the nation’s mental health crisis — incarceration rates, suicides in youth, military veterans with post-traumatic stress disorder — but experts point to the deinstitutionalization of state-run mental health hospitals in the mid- to latter-half of the 20th century as exacerbating the problem.
Conditions in these hospitals were often horrendous. But plans to fund and open community mental health centers as replacements never materialized to a significant degree in the 1970s and ’80s.
So law enforcement began to fill in.
The number of those with mental illness in jail now outnumbers those in state hospitals 10 to 1.
More than 2 million mentally ill individuals are booked into jails each year in the United States.
But the decadeslong treatment of those with mental illness is starting to change as government, law enforcement, businesses and nonprofits grapple with the ways the illnesses can manifest in criminal acts.
There’s no simple answer or limit to kinds of crimes mentally ill individuals commit, according to local law enforcement. They can range from misdemeanor charges like drinking alcohol in public to violent felonies. Drugs are often present.
Gainesville Police spokesman Sgt. Kevin Holbrook said officers receive annual specialized training in dealing with mentally ill individuals.
And officers on each shift are specially equipped as part of a crisis intervention team.
Holbrook said the primary purpose of these teams is to “promote and support collaborative efforts to create and sustain more effective interactions among law enforcement, mental health care providers, individuals with mental illness, their families and communities.”
Holbrook described this as “verbal judo,” which teaches the officers how to specifically speak with individuals. This is important when dealing with subjects who are mentally ill.
The success of this training was evident for Robert Cipriani of Gainesville.
A military veteran, Cipriani showed up at a recent City Council meeting to express his gratitude to police officers who professionally de-escalated a volatile situation when Cipriani was under PTSD-induced delusions.
His wife, Wendy, said Cipriani was acting as if he were back on the battlefield.
But officers were familiar with Cipriani, his service in the military and his mental illness.
And so they responded with guns holstered and the tone of their voice dialed down.
Robert said their actions to peacefully resolve the matter may have saved his life.
“Officers form relationships with these subjects so that when they encounter them on the streets they are not afraid of law enforcement,” Holbrook said.
Couch said training is constantly updated and improved to help law enforcement better respond to incidents involving mental illness.
“Since resources are limited, this places a greater burden on any agency,” Couch said.
Still, police are often the last to know of an individual’s condition, and the most severely burdened can still fall through the cracks despite best intentions and efforts to the contrary.
For example, Stephan Womack, 30, died in late February after being hit by a train while strolling along railroad tracks in the industrial section of Gainesville.
Womack had begun showing up at local homeless camps in the weeks prior to his death, but few knew of his circumstances.
His mental state was obviously deteriorating, as evidenced by his inability to have a normal conversation. He was frequently seen partly dressed and mumbling to himself as he loitered around businesses off Queen City Parkway.
He was even arrested on that charge and taken to court the day before he was killed, and he was let go on his own recognizance.
Those who had encountered Womack in the final weeks of his life said he was despondent and mentioned that his family didn’t care for him anymore. They wonder if he didn’t commit suicide. Police said he was listening to music and turned away from the train when he was struck.
The next steps
Partnerships and close collaboration with community mental health organizations, such as Avita, is critical to meeting the challenge, Holbrook said.
The Hall County jail has an Avita nurse practitioner available to evaluate inmates weekly. This includes diagnosing mental health conditions and prescribing treatment.
Every inmate is screened when first entering the jail, and medical intake forms are compiled to manage each individual’s medical and mental health needs.
“We have taught classes with these groups on how to handle police interactions,” Holbrook said.
The Hall County Mental Health Court is also critical in reducing recidivism by providing alternatives to incarceration for defendants who are wrapped up in the criminal justice system as an explicit and direct result of their mental illness.
Daily access to medication and other treatment is sometimes lost when the most vulnerable of the mentally ill leave jail and end up back on the streets.
“Subsequently, they may revert back ... which led to them being arrested in the first place,” Couch said. “Having a statewide program available to specifically assist the mentally ill while in jail and then post-release may help with recidivism.”