>> Polk County Officers are first line of defense in war against mental illness on the streets

LAKELAND — The call came into the 9-1-1 communications center in the last year.

A husband was on the line trying to get help for his mentally ill wife, who could be heard in the background screaming, talking to herself, and talking to the television.

The husband said his wife was on medication for a mental illness, but she had been taking a new, unrelated prescription that was negating her mental health medicine.

“I need somebody to come out here and Baker Act my wife,” the husband told the 9-1-1 operator, referring to the Florida law that allows a person to be involuntarily committed for up to three days. “We were out earlier and she was fine. We came home, she is just screaming at the top of her lungs.”

Linstening in on that call was Polk County Sheriff Grady Judd.

“She has had a (psychotic) break and I listen to that and I think how sad is that?” Judd said during an interview in his office. “So, who does he call? He calls law enforcement. We get there and talk her down.”

The deputy who responded took her to the hospital.

First line of defense in mental health crisis

Judd and other law enforcement agencies around the country know that they have become the first line of defense in a war with an invisible enemy — mental illness.

“My heart breaks for those who are suffering from mental illness,” Judd said. “It’s by the grace of God that us and our children (don’t)… and we need to go above and beyond for those who suffer from mental illness. I pray for these people every day, they’re on my standard prayer list.”

According to 2016 Computer Aided Dispatch data for calls for psychiatric/abnormal behavior/suicide fielded by local emergency medical service providers, there were:

• 451 calls in Lakeland;

• 309 in Winter Haven;

• 105 in Auburndale;

• 85 in Haines City or Poinciana;

• And 78 in Lake Wales

Based on the number of people being Baker Acted, those call numbers are only increasing.

“The sheriffs, police, and courts have become the new psychiatric outpatient system,” said Dr. E. Fuller Torrey in his book “American Psychosis, How the Federal Government Destroyed The Mental Illness Treatment System.” “As a consequence of having discharged hundreds of thousands of seriously mentally ill individuals from hospitals to live in the community without adequate medications or support, psychiatric crises occur frequently. The people who respond to these crises are mostly law enforcement officials, and for many officials, such calls have become a significant part of their job.”

The situation can be dangerous. The Treatment Advocacy Center, based in Arlington, Virginia, states that people with untreated serious mental illness are 16 times more likely to be killed during a law enforcement encounter than other civilians. In fact, they say, one in four fatal law enforcement encounters involves an individual with serious mental illness.

Baker Acts

The Florida Mental Health Act — commonly known as The Baker Act — was established in 1971 and named after state Rep. Maxine Baker of Miami, who was a staunch advocate of mental health care.

Alice Nuttall, associate vice president of behavioral health at Lakeland Regional Health Medical Center, said she counts the lawmaker as a personal hero of hers.

“She spent multiple years touring psychiatric facilities around Florida and really revolutionizing, you know, the Florida law to be able to support individuals and to honor an respect their personal rights, their dignity, and allow them to receive care in a least restrictive way,” Nuttall said. “That is something that every single person that works with me every day — our physicians, our nurses — that is something that is a key tenant for us, that we are able to care for that person and be able to, you know, maintain their dignity.”

According to the law, a person can Baker Act themselves if they are able to understand the decision and its consequences and are able to fully exercise their rights for themselves. Otherwise, they can be involuntarily examined for 72 hours if:

• There is reason to believe that he or she is so mentally impaired that the mental or emotional conscious control of one’s actions, or of the ability to perceive or understand reality, substantially interferes with a person’s ability to meet the ordinary demands of living

• The person has refused voluntary examination or is unable to determine whether examination is necessary because of his or her mental illness

• Without care or treatment, the person is likely to suffer from neglect resulting in real and present threat of substantial harm that can’t be avoided through the help of others; or there is substantial likelihood that without care or treatment the person will cause serious bodily harm to self or others in the near future

The patient must be “examined without unnecessary delay by a clinical psychologist or a physician experienced in the diagnosis and treatment of mental and nervous disorders,” according to the statute.

After they are examined, the patient must be released after 72 hours unless charged with a crime. They can also be released for outpatient treatment or if they give voluntary permission for placement at a treatment facility. Or a circuit court judge can involuntarily commit them for further treatment. They cannot be released without the documented approval of a psychiatrist or clinical psychologist.

“The Baker Act is a very good law and very necessary,” Judd said.

He referred back to the case of the woman whose husband asked that she be taken to the hospital.

“She lives in a nice neighborhood, a responsible neighborhood. She just had a quick emergency in the estimation of her significant other that called us,” Judd said. “There’s that person and you get them straightened out and they’re good to go.”

But then, he said, there’s the person who has no one to help them make sure they’re taking their medication and getting to their counseling appointments.

“That’s the person that gets into a real crisis. And the only time we see them is when they get into the next crisis,” Judd said. “That’s the people we need long-term care for. Some of them want help and some are so sick they don’t realize they need it. Someone has to have the authority and the responsibility to act in their best interest.”

The Treatment Advocacy Center released a study of all 50 states in 2020, grading them on their involuntary psychiatric treatment laws, asking if the state law allows an individual in need of involuntary evaluation or treatment to receive timely care, for sufficient duration, in a manner that enables and promotes long-term stabilization. Florida earned a D.

“We are effectively running 50 different experiments, with no two states taking the same approach,” the TAC report states.

In Florida, any responsible adult can petition that a person undergo an emergency evaluation, but only a professional can petition for inpatient commitment. The state has no “psychiatric deterioration standard,” but does allow for a 90-day renewal order on patients who need more than 72 hours of care under a Baker Act.

Percentage of Baker Acts has skyrocketed

In the last 20 years, Florida’s population has risen by about 22%, to 21.5 million people. But the percentage of Baker Acts has skyrocketed by 121%, from 95,574 people in the 2001-2002 fiscal year to 210,992 people in the 2018-2019 fiscal year, which runs from July 1 through June 30. That is the most recent year available on the University of South Florida Baker Act Reporting Center website.

The statistics are even more alarming when looking at the number of Florida children who have been involuntarily committed for evaluation – it has increased 152% from 15,000 children in 2001-2002 to nearly 37,900 children in 2018-2019.

A little more than half of the state’s Baker Acts — 51% — were initiated by law enforcement, with another 46% begun by a physician, clinical psychologist, psychiatric nurse, mental health counselor, marriage and family therapist, or clinical social worker. The remaining nearly 3% were done via ex parte order, which can be filed by anyone who has observed the mentally ill behavior and can describe the actions of the person that cause them to think they require a mental health examination.

In the last 10 years, the total number of people Baker Acted in Polk County has increased by more than 50% — from 5,588 in 2009-2010 to 8,407 in 2018-2019. The majority — 5,419 — have gone to Peace River Center or Lakeland Regional Health Medical Center. The number of juveniles Baker Acted in the last ten years has doubled from 1,009 to 1,999.

Crisis Intervention Training

One area on which Polk County mental health officials give high marks in the Polk Vision Report is the Crisis Intervention Training that many law enforcement agencies in the country use, including the Polk County Sheriff’s Office.

It is called the “Memphis Model” and it originated in Memphis, Tennessee, following an officer-involved killing of a mentally ill man who was threatening people with a knife.

“Many citizens raised their voices in angry protest against the officers, with cries of racism and police brutality,” reads the University of Memphis website — the repository of information about CIT training. “Calmer voices prevailed, calling for the community to develop a better way to intervene with individuals in mental health crisis.”

The result “revolutionized how individuals with mental illness in crisis would be approached by police officers and effectively routed to appropriate mental health care facilities rather than jail.”

Law enforcement personnel, who undergo about 40 hours of training, learn about various mental health diagnoses, psychiatric medications, and issues of drug abuse and addiction. In addition, officers spend time with individuals who have experienced mental illness to learn first-hand the challenges of the illnesses.

“Most importantly, the officer would receive intensive training in verbal de-escalation skills, with consistent attention to officer safety throughout all components of the CIT training,” their website states. “The efforts of the Memphis founders of CIT led to a network of over 2,700 CIT sites throughout the nation.”

Locally, in addition to PCSO, Lakeland, Bartow, Haines City participate. In Florida, 32 counties and five areas are trained.

“They recommended we have one or two on a shift. I said, ‘Everybody,’” Judd said, adding that he initially had pushback from some in the mental health community, thinking it would be too much. But he wanted to add the de-escalation techniques to his deputies’ toolbox.

“It’s the opportunity to teach our deputies how to recognize mental illness, how to learn how to communicate with them, how to learn to watch their actions and reactions so the deputies can see that some of their appearances that could look like resisting or violence is not really a directed resistance or violence,” he said.

Every deputy is either trained or, for new hires, will be shortly, along with every emergency call center operator and every jail bailiff.

Judd said that calls to “defund” law-enforcement and to instead fund a small army of mental health counselors to respond to people in crisis will only backfire in the most serious of ways.

“If we get a call that somebody’s in crisis and you send this (mental health) responder, you’ll get them shot, you’ll get them stabbed, you’ll get them beat up,” said Judd, adding that some in the community say that won’t happen very often. “Well, ok, how often do you want to be shot or stabbed or beat up? So let us go, we have the equipment, we have the training, we can recognize it.”

Capt. Larry Davis is in charge of Crisis Intervention Training at the sheriff’s department. He said one of the most difficult mental health crises to deal with is someone with schizophrenia who is seeing and/or hearing things that are not there.

“We’re trying to talk to a person in a calm manor, but we’re not buying into their hallucination. (We say) you may see it, we don’t, but we’re here to help,” Davis said. “Unfortunately controlling schizophrenia is controlled with medication, which we can’t control. What we do is put them in touch with the right resources to get them help.”

Davis said he has seen people with medication imbalances, when they’ve been prescribed something and it’s not working well for them. They will need to get it adjusted or switched to something different.

“So, what we do is get them help to go back to see somebody to get this fixed. We talk to the family – we have the crisis response team from Peace River,” Davis said, referring to one of several local agencies that handle mental health crises. “We also do the Baker Act if someone is going to be a harm to themself or somebody else.”

He also said there is a fine line between violating someone’s civil rights and simply making sure they are ok. For instance, there is a homeless man who was frequently seen in downtown Lakeland, wearing multiple layers of clothes in the summer, talking to himself and dancing down the sidewalk.

“I would say it’s eccentric,” Davis said in describing that behavior. “If he was displaying other things, like getting into traffic or being confrontational, then people should get involved and call someone. We try to make sure that, whoever we deal with, that we’re not treating someone unjustly and making sure we’re not making assumptions before the facts are all in.”

Davis said CIT law enforcement personnel are trained to be empathetic and provide hope.

Local mental health experts agree that Polk County law enforcement agencies are working to better understand mental health and to work with providers to help people.

“I think that there is phenomenal collaboration happening between law enforcement and behavioral providers in the area,” said Alice Nuttall, director of behavioral health services at Lakeland Regional Health Medical Center. “I think that we have to do it in a way to continue to uphold patient rights, patient dignity, and patient privacy because that is an inherent right.”

Judd said once someone is Baker Acted, they go on a list for the deputy who handled the case to go back and check on them in 30 days to see if they’re taking their medicine, going to counseling, having self-harm thought and if their family is taking care of them.

“That’s unheard of in the law enforcement world,” Judd said. “Law enforcement agencies don’t do that – but we do.”

Like with any first responder, some cases linger with Davis. He remembered a case from 10 years ago, when he was just down the street from a man who was contemplating suicide.

“Once I made contact, I ensured that he wasn’t armed. I sat him down and talked about what was going on with him,” said Davis. “He had gotten into a crisis. A lot of time, the crises are started by little things – finances, relationships with significant others. It puts them into a situation where they’re (feeling) no longer worthy of living or they put themselves in a problem they can’t get themselves out of.”

Davis said Baker Acting someone is not always the best solution, but in this case, the man was sent to the hospital.

“I was able to talk to him prior to him being transported,” he said. “You know when you make that connection with someone and you think that you’re actually doing some good. I had that feeling prior to him being Baker Acted.”

Ledger reporter Kimberly C. Moore can be reached at [email protected] or 863-802-7514. Follow her on Twitter at @KMooreTheLedger.

To get help

Polk County’s Peace River Center offers a 24-Hour Emotional Support and Crisis Line: 863-519-3744 or toll-free at 800-627-5906

Crisis Intervention Training

Deputies look for multiple things when they are sent to mental health crisis calls:

• Does the person have a weapon?

• Is the person holding something that could be improvised as a weapon, like a pen, pencil or tool?

• Are they threatening to harm themselves or someone else?

• Is there anyone else home?

• What is causing the crisis?

• How are they coping with the crisis?

• Do they know what day it is? (are they stuck mentally in another year or decade?)

• Can they follow simple commands?

• Has the person ever seen a counselor?

• Has the person been diagnosed with a mental illness?

• Is the person on medication for a mental illness?

• Is the person actually taking that medication?

• Is the person taking drugs?

• Is the person hearing voices or seeing people not actually there?

• If so, what are they telling you to do?

• Does an ambulance or paramedics need to be called?

This article originally appeared on The Ledger: Law enforcement officers are on the frontline of the mental health crisis in Polk County