Policing mentally ill often requires caution

Stacy J. Willis

Friday, March 9, 2001 | 4:02 a.m.

Inside his mother's Las Vegas home just minutes before his death, David Herrera spoke to his aunt on the telephone.

He told her he was afraid that the police were going to kill him.

His family had heard about this fear before. It was a notion that Herrera, who suffered from schizophrenia, had wrestled with during much of his 27 years; a restless paranoia that turned an otherwise calm and polite young man into a tormented and angry force.

When medicated, when receiving treatment from caseworkers and psychiatrists, Herrera easily could blend with the rest of society. As one friend said, "If he were standing at a bank behind you, you would think he was just another guy."

But when he slipped off of medication, when his Spanish-speaking family lost communication with state mental health workers because they had trouble finding translators, Herrera's mind would slink away, would slowly leave reality.

He would bicker with his two little brothers -- grade-school kids. He would deny any need for medication, fail to bathe and shave, and often he would fixate on his inexplicable fear of the police.

No small irony occurred Jan. 14, 2000, when Herrera was shot and killed by Metro officers in the front door of his mother's home, just moments after hanging up the phone with his aunt.

He had been off of his medication more than four months. He had shaved his head. He had argued with his mother and state mental-health care workers, and grabbed a sizable knife from the kitchen and holed himself up in the house alone.

Metro officers forced their way into the home, drew guns and repeatedly told him to drop the knife. Herrera, more than 6 feet tall and weighing more than 200 pounds, did not. Officers fired bean-bag bullets at him and doused him with pepper spray.

Alfred Woodruff, one of the five officers, felt so threatened by Herrera that he shot him five times. Herrera fell dead, a knife in one hand and a mobile telephone in the other.

The whole interaction between Metro and Herrera lasted less than 20 minutes, onlookers said.

A coroner's inquest ruled the shooting justified.

"If the department had more training, and knew how to defuse a situation with a mentally ill person, that man would not be dead," said Vic Davis, president of the Nevada chapter of the National Alliance for the Mentally Ill.

Although Sheriff Jerry Keller stands by his officers' actions, he decided it is time for Metro to take a look at improving its interactions with the mentally ill.

Last week Keller met with advocates for the mentally ill to discuss a new mental-illness training program for police officers.

Metro also wants other agencies to join in developing a communitywide program to deal with the mentally ill. Keller sought support from Gov. Kenny Guinn, Las Vegas Mayor Oscar Goodman and the Clark County commissioners.

"We need to have everyone moving in the same direction -- police, government agencies and advocates. At this point, we don't have that," Keller said.

Right choices

Herrera was not the first, nor do the odds bode well that he will be the last, mentally ill person to be shot and killed by police. There have been other such deaths in Las Vegas; there have been others across the nation.

But cops can -- and often do -- make other choices when faced with a mentally ill perpetrator. In 1996 Steve Caldwell strapped ammo to his back, chased his wife and kids out of his Las Vegas home, barricaded himself inside and said that "today is a good day to die."

"When you're in that state, you don't realize what you're doing," Caldwell, now 52, said. "You don't have any consciousness. I was confused. I didn't know what to do."

Caldwell was suffering from an acute episode of post-traumatic stress disorder, a mental illness in which the brain packs away disturbing memories sometimes for years before exploding in a fit of abnormal behavior. In Caldwell's case, it was memories of the Vietnam War that were erupting in his head in 1996.

Metro Police officers spent hours talking him out of his violent frame of mind.

"They stayed with me. They took me to the veteran's hospital, which wouldn't admit me because they don't have lock-down facilities. Then they took me to UMC, and then to (now closed) Charter Hospital," Caldwell said. "I am very grateful to them."

But Caldwell wasn't out on the street threatening people. In cases where harm to others is likely, Keller said, officers face more critical decisions.

"Cops do every single thing they can to help. The street cops face all of the criticism ... (but) no cop wants to shoot a mentally ill person or anyone else," Keller said.

But, Davis said, the odds of shooting would be smaller were the department to have a unit of officers specifically assigned to handle the mentally ill.

"If we had a program like Memphis', fewer people would be killed," Davis said.

One plan

"A program like Memphis' " is what dozens of police departments across the nation are talking about.

In 1987 Memphis police shot and killed a knife-wielding man with a history of mental illness.

Public outcry over the shooting caused the department to develop a special unit to deal with the mentally ill.

Officers with an interest in mental health issues volunteer to be specially trained to deal with mentally ill suspects. They receive at least a week's training about mental illness, meet and interact with mentally ill people, learn about diseases, medications and symptoms.

When possible, these officers are dispatched to calls where the mental state of the suspect is at issue. Those officers assume control of the scene, regardless of whether higher-ranking officers are present.

One-fifth of Memphis's 900 uniformed officers now serve on the Crisis Intervention Team.

Metro is studying the Memphis plan, along with similar programs in Charlottesville, Va.; Albuquerque, N.M.; and Jacksonville, Fla. Currently Metro officers receive less than 20 hours of mental-health training in the academy.

Memphis Police Maj. Sam Cochran said the program has reduced injuries to officers and suspects.

"I think police officers think the mental-health system has burdened them," Cochran said. "They think it's not police responsibility. And it really is a community's responsibility.

"But the police end up with it by default."

On the streets

Squatting under an eave of a vacant building in downtown Las Vegas, a wiry Mexican woman named Artemisa takes shelter from the rain.

She has a grocery cart full of cardboard. Metro officers have come to check up on her, as they do regularly, but she tells them she doesn't want any food or any help.

"I'm fine," she says. One nostril is plugged with bloody tissue paper.

Officers Kendall Wiley and Eric Fricker, who are assigned to patrol Las Vegas' homeless population, keep a list of the mentally ill homeless.

Their goal is not to direct them toward medication and therapy that might allow them to lead more functional lives, but to maintain the status quo -- to prevent them from becoming "a danger to themselves or to others."

Thirty-three percent of the nation's homeless population is mentally ill, according to the Treatment Advocacy Center in Arlington, Va. When applied to population statistics compiled by UNLV, that means somewhere between 2,500 and 6,500 mentally ill, homeless people roam Las Vegas' streets.

"The volume of mentally ill people we deal with is huge," Fricker said. "And we're having more and more confrontations with mentally ill people in general lately."

But what should Metro do with the mentally ill and homeless once they have become a potential danger? Take them to jail? To the hospital? To the mental hospital?

By most accounts Las Vegas is lacking a mental-health services structure that adequately shepherds a mentally ill offender from the streets into long-term psychiatric care. What exists today for the indigent mentally ill offender is a web of redundant but insufficient mental-health programs, which are difficult to access, advocates say.

"It's a revolving door for these people," Davis said. "They really don't have a chance of getting long-term care. And some of them could lead normal lives with the right treatment." Commonly, if a Metro officer manages to get a mentally ill offender into the state's mental-health facility -- a feat in itself because of a limited, 10-bed intake unit -- the person is within days back on the streets without a case manager or ongoing relationship with a psychiatrist.

"We get very little done at 6161," Fricker said, referring to the Southern Nevada Adult Mental Health Services facility at 6161 W. Charleston Blvd.

The waiting list for state caseworkers in Southern Nevada is more than 100.

Last year Fricker tried to get help from the facility for a homeless man called Stinky Pants -- named by other homeless people in a camp by the railroad track.

As Fricker tells it, the man was "obviously mentally ill" and also was incontinent and suffered from a host of other health problems. Fricker took him to Sunrise Hospital, which addressed his health problems but not his mental-health problems. For that, they sent him to the state mental hospital on Charleston.

But a state psychiatrist decided that Stinky Pants was not mentally ill and released him.

"I asked (the psychiatrist) to keep him in there for a few days while we searched more for his family. I told her she was giving him a death sentence by sending him back out. He was clearly mentally ill and unable to care for himself," Fricker said.

Stinky Pants went back to the homeless camp, where again his health began to decline. "We were watching this guy die," Fricker said.

Finally, Metro was able to figure out the man's identity, and it turned out he was a missing person from San Diego. He had wandered away from a group home for the mentally ill, where he was being treated for chronic schizophrenia.

Jim Northrop, director of Southern Nevada Adult Mental Health Services, said that diagnoses of mental illnesses can vary greatly.

"It is possible for someone to mask their symptoms," Northrop said. "Different psychiatrists diagnose differently at different times.

"And you have to remember, it's very difficult to treat a person who doesn't want to follow through on their own."

But Maurice Silva, a state social worker and the only state mental-health employee assigned to work with Las Vegas' homeless, said the state could do more to help the homeless mentally ill if it had more resources.

"It's frustrating to see them end up back on the streets," Silva said. "But it is a revolving door. They are really overburdened at the mental-health (facility).

"It comes down to needing more resources. More psychiatrists, more caseworkers, more housing," Silva said. "More money."

While the Legislature considers budget increases, many mentally ill end up, by default, in the hands of the police.

For Metro, the alternative is to take them to jail.

Locked up

In the mid-1990s, Nevada joined other states in de-institutionalization of the mentally ill. In "liberating" the mentally ill from the stigma of asylums, governments also managed to save money by cutting services.

Northrop said the goal of the state's mental-health program today is to treat them on an out-patient basis when possible.

The West Charleston facility has an 86-bed in-patient hospital, which is "rarely at capacity," Northrop said.

But as the number of mentally ill has grown with Southern Nevada's population, the out-patient plan has in many cases resulted in the no-treatment plan.

Davis said instead of ending up in mental hospitals, many mentally ill people end up warehoused in jails and prisons. In 1998 283,800 mentally ill people were incarcerated in U.S. prisons and jails -- four times as many as in state mental hospitals nationwide, according to the National Alliance for the Mentally Ill.

According to the Nevada Health Division, 14 percent of the state's prison population is mentally ill.

But only seven of Nevada's 22 correctional institutions have restricted holding areas capable of diagnosing and treating prisoners for mental-health problems.

And Silva, who also has worked at the county and city jails, said the revolving door is at work behind bars, too.

"We had one mentally ill guy who was in the county jail 55 times in one year," he said. "This is a big problem in the jails, too. It's a communitywide problem."

The group of Las Vegas mental-health advocates, officers, state employees and ambulance personnel that met with Keller last week plans to meet again next month to advance ideas about adopting a communitywide program to better deal with the mentally ill.

Sun reporter Keith Paul

contributed to this article.

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