Waldo County Corrections Administrator Raymond Porter with restraint chairs. Inset top, NAMI Maine Executive Director Jenna Mehnert (Photos by Brian P.D. Hannon)
Waldo County Corrections Administrator Raymond Porter with restraint chairs. Inset top, NAMI Maine Executive Director Jenna Mehnert (Photos by Brian P.D. Hannon)
" “We make an impact one person at a time. I don’t expect to sit here and change the system statewide, I want to make a difference here.” — Waldo County Sheriff’s Office Chief Deputy Jason Trundy "
They resemble wheelchairs, but the straps for binding shoulders and limbs suggest a different purpose. The apparatuses with gray seats and black push handles are parked in a corner, where the facility’s administrator is happy to report they have remained for months.

“There’s dust on those chairs. We rarely use them,” Raymond Porter said as he pointed to the pair of “restraint chairs” in the garage at the Waldo County Jail. In years past, however, both of the carriers were used often.

“One wasn’t enough,” said Porter, the Waldo County corrections administrator who oversees the jail. “Mainly we put individuals in there that were a threat to themselves, to keep them safe from themselves.”

Sidelining of the chairs is evidence that de-escalation strategies are becoming more commonplace in law enforcement, often as a way to deal with people suffering a mental health crisis. Training and partnerships with counseling and medical professionals has helped shift the focus to mental illness as a matter for treatment rather than criminalization.

But police and corrections officials across Maine struggle with the multitude of cases stemming from mental illness. Law enforcement officials in Waldo and Knox counties said they see the issue every day to varying degrees. Not every request for help or report of a crime has an underlying mental health cause, but police administrators have taken steps to make sure their officers are trained to look for signs of a deeper problem.

“The grout between the tiles”

A large part of that effort has involved the National Alliance on Mental Illness (NAMI), which offers free training to police on how to interact with people suffering from mental health issues and crisis.

NAMI Maine is the state chapter of the largest mental health advocacy entity in the nation, according to Executive Director Jenna Mehnert. The organization, headquartered in Augusta, provides support, education and advocacy to individuals and families impacted by mental illness, including support groups and suicide prevention training. Mehnert calls it “the grout between the tiles” of various other organizations that provide mental health services such as school districts, hospitals and law enforcement.

“We’re not the educators and we’re not the clinicians, but somebody needs to come in and provide information,” Mehnert said. “It’s about health literacy, just like first aid.”

NAMI Maine was initially funded in 2002 through Maine’s Consent Decree. The 1990 legislative act mandated a comprehensive mental health system following a class-action lawsuit that closed the Augusta Mental Health Institute. A court master with administrative oversight announced in January that he will present Gov. Janet Mills with a proposal to end the decree, which supporters say has been underfunded since its inception.

NAMI’s Crisis Intervention Team (CIT) training, conducted throughout the nation, is considered a gold-standard program for police who frequently interact with people suffering a mental health crisis in public or at home.

Approximately 10 of the 40 training hours in the week-long program focus on enhancing de-escalation skills specific to mental health. “If you think about what law enforcement is trained to do, it’s often to storm the fort and take control,” Mehnert said. “When you talk about a person experiencing psychosis, you really need to slow it down, give them time, talk very differently, not be intimidating or threatening.… The greatest risk for injury is if they’re trying to get away from someone because they feel cornered.”

While there is a standard curriculum, Mehnert said the training is also intentionally flexible so as to include regional or local issues. “It’s not NAMI Maine’s roadshow that we do exactly the same thing in each county. We go to that county, work with the mental health folks and the law enforcement folks,” she said. “We’re sort of the backbone to pull it all together.”

While the Maine Criminal Justice Academy offers mental health training for prospective officers, Mehnert said the NAMI program could not be offered there “because it’s all about the connection and the local community.”

CIT also focuses on “breaking down the barriers between law enforcement and the mental health providers so that they can work together as partners and gain experience and perspective from each other,” she said.

Participation in the program has become a priority for many Maine police departments. Waldo County Sheriff’s Office (WCSO), for example, puts every one of its corrections officers through the course, according to Porter, while Deputy Chief Jason Trundy said at least half of the county’s 21 patrol division officers have had NAMI training, with the intention of increasing that number when budget constraints allow.

Hannah Longley, NAMI Maine director of community programs, has spent 10 years teaching police to deal with mental health crisis situations.

“One of the big things I stress is you’re not here to diagnose, but to recognize when someone is struggling and someone is having a mental health crisis and how to recognize the signs and symptoms of a mental health concern,” Longley said. “Really looking at making sure that we’re not criminalizing mental illness and incarcerating people. And then I’m also looking at trying to maintain the collaborative relationships in the community as much as possible.”

Officers often struggle with knowing what resources are available in their communities, according to Longley. “Two o’clock in the morning, when someone’s experiencing a mental health crisis, and you have a police officer who has really great intentions, but they’re not a social worker, they don’t necessarily know what’s going on,” she said.

Feedback from officers who complete CIT training reinforces Longley’s belief that the program works. “One of them wrote that he’s been in law enforcement for 13 years and he wishes he took this 13 years ago,” she said.

“It helps to give them a different understanding of what they’re looking at,” she said. “They have all the tools in their belt that they wear and it just gives them a different tool to use. It’s not going to be perfect in every situation but it does give them that option.”

Longley said there is “increased understanding and knowledge” about law enforcement’s role in the mental health system. They also become more aware of their own mental wellness. “We lose more officers to suicide than we do to line-of-duty deaths,” she said, noting the importance of bridging the gap between the issues police encounter on the job and how they are affected personally. “Oftentimes we view the criminal justice system as so separate from the mental health system and they’re not, they’re connected.”

Another goal for NAMI is ensuring officers do not approach mental illness as deliberate lawbreaking.

“How can we not just incarcerate them and criminalize that mental illness? How can we get them the help and the support,” Longley said, noting there are times when arrests of the mentally ill must be made. “One of the big things is being able to recognize that this is not intentional criminal behavior. This is someone who needs some help and some support, and what do we have for resources to be able to assist them.”

“I do not hire psychiatrists”

Rockland Police Chief Chris Young said the NAMI course has helped reduce instances of “blue-papering,” the term for involuntary commitment to a hospital for evaluation, commonly known as “protective custody.”

“This is a really, really well thought out, very informative, 40-hour week of training just on mental illness identification, de-escalation skills, that whole component for us on the street that is very, very helpful,” Young said. “We’re better skilled at just talking to them and convincing them, ‘Let’s go down and talk to somebody. Let’s work through this problem.’ We’re seeing a lot of value in that.”

Young compared strategies for dealing with mental health crisis used by police before and after NAMI’s CIT training became prevalent. In both cases, officers ask questions such as whether people intend to hurt themselves or others. Years ago, however, officers had limited options.

“You don’t have a crime, so you would just leave them. Because they’ve not given you any reason to believe they’re going to hurt themselves or somebody else and they haven’t committed a crime,” Young said. “And with the CIT model and the way that we’re approaching this now, the officer engages in a dialogue and starts to figure out what is going on. And maybe the officer still articulates that they’re a danger to themselves or they’re a danger to somebody else, and they still take them to the hospital.”

Porter said the rapport Waldo corrections officers attempt to build with inmates, rather than resorting to confrontation and overt authority, is vital to understanding their circumstances and reducing the harm they can suffer during a mental health crisis.

“The staff don’t have to say, ‘I’m in control here.’ I mean, the building screams it,” he said. “Their job really is to give the individual some empowerment and say, ‘Okay, this is where we’re at ... but what can we do to make you comfortable and get through this?’”

Porter said 100 percent of the officers operating Waldo County Jail undergo CIT training. All but two of the staff members have been at the jail for more than 10 years and a priority for new hires is getting them into the NAMI program. “It’s important to us that they get that training because we have seen so much value in that,” he said.

Richard Roberts, a Waldo County corrections officer for 27 years, said he has used techniques from crisis intervention training.

“It doesn’t help everybody, but it’s a good start to de-escalate the situation,” said Roberts, who recommends the training to other law enforcement personnel. When he began his tenure at the jail, “officers would just get people wound up on the streets and bring them in,” but their training and professional conduct have evolved to a point where that rarely occurs now. “I think it’s good for police officers. It helps them to understand the person a little bit more.”

“I do not hire psychiatrists,” said Mike McFadden, chief of police in Belfast. Although, he said, familiarity and experience can bring recognition of problems. “You take a police officer who has been on the job for 10 years, I’ll show you a person that may not be able to diagnose a certain type of psychiatric issue, but he can tell you whether or not that person suffers from a mental health issue.”

McFadden is among the police officials who appreciate the need for NAMI and other organizations that share the large workload of addressing community mental health.

“I know there are people out here that are struggling and their quality of life is not good. And it’s because we don’t have the resources to provide them the help that they need. And it’s a shame,” McFadden said. “It’s a shame because these people are losing their dignity. They’re losing their self respect with the things that they’re doing that they can’t control.”

The 30-year veteran, who started his career as a Waldo County corrections officer, said law enforcement professionals as a whole want to find solutions rather than cycling people through the criminal justice system for infractions driven by mental health struggles.

“These aren’t bad people. I know these aren’t bad people because I’ve worked to get them the help that they need,” McFadden said. “And there is normalcy on the other side of that with high-quality mental health treatment. And I’ve seen that success, I’ve seen it work.”

“We can’t just keep them”

In the space between interactions with police on the street and mental health treatment, there are medical and counseling professionals who conduct examinations and make initial evaluations.

Waldo County General Hospital (WCGH) in Belfast is one of the facilities in the midcoast providing the first layer of mental health assessment. Kim Spectre and Denise Lindahl help oversee the hospital’s emergency department (E.D.), where police bring anyone thought to be suffering from mental illness or crisis. Spectre said the insights provided by officers can be invaluable to medical personnel.

“Police are really, truly the first responders. They really see what happens; the smells, the sights, they see it. But often that doesn’t get communicated,” said Spectre, the regional E.D. director for Coastal Healthcare Alliance who manages the departments at both WCGH and Pen Bay Medical Center in Rockport. “We want to do better at caring for these mental health patients and really part of that is having a better picture and understanding where they came from.”

After police officers escort individuals to the hospital, Spectre said a screening process includes mental health questions. Patients are categorized as low, moderate or high suicide risks, with those in the highest level put under direct observation in a “safe room” free of items with which they might harm themselves. Further questioning by a “crisis team” determines whether hospitalization is needed.

“If they’re highly suicidal, 99.9 percent of the time that patient will meet inpatient criteria and be transferred, at some point, to a psychiatric hospital,” she said, explaining that a physician or nurse practitioner makes the final determination. The medical screening, however, goes beyond a cursory exam.

“There’s more than what just meets the eye when a patient comes in,” Spectre said. “Sometimes there’s additional information that the family can provide that may not be right there physically, and we have to get that information to really make a holistic disposition on that patient. We can’t just assume, based on what the patient is telling us. We have to really understand what brought them in.”

Some law enforcement officials noted that patients are occasionally back on the streets much sooner than they expected, but Lindahl, the E.D. clinical coordinator at WCGH, said hospital staff may quickly find the problem is a temporary detour from treatment. Patients who resume their prescriptions with the aid of hospital staff frequently regain mental equilibrium and check themselves out.

“Sometimes it’s a matter of getting them back on their meds because they just don’t think they need them anymore,” Lindahl said. “They’re fine and they can function and then they decompensate quickly without their meds.”

They both observed there can also be a divide between the concerns of police and the rules governing medical personnel.

“Often within 24 to 48 hours they have the capacity again; they have the capacity to say, ‘I’m not suicidal, I’m not homicidal,’” Spectre said. “And they can walk out that door ... they have their basic human rights, we cannot violate that by keeping them. And that’s where it gets really grey.”

Spectre and Lindahl are aware that discharging those patients can result in a cycle of abandoned medication and repeat police escorts to the hospital.

“I think that law enforcement doesn’t realize that we are held to certain legal rights for the patient and we can’t just keep them,” Spectre said, adding that there are also strict limits on calls to police about patients. “There are only a few occasions where we can actually notify police. And that’s in the cases of elder abuse, child abuse, and a gunshot wound.”

Beyond those limitations, Lindahl and Spectre say cases of mental illness would benefit from better communication between police and service providers.

“There are so many resources within our own community and I think all of us don’t realize what those resources are,” Spectre said. “We want to be able to ... have tools in our toolbox to offer to people, particularly law enforcement, who feel really sometimes their hands are tied. They don’t know what to do in the middle of the night, where do they go with this patient? I think that part of that is being able to understand what our local resources are, who they can call.”

To that end, the nurses are members of a group of Waldo County professionals whose goal is improving their cooperative responses to ongoing mental health issues in the community.

“We’re working in silos”

At its third meeting in late November, a group calling itself the Waldo Alliance pulled together tables in a meeting room of the sheriff’s office to form a makeshift rectangle. They sat and faced each other, police and corrections officials, doctors, nurses, and counseling professionals from Maine Behavioral Healthcare, Seaport Recovery Program, SequelCare of Maine, and Sweetser Crisis Services.

The group displayed a do-it-yourself attitude born of a shared recognition that the mental health problems of regular citizens far outpace the services available to them. The other obvious factor is the need for the organizations to pull together their complementary but disconnected efforts.

Alliance members discussed ways to improve contact and reduce duplication of their efforts, including group emails and shared Google documents. A standardized intake form was suggested to ensure crucial information is communicated each time someone in protective custody is transferred from police to hospital staff.

Jessica LeBlanc, who attended the meeting, is a clinical supervisor for Sweetser, a nonprofit community mental health provider with crisis services contracts across Maine, including in Waldo and Knox counties. LeBlanc said her work with Sweetser has included crisis assessments at the Waldo County Jail, work on a training program with the sheriff’s office, and partnerships with NAMI to facilitate aspects of CIT training.

She believes increased communication and information sharing is key to boosting the combined success of mental health support organizations and law enforcement.

“We would go to the community with police, as appropriate, assess and determine level of care, provide resources,” LeBlanc said, noting that Sweetser and the WCSO had discussed a ride-along during a patrol so counselors and officers better understand each other’s methods.

Trundy, one of the Waldo Alliance organizers, urged participants to collaborate on various aspects of mental health services, whether clinical, administrative or legal.

“I feel like our biggest problem is that we’re working in silos,” Trundy said, noting that greater communication will build mutually beneficial relationships between neighboring agencies with matching goals. “We make an impact one person at a time. I don’t expect to sit here and change the system statewide, I want to make a difference here.”

As they continue working from police cruisers on the streets, in counseling sessions and emergency departments, and in meeting rooms with rearranged furniture, many of the professionals express cautious optimism about their ongoing, incomplete efforts to help those suffering from mental illness experience protection and assistance rather than misunderstanding and criminalization.

At the Waldo County Jail, Ray Porter, another Waldo Alliance member, has seen firsthand the benefits of setting aside confrontation and force in favor of de-escalation and patience. Pressed to recall the last time one conspicuous example of authority — a restraint chair — was used, Porter shook his head.

“I think it’s a good thing that I can’t even remember,” he said.