SHOTS FIRED: How to stop a crisis before it happens. 

  • Susan Allen-Samuel and Ken Norton at the Fire Academy training classrooms off of Route 106 on Thursday, December 9, 2021. GEOFF FORESTER—Monitor staff

  • Susan Allen-Samuel and Ken Norton at the Fire Academy training classrooms off of Route 106 in Concord on Dec. 9. GEOFF FORESTER / Monitor staff

  • Ken Norton, the executive director of NAMI NH. GEOFF FORESTER / Monitor staff

Monitor staff
Published: 12/20/2021 1:50:57 PM

With a prescription bottle in hand, Karen looked forlornly at the floor and sighed.

She couldn’t do it anymore, she told her closest friend. Mounting financial pressure and messy divorce proceedings had driven her to her limit. She downed half a bottle of prescription pills and locked the bathroom door.

The crisis was not real. Karen was an alias, the pill bottle was filled with Skittles and the bathroom door was a thin piece of poster board. Staff from the New Hampshire chapter of the National Alliance on Mental Illness concocted the exercise as part of crisis intervention team training, a program designed to teach first responders how to handle mental health emergencies.

Dozens of state and local police along with EMS personnel spent the week studying symptoms, listening to speakers with mental illness, and learning verbal techniques to calm escalating situations.

Now, it was time to put it to the test.

“Typically, we go and just kick the door to call it, I get it, ” said Lt. Frank Harris, a workshop leader at the training who works at New Hampshire Hospital, the state’s psychiatric medical facility. “But for instructional purposes, try to apply some of the stuff you learned this week.”

Out of the crowd of first responders dressed in brightly colored polos tucked into duty belts, one state police officer stepped forward. She sheepishly smiled as she knocked on the poster board.

“I just want you to open the door a little bit for me, just to have a peek inside. Is that something you can do for me?” she asked.

“No,” Karen curtly responded.

She tried again, this time bringing up Karen’s children while repeating her first name frequently to build rapport. She assured Karen that she understood what she was going through, but was met with silence or brief answers.

The officer breathed out an exasperated sigh, pantomimed kicking the door down to the audience, and then gently continued.

“Like I said, I just want to make sure that you know that you’re not in any trouble or anything like that,” she said.

After several more minutes of careful prodding, Karen unlocked the door and the crowd applauded.

Crisis intervention team training originated in Memphis, Tennessee through a collaboration with law enforcement, academics, and advocates in the late 1980s, after Joseph Dewayne Robinson was shot eight times while walking towards officers holding the knife he used to cut himself. About 40 years later, the University of Memphis boasts a network of 2,700 training sites across the United States.

CIT instructors teach officers to slow their interactions down, keep their voices calm, and avoid sudden movements that could startle or aggravate. The hope is that if officers can diffuse crises, both police injuries and police violence towards people with mental illness will decline.

NAMI NH began routinely offering these classes in 2019, in large part to address the alarming number Granite Staters with mental illness who have been shot and killed by police.

Though no state agency regularly collects data on the mental status of those killed by police, a Monitor analysis based on years of Attorney General reports, found that more than 60% of the people killed by police in the last decade struggled with mental illness.

To date, 231 state and local officers of the estimated 3,084 full-time, certified officers in New Hampshire have completed CIT training by the National Alliance on Mental Illness NH and many more have been trained through community mental health centers. More than $200,000 has been set aside in the 2022-23 state budget to expand core and refresher classes.

Ken Norton, the executive director of NAMI NH, said members of law enforcement clamor for spots in the training program. Beyond occasional in-service workshops and 24 hours of mental health training during the NH police academy curriculum, officers have few resources to learn about handling mental illness, a growing part of their jobs.

Adam Bissonnette, a young Concord Police Officer who attended the training in June, was one of two officers selected to attend out of 30 people who signed up from his department, he said.

Concord officers have a particularly high volume of mental illness-related calls because of their proximity to Concord Hospital and New Hampshire Hospital, the only state-run psychiatric hospital for adults.

“It’s every day, every day,” he said. “Some days, it’s literally like call after call after call, all for mental illness.”

This was a point of frustration for many officers during the training, who joined the police force to stop crime, yet found most of their time dominated by mental health calls. During one role-playing session, during which officers responded to a woman sitting in McDonald’s while talking to herself, a trooper raised his hand from the back of the classroom to vent his exasperation.

“It’s like we’re social workers, crime-stoppers, parking enforcement,” he said. “We’re a jack of all trade but master of none.”

By some metrics, the program has been a success.

During the training in June, instructors hammered the importance of connecting citizens with mental health resources. Officers were given laminated pamphlets with a list of phone numbers to pass on to callers in distress.

Over the last three years, officers that had been through the training made 359 referrals. Patrick Roberts, the Program Evaluation and Improvement Coordinator at NAMI NH, said this could be as simple as handing out a number for the local mental health center or as extreme as transporting someone to a hospital for an assessment.

Still, there is little concrete evidence that CIT training reduces serious injury or death for people with mental illness during police encounters. A 2019 study published in the Journal of the American Academy of Psychiatry and the Law reviewed several decades of studies regarding the effectiveness of CIT training.

“Studies generally support that CIT training has beneficial officer-level outcomes, such as officer satisfaction and self-perception of a reduction in use of force,” the authors wrote.”There is little evidence in the peer-reviewed literature, however, that shows CIT’s benefits on objective measures of arrests, officer injury, citizen injury, or use of force.”

Norton said it’s hard to measure many of the intangible impacts the training has made and it’s too soon to tell whether fatal shootings have decreased at participating departments as a result of the curriculum.

“How do you measure behavior change?” Norton asked. “You can’t measure a police shooting that doesn’t happen.”

When is ashooting justified?

At a Law Enforcement Accountability, Community, and Transparency Commission meeting in Aug. 2020, Norton proposed the idea of a deadly force review panel, a committee that would review fatal shootings and determine ways in which similar deaths could be avoided in the future.

“I would just say at the outset, I understand that this is really controversial,” he said at the meeting. “I do think that there have been incidents in the state that leave people wondering whether this could have, or should have, been handled differently...”

John Scippa, the director of the Police Standards and Training Council, said at the meeting that the Attorney General’s office already investigates whether each instance of police use of force is legally justified. Police stations also typically conduct their own internal review to determine whether department policy was violated.

But some families of police-shooting victims have raised concerns about whether the Attorney General, codified by law as the state’s “chief law enforcement officer,” can impartially review the actions of other members of law enforcement.

Associate Attorney General Jeffery Strelzin said the office applies the relevant law to the facts in an unbiased and objective fashion, regardless of who is involved.

All but two fatal police shootings over the last decade have been deemed justified by the Attorney General’s office.

The two exceptions included a 2016 shooting in which the office retroactively changed their “justified” ruling after learning the involved officer falsified a police report in an unrelated case. In a 2013 incident — during which an officer shot at a car that was fleeing a drug sting— was deemed neither justified nor unjustified, despite the then-Attorney General, Joseph Foster, calling it a“rash and poorly-planned response.” The Attorney General’s office did not bring a criminal case against either officer.

Lawrence Vogelman, a New Hampshire-based lawyer that has litigated about 50 cases involving police shootings, said the vast majority of shootings are classified as justified due to the narrow scope of the Attorney General’s investigations.

Despite using language like “justified” and “unjustified,” these reports do not address whether the police officer acted appropriately. Rather, the Attorney General’s office is tasked with determining whether a police officer should be criminally prosecuted based on a patchwork of state and federal laws.

New Hampshire law dictates that shooting someone is justified when an officer “reasonably believes” it is necessary to protect themselves or others from what they perceive as imminent “deadly force.”

“What’s not looked at is what happened preceding that moment,” Norton said. “What happened in the minutes before or whether different alternatives could have been used.”

Norton pointed to one shooting in 2015 that resulted in the death of Harrison Lambert.

Lambert, 23, struggled with mental illness for many years while living with his parents, Gregory and Sigrid Lambert, in a quaint house in Merrimack. His psychiatric health had been declining in the days leading up to the event— he was off his medication and hadn’t been sleeping well, Gregory Lambert told police.

On the morning of the shooting, Harrison became agitated about a $150 debt he owed his father. He insisted on paying his father, only to immediately request the money back.

The rage and frustration escalated until he chased his father into a bedroom with a knife and stood outside yelling threats. Fearing for his wife’s safety, who was expected home from work in a matter of minutes, Gregory Lambert called 911.

Three Merrimack police officers arrived at the home and immediately pointed their guns at Harrison, while shouting at him to drop the knife. Within about 30 seconds of arriving at the scene, two of the officers shot him five times— twice in the left shoulder and once in the neck, abdomen, and leg. They later told investigators that Harrison ran towards them in a “zig-zag” fashion, knife in hand.

“Why did you do that” Lambert’s father yelled as he ran towards his son’s limp body. “I knew I should not have called.”

The Attorney General determined the shooting to be justified. There was enough evidence to conclude that the officers reasonably believed their lives were at risk, the report read.

An independent review committee, Norton argued, would look beyond whether a shooting was legally justified and consider where tangible improvements could be made.

Norton rattled off some examples: What would have happened if an officer stood further away to buy him time for deescalation? Could a nonlethal alternative, like a stun gun or beanbag gun, have been used?

One of New Hampshire’s bordering states has already implemented a similar review committee.

Maine’s governor signed a bill in 2019 that established a panel of public members, mental health professionals, and law enforcement to review use of force cases.

During the first meeting last December, the 15-person panel reviewed a 2017 case in which a patrol officer shot and severely hurt an armed man in the throes of a mental health crisis. The shooting had already been deemed justified by the Maine Attorney General’s office, which has made the same determination in every shooting since the 1990s, the Bangor Daily News reported.

The group issued several recommendations to avoid future shootings, including one that advised rural police departments to regularly communicate about how to effectively control mental crises.

The structure of the committee also has precedent in New Hampshire. The state has a child fatality review committee and a domestic violence fatality review committee that evaluate the details surrounding sudden deaths, and suggest actions to prevent similar tragedies in the future.

Even so, the majority of New Hampshire’s LEACT commission, including Deputy Attorney General Jane Young, voted to table discussions about the review committee.

Norton said he expects a bill codifying a mental health incident review board to be introduced in the upcoming legislative session.

Upstream Solutions

Some mental health advocacy groups don’t believe that police should be involved in fixing a problem that is primarily a failure of the healthcare system.

Geoffrey Melada, a spokesperson for the national nonprofit Treatment Advocacy Center, said training police how to handle someone in crisis is intervening far too late in someone’s mental decline.

“We do not believe that there is a police solution to this problem, that there is a certain amount of training that’s going to make it appropriate or helpful to send the police,” he said. “They require that a person with severe mental illness deteriorate to the point that the police are sent.”

Rather than funneling resources towards police training, he said money should be invested in what the industry calls “upstream solutions,” like inpatient and community mental health resources, that help address psychiatric conditions early enough that a crisis can be avoided in the first place.

New Hampshire is in the process of building out one of the most ambitious community mental health programs in the state’s history. Soon, there will be a network of ten mobile crisis teams that dispatches a clinical specialist and a “peer support specialist,” someone recovering from their own mental illness, to callers in crisis.

The teams, heavily funded by a grant from the Substance Abuse and Mental Health Services Administration, are expected to be operational by Jan. 2022 along with a single phone number that routes callers to a dispatcher trained in mental health services.

Most of the calls to the hotline— or calls rerouted from 911— will likely be resolved without police involvement. If the dispatcher has concerns about the safety of the situation, they may ask law enforcement to accompany the mobile crisis teams.

Norton said the crisis hotline presents the most significant opportunity in decades to reevaluate how the state responds to mental health crises and law enforcement’s role in that response.

Three mobile crisis units in Concord, Nashua, and Manchester have been responding to calls for several years, since the state reached a 2013 settlement with the Justice Department over the state’s lacking community mental health system. The teams field calls from an emergency hotline and from police, who can refer those who they think need mental health support.

Patricia Carty, the chief operating officer of The Mental Health Center of Greater Manchester mobile crisis teams have dramatically reduced the number of mental health calls police need to respond to.

Over the last year, Manchester’s crisis response team provided phone and in-person services more than 6,000 times and only about 7% of those calls required law enforcement to accompany the team.

“If you talk to some of the old guard who were around pre-mobile crisis they will tell you that they never want to go back,” she said.”They know that they are not going to be spending the same amount of time on mental health calls that they once did.”

Jessica LaChance, the director of the center’s mobile crisis response team, said their two-person groups connect the person in crisis with community-based resources and then check in with them for up to 30 days afterward. She said about 93% of people who receive care through mobile crisis units avoid hospitalization for psychiatric treatment.

Mobile crisis units were never explicitly intended to solve the problem of police shootings. But LaChance said the fact that they are seeing success in their clients’ treatment indicates that some negative outcomes, like fatal police shootings, have been avoided.

Norton said he is hopeful that New Hampshire’s mental health infrastructure will eventually be expansive and well-funded enough to help people before mental illness pushes them to a point of crisis.

That when people go to the hospital for a psychiatric emergency, they’ll have prompt access to treatment instead of languishing in emergency rooms. That there will be enough community resources to practically eliminate the need for hospital visits in the first place.

In the meantime, though, they have to work with the resources they have: police officers. Susan Allen-Samuel, the CIT training coordinator with NAMI NH, acknowledged this much to her class of officers in  June.

“We know you’re not social workers, but we’re misusing you because it’s what we have,” she said.

Teddy Rosenbluth bio photo

Teddy Rosenbluth is a Report for America corps member covering health care issues for the Concord Monitor since spring 2020. She has covered science and health care for Los Angeles Magazine, the Santa Monica Daily Press and UCLA's Daily Bruin, where she was a health editor and later magazine director. Her investigative reporting has brought her everywhere from the streets of Los Angeles to the hospitals of New Delhi. Her work garnered first place for Best Enterprise News Story from the California Journalism Awards, and she was a national finalist for the Society of Professional Journalists Best Magazine Article. She graduated from UCLA with a bachelor’s degree in psychobiology.

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