A MENTAL HEALTH NEWSLETTER FOR LAW ENFORCEMENT PROFESSIONALS
 

Mental Health Association of Greater St. Louis A United Way Agency

In this issue . . .

By Sgt. Dan Fitzgerald, a 20 year veteran of  the Brentwood Police Department. He is a presenter on the Mental Health Association’s Police Training Team and a member of the Street Talk Advisory Committee.

Later that day he checked into a local motel, requesting a smoking room. The clerk thought it was strange he had no belongings. At 9:00 p.m., he called police and told them they would find his body in the hotel room. When they arrived they found a suicide note, but no body.

Officers then spotted Leber leaving the hotel in his vehicle. Moments later, police stopped Leber. He exited the vehicle with his gun drawn, pointed at the officers. Three officers opened fire, killing Leber instantly.

What a terrible scenario. Certainly no way for a human being to end their life. What a terrible ordeal for a police officer to endure, especially when the victim is a fellow law enforcement officer. What could have been done to prevent this from happening? What are the chances that you as a police officer will have to deal with this type of situation?

"Suicide by Cop" is a term used to describe an incident whereby a suicidal subject acts in a consciously life-threatening manner to the degree that it compels a police officer to respond with deadly force. Many times these cases are referred to simply as justifiable homicide. Author Rebecca Stincelli in her new book "Suicide by Cop", states there are four basic criteria when classifying a suicide by cop:

1. The subject must demonstrate the intent to die.
2. The subject must possess a clear understanding of the finality of the act.
3. The suicidal subject must confront a law enforcement officer to the degree that it compels the officer to act with deadly force.
4. The suicidal subject actually dies.

Research shows that most suicide by cop situations happen in urban areas and that the victims are usually male, keeping in mind that males are more likely to use guns for suicide. In interviews with survivors, it was found that the reason for this method of suicide is that the subject does not have the courage to pull the trigger.

What would you as a police officer do with a suicidal subject? How do you handle that call? First, know the danger signals.

• Previous suicide attempts – Many times they have attempted before. They are at a higher risk.
• Talking about death or suicide – People who commit suicide often talk about it directly or indirectly.
• Planning for suicide – Suicidal individuals often take care of personal arrangements before hand.
• Depression – Although most depressed people are not suicidal, most suicidal people are depressed. A loss of interest in friends, family or special interests is expressed.

What can you do if someone you know is suicidal? What do you do if your next call involves a suicidal subject?

• Take It Seriously – Most suicides gave some warning. All threats should be taken seriously.
• Be Willing To Listen – Do not be reluctant to discuss the matter. Police officers certainly know how to be assertive. Ask about a plan or method. This will help you gauge the seriousness of the situation. Sometimes one of the reasons a person considers their life so hopeless is because they feel no one cares about them. Do not be one of those people. A caring listener could be a big help to getting the person some assistance.
• Be Involved in Seeking Professional Help – A person may say they will get some help, but they are more likely to do it if they are accompanied by someone who cares. Offer to drive them to the hospital or to seek a mental health professional. I know - you don’t have time. If a person’s life is on the line, you should make time. Do not leave the person alone, until you found them some help.

All officers should have some helpful phone numbers on hand in case this situation occurs. Make sure your dispatchers have the information they need to help a suicidal caller. See the Mental Health Directory below for phone numbers to 24-hour crisis lines.

I wonder if Marc Leber sought out the help of a fellow officer. Be prepared if it happens to you.

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There are several myths surrounding suicidal behavior that need to be dispelled.

Myth: Talking to an individual about suicide will promote suicidal behavior.

Truth: Research has shown that this is not the case and that actually talking with an individual about suicide and suicidal behavior provides the person an opportunity to talk about their feelings and issues.

Myth: Persons who attempt suicide act impulsively and did not have any prior suicidal thoughts.

Truth: Most persons who commit suicide frequently engaged in previous suicidal behavior.

Myth: African-Americans do not commit suicide.

Truth: Until the mid-1980’s African Americans had a considerably lower rate of suicide compared with Caucasians. Today, statistics show African Americans commit suicide at a rate just below Caucasians.

Myth: More suicides occur during the winter or the holiday season.

Truth: Individuals do become depressed over the winter; however, research proves that the suicide rate is higher in the spring.

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By Brad Perry, an Investigator for the Des Peres Department of Public Safety, where he has worked for about nine years. He has been a paramedic for 15 years, and currently is the Secretary/Treasurer for the Greater St. Louis EMS Officers Association. Brad has trained hundreds of fire personnel and lectured to St. Louis County Police Chiefs about the effects of HIPAA on law enforcement.

Until now, virtually no federal rules existed to protect the privacy of health information. The Health Insurance Portability and Accountability Act (HIPAA) has provided health care professionals with standards and fair information practices that provide all Americans with a basic level of protection.

Most health care providers are "Covered Entities" and are required to apply HIPAA to their daily policies and procedures. These entities include physicians, hospitals, pharmacies, ambulance services, mental health care facilities, and so on…. Covered entities have been given specific guidelines of when and why protected information can be shared.

What are we protecting? We are protecting personal, identifiable information. Any piece of information that can be applied towards identifying an individual is protected. This information includes past, present, or future physical or mental health.

How does this effect law enforcement personnel that deal with physical or mentally impaired individuals? HIPAA handcuffs law enforcement. Most law enforcement agencies are not covered entities, and are not privileged to identifiable information. We have always had the ability of receiving names, addresses, phone numbers, and other necessary information to complete investigations, and provide information for reports.

Now, does this mean we are not allowed this information ever? No! Statutes may allow the release of information to protect life of self, patients, and others. Protected information can possibly be used to capture dangerous individuals. Justification of the "reasons" that information is released is a responsibility of the covered entity, and not a determination drawn by individual police officers.

Only covered entities can violate HIPAA, and only covered entities receive the penalties for improper protection. These penalties can be severe. As law enforcement, let's also remember: If information is obtained illegally, the possibility of it, and anything received as a result of having this information is in jeopardy. Loss of cases and civil judgments can, and will occur. Let's pretend protected information has actual structure, like any other physical evidence. Whatever legal process is needed to obtain this evidence, such as subpoenas, may be needed to obtain identifiable information. If exigent circumstances allow us to seize physical evidence, these circumstances may allow for the use of this highly protected information.

Now, if police officers have personal, identifiable information, must we protect it? The answer is no. Should we protect this information? YES. All of us must practice common sense and think about the individual that this information belongs to. Currently, the rules of HIPAA only apply to covered entities, but that may be changing soon.

Being a Paramedic and an Investigator for the Des Peres Department of Public Safety, I did considerable research into HIPAA. These very issues apply to our department on a daily basis. Having an ambulance in the same building as police, and having the same employees working on both, internal changes had to occur to protect personal information. I recommend seeking legal counsel concerning your department’s relationship with HIPAA. Knowing your legal boundaries is how you can protect yourself and your department. I have met with many departments, and everybody that I have talked to has a different interpretation of this act. I have currently taught many fire departments, and met with area police chiefs. Currently, the protection of information is a difficult process, and has covered entities very busy. Research and training involving covered entities and area law enforcement about HIPAA-related policies can be very beneficial.

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A person with mental illness could be your sibling, parent, cousin or friend. Perhaps it’s your neighbor or the person next to you at your place of worship – and some of these persons are homeless. One in four families is touched by severe mental illness. The brain is part of the body. It too can become ill.

Mental illness is a term used for a group of disorders causing serious disturbances in thinking, feeling and relating, which result in a substantially diminished capacity for coping with ordinary demands of life. Mental illnesses can affect persons of all ages and can occur in any family.

The causes are not yet fully understood, but science is making new discoveries every day. Researchers now believe that the functioning of the brain's neurotransmitters is disturbed biochemically and/or structurally. These changes are not unlike the changes that occur in diabetes or heart disease.

There is no effective prevention for mental illness at this time; no "cures" have been developed. However, the severity of the episodes can be minimized by a healthy lifestyle. Just as diabetes and heart disease can be managed by medication and treatment, an ever-expanding range of psychotropic medications and treatment regimens enable persons with mental illness to manage their symptoms and lead fulfilling lives.

Here are some facts to help dispel the most common misperceptions about mental illness and the persons who have them.

• No one is immune to mental illness. Statistics from the National Institute of Mental Health indicate that 35 million Americans have some form of mental illness in any given six months.

• About two-thirds of Americans who have mental illness live in the community, either with their family or in various types of community living settings.

• Twelve million children and adolescents suffer with diagnosable mental disorders including depression, attention deficit disorder and conduct disorder.

• Recovery is possible when the person receives the necessary treatment and supportive services.

• People with a mental illness are no more violent than someone suffering from cancer, diabetes or any other serious disease. More often, they are the victims of violence.

• Even those with the most severe mental illnesses are in touch with reality as often as they are actively psychotic. Many quietly bear the pain of mental illness without ever acting "crazy."

• Most people who have been through a disabling illness need help or rehabilitation to return to normal functioning. Physical therapy often fills this role after physical illness. Similarly, following mental illness, social rehabilitation is often needed.

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Jeremy Cantrell is a 12-year law enforcement veteran. Currently assigned to the Division of Patrol, he has over five years experience in the Tactical Operations Unit, with two years as a team leader. He has been the course developer and lead instructor for the County and Municipal Police Academy and the St. Louis County Police Department’s less-lethal programs.

Shotgun-launched impact munitions can trace their origins as far back as the late 1800’s in the Far East. American law enforcement recorded many successful deployments in the late 1960’s, with 12 gauge and 37mm "shot bags" being used to quell Vietnam War protests. Tragically, the death of a 14-year-old New Mexico boy who was struck in the chest with such a projectile caused a collective abandonment of the concept for years. The mid-1980s saw a return of these valuable tools, with more emphasis being placed on safer target zones of the human anatomy, and projectiles delivering less kinetic energy. Under the leadership of Chief Ron Battelle, the St. Louis County Police Department added "baton projectiles" to the inventory of tools used by its Tactical Operations Unit. The following is an account of a successful deployment of these projectiles.

In the fall of 1999, the Tac/Ops Unit was activated to respond to a barricaded gunman. A domestic disturbance had escalated to the point where shots were fired with a large caliber rifle, and precinct officers were now engaged in a "face to face" negotiation with the suspect who was still armed with the rifle.

Upon deployment, an element of tactical police officers found two precinct officers on a large covered porch, speaking to the suspect through an open front door. The suspect was seated on a small stool approximately 20 feet inside the front room, with the muzzle of the rifle resting under his chin, and a hand on the receiver. Officers on the scene reported that all other occupants of the house had been safely evacuated, leaving the suspect as its lone occupant. The precinct officers were relieved of their posts and tactical officers assumed their positions on the porch. A trained negotiator was positioned off the porch and out of the line of fire, and negotiations with the suspect were initiated.

Negotiating with the suspect was unproductive; he was uncooperative and becoming increasingly aggressive and confrontational. At one point, the gunman stood and began to approach the front door, intending to close it on the officers. Tensions rose to a very high level before the suspect was convinced to return to his seated position.

I was in the second position in the lineup of officers, and equipped with a 12-gauge shotgun loaded with "sock" type impact projectiles ("bean bags"). The first, or "point" officer in the element was equipped with a shoulder weapon to deploy lethal force if the gunman turned the rifle on an officer. Although we were using the doorframe of the residence as "cover," I was concerned that it would not realistically offer protection from the large caliber round if we were fired upon.

Negotiations with the gunman continued to be ineffective, and the potential to use lethal force seemed to elevate with the suspect’s level of aggression. The tactical commander, (Lt. Jeff Bader), notified me by radio that I was authorized to deploy less-lethal force if I perceived an opportunity to do so.

As I evaluated the situation for a "window of opportunity," I noticed that the suspect would occasionally remove the muzzle from under his chin. I also noted that the rifle was a lever-action type, but could not ascertain if the hammer was cocked.

I told other officers on the porch that if the muzzle was again removed from his chin I was going to target the left hand, which rested on the receiver of the rifle. If this caused the weapon to discharge, it would do so in a safe direction (the ceiling/roof) and the impacted hand should not be capable of manipulating the lever to chamber a second round before the gunman could be subdued.

Shortly thereafter, the opportunity presented itself and the round was placed as planned. The gunman dropped the rifle without firing a shot and tumbled backwards, being subdued before he was able to recover or even realize what had transpired.

After the incident, I felt strongly that our less-lethal tools saved a life, whether it was the gunman’s, an officer’s, or both. However, I cannot stress with enough emphasis that this situation in no way advocates the routine deviation from primary "bean bag" shot placement locations (primarily muscle groups below the waist). It is accepted that as the use of lethal force or loss of life becomes imminent, an officer may consider a target zone that might otherwise be classified as "higher risk", but must consider if this risk can be justified.

The St. Louis County Police Department now equips its Division of Patrol with "baton projectiles" and will additionally deploy Advanced Tasers in the near future. Although these tools continue to evolve and improve, officers must familiarize themselves with the realistic capabilities of their particular tool to determine how to deploy them, or if they should be deployed at all.

Since 1987, Kids Under Twenty One (KUTO) has been helping young people help themselves and their friends learn positive and productive skills to better manage the daily hassles of life: stress, conflict, anxiety, loneliness, depression, even thoughts of suicide. KUTO provides:

• School-based peer helper trainings, building better helping skills for "frontline" student gatekeepers.
• Telephone hotline staffed by trained youth volunteers, open everyday after 4pm at 1-888-644-KUTO (5886).
• Service Learning Projects in which students develop and implement health and wellness awareness programs that encourage healthy life choices.
• Education programs in schools, churches, civic organizations and service agencies that reduce the incidence of suicide in the community.

For more information, call 314-963-7517 or visit www.KUTO.org

Since 1966, LCS has helped over 1 million St. Louisans who were struggling with life's problems: divorce, abuse, violence, food, jobs, mental illness, money, housing, drugs, family, crime, feelings of suicide.

• Offers immediate telephone help and support 314-647-HELP (4357)
• Promotes the use of the 1-800-SUICIDE telephone hotline network
• Offers case management for older adults with identified unmet needs
• Hosts a weekly a Survivors of Suicide (SOS) support group for those who have lost a loved one to suicide

For more information, call 314-647-3100 or visit www.lifecrisis.org

DMH initiated a statewide suicide prevention and education effort in 2001. Four regional sites offer QPR (Question, Persuade, Refer) suicide prevention training, coordinate educational programming with schools and elder care facilities, and strive to bring greater community awareness to the issues of depression and suicide intervention. For information on program availability in your area, contact Debbie Meller 573-751-8017. www.modmh.state.mo.us/cps/suicidee/resources.htm

Coordinating development of a state suicide plan that will meet the criteria set forth in the National Strategy for Suicide Prevention, DHSS is working closely with the national Suicide Prevention Resource Center to establish regional goals and objectives to reduce the incidence of suicide in the midwest region. DHSS also offers suicide prevention training workshops. For more information, contact Aurita Prince Caldwell 314-877-2869.

As St. Louis’ voice on mental illness, NAMI strives to improve the quality of life for people of all ages living with serious mental illnesses and their families. NAMI sponsors support and education programs to consumers and their families, provides the most up-to-date information on all brain disorders, offers community resources and much more:

• Offers a telephone support and referral service; 314-966-4670
• Coordinates community education programs for mental health consumers, family members & peers
• Supports the Multicultural Outreach Project at Prince Hall
• Provides training for support group facilitators.

For program information, call 314-966-4670. www.namistl.org

Founded in 1999, NOPCAS strives to educate all people of color about the stigma and fallacies of suicide. NOPCAS facilitates QPR (Question, Persuade, Refer) workshops in St. Louis area public schools and coordinates community outreach and education activities. For more information, contact Keith Antone Willis at 314-371-0975.

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Moving on…

Street Talk's Advisory Committee bids farewell to two of its original members: Keith Shaw, Ph.D. (Hawthorn Children’s Psychiatric Hospital) and Officer Jim Rudden (St. Louis City Police Department).

Dr. Shaw has relocated and will be working at the National Center for Post-Traumatic Stress Disorder/Boston Veterans Administration and at the National Child Trauma Center, part of Boston University Medical Center.

Officer Rudden officially retired on August 15, after more than 40 years of service to the police department and citizens of the City of St. Louis.

We appreciate the professional accomplishments and volunteer service of Keith and Jim, and wish them the best in their new endeavors.

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Open Mind is a column produced by the Mental Health Association, which appears weekly in many Suburban Journals.  Click here for the reprint above and access to the entire Open Mind Archive on this website.

The Missouri Department of Mental Health (DMH) received a three-year grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to initiate a Jail Diversion Program. DMH Regional Coordinator, Joe Yancey, in coordination with Saint Louis County Justice Services and the Saint Louis City Division of Corrections, initiated a new screening process to identify individuals who may be demonstrating symptoms of mental illness and to divert them from jail to community-based treatment. BJC Behavioral Health, an Administrative Agent to DMH, has partnered with the Jail Diversion Project Team to provide psychiatric evaluations, medications and intensive case management. Researchers from Saint Louis University’s School of Social Service provide evaluation of the project.

The Jail Diversion Program is a post-booking jail diversion model designed to identify, screen and refer offenders demonstrating symptoms of mental illness for additional evaluation and appropriate services. Additionally, the offenders deemed appropriate for participation in the Jail Diversion Program receive intensive, short-term case management during a critical time frame to increase the utilization of mental health services and decrease pre-trial jail time and recidivism.

The program is available to individuals with ordinance violations and non-violent, misdemeanor charges. Saint Louis County Justice Center has employed Mary Franke, MSW, as the Jail Diversion Specialist. Under the direction of Herb Bernsen, Assistant Director of the Saint Louis County Justice Center, Ms. Franke interviews individuals referred by Justice Center staff and screens confined docket cases for potential program participants. The screening includes assessment of symptoms of mental illness and review of criminal charges/history. When an individual is identified as potentially appropriate for the program, Ms. Franke contacts the Saint Louis Prosecutor’s Office to request participation. Saint Louis County Prosecutor, Joyce Kelly, in consultation with numerous area judges, has provided guidance on the legal elements of program eligibility. Ms. Kelly and others in the Prosecutor’s Office provide guidance on a case-by-case basis. The Court and/or the Prosecutor’s Office may set aside charges and release the individual from incarceration with the condition of program participation.

Similarly, Beth Schneider has been employed by the Saint Louis City Division of Corrections to provide the services of Jail Diversion Specialist. Under the supervision of Bob Crecelius, Chief Parole and Probation Officer, Ms. Schneider is available to provide initial assessment for program eligibility.

Each Jail Diversion Specialist refers cases to BJC Behavioral Health for additional evaluation and treatment. Intensive Case Managers work with these individuals on all social aspects. Case Managers assist clients in areas such as employment, housing, benefits and other daily living needs, as well as keeping appointments with psychiatrists, probation officers, etc. The Project Team meets bi-monthly to review cases and work toward improving project design.

The program builds on existing relationships between the criminal justice system, mental health providers and other local community resource agencies. Other key collaborators include the National Alliance for the Mentally Ill and the Mental Health Association. These agencies participate on the Governance Committee.

The Jail Diversion Governance Committee meets monthly to monitor the progress of the program and make process improvement recommendations as necessary. The Governance Committee continues to explore options for additional funding of successful services and will publish the outcome information provided by the evaluation of this project. Dr. Sabrina Tyuse, Saint Louis University School of Social Service, directs the project evaluation.

Governor Holden has given public support to the program. "Attempts to offer psychiatric services to persons with mental illness who are incarcerated are not as effective as community-based mental health services," Holden said. "The jail environment is not a therapeutic setting conducive to treatment. Release of these persons to community-based providers for treatment, services and follow-up will result in much better outcomes for both the criminal justice system and mental health."

Jail Diversion Specialists may be reached for questions regarding referral to this program by calling Mary Franke (St. Louis County) at 314-615-5764 or Beth Schneider (St. Louis City) at 314-641-8492.

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We have archived past issues of Street Talk on this website. 

October 2002

July 2002

April 2002

Following is a dated index of previous articles that have appeared in Street Talk.  To get a copy of any article or a previous issue, please call LaDonna Haley at 314-773-1399.

"It Worked for Me" (Officer Gorman)

Holiday blues vs. Seasonal Affective Disorder (SAD)

What should I know about Bipolar Disorder?

"When it finally hit home – part 1" (FBI agent Burt Jensen)

Public policy, mental health, your work

Liability issues for officers and departments

In the Limelight: Hazelwood PD

At Your Service: St. Patrick Center

I’d like you to know (helpful hints)

Dealing with frequent callers

"When it finally hit home – part 2" (FBI agent Burt Jensen)

Officer and Department of the year awards

At Your Service: Provident Counseling

Q&A: All about EAP’s

Know your mental health options

What does confidentiality really mean?

Rethinking our strategies (John Bozarth)

Anger management

Helping peers in distress

In the Limelight: Ballwin and Hazelwood PD’s

January 2002

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