Area police departments - concerned about complex, sometimes dangerous calls involving the mentally ill - are mounting expensive new programs they hope will balance the needs of public safety and those with mental health issues.
Baltimore County has budgeted $900,000 for a program that will put mental health professionals in the field to back up its officers.
Anne Arundel County is spending $1.4 million a year on a similar program, which has responded to about 1,300 calls in its first six months.
In Prince George's and Montgomery counties, officials are considering plans that would give trained officers primary responsibility for calls involving people who appear to be mentally ill.
Modeled after long-established programs in Berkeley, Calif., and Memphis, Tenn., these efforts come as about 7 percent of police calls involve the mentally ill, according to one national study.
Those calls can range from routine complaints involving the homeless and disoriented to serious confrontations that escalate into violence.
"Police have become the front line for mental health," said Ron Hornberg, legal director for the National Alliance for the Mentally Ill.
"But the police can only do so much. You have to have a mental health system to back it up."
Officials in Baltimore County and elsewhere say they are braced for resistance from officers concerned that they will have to share responsibility with a mental health system that might be unfamiliar with police procedures.
"This is not as simple as throwing a couple more people out there," said Sheldon F. Greenberg, chairman of the Police Executive Leadership Program at the Johns Hopkins University, who has researched police response to the mentally ill.
"It is a change in culture of how police respond to these calls, and that change takes time."
Calls on the increase
Police say calls involving the mentally ill have been on the increase since the 1960s, coinciding with the effort to move people out of mental institutions and into the community.
Police also say that many routine calls - domestic disputes, for example - turn out to have some mental health component.
Sometimes the calls end in tragedy.
In January 1996, Baltimore police shot and killed Homeland resident Betty Keat, 64, at her home when she allegedly refused to drop a knife, even after officers used pepper spray on her. Keat had a history of mental illness, and the family sued over her death.
Last year, a jury found in favor of the police.
In September 1999, Baltimore County police fatally shot Tambra W. Eddinger of Rodgers Forge after a daylong standoff.
Officials at the scene said they knew that Eddinger, who was wielding a .22-caliber rifle, had recently refilled a prescription for antidepressants, and they feared she might have mixed drugs and alcohol.
The police actions were ruled justified.
Even routine calls can put a strain on the system, officials say. In March, a Baltimore County patrol officer was taken off his beat for 24 hours to sit in a hospital waiting room with a mentally ill man seeking admission.
Undeserved criminal record?
Greenberg, the Hopkins researcher, said that police typically have found it more practical to arrest someone whose psychological problems are causing a disruption than to take him to the hospital. The idea is that the person would have access to mental health services in jail.
"The problem by criminalizing is that you are giving the person an [unfair] criminal record," said Greenberg.
Police, who have been trained in law enforcement tactics, can find themselves in the position of a mental health worker.
"Asking the right questions and talking to the person in a way that calms them down is not necessarily the way they are trained in the police academy," Hornberg said. "They are trained to think about safety."
That attitude is changing in places such as Baltimore County, where Col. M. Kim Ward, who is in charge of police operations, brings personal insight to the issue. Ward's brother was diagnosed with schizophrenia, and she knows what it is like to be the family member asking for police help.
Her brother "was handled very well by the police. ... But many [families] have high anxiety about how police handled their calls," said Ward, who is president of the Baltimore chapter of the National Alliance for the Mentally Ill.
"We want to teach officers empathy and safety."
Different approaches favored
Although a growing number of police agencies agree on the need for a sophisticated approach to the mentally ill, they are choosing different approaches.
In Baltimore, a police lieutenant is assigned as a liaison to the city's mental health system.
And every officer receives specialized training in the academy, said Col. Margaret Patten, chief of the community resources bureau.
Baltimore County's plan and the one operating in Anne Arundel County are modeled on the system used in Berkeley, where contract mental health employees work with officers in mobile crisis teams.
Berkeley began its program in 1979, prompted by public pressure after a decade of "de-institutionalization," said David Wee, who leads the program.
Wee said that, in his experience, many of those who need the most help from the mental health system don't seek care at area clinics, but become the subject of a call to police.
He said mental health workers in Berkeley respond to as many as 20 percent of police calls a year.
In Anne Arundel County, about 20 mental health workers in a mobile unit respond to calls on a rotating basis.
Last month, for example, Officer April Ballard responded to a destruction of property call and found that a boy had not taken the medication he needs to calm him.
After talking with the boy, Ballard called the Glen Burnie Crisis Response Team. Two mental health workers went to the scene and met with the child. It turned out they had been to the house before and had a file on the boy.
"Before, I had to try to contact juvenile services," Ballard said. "Now we each file a report ... and I am on my merry way."
The Baltimore County Police Department, working with the county Department of Health, is looking to create its own specialized unit. Teams of mental health workers and officers would respond, one each to a police car, said Lt. Mel Blizzard, who will help coordinate the program.
"They would both go to the call together. They would both be in plain clothes," Blizzard said.
The system can have drawbacks. For one thing, police must be careful about how they share authority with mental health workers. Blizzard said officials also must consider the safety of the mental health workers.
And a Berkeley-style program is expensive: In Anne Arundel County, the start-up costs totaled about $1.5 million, said Dr. Marcia Cooley, a consultant working with Anne Arundel, Montgomery and Prince George's counties. Baltimore County's start-up includes $200,000 in federal grant money.
Trained police officers
Memphis, Tenn., uses a different model - one being considered by the Montgomery and Prince George's county police departments.
Adopted in response to a 1987 shooting of a mentally ill man who attacked police while he was high on cocaine, the Memphis program uses police officers who have been through extensive mental health training.
The 190 officers who are part of the Memphis Crisis Intervention Team wear civilian clothes and identifying pins. They - not mental health workers - respond to mental health-related police calls, and can refer people for treatment.
Last year, the CIT team responded to 7,000 calls - about 8 percent of all police calls.
Supporters say the system, which uses existing police resources, has several strengths. Officers do not have to wait for a mental health worker and can respond if the situation escalates into a dangerous one.
Lt. Sam Cochran, who heads the Memphis CIT program, said those who call police know that the officer responding has training in mental health issues. "I think [citizens] know that an officer is there who understands them," he said.
One disadvantage is the lengthy learning process for officers who are not certified mental health workers, said Cooley.
Still, she said, "I think many police departments are looking to change public perception about how they handle calls. The Memphis model helps them do that."
While experts debate the fine points, officials in Memphis and Berkeley say interest in their programs is high: At least 20 police agencies have contacted them for information in the past three years.
"I think people are trying to be more efficient," said Wee. "We are all trying to defuse [situations], so the officer doesn't have to pull out the baton or the pepper spray or the gun."