Wellness Checks for Dementia: Police and Mental Illness

Today we will reflect on the problem some of us may face, What will
happen when we call the police to do a wellness check on a neighbor
who possibly is suffering from dementia?
My perspective that of a volunteer officer of an over-55 condominium
association. Indeed, determining whether a resident is simply being
difficult or whether they are in the early stages of dementia can be
difficult.
One warning sign of dementia is the elderly can no longer handle their
financial affairs. If someone who has been paying their bills, including
condominium maintenance fees, for decades is suddenly delinquent,
could that be a warning sign for dementia?

Another warning sign is puzzling and/or abusive behavior, or
sexually inappropriate behavior. Often, the demented are
combative through frustration, or literally because they lose the
presence of mind to fix their meals when they should, or go to
the doctor, and they may have urinary tract problems.
Can we blame those suffering from dementia for their demented
behavior? Are those suffering from dementia responsible for
their actions?
What training do the police undergo to deal with citizens with
mental health issues, including dementia?

https://www.alz.org/help-support/caregiving/stages-behaviors/agression-anger

Please, we welcome interesting questions in the
comments. Let us learn and reflect together!
We will discuss available resources at the end of the
video.
Feel free to follow along in the PowerPoint script we
uploaded to SlideShare.

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Police and Mental Illness, Including Dementia
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Who should you call for wellness checks? We were reluctant, at
first, to ask the police perform these wellness checks. We
wondered, Do the police have the training necessary to take the
place of social workers when performing these wellness checks?
We live in Florida, and the social welfare agencies just do not
have the staff to perform these wellness checks, and other
professionals are reluctant to do them for liability reasons, and
because they are also busy. So, we have no choice but to rely on
the police to perform wellness checks. Unfortunately, the police
may not want to share what they learn because of HIPAA, or the
health-care privacy regulations.

https://www.citinternational.org/What-is-CIT

The good news is that to be accredited, police departments need
to provide a week of Crisis Intervention Training, or CIT, on
mental health issues to their police, with continuing education. In
Florida, our state, all but four rural Florida counties provide this
training for their local police. Many of the mental health issues
the police encounter overlap with drug abuse problems.
The bad news is that this mental health training is geared toward
the younger and middle-aged offenders, police receive little
training on dealing with the elderly who suffer from dementia.

https://www.flsheriffs.org/law-enforcement-programs/crisis-intervention-team

How Do You Respond to Dementia?
Both Ronald Reagan and Sean Connery suffered from dementia.

How does dementia differ from other forms of mental illness? One difference is that
no matter what you do, the elderly suffering from dementia will not substantially
improve, they will only get worse. Of course, if you ensure they have enough to eat
and drink, and have the necessary medical care, that will help.
I joke with the members of my over-55 community that if one of our elderly
neighbors is ornery, that we should be patient with them, as they may suffering
from dementia, and we do not know it. This is literally true. While you can often
sense if someone is autistic, or has a drug problem, or is schizophrenic, often you
cannot tell if someone is in the early stages of dementia.
When you suspect that a neighbor could be suffering from dementia and needs
help, who do you call? This could include the elderly who have fallen behind in their
bills or are behaving inappropriately.

Most important, call their family or loved ones. This is critical, especially if
they are living alone. If the family are not involved in their life, then some
alcoholic or homeless person could flatter them, move in, and take
advantage of them. If they suspect intervention, they may drag the
person suffering from dementia down to the courthouse and marry
them. That could make them untouchable, so they can drain their assets
at will.
Often their family members are aware of their condition and are trying to
take care of them. In that case you can let them know what local
resources are available, which would include the local Council of Aging,
and in particular, the Alzheimer’s Association, which has an excellent
twenty-four-hour hotline you can call for free assistance and advice.

Norman
Rockwell,
who also
suffered from
Alzheimer's,
posing with his
painting "New
Kids in the
Neighborhood",
by Louie
Lamone, 1967

We sometimes get pushback from people in our
community when we suggest we need to keep in
mind that our elderly who are behind in their bills, or
are behaving inappropriately, might be suffering from
dementia. Their objection: We are not an assisted
living facility!
The problem is that the Almighty answered this
question from Cain many millennia ago:
Unfortunately, We are indeed our brother’s keeper.

We see in this 2015
painting by Andrei
Mironov the anguish in
the heart of Cain that
shows up in his sour looks
that is caused by the envy
of the favor that God has
shown for the sacrifice of
his brother Abel.

There are common-sense responses to this concern: (REPEAT)
• If someone is suddenly behind in their financial obligations, ask the police to
perform a wellness check. If you inform them that foreclosure is a possibility, this
will add urgency, and may give them the leverage needed to entice the social
welfare agencies to get involved in the case.
• If a resident is harassing the staff or other residents, or acting inappropriately,
including sexually inappropriate actions or remarks, ask the police to perform a
wellness check. Emphasize you are as concerned with their welfare as you are
concerned about their behavior.
• Share with their family what is happening, many condominium associations have
emergency contact information in their files.
• This emergency contact information should be updated every decade or so.
• Inform your staff that if an elderly person is acting inappropriately, this could be
due to early-stage dementia. The association should not hesitate to ask the police
to perform a wellness check. These policies will also lessen staff turnover.

There are common-sense responses to this concern:
• If someone is suddenly behind in their financial
obligations, ask the police to perform a wellness
check.
• If a resident is harassing the staff or other
residents, or acting inappropriately, including
sexually inappropriate actions or remarks, ask the
police to perform a wellness check.
• Share with their family what is happening.
• This emergency contact information should be
updated every decade or so.
• Inform your staff that if an elderly person is acting
inappropriately, this could be due to early-stage
dementia.
Drawing of patient with dementia, 1896

Police Crisis Intervention Training Program

The Crisis Intervention Training (CIT) program was created in response to
a tragedy that occurred in Memphis, Tennessee in 1987. The police
responded to a call involving someone threatening to commit suicide.
When the police ordered him to drop the knife, he charged the officers
with the knife, who then shot and killed him.
In response to the community and media blowback, the Memphis Police
Department consulted with the local chapter of the National Alliance on
Mental Illness (NAMI) and two local universities to develop the Memphis
Police Crisis Intervention Team and Training program, which has been
adopted by police departments all over the country.

In 2017, Steve Leifman, an associate administrative judge
for the Eleventh Judicial Circuit in Miami-Dade County, was
one of the authors of an article in the Atlantic magazine:
How Mental-Health Training for Police Can Save Lives and
Taxpayer Dollars, with the subheading, “But only if officials
at all levels of government are willing to invest in it up
front.” Judge Leifman has lobbied for a police training
program in Miami-Dade, which has been in place for
several decades, with dramatic results.

https://www.theatlantic.com/politics/archive/2017/08/how-mental-health-training-for-police-can-save-livesand-taxpayer-dollars/536520/

We cannot improve on his first few paragraphs: (REPEAT)
“Every day seems to bring a new tragic story of a person with serious mental illness
killed by police. In Seattle,” “a 30-year-old pregnant woman shot in front of her
children, and a 20-year-old man killed right before his high-school graduation during
what appeared to be his first psychotic episode, with a pen in his hand police
mistook for a knife. Sometimes, the consequences are not death but violent
confrontations, arrests, and incarceration: occurring only because of
miscommunication, missed signals, and misunderstandings.”
“Most of these tragedies result from officers’ lack of training on how to deal with
people with serious mental illnesses. Standard police training: to issue commands,
and when they are not followed, to push harder and more aggressively. That may
work in other circumstances but are exactly wrong for those with mental illnesses or
developmental disorders.”

Another 2014 Atlantic article describes how the CIT
program has been implemented in San Antonio.

https://www.theatlantic.com/health/archive/2014/08/san-antonio-police-have-radical-approach-to-mental-illness-treat-it/378780/

The article states that before this
program, “police responded to
mental-health emergencies the way
they would to any other call: They
used the tough guy command voice
they’re taught to handle criminals.
‘Police are notorious for the A
personality type. They walk into a
situation. They gain control of it. It’s
their call now. They’re in charge,’”
said one officer.

The article continues, “More often
than not, the officers ended up
taking people with serious mental-
health issues to jail.” “The other
option was to take the person to a
hospital emergency room. But in
San Antonio, the police were
waiting an average of a dozen
hours in the hospital until the
person could be triaged; that
made jail seem more appealing.”

Judge Leifman noted, “Since 2010,
fewer than two hundred deaths for
mental health related calls to police,
fatal shootings by police down nearly
ninety percent” in Miami-Dade county.
“What changed?” “A key component
was the CIT training of over 5,400
police officers in Miami-Dade,
representing all 36 police
departments, using a 40-hour program
crafted initially in Memphis,
Tennessee, in the late 1980s.”
Charles Bronson suffered from dementia.

Judge Leifman continues, “To be sure, it
was not easy. First, many police officers
believe they know what they are doing
and don’t think they need additional
training. Second, it was a battle to
convince police chiefs to take their cops
off the beat for a week to take the
course.” Many police departments were
not eager to adopt the CIT program, and
Congress was not willing to push for its
expansion nationwide.
Peter Falk, or Columbo, suffered from dementia.

Judge Leifman notes, “Finding treatment for
people with these illnesses, including medical
care and often a place to live, usually requires
Medicaid. In Miami-Dade, the program has
done so well that both the county and the
conservative Florida legislature have
appropriated funds to build a new
comprehensive treatment center for the most
acutely ill, who regularly recycle through both
the criminal-justice and mental-health
systems. Most states and counties have failed
to invest in expanding the number of beds
available to residents overall, much less invest
in quality treatment facilities.”
Jimmy Stewart, suffered from dementia.
Here he is with John Wayne in the movie,
The Man Who Short Liberty Vance, 1962 Western

https://www.theatlantic.com/ideas/archive/2022/05/mental-illness-treatment-funding-incarceration/643115/
In a follow-up article in 2022, Judge Leifman
notes, “As a result, the makeup of our prison
population tells its own tale: More than
seventy percent of people in American jails
and prisons have at least one diagnosed
mental illness or substance-use disorder, or
both. Up to a third of those incarcerated have
serious mental illnesses, a much higher rate
than is found at large. On any given day,
approximately 380,000 people with mental
illnesses are in jail or prison across the United
States, and another 574,000 are under some
form of correctional supervision.”

Miami-Dade Documentary on Mental Illness
https://doifilm.com/

In addition to implementing the Crisis Intervention Training program for its police
officers, Miami-Dade has also instituted a Mental Health Court system. In their
documentary film, they follow several cases as they progress through the system
over a few years. Not all cases are successful, and they include one backsliding case
where the defendant eventually graduated from the system. These cases also
involved drug and alcohol addictions and community counselors, and helped the
participants get on their feet and earn a living rather than be sentenced to jail
terms.
The participants need to be accepted by the judges to participate in the Jail
Diversion program, with supervised court-ordered counseling. At first, only
misdemeanor offenders were accepted into the program, but as the county gained
experience, now second and third-degree felony offenders can be accepted.

Some of the statistics mentioned in the film are:
• People with mental illness are nineteen times more likely to find a bed in jail
than in a state civil hospital.
• The cost of incarcerating someone with mental illness is $31,000 a year.
• The cost to enroll someone in community mental health services is $10,000
per year.
• If trends continue, Florida will need to build ten prisons in ten years, costing
$2.2 billion.
• Since the Jail Diversion project began, the number of arrests in Miami-Dade
has fallen from 118,000 to 56,000 per year, saving the county twelve million
dollars.
• Recidivism for felony and misdemeanor clients who complete the program
has dropped from 80% to less than 25%
• Police shootings went down from two a month to sixteen over several years.

Another article in the Atlantic Magazine discusses the
history of deinstitutionalization of the mentally ill, and
mentions the Crisis Intervention Program, which in 2021
was implemented in over 2,500 police departments across
the country. The article is skeptical how effective “a few
hours” of training is in countering police attitudes, though I
can attest that in my community most policemen are very
aware of the challenges posed by the mentally ill.

https://www.theatlantic.com/health/archive/2021/05/truth-about-deinstitutionalization/618986/
Effects: Closing Institutions for Mentally Ill

We do wish to include some quotes from
this Atlantic article: “In many prisons and
jails, the urgent question is not how to
reduce this surging population but how
to build larger and better psychiatric
units and treatment facilities inside the
walls” of the prisons. “Rikers Island, for
example, now has specialized therapeutic
units for people who might need
hospitalization or who have just returned
from a psychiatric hospital.”

“It’s easy to think that if people with mental
illness could be housed and treated in
asylums or similar institutions, they wouldn’t
be policed and incarcerated at such high
rates. But it’s important to remember that
those hospitals had deteriorated to
conditions shockingly similar to today’s worst
prisons and jails. Instead, we need to face
head-on the enormous problems of mass
incarceration and a system of mental-health
care that effectively does not exist. No
nostalgic looking back will change that.”

We definitely agree, the recent New York City
elections prove that even in a liberal district,
campaigning on the idea of transferring money from
the police budgets to the mental health budgets is
political suicide. Perhaps police departments should
pin badges on dedicated mental health workers
instead.

https://nypost.com/2021/07/10/eric-adams-win-in-nyc-proves-defund-the-police-dem-non-starter-james-clyburn/

Odds of Developing Dementia
What are the odds of
developing dementia?
Over 65, one in fourteen;
over 80, one in six.

Which brings us around to our original concern,
these Crisis Intervention Programs often do not
include training on how police can spot and handle
those citizens who are suffering from early and late
stages of dementia. We feel compassion for our
police officers. How can they tell whether someone is
just ornery, or whether they are in the early stages of
dementia?

Our primary sources are past articles from the
Atlantic Magazine. We also explored many of these
same issues in our video:
How I Halted a Foreclosure on a Destitute Owner
with Advanced Dementia! We Discuss Dementia
This video strives to be educational in the challenges
we face when encountering Alzheimer’s, and how
this issue makes many people uncomfortable.

There is an excellent case study by Kim Campbell,
widow of Glen Campbell, on how his personality
changed from before he contracted Alzheimer’s to
his early, middle, and late stages of this condition.

In both of these videos, we also included much helpful
information from the Alzheimer’s Association website on
the symptoms and stages of Alzheimer's. They have an
excellent network of support groups, plus they offer an
excellent twenty-four-hour hotline, free of charge, for
caretakers and others wanting information on dementia.
For clarification, about seventy percent of dementia
patients suffer from Alzheimer’s, and there are other types
of dementia.

In the near future, we will be releasing a review of a
book released in 2023, Travelers to Unimaginable
Lands: Stories of Dementia, the Caregiver, and the
Human Brain. We will also briefly discuss the latter
life of Rita Hayworth and Tony Bennett, both of
whom developed Alzheimer's.

The thumbnail photo was by Walt Stoneburner on Flickr.
https://www.flickr.com/photos/waltstoneburner/2863583929/

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Wellness Checks for Dementia: Police and Mental Illness

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