Lakewood Police Department Policy and Procedure		Effective Date: 06/27/2023
	Policy Number:   PP-4830 - Mental Health Issues

 A.     Policy

The Lakewood Police Department recognizes that persons with mental health issues and their families need to be treated with compassion and respect. The following policy outlines how to work with persons with mental illness in order to maintain the safety of the individual, their families, agents, other City employees and the public to provide an opportunity for proper medical attention. To facilitate the provision of mental health services, the Jefferson Center for Mental Health (JCMH) case managers will provide mental health case management services to Lakewood citizens who have been identified by a police agent as in need of such services. 

Definitions

1.      Case Manager

An employee of JCMH who is assigned to the Lakewood Police Department to provide mental health intervention and case management services to Lakewood citizens. 

2.     Danger to Self or Others

With respect to an individual, that the individual poses a substantial risk of physical harm to himself or herself as manifested by evidence of recent threats of or attempts at suicide or serious bodily harm to himself or herself; or (CRS 27-65-102(4.5)(a))

With respect to other persons, that the individual poses a substantial risk of physical harm to another person or persons, as manifested by evidence of recent homicidal or other violent behavior by the person in question, or by evidence that others are placed in reasonable fear of violent behavior and serious physical harm to them, as evidenced by a recent overt act, attempt, or threat to do serious physical harm by the person in question (CRS 27-65-102(4.5)(b)).

3.     Gravely Disabled

A condition in which a person, as a result of a mental health disorder, is incapable of making informed decisions about or providing for his or her essential needs without significant supervision and assistance from other people. As a result of being incapable of making these informed decisions, a person who is gravely disabled is at risk of substantial bodily harm, dangerous worsening or any concomitant serious physical illness, significant psychiatric deterioration, or mismanagement of his or her essential needs that could result in substantial bodily harm. A person of any age may be “gravely disabled,” but such a term does not include a person whose decision-making capabilities are limited solely by his or her developmental disability. (CRS 27-65-102 (9)).

4.      Person with a Mental Illness

A person with one or more substantial disorders of the cognitive, volitional, or emotional processes that grossly impairs judgment or capacity to recognize reality or to control behavior. Developmental disability is insufficient to either justify or exclude a finding of mental illness within the provisions of this article. (CRS 27-65-102(14)).

B.         Procedures

1.      Recognizing Abnormal Behavior

All Employees should be aware of and recognize behavior that is indicative of mental illness and that is potentially dangerous. Employees should not rule out other causes of abnormal behavior such as reactions to drugs, alcohol, temporary emotional disturbances or a medical disease.  Agents should evaluate symptomatic behaviors in the total context of the situation when determining a subject's mental state and the need for intervention absent the commission of a crime.
 
General signs/symptoms that may signal mental illness exists (the following are examples and not all inclusive):
 

a.      Degree of Reactions:
Persons with mental illness may show signs of strong and unrelenting fear of persons, places or things. For example, the fear of people or crowds may make the person reclusive or aggressive without apparent provocation. 

b.      Appropriateness of Behavior:
A person may act extremely inappropriately for a given situation. For example, a motorist who vents frustration in a traffic jam by physically attacking another motorist may be mentally ill.

c.      Extreme Rigidity or Inflexibility:
Persons with mental illness may be easily frustrated in new or unforeseen circumstances and may exhibit inappropriate or aggressive behavior.

 d.         Other Specific Behaviors:

1).     Abnormal memory loss such as name, address or phone number.

2).     Delusions of grandeur or paranoia.

3).     Hallucinations of any of the five senses; e.g. hearing voices, feeling one's skin      crawl.

4).     Belief that the person is suffering from extraordinary physical illness that is not possible, such as their heart has stopped beating.

5).     Extreme fright or depression.

6).     Inability to sit still, to communicate effectively, rambling thoughts and speech.

7).     Wide eyes, clutching one's self or objects to maintain control.

8).     Begging to be left alone.

9).     Frantic assurances that he/she is all right.

10).   Inappropriate verbal or physically exaggerated rage.

2.      Assessing Danger

Not all persons with mental illness are dangerous.  Persons with mental illness may be dangerous under certain circumstances.  As with any situation where there is any level of uncertainty, personal safety is the  employee’s first priority. Indicators may exist to assist in determining if a person with apparent mental illness represents an immediate or potential danger to him/herself, officers or others. Indicators include but are not limited to the following:

a.      Weapons and their availability to the subject.

b.      Substantiated statements (suicidal statements, direct threats or subtle innuendo) that the person is prepared to commit a violent act.

c.      A history of prior violence under similar circumstances.

d.     The failure to commit a violent act does not guarantee that such an act will not occur.

e.     The lack of control the subject demonstrates over his/her emotions of rage, anger, fright and agitation. 

3.         Actions

a.      Agents may contact the JCMH Mobile Crisis Unit to respond to the subject’s location for evaluation. The contact shall be documented on an FI card or in an incident report. 

b.      Under the below criteria, Persons with mental illness may be detained by an agent, taken into protective custody, and transported to an appropriate medical or mental health facility for purposes of a seventy-two hour treatment and evaluation when:

1).     The subject appears to be an imminent danger to others or to himself or herself or;

2).     The subject appears to be gravely disabled; and

3).     Acting at the direction of an “intervening professional” as defined in CRS 27-65-105(1)(II). This includes but is not limited to: a certified peace officer, a physician, a psychologist, a registered nurse who has mental health training, a licensed therapist or counselor who has mental health training, or a licensed clinical social worker. 

c.      Court orders. Persons with mental illness may be detained, taken into protective custody, and transported to an appropriate medical or mental health facility for purposes of a seventy-two hour treatment and evaluation when the court orders the person to be taken into custody for such an evaluation based upon an affidavit sworn to or affirmed before a judge that relates sufficient facts to establish that a person appears to have a mental illness, and, as a result of the mental illness, appears to be an imminent danger to others or to himself or herself, or appears to be gravely disabled.

d.     Once it has been deemed necessary to take a subject into protective custody, the person may be transported to an area hospital emergency room, or an appropriate mental health facility that can provide for the needs of the subject.

e.      Persons with mental illness who are intoxicated by alcohol and are clearly a danger to the health and safety of themselves or others as a result of intoxication may be taken into protective custody and transported to a detox center or hospital emergency room (CRS 27-81-111). The detox center supervisor or emergency room staff shall be notified of the intoxicated person's behavior as it relates to their mental illness (i.e. suicidal ideology, delusions).

f.       Persons with mental illness who are under the influence of drugs may be taken into protective custody and transported to the appropriate hospital emergency room or other facility designated as a mental health care center. As with intoxicated persons, the agent shall advise the treatment unit supervisor of the circumstances surrounding the custody. 

g.      When deemed appropriate, based upon the circumstances, a subject may be transported by ambulance to the appropriate medical/mental health care facility for an evaluation.

h.      In cases where a subject has been taken into protective custody and transported to a medical/mental health facility, an emergency mental illness (M-1) report and supplemental report shall be written which sets forth the probable cause for the protective custody.

4.      Persons with mental illness who do not meet the criteria for an emergency mental health hold may be worked with in the following manner: 

a.      The agent or other employee may determine no action is necessary. A contact or incident should be appropriately documented. 

b.      In the workplace, an agent may be summoned by a non-sworn employee if necessary. The agent may utilize the services of a case manager as outlined below in Section (B) (5).

c.      The subject may be voluntarily transported to a Jefferson Center for Mental Health facility (i.e. walk-in crisis center, JCMH office). The contact shall be documented on an FI card or in an incident report. 

d.      If the subject has committed a crime, the agent should take appropriate action (citation or arrest). Depending on the subject’s symptoms, he/she may be interviewed or interrogated regarding the crime.

e.      When employees document a mental health related situation, an incident report should be created that will be routed to the case manager.

5.      JCMH Case Manager Program

The goals of the behavioral health services provided by case managers are to increase early identification and intervention for citizens with mental illness who have contact with the Lakewood Police Agents and to provide more comprehensive and more effective interventions and resources for Lakewood citizens who are experiencing a mental health crisis.  The services aim to reduce the number of repeated calls for service for police agents to respond to citizens through effective case management and referral to appropriate and effective community based resources.  

a.         The following services can be provided by a case manager:

1).     Field response with agents

2).     The case manager will respond to a request by an agent in situations which, in the agent’s opinion, involve mental illness or significant mental health concerns and the agent believes additional resources, support, or further assessment would be beneficial.

3)     Case managers shall communicate with the agent to coordinate any security needs while the case manager remains on scene.

4)      Follow-up response and services

The case manager will follow up on a referral, after the initial call for service has been completed, from an agent who has contacted an individual who, in the agent’s opinion, suffers from a mental illness or mental health crisis and would benefit from additional mental health resources, support, or further assessment.

5).    Case managers will conduct intervention or assessment with clients and members of clients’ support system as needed and appropriate.  

6).    Case management

(a)    Provide follow up to clients and their support systems including assessing the effectiveness of the intervention and support services provided and making appropriate additional referrals or providing additional resources.

(b)    Interface with other agencies

(c)     Maintain relationships and collaborate with mental health and substance abuse service providers 

7)         Participate in stakeholder meetings

8).        Data collection and tracking

(a)     Develop a tracking mechanism to share the number of contacts and referrals 

(b)    Track the number of repeat contacts with clients 

(c)    Track the number of repeat calls for service by agents for a client.

(d)   Track any other information that may be deemed beneficial for the support of the program.

9).     Agent Referrals

Agents should make a referral for follow up services for an individual whom the agent believes may benefit from case management services.  They can do this in several ways:

(a)     Requesting the response of a case manager to an incident where agents have already arrived.   Agents should request the response of the case manager when encountering situations which, in the agent’s opinion, involve mental illness or mental health concerns and the agents believe that additional resources, support, or further assessment would be beneficial.  Agents shall remain with the case manager for safety reasons until the case manager no longer requires his or her presence and the Agent feels that the case manager is not in any danger.

(b)    Requesting follow-up intervention after the initial call for service has been completed.  Agents may refer citizens  to the case manager by telephone, email, or in-person when the agent believes that additional support, referrals, or mental health-related intervention might be beneficial.

(c)     Referring citizens  and their families or members of their support system directly to the case managers/co-responders by providing the unit’s telephone number and/or email address.

b.      Confidentiality

Case managers are not authorized to provide information regarding Lakewood Police employees or police investigations to the media or any member of the public.

c.      Administration
The administration of the Case Manager Program will be the responsibility of a Patrol Commander.

6.      Crisis Intervention Team (CIT)

Due to specialized training in the area of mental health, Crisis Intervention Team agents (C.I.T.) should respond, when operationally practical, to assist with calls for service, as well as interviews and interrogations involving a crisis where mental illness is believed to be a factor or where a subject in crisis represents a danger to him/herself or others. 

*See Department Manual 9607 for further information on the purpose and role of the Crisis Intervention Team (C.I. T.).

C.      Rule

All newly-hired police agents and non-sworn personnel will receive documented training on accessing resources, the recognition of and guidelines for responding to persons with mental illness”.  Refresher training of all department personnel in responding to persons with mental illness will be conducted and documented annually.  Training attendance records will be maintained by the Training Unit.