Mentally Ill While Black

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Brian Lehrer: Brian Lehrer on WNYC. For all individuals suffering with mental health issues, there's the danger of stigma, of getting called crazy or psycho, or not being treated with compassion in one way or another. When you're Black and have a mental illness, that stigma can more frequently turn deadly. That was the case of course with Daniel Prude, the 41-year-old man who was killed by the police in Rochester, New York. The medical examiner ruled it a homicide. His brother had called the police because Daniel had left the house and he was worried for his brother's safety because he was in the midst of a mental health crisis. Here is Joe Prude, Daniel's brother, recalling that night in March.

Joe Prude: For a person like that, that you love so much to just disappear in thin air, it's like, "Wow, how did I lose sight of him that quick when I had my whole eye on him the whole time?" In the process of me trying to figure out which way he went, immediately got on the phone with 911. This is what the outcome. I called them for to lynch my brother? I didn't call them to come help my brother die. I called them to come help me get my brother some help.

Brian: Since that story came out last month, protesters have been out in Rochester demanding a change in police leadership. Also that the police stopped responding to calls relating to mental health. We've talked about that aspect of the defund the police or police reform movement before and we'll touch on it again during this segment, but today we wanted to focus on looking at the compounding forces of having a mental illness and being Black of the fear and anxiety that surrounds those forces especially when thinking about how society sees you and interactions with the police. I'll invite your calls in a minute, but first, let me introduce my guest.

Dr. Ashwin Vasan is an epidemiologist and professor at Columbia and the CEO of Fountain House, one of the world's oldest and largest community based mental health and public health charities. Christina Sparrock, she's a mental health advocate and Fountain House member. In her day job, she works as a CPA. Dr. Vasan welcome back to WNYC and Christina, welcome. Thank you so much for joining us.

Dr. Ashwin Vasan: Thank you for having us.

Christina Sparrock: Thank you. Thank you.

Brian: Dr. Vasan, if people have heard you on the show previously, you've been here several times recently, they may think of you as a COVID expert, but you also work extensively on issues related to mental health. I'll remind everybody not just physical health, we're finally doing a segment on your day job. As a doctor, what should have happened that March night with Daniel Prude?

Dr. Vasan: Yes, thanks, Brian. I think part of what-- because I wear these two hats, I think one of my goals is to really push forward a conversation where we talk about health holistically where mental health and physical health are treated the same and really thought of as requiring health responses. What we saw with Daniel Prude, and with just so many other victims of these tragedies is that we don't have systematic health responses in the community for mental health crises. Instead, we deploy solutions that emphasize control, punishment, and unfortunately, law enforcement. We wouldn't do that for a heart attack, we wouldn't do that for a diabetic emergency, but for some reason, and I think the reasons are clear, we stigmatize and discriminate against mental illness and people living with mental illness in such a way that we end up criminalizing it and have historically criminalized it for so long.

What should have happened on that day with Mr. Prude and his family was-- his brother did all the right things. He called for help. There are no real options for people who need help for their family members and loved ones in crisis other than 911 in most cases. What we needed and what many people need is a better matching of the problem and the solution. When a house is on fire, you don't call the cops, you call the fire department. When someone is having a health emergency, you call a paramedic and EMS worker, not the public police.

What happened with Daniel was a health crisis. Something was happening with him biologically, neurologically, cognitively that was manifesting in his behavior not being outside of the range of normal for him. At that moment, I can imagine Mr. Prude was one of the least aware and most frightened parties in that situation. The presence of a police officer as his first point of contact, in many cases, is escalating and not de-escalating.

What should have happened is that his first point of contact should have been a mental health professional. Ideally working with a peer. Someone who lives with a mental health condition who are skilled and trained and expert and go through years of training to understand how to connect with, engage, relate to, de-escalate, and respond non-violently to people in mental health crises. The good news is that we have models all around the country that work and that have good results on how to do this, but unfortunately, those are just islands of excellence instead of standard practice and we have to change them.

Brian: Before we bring in Christina, I think we should mention that your organization, Fountain House, has a direct link to this issue. With member Deborah Danner, sadly being killed in a police encounter during a mental health crisis in 2016. That was a "new story" at the time. Can you remind us of what happened with Deborah Danner?

Dr. Vasan: Yes, absolutely. Deborah was a member of Fountain House before my time but someone who had a long history with our organization and was just really a fantastic member of our community, a fantastic peer, a fantastic supporter. Helped many others who were trying to recover and live with mental illness connect up with our community, and begin their journey of recovery. She was a 66-year-old woman with schizophrenia. She was undergoing a mental health crisis. A neighbor called for what they thought was a wellness check, a welfare check, and she was in her apartment having an active mental health crisis and was the victim of a police shooting in her own apartment. That was entirely preventable tragedy.

In addition, Deborah was a writer. Tragically, she wrote openly and publicly predicting her own death at the hands of police. This is very personal to us at Fountain House. It's very personal to our community. It's very personal to everyone at the 14 projects around New York City that we support and others in 37 states around the country that we support. It's personal to everyone involved who really fundamentally believes that people living with mental illness don't belong in institutions. They don't belong behind bars. They don't belong in our emergency rooms and in our hospitals. They need supportive infrastructure and communities where they live to help them on their journey to recovery and reintegration.

Brian: Was there a racial component, in your opinion, in the Deborah Danner case? Did that case, since it did generate at least some publicity, certainly not like what's happening with Daniel Prude and some of the other things that have gone on this year, but some, did it result in any systemic reform in the NYPD?

Dr. Vasan: I'd be remiss if I didn't highlight the underlying racism here. The structural racism both in our response to people with mental illness as well as in policing. Just to give you some statistics, only one out of three Black Americans can actually receive mental health care when they need it. Not only do we lack providers who work in low-income communities, and we lack psychiatrists to accept Medicaid, we have an issue where we don't have enough culturally competent providers. There aren't enough Black and brown psychiatrists.

We know through a whole bunch of evidence that establishing a therapeutic relationship for mental health requires some ability to connect up with the provider and their lived experience as well so that you feel like the person listening to you comes from a similar place and can understand your cultural and specific background. We have this situation where Black and brown Americans, particularly Black Americans, lack access to care. The quality of care they receive is lower because of the lack of cultural competency.

Historically, we have overdiagnosed more serious forms of mental illness in Black Americans versus white Americans. For example, Black Americans are more likely to be diagnosed with schizophrenia and bipolar disorder instead of garden-variety depression and anxiety which is a much more common diagnosis in white communities and non-Black communities. With that, there's an inherent racism in the way we deliver mental health care and access to mental health care and quality of mental health care.

Add to that, the fact that in the absence of mental health solutions and health care solutions, we choose to criminalize it and to put on this notion of violence and safety predominantly for Black Americans with mental health crises which is very much in line with what we're seeing with policing overall and racial injustice and policing overall. You have this really toxic intersection of these two systems failures which both are driven by structural racism.

Yes, I think that's a long answer but the short answer is there must have been. That isn't to say that the officers in the case and the specific decisions made at the time were racist. It's that our systems and our drivers for why there are these interactions and why these interactions play out the way they do are certainly driven by structural racism. Just to give you a data point, there have been 16 victims over the last five years of police shootings or police violence with mental illness in New York City alone; 14 of those 16 were Black or people of color. We have a systematic response to mental illness that is failing. We have a systematic response to policing of Black communities and brown communities that is failing and this is the intersection of those two things.

Brian: Listeners, we do want to invite some of you to call in. We have time for a few phone calls in this segment. If you or a loved one is struggling with a mental illness and if in addition to the stress of dealing with that illness whether it be depression, anxiety, bipolar disorder, schizophrenia, or anything else, you're more anxious around the police, worried that the mental illness will be mistaken for violence or that you might not be able to answer to a police's order in the midst of a crisis and that will be mistaken for disobedience. 646-435-7280. We know, as Dr. Vasan was just describing and citing a statistic around, that this is true especially for our non-white listeners.

If you're Black and dealing with a mental illness or a neurodivergence like autism or OCD, Tourettes, or some examples, do you think about how you're perceived by the police? Even more so than how you're perceived by anyone else in society, maybe it's not you but your son or daughter, are you worried about their safety as they get older? Not children anymore. Anything you want to add to this. Tell us a relevant story from your life experience.

646-435-7280. 646-435-7280. With Dr. Ashwin Vasan, CEO of Fountain House, one of the oldest and largest community-based mental health and public health charities. Also with us is Christina Sparrock who is a mental health advocate and a Fountain House member. In her day job, she works as a CPA and Christina thank you for your patience. As a Fountain House member, I know you've been open about your bipolar diagnosis and subsequent anxiety regarding police encounters. When did you first think about your mental illness in terms of the police like whether to avoid them or not?

Christina: Thank you for having me today. I appreciate it. Back in 2013, Brian, I had my first encounter with NYPD. I wasn't experiencing any mental health system and I was well, but I was assaulted in the street and I called 911. The huge mistake I made was that I said to the 911 caller I had bipolar and I had been assaulted and needed help. That was the biggest mistake that identified myself as someone with a mental health disability.

From a 911 dispatcher to the responder, I could see that they weren't hearing my complaints or seeing me as a person. When the officers arrived, they treated me as if I was crazy and I refused to take my complaint. They refused to investigate and they allowed the assailant to flee the scene. I was hurt and felt violated and from that incident that day, this led me to my distress with NYPD.

Brian: I know you've participated in training designed to teach officers de-escalation techniques for people with mental illness. Did anything surprise you in those training sessions or something that an officer did or didn't know, for example?

Christina: Brian, police interact with people living with mental illness. They only see people when they're in crisis. Too often the police fail to realize is that's just a snapshot of our lives. We have plenty of good days. As part of the 40-hour Crisis Intervention Training Program or CIP training, mental health peers share personal stories of their struggle and recovery with mental illness and/or substance abuse.

Officers hear about their families, their profession, dreams that they have and learned that peers are no different from any other person with human conditions like diabetes or hypertension. Officers ask candid questions about approaches to de-escalate. What surprised me the most was when officers share their battles with mental illness with me in private because many of them suffer in silence.

Brian: Do you want to add anything to that Dr. Vasan?

Dr. Vasan: I think what Christina is highlighting so poignantly is that the stigma and discrimination we have for mental illness and people living with mental illness affects all of us. It affects not only the victims and the recipients of services, it affects the providers too. I think it's particularly poignant that Christina points out that her experiences with NYPD officers sharing their own stories of mental health challenges because our own views on mental health and the stigma associated with it, drive our responses.

That's why I say that structural racism is certainly a major driver of these tragic events but there's also this added layer of just the way we regard mental health and mental illness in our society which is in as old as the time itself. These perceptions of people as crazy and violent and unstable rather than people with health conditions who require health responses. Just quickly going back to solutions, we know what works. There are examples from around the country that show that we can structurally change the way that we interact with people in mental health crises to good effect.

The oldest and most famous example of this is a program out of Eugene, Oregon called the cahoots model where 911 calls are redirected away from the police and towards crisis response teams that are staffed by mental health professionals. Over 30 years, they have no reported fatalities. In the last year, there were 24,000 calls, I believe, in 2019 to this service and only 250 required any law enforcement backup. What that tells us is that these are skilled professionals with whom the city and any municipality should be able to partner and invest in to fundamentally change the way we respond to people who are experiencing mental health challenges and really at the end of the day just calling for help.

Not only is it the humane and the moral thing to do, it's grounded in science and public health and it saves money. In Eugene alone, a city with a annual budget of around $800 million, for the listeners, you'll know that New York City is on the order of $50 billion so it's a different scale. It saved $14 million in ambulance and emergency room treatment costs alone and almost $9 million in policing costs, law enforcement costs, and in a city with a budget of $800 million. That's a non-trivial amount.

By every measure, this model has been replicated and even extended further in places like Baltimore, Indianapolis, Denver, and Seattle. Here in New York, we have a fantastic coalition that Fountain House is proud to be a part of called CCIT-NYC. Correct Crisis Intervention and Treatment Now. We've been working closely with city council and city hall to really begin to rethink the way we do things.

Last year, the mayor's office and city council announced that they were investing $37 million towards services for the mentally ill. Of that, the bulk of it going towards adding new personnel to support things like mobile crisis teams. We've also had, in the event that NYPD does interact with someone in mental health crises, we've allocated a budget and tried to set up diversion centers, which is basically where you can take someone in distress and really give them services and give them support and allow them to choose what they need to get themselves back on their feet, even if it's just a hot meal and some medication and a place to stay.

We're trying. I know that the city is trying but it's not happening as widely and as quickly and as extensively as we'd like and certainly nationally, we can't get through this if cities and states are left to do this on their own. We need some real federal guidance and national level leadership on this issue.

Brian: Let's take a phone call. Zulema in North Bergen. You're on WNYC. Thank you so much for calling in, hi.

Zulema: Thank you. Hi, this is Zulema. My niece is 23 years old. She's on the autism spectrum. I refer to her-- I'm a mental health professional. I refer to her for dialectical behavioral therapy so she can manage her emotions. She got agitated at the therapist's office at the counselor. The counselor called the police claiming that she was suicidal, which she was not. The police came and they put her in a straitjacket. They said they didn't necessarily want to do that, but that they were getting orders from above. Somebody who was off-site.

They kept her in a straitjacket for hours in a mental institution. She's been traumatized because she's been bullied. She was already traumatized and now she's even more traumatized, nevermind that it traumatizes the whole family. She's skeptical about seeking help now for the same issue.

Brian: What would you recommend based on your experience as a matter of policy or standard practice, if you've thought that through, Zulema?

Zulema: I agree with everything that's been said that we don't need police responding, as particularly when they're receiving orders from somebody who's not on-site. The therapist herself, who was supposed to be trained in de-escalating, escalated the entire situation to the point, again, where [unintelligible 00:22:49] been traumatized. That was a year ago. I'm glad to be able to talk about it because we didn't know where else to go.

Brian: Thank you very much for your call and I hope everything works out for you and your niece. Peggy in Jamaica, Queens. You're on WNYC. Hi, Peggy.

Peggy: Hi, how are you?

Brian: Good. How are you?

Peggy: Good, good. I am a mom and a community activist for mental health. On August 25th last year, my son was having a mental health crisis. I called 911 and when they showed up, they showed up in big numbers. I told them, I'm not going to let them in until EMS is here because my son is having a crisis. They insisted [unintelligible 00:23:39] when I opened the door. We moved into a new apartment, I don't have the key for the lock. I stood outside with them. My son was willing to speak to an officer through the window because he's afraid of police. Once he sees uniform, he gets scared. It's a trigger for him.

Eventually, the officer asked to speak to him on the phone and my son was more than willing to speak through the window. I live on the first floor and they spoke for 41 minutes. He was counseled. He wasn't aggressive at all at any time. He spoke to them, had a good talk with them. In fact, there was an officer that had an interaction with him sometime before that so they knew him. They know that I've called before for mental health crises. They counsel 41 minutes everything went well. He was calm, he was fine, he pull up his shirt. He said, "I'm fine." They said, "No, we have to get in there."

The sergeant insisted they have to break the door. 41 minutes later, everything was completely calm. We had trucks pull up here like there was a drug bust with officers coming, with shields on and these big tools in their hands. They never once said, "Please move." They took me right down, dragged me away. My son heard me screaming, he opens the door to defend me. Opened the door, they grabbed him by the neck, pulled him down, beat him up. All I can look back and remember is I could not see my son buried under all the policemen on top of him beating him up.

As they dragged me away, I spent the night in jail. I fought that case for months with the support of elected officials and my leaders that were from Jack Leadership, Vocal, and many other numerous organizations and we beat the case. I am a big believer that police should not be responding to mental health calls. 99% of mental health calls are not aggressive or violent. The last person we need to see in a crisis is somebody in a uniform with a gun.

Brian: Peggy, I'm going to leave it there. Thank you so much for your call and sharing your story. It sounds horrific and I'm glad you had the courage to do all the fighting, it sounds like you did and to call and relive some of this on the air with us today. Thank you very much.

Peggy: Thank you.

Christina: Brian, am I allowed to say something? Can I say something?

Brian: Christina, I was just going to ask. Yes, of course.

Christina: Oh, yes. I know Peggy Herrera and she and I, we advocated in the community together. What's unfortunate about this situation is the fact that the CIT training program at NYPD don't factor when they respond to a mental health crisis that it not only affects the person who's in crisis but affects the family and the community. What Peggy went through was horrific. Her son was traumatized with the fact that the police had to break down the door and to bring them to the hospital. The son was also traumatized to see his mother thrown down to the floor and handcuffed and brought to the policemen.

That affected Peggy's reputation, how she felt her self esteem. The whole thing was horrific and traumatizing and the community has to see it. It's humiliating and that's criminal. Mental health response should never be treated like a crime scene. People need empathy and as Peggy always said, "You can't teach police empathy." That needed a public health response. A public health person should have been there responding.

Brian: I understand Christina that 911 is not linked to mental health assistance. You have to call through NYC Well, which is something else. Is that your understanding and is that something that could be easily fixed?

Christina: What we're advocating for, many people are advocating for an alternative number like 988. In my opinion, we need to separate emergency calls which is just the 911 from mental health calls which should be 988. That would definitely streamline the process and make it quicker and when you call a 988 number, we're hoping that we'll get mental health responders to respond like what peer specialists and crisis responders like Dr. Vasan mentioned earlier, but for now, we only have 911.

Brian: This is such an important topic and being brought to the public's attention through the death of Daniel Prude more than it was maybe ever before. We're going to take one more person calling in with a story. What's so sad, really, is that we have a board full of people who have had experiences like we've been hearing from our first two callers and we're going to take one more who has a six-year-old son who he's worried about for his future. That is Andre in The Bronx. Andre, you're on WNYC. Thank you so much for stepping into this conversation.

Andre: Good morning. Thank you very much for having me. I have a six-year-old son and he is definitely one who gets easily distracted. He can function great on a six-year-old level for academics, but everything else is about a two or three-year-old. He goes into his screaming feats and I'm concerned that when he gets to be a teenager or older, he's going to be a handful for law enforcement. I doubt very much that they'll be able to do much for him at that point.

Brian: Dr. Vasan, can you give Andre any advice to keep his son safe?

Dr. Vasan: I have a lot of empathy. I have a seven-year-old daughter myself and two other kids. While I'm not dealing with the challenges you're dealing with, I can completely relate to Andre's worry about the future. I guess what I would say is there are certainly schools and services we can do to keep the very youngest of us safe and in therapeutic environments, but as his son gets older, at that time he gets older, my sincere hope is that we have a fundamental change in the way we respond to mental health, both in crisis which is just a snapshot in time as Christina nicely pointed out. Also, just generally in our health system and how we regard it. One out of every three Americans lives in something called the Mental Health Professional Shortage Area. Access to care is really hard.

On average, we spend about $0.83 on the dollar for mental health care in terms of insurance and reimbursement versus physical health care. We have a lot of structural problems. With respect to crisis response, Christina referred to 988. That's a national suicide prevention lifeline hotline that will be available as an alternative to 911 by 2022. There are steps being made. What we need is leadership on this level. We need federal leadership and of course, we need state and local leadership to be able to fundamentally shift the access of control of the situation away from a system law enforcement that doesn't have enough nimbleness and flexibility in its response.

I think your listeners will understand the adage that if you give a carpenter a hammer, everything looks like a nail. Well, that's what we're doing here. We have a blunt instrument which is law enforcement that is being asked to go and deploy on issues that are far more nuanced, far more complex. You heard the painful story. You heard about 40 minutes of just sitting there and counseling. That's what's required. There are skilled professionals who know how to do that. Most of them in the main are not police officers. We need a fundamental rethink of the way we do this.

Just one last point which is that I've worked in hospitals and emergency rooms for most of my career until now. Violent and unstable behavior and all sorts of situations happen in emergency rooms all the time. We don't respond violently. We don't respond violently because we know how to deploy de-escalation. We know how to deploy restraints, both chemically and physically, that can be deployed in the field as well.

The idea that there aren't solutions, that there aren't complex solutions for complex problems and that we don't have a public health approach to deal with this, is just wrong. Anyone else arguing otherwise is that's not a good fit argument. We just need to get down to the facts and get down to the solution. There are lots of difficult problems in our society that we are facing today, but this isn't one of them. This is one where we actually know what to do. It's just a question of political will and leadership.

Brian: Dr. Ashwin Vasan is an epidemiologist and professor at Columbia and the CEO of Fountain House, one of the world's oldest and largest community-based mental health and public health charities. Christina Sparrock has also been with us, a mental health advocate and Fountain House member. In her day job, she works as a CPA. Christina, were you trying to get in there with the last word? You can hop on if you want.

Christina: No, I'm very concerned with the last speaker and this issue; because I have a cousin whose little son was misdiagnosed several times and he is very active and animated. That's why I would rather say a positive word. She struggles and struggles. He gets kicked out of school often and suspended. He eventually got diagnosed. I think it was Asperger's. Now, she has to do one on one training and teaching with him. It seems it's going better, but it seems like it's going to be a lifetime challenge with her son. I'm concerned about him because he is Black. I don't want him to have interactions with police at all.

Any support that I can give her, I will help her. I'm definitely advocating for non-police responses to mental health calls. We do need to push and I encourage all the listeners and viewers and everyone across the city to advocate and push and write to our legislators that we need to establish a non-police response to mental health calls, not yesterday but now.

Brian: Any personal advice for our caller Andre with a six-year-old son who has autism while he's waiting for those policy changes?

Christina: [exhales] Boy. Don't give me up. Pray, monitor who is around your six-year-old son. Just have faith. Just be supportive and be patient. That's all I can say for now.

Brian: Andre, I hope that's at least a little bit helpful.

Andre: It does, Brian. Thank you so much. My wife quit her day job so she can be with him 24/7.

Brian: Thank you [crosstalk].

Christina: It's a lot of strain on the family. I get it.

Brian: Christina--

Christina: Write to your elected officials. I'm sorry.

Brian: No, go ahead. You can say it.

Christina: No, write to your elected officials. Write to your elected officials right now and tell them this is what you need and tell them, "Look at these non-police responses to mental health calls. Get more public health services. Get more culturally-competent doctors involved and trained." Have more supportive services coming to your house. They help you and your wife with the challenges that you have raising your son.

Brian: Christina Sparrock-

Christina: You're entitled to it.

Brian: -and Ashwin Vasan, thank you again so much.

 

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