Mental health challenges law enforcement, rural areas

Among the many things they do, law enforcement officers are often the first responders for people with mental health problems. That has prompted some new thinking about how to respond, as well as highlighted some challenges, especially in rural parts of Nebraska.

When you think about people calling the police, you might think of calls reporting violent crimes, like murder or robbery. But according to Lincoln Police Officer Luke Bonciewiez, calls about crimes pale in comparison to others.

“For every one or two of those, there’s probably five or six mental health calls for service that never make the news, but which occupy actually more of our time,” Bonciewicz said.

This is not just a problem in Nebraska’s largest cities, said Rollie Kramer, chief deputy sheriff in Lincoln County, which includes North Platte and a large rural area.

“We see it very often that officers, deputies, troopers have to arrest someone for a low level misdemeanor crime – disturbing the peace, (a) trespassing crime-- and they’re mentally ill. That’s the only reason they’re being arrested is they’re mentally ill. They don’t know that they’re committing a crime. They’re confused. They don’t belong in a jail. But there is no other option here,” Kramer said.

In Lincoln, police have been trying a different approach since 2011. If a call involves someone with a mental health problem who has not committed a crime and is not dangerous to him or herself or others, someone who has had similar experiences themselves, undergone training and is now employed by the Mental Health Association of Nebraska, is dispatched in the next day or two to offer help.

“They knock on the door, they call the person that we’ve referred, and they will say something very nonchalant, something like, ‘Hey, the officer that was out with you a couple of days ago, he referred you to us. I live with a mental health condition. I’ve been where you are right now. Is there anything I can do to help?’ Bonciewicz said. “And that’s how that conversation begins.”

(For a link to mental health resources in Nebraska, click here).

The program is called the REAL – an acronym for Respond, Empower, Advocate and Listen. Program coordinator Chad Magdanz, who overcame his own drinking problem and mental health issues, says it can help both of the people who are involved in the conversation.

“When we have had an experience in our life, a big part of it not being tragic or completely taking us down is maybe walking through that with someone else. And that can be as easy as a conversation or a cup of coffee with them. And that’s really what peer support is,” Magdanz said. “It’s viewing someone not as broken, but as having some experience and finding what will work with them to move out of it.”

Magdanz cited an example of what one of the peer support specialists he works with has done to help someone after an encounter with police.

“What she’s doing with him is meeting with him daily. ‘Are you okay?’ We check in with each other. ‘Did you take a shower?’ And that might seem as elementary as it gets, but that’s where it starts,” he said, adding that help can go “from personal hygiene all the way to dealing with severe and persistent mental health symptoms,” including hallucinations and voices.

Other communities in Nebraska do not have a program like the one in Lincoln. In North Platte, Lori Schoenholz, a senior director of nursing at Great Plains Health, says a lack of long-term treatment programs creates a cycle of readmissions for people admitted for drug and alcohol problems, which often overlap with mental health problems.

“Once they are no longer intoxicated or high, they many times leave, against medical advice, and then they go out and they are repeatedly admitted. So it’s cycle. We aren’t helping. And they’re taking up beds. So it’s a huge dilemma for us,” Schoenholz said.

State Sen. Kate Bolz, chair of a special legislative committee on behavioral and mental health, said a recent study underscored a lack of treatment programs statewide.

“Only 11 percent of individuals who could benefit from substance use treatment are receiving it. And only 7 percent of people who could benefit from alcohol use treatment are receiving it in the state,” Bolz said.

Dr. Naranya Koduri, a psychiatrist at Great Plains Health in North Platte, says social attitudes can work against people seeking help, especially in rural areas.

“People are very conservative. Mental health is still viewed as some sort of non-existing illness which a patient should like just tread through and not seek help for. It’s kind of seen as a weakness in personality rather than illness itself, still,” Koduri said.

Tamara Martin-Linnard, interim chief clinical officer at Great Plains Health, has worked for 40 years in rural and urban settings across the country. She said that stigma still persists, and is widespread.

“If we had heart trouble, it’s okay if we talked about a heart attack and our cardiologist and that’s okay. If we had diabetes, it’s okay to say our blood sugars are good and I’m following up. If we’ve had surgery its okay to talk about that,” she said. However, she added “It’s not ever okay to say that we’re depressed or we need help. And people are stigmatized if there is a mental health or a substance abuse issue as part of their psyche and part of their world.”

How the state responds to those issues could have a big effect on law enforcement and on all Nebraskans in the future.