What should we do when there is a shooting?

I had planned to write today about my trip out of the snow-bound Washington D.C. area to Los Angeles where I toured Skid Row and the Twin Towers, which is the nickname for the city jail. As many of you know, the jail is the largest public mental institution in the U.S.

However, I decided to wait until Monday to post that account because of the police shooting here in Fairfax, Va.  that put Ian Smith, a person with mental illness, into the hospital in critical condition.

As we all know,  the Ian Smith incident is not an isolated affair.  As my friend, Judge Steven Leifman said on the Minds on the Edge program, police officers and judges deal with persons with mental illness much more every day than psychiatrists and psychologists do.  Sometimes those encounters end in violence.

One of the comments posted here after the Smith shooting raised an interesting question. NAMI bills  itself as “the voice of mental illness” so what should NAMI chapters do, if anything, when an incident such as this happens? What about Mental Health America and other grassroots groups?

Jim Payne,  the very capable president of the Northern Virginia NAMI chapter, said his board has voted to spent $2,000 to help underwrite the cost of sending two police officers to the International Crisis Intervention Training conference this June in San Antonio, Texas.  He asked his members what other suggestions they had.

So I’d like to join him in asking:  When these tragedies happen, how should the mental health community react?  Should we keep silent? Should we hold a press conference? Should we write letters to the newspaper? Should we call our local representatives? Should we ask for meetings with the police? Should we rally around the family?  Should we speak out on local television?

What have groups in other cities done? What, if anything, should be done?

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.

  • jmc15

    Since I have a very dear friend whose son with a mental illness was shot last year by a police officer in my county, this topic truly touches my heart. Although I've met so many wonderful families through my association with NAMI and during my advocacy efforts, this family's love and support for their son who was ill since childhood was amazing and his loss will be felt for the rest of their lives. I think it is very important to advocate for CIT training and we are fortunate that advocates in my county were successful in bringing that training here. However, as mentioned by one of the police officers that I spoke with who is involved with our CIT, most of the crisis encounters that police officers have to deal with are when individuals with mental illness stop taking prescribed medications, often because they lack insight of the need to remain in treatment. I am an advocate for assisted outpatient treatment (AOT) legislation such as the successful New York's Kendra's Law which is a compassionate way to help someone remain in treatment while living in the community. AOT would help lessen (certainly not eliminate) the need for police intervention. I believe AOT would also help reduce stigma because people with a mental illness who are receiving effective medications and therapy and whatever other type of services that are helpful would not appear on the news in the type of article you mentioned. They would just be living their lives like you and me, without crisis situations that often require police assistance. Stigma will only go away when the public perceives serious mental illness as just another disease, in this case a biological brain disease, that can be treated successfully and that enables people to move forward in their own recovery.

  • We have got to reduce stigma. Period.

    Training is effective and is needed, and I support that. However, what I also support is that those of us with mental illnesses, especially those on the more “serious” spectrum, stop hiding what we are and showing the world that we can, and do, function as responsible citizens. Part of doing that is taking responsibility for who and what we are and actively working to learn how to manage our diseases.

    When we stand up and say, basically, “Hey! I have this problem, I live my life like you do and I won't be shoved under the rug!” we take one more effective step as a community.

    At the same time, we have to be realistic about what mental illness is and what it can mean. While we have to be vigilant and do everything possible to prevent tragedies, we have to realize that they are going to happen. Even a cop trained in all the latest and greatest intervention techniques is going to pull his gun if he perceives that he or others are in danger from a mentally ill person – s/he may try everything there is to try, and the end result may not change. We can't rush to judgment any more than others should rush to judgment about us.

  • Donna Kay Smith

    I think I have a unique perspective as I have worked as a police crisis counselor for 12 years, have worked with those with MI for 25 years, was a certified BLET (basic law enforcement training) instructor, was married to a police officer for a time, and my only child (now adult) is bi-polar. Police exist in a dangerous world and much of the time you do not know when or how or from whom that danger will come. So you have to, you have to, always walk as if this is that moment. When you make a traffic stop, walk into a home, are approached by someone on the street – you do not know this person, the complexities of their life, who they are, what they would do and what they would not do. You rarely have background on this person, this situation that you can bring to bear. Decisions on how to act, what to do may need to be made in a matter of seconds – and one wrong decision can cost your life and the lives of others. All too often, the fact that any given decision would lead to just this can only be seen in retrospect. So you use your best judgment based on your training, your experience, and your instinct. Pardoxically, the way that officers are trained to respond to individuals who are threatening or out of control – and works most often with those who do not have a mental illness to establish control – is just the response that will escalate a situation, spiral things out of control, when someone is actively symptomatic. And yet, when you are making that traffic stop, responding to a call you often do not have the information that would inform you in advance this person is actively symptomatic, and most officers do not have the training that would inform them that everything they have learned to do with everyone else in any other situation is exactly the opposite of what they should do with this person here and now.
    I think we in the MH community would benefit from an awareness of the true situation of the police. They are not possessed of ignorant disregard and the training most receive at a basic level does not really the cover the complexity of responding to situations involving those with a MI. Officers are not trained to assess MI status, and the situation may not afford that luxury or the time needed. And yet, they are so often the line of first response in a MH crisis. It is essential to the development of a good working relationship and making some progress in supporting their efforts to make the right decision in a crucial moment that we bring our knowledge of MI to bear with real understanding of the situation that police work within.
    That said, I think the greatest damage that is done in the media in situations involving the police and persons with MI is the flat, one-dimensional, representation that both receive. Each incident creates the illusion that MI=dangerousness, a propensity to harm or kill, and/or that the police act with wanton disregard, callousness, or precipitously. Neither is true and this not only creates false understandings but pits law enforcement and the community of those with MI/their families, and friends against one another.The most useful response that NAMI and others could make then, I think, is one which counters this skewed depiction and serves to support the police and this community becoming and seeing one one other as allies – who are both doing the best that they can to respond to the crisis which occurs in a nation which does not treat MI well, and does not provde the systems and structures needed to truly address the needs of this illness.

  • Hazel W.

    Thanks for asking this question. These comments are very helpful and throughful. There are more than 80 comments on the Washington Post story and many of them are written by bitter and ignorant people. This is not a situation where the police and persons with mental illness should be enemies. We need to work together. CIT helps fight stigma and educate people. Getting CIT, fighting stigma, are part of the solution to preventing shootings, but so is getting people help and that involves fixing our mental health system. I read about Ian Smith and you got to wonder why his family had to call for help seven times before this incident? Why didn't he get the help he needed before the shooting?

  • Charles Fitzgerald

    NAMI officials should speak out everytime something like this happens. They should use these incidents to educate the public. The Treatment Advocacy Center uses shootings to demand assisted outpatient treatment laws. NAMI fails when it keeps silent. People need to know that these shootings should not be happening.

  • Sandra Rogue

    The Smiths called the Fairfax Crisis Mobilization Team and it should have handled this problem. Instead, that team told the family to call the police. If the mobilzation team isn't going to take on these cases, then what's the point of having a team? If you want to blame someone, blame that team for not doing its job.

  • I've been following this story on the Washington Post website and in the prayer vigil on Facebook.

    The mental health community, while sharing common bonds of suffering, is NOT unified. Reaching out across the many splintered mental health groups over a tragedy such as this one, answering these questions together…All that would take a miracle or Pete Earley.

    Speaking only for myself, I answer no to silence, yes to press conference, yes to letters to the editor, yes to letters to representatives, yes to meeting with police, yes to rallying around the family, yes to local TV.

    I don't know what other groups in other cities have done. I do know that this is a moment. The public is listening.

  • juliegardner

    Hi Donna, I think you are exactly right in everything you say in your post. I am a single mother with an 8 year old daughter who is bipolar. She has had run in's with the police already at her young age mainly for running away from home. I can say one thing, that while expensive and time consuming, all officers being first responders most of the time should have the training in MI and how to respond. I will tell you of my experience in which if I had not bit my tongue would have gone to jail. My daughter had escaped from the house and was found early in the morning out on a busy road close by the house. She was picked up and brought home, I was threatened with arrest regardless of her MI and her history and the fact that she had just been released from Vanderbilt Psychiatric. So I got her ready to go back to the hospital, she was a danger to herself. While I was doing this she got out again and ran. This time the officer that responded when she was brought back took one look at me and said “what's the matter, don't you watch your child?” Now he was assuming that because of the area I live in that I was some drugy mom who was not watching her kid when in fact I was preparing to return her to hospital. All officers should get this training and if I knew how to advocate for it locally I would. Any ideas from you and I will run with it.

  • juliegardner

    I also forgot to mention that I am also bipolar like my daughter. And just to throw this in about what is said in the next post, we do need to fight the stigma of MI. It's runng rampid and it's found in the local police here and in churches and in the general population. It needs to stop and those with MI need to be able to get the help they need to live productive lives as we know they/we can.

  • ericspeaks

    I serve as a citizen volunteer on our county's mental health board. I asked the board president to appoint me as chair of a critical incidents committee to bring such incidents to the attention of the entire board, the county mental health dept. and our county supervisors. Thank God we have a Psychiatric Emergency Response Team (PERT) as it has saved lives in our county. Our greatest challenge is obtaining treatment for those who have no insight into their own mental illness and refuse medication and treatment. We are working to adopt Laura's Law, similar to Kendra's Law, in our county. It will be an uphill battle.

  • juliachristopher

    I really feel the need to jump in on this conversation, being in the middle of trying to help my daughter put her life back together after a hospitalization. What I am finding is that the few sevices we do have available are emergency services. Ok so what if we as a society decided to handle say..diabetes this way, you go to the hospital with sympton you are needing help with and you are told you can not be helped until you are in critical condition..say a diabetic coma(a danger to yourself and others). Would this be effective?, would the obvious thing to happen be many cases would end badly. does this sound familar? Why do we go this route with mental illness? The issue of treating people who do not want treatment is extremely difficult, so because of that we supply litttle to no treatment for people who are desperately seeking it? do we do it because emergency services are cheaper? I am thinkin NO Is filling up our jails cheaper? No again…We have to spend the money to make tretment available and as user friendly as possible..because if we dont then we are choosing to have things end badly…and be expensive and as in this case as many others be deadly
    Do all the media thing we can..
    Get the word out We have got to do better
    Or it is gonna continue to cost big time in many ways

  • These are some very intelligent comments.

    MENTAL HEALTH–IT'S COMPLICATED.

    The Treatment Advocacy Center's campaign equating lack of psychiatric treatment with acts of extreme violence has been successful.

    Gruesome murders and suicides are committed by people taking psychiatric medications, too. Reporters are starting to pick up on the dangers of SSRI's in particular. The wrong treatments may kill.

    While I fret about TAC's success, Ian Smith remains on life support.

    I feel the mental health system in Virginia is on life support, too. That's why it is so tempting to exploit this tragedy.

    Using tragedy–that's my beef with TAC.

    I'm trying to be still.

  • brenda smith

    to answer your comment about calling for help we have been struggling with helping ian for 10 years – and in those ten years he has had 7 hospitalizations – and he has also been to a rehab center but you cannot control when someone has a psychotic episode they just happen and ian was on meds all the time and seeing a psychiatrist – so this is just an unfortunate incident we have helped him constantly and it is not unusual for a person with severe mental illness to have to be hospitalized.

  • Sue Johannsen

    Pete,
    Here is an update on Ian Smith who was shot by Fairfax Police

    Fairfax officer cleared in shooting of mentally ill Herndon man
    The Fairfax County police officer who shot a mentally ill Herndon area man in his basement on Feb. 5 will not be charged with a crime, the Fairfax prosecutor said Friday.

    Tactical officers were trying to take Ian C. Smith, 25, into custody after he had shown the handle of a gun to his mother and sister. Fairfax police said they thought Smith was asleep, but when they went to the basement, he reportedly pointed a gun — now known to be a plastic BB gun — at an officer.

    The officer heard “click click click,” and thought a trigger was being pulled and shot Smith in the chest and the stomach.

    Smith's family said Thursday that Smith had regained consciousness this week in the intensive care unit at Inova Fairfax Hospital, but doctors told the family that Smith is not out of mortal danger.

    Fairfax Commonwealth's Attorney Raymond F. Morrogh said Friday he had reviewed the case and “found no criminal liability on the part of the officer who fired his weapon.” The officer's name has not been released. Fairfax police typically do not release the names of officers involved in shootings or other critical events.

    Alan E. Smith, Ian Smith's father, said he was not surprised by the ruling. He said he has become increasingly suspicious of the police explanation of how the shooting occurred in the basement, and why the decision was made to enter the basement when his son, who the police knew was paranoid schizophrenic, was the only person in the house.

    “Ian is going to live to tell his side of the story,” Alan Smith said. He said his son has undergone eight operations to repair the damage from two .45-caliber slugs, and that doctors have not yet been able to close his chest up.

    — Tom Jackman

  • Thanks.
    The mental health community, while sharing common bonds of suffering, is NOT unified. Reaching out across the many splintered mental health groups over a tragedy such as this one, answering these questions together…All that would take a miracle or Pete Early.

  • Thanks.
    The mental health community, while sharing common bonds of suffering, is NOT unified. Reaching out across the many splintered mental health groups over a tragedy such as this one, answering these questions together…All that would take a miracle or Pete Early.