Mental Health in Carson City: Working together to address the core of the problem

September 6, 2011. The day that brought a city to its knees, the day that left six people dead and another six wounded, was the day Carson City changed how it viewed the world.

That day, 32-year-old Eduardo Sencion, suffering from paranoid schizophrenia, walked into the Carson City IHOP and shot and killed six people. Authorities reported that Sencion told his family he heard voices telling him to do “bad things” to people, but his family reported that everything seemed fine the morning of the shooting.

Sencion used a Norinco MAK-90 assault rifle to fire 79 rounds into Carson City businesses, including the IHOP, where he killed five people then himself. From the first 911 call at 8:58 a.m. to 9:06 a.m., when Sencion was found dead, is all it took for an untreated mental illness to wreck havoc on a community.

“That day, that moment is when our eyes were opened to the problem of mental health,” said Carson City Sheriff Ken Furlong. “That event changed our community forever in how we approach mental health and the devastating effects of leaving a crisis circumstance unchecked or without adequate resources.”

One in four people nationally — nearly 57.7 million — suffer from mental illness, and most of the population has someone in their family or knows someone who suffers from a mental illness, said Carson Tahoe Regional Behavioral Health Coordinator Jessica Flood.

“It is easy to forget we are all on a mental health continuum between mental health and mental illness and there are many people who experience mental health issues in our community that are high functioning,” Flood said.

One of the most common entities to come into contact with mentally ill people is law enforcement.

For the Carson City Sheriff’s Office, resourceful response to mental health individuals wasn’t always a priority, but, for many of the deputies, that response has transformed in recent years.

“When I first started 15 years ago, you would hear about some mental illness but you wouldn’t equate it to much,” said Deputy Nick Pinochi. “So it was hardly ever known or dealt with or talked about.”

“In the old days, you would talk to them every day, but there was no way to help them. Then you would deal with them for year after year.”

Furlong said law enforcement often would respond to violence with violence when dealing with mentally ill subjects because there was no training to de-escalate a situation.

“It is problematic because not only would our own people get hurt, but we were inflicting it on others with every good intention to stop the violence,” Furlong said. “But now we recognize that violence (from a mentally ill person) is nothing more than a flag for crisis and still today we see those flags with people acting out while in crisis.

“Sometimes when people are in crisis it results in a police presence and in those cases, the old days of great big police officers (to intimidate) has faded away and we are looking for more intelligent, better-trained officers and use our resources, training and thinking.”

Across the nation, jail often becomes the “dumping ground” for individuals with mental health issues, where they don’t receive proper treatment to fix their crisis.

“For decades the jails and prisons are the defactos for our mentally ill,” said Carson City psychiatrist Dr. Joseph McEllistrem.

A majority of mentally ill inmates are arrested on minor offenses such as trespassing, drug use or disorderly conduct. The risk of violence for mentally ill individuals is no greater than the general population, said Bekah Bock, Carson City forensic program manager for Carson Rural Clinics. She said the problem is that while incarcerated, the individuals aren’t connected to treatment within the community to stabilize them when they are released and they often end up being arrested multiple times.

“This costs the community money with no outcome,” Flood said.

The mental health problem causes as many issues outside the jail as it does inside.

“Upward of 60 percent of our calls for service have crisis at the heart of it,” said Furlong. “Handling mental health calls does increase time on scene, an average call is 30 to 35 minutes, but cases with mental health can take much longer.”

The Sheriff’s Office has created several programs around mental health that include training for deputies so they can recognize and resolve crisis calls.

“The evolution of responsibility to mental health has been moving over the last five years,” Furlong said. “When we first recognized that officers needed more training and a recognition process for the officers, that spurred department-wide training certificates for crisis intervention.

“Just the mere presence of a uniform can throw someone into crisis and we have realized that and created an entire new generation of officers here for law enforcement and mental health individuals to interact more effectively.”

The hope with the Crisis Intervention Training is for officers to recognize mentally ill subjects and be able to provide the option of treatment or counseling rather than arrest.

“When you dig deeper than the offense you make progress because when you address the offense, you get to the underlying issues and the co-occurring problems such as alcoholism or homelessness,” Furlong said.

Many of the officers work diligently to identify and refer mentally ill individuals to treatment.

“It allows us to go out and help and offer resources instead of just incarcerating them,” said Deputy Israel Loyola. “Often (with mental health) it becomes a revolving door, but this gives us a chance to help them out and point them to the direction to get their life back on track.”

The Sheriff’s Office also created the Mobile Outreach Safety Team, which pairs Bock with a patrol deputy to respond to mental health calls. Other deputies can also refer cases if they recognize a mental illness so they can follow up and help that person receive treatment.

From January to October 2016, MOST reached out to 222 individuals to provide treatment instead of jail time.

“Persons with a mental health problem aren’t convicts,” Bock said. “They are people who are easily exploited or victimized.”

“It has been awesome with the Sheriff’s Office, I have seen a shift where people are being identified and diverted by our officers who are more knowledgeable. We now have highly skilled deputies out doing these calls so even without a social worker they are still very skilled.”

Now, most of the department is trained in how to assist people with mental illness and provide alternatives to jail when possible.

“Everyone needs to focus on it because without knowing what was going on, without the training, there are very few indicators sometimes that there is a deeper problem with mental illness,” Pinochi said.

Loyola and Pinochi worked with the department’s MOST team.

“It was an extremely heavy case load we had — we could hardly keep up with everything we had to do,” Pinochi said. “So seeing people for mental illness is definitely very busy work, because there are more mentally ill people than people to take care of them. I found I would end up doing my one day a week with (Bock), but the follow-up from it is nonstop because I would be checking on people to see if they are OK even on my regular days.

“It is definitely harder to do it this way; it is not easy by any means because it’s not just something that gets handled quickly, it takes a little more time. But that time will help a person get help sooner rather than later and be healthy in the long run. It helps families and society because they can get stable.”

However, creating this new response to mental health uses a lot of resources. The CIT class is a 40-hour training, meaning the department has to backfill sometimes dozens of positions while training is underway.

“That is 95 sworn positions, plus dispatchers that we have to pull and train,” Furlong said. “Including semi-annual follow-up training. However, this is a very proactive and positive stance the department made because it addresses the core of the problem and that is better than just dealing with the surface level offense that may have occurred.”

However, when the deputies are able to identify and provide these separate resources, it is not only good for the individual, but also the department.

“It helps us because then we don’t have all of our jail booking area filled with mentally ill individuals and they aren’t calling dispatch constantly for non-emergency things,” said Loyola. “But it does help the community too because then they don’t have to deal with it if we can get them on the right track. It is just good for everyone.”

Though the deputies try to combat the problem, the number of mentally ill individuals in Carson isn’t declining.

“From a MOST standpoint (the prevalence of persons in a mental health crisis) is never ending,” Bock said. “I meet people every day, who have a serious mental illness, and deny they have a problem, the problem is with everyone else. So those are the people we are referred to with MOST, who are not in services they are out there with a major mental illness and delusional and without support services.”

Over the last several years, a number of coalitions, meetings and task forces have surfaced with the goal of discussing policies and processes to bring continuity between services and help improve the overall treatment plan for individuals. Surrounding law enforcement agencies also are creating programs to combat mental illness.

“We are trying to strengthen these relationships and ensure we are communicating so we aren’t duplicating efforts by giving the same individual the same resources with multiple agencies and coordinating so we learn from plans we tried before,” Flood said. “It takes coordination to discuss tried and failed intervention and possible solution for that individual to be more effective.”

Previously, many of the organizations operated in individual sectors, resulting in clients not getting the right help and falling through gaps in the system.

“These silos have been broken down and we don’t look at a person as our agency’s client, it’s a shared client in the region,” said Bock. “So the same person that Health and Human Services is serving is the person we are serving, is the person that F.I.S.H is seeing and Carson Tahoe Hospital is seeing. It’s our person in the community, not just one organization’s client.”

Bock, Flood and several other players have been working closely in Douglas, Churchill and Lyon counties to bring mental health programs to those areas.

“Why should a county line be a barrier to information?” said Furlong.

One of the biggest successes for the community has been the program collaboration between nearly two-dozen organizations in Carson City and the surrounding regions.

“On the brightest side on response we have seen tremendous amount of inflow of interest and assistance,” Furlong said. “Non-profits have elevated mental health to a higher priority for organizations like BHS to implement programs to benefit the entire community.”

“What we do as a community is an investment. It is long term and you hope to see positive results of the health of the community at large.”