Police are learning how to better defuse situations involving mentally unstable people at a time when the city is bracing for an increase in emergency calls involving the mentally ill over the coming year because of cuts to mental health services.

The training, meant to educate police on mental illnesses and teach officers the recommended ways to act around someone who is mentally unstable, is also designed to improve compliance with a department policy started in 2006. The policy requires officers in situations involving the mentally ill to call an on-duty police psychologist.

Right now, HPD estimates the psychologists are being called in only about 33 percent of crises involving the mentally ill. They should be getting calls in all of those situations as part of the policy, chiefly aimed at getting the mentally ill into treatment if needed and averting violent confrontations.

Mental health advocates are applauding the new training and the push to get the psychologists more involved in crises, saying that the reality in Honolulu (like most cities across the country) is that police — not mental health workers — are on the front lines of dealing with the mentally ill.

They say the training could help officers avoid outcomes like the one seen April 3, when a woman described as mentally unstable was shot in the abdomen after lunging at police with metal rods. The woman has not yet been charged. She was taken to the hospital in critical condition, but police were not able to give an update on her condition because of privacy laws.

Advocates also say that while the HPD's three-hour training course is not nearly as expansive as what other cities have, at least it's a start.

"It's a drop in the bucket, moving in the right direction," said Keith Claypoole, associate professor of psychology at the University of Hawai'i-Manoa and an expert on programs designed to get the mentally ill into treatment instead of behind bars.

Michael Christopher, one of three on-call Honolulu Police Department psychologists, said the training that officers will get this year is modeled on what other cities have. The training is centered on de-escalation, and is being offered for the first time this year.

It comes as HPD is expecting an increase in emergency calls involving the mentally ill because of recent state cuts, Christopher said.

"I don't really think we've seen the consequences of those cuts yet," he said.

PSYCHOTIC BREAKS

Advocates agree that the city will likely see more mentally ill suffering psychotic breaks because of the cuts to state services, including to case management hours that are designed to ensure those with severe mental illnesses remain on medications.

The Department of Health, which made the cuts to avert a funding shortfall, has countered such concerns, saying appeals can be made to reductions in case management hours and that services — though reduced — are still available.

Marya Grambs, Mental Health America of Hawai'i executive director, said the training for police is a positive move in a decades-long national movement to better sensitize police to mental illness. "The purpose is so police learn how to de-escalate the situation," she said. "They are more educated about what mental illness ... looks like."

The Honolulu training is also part of a nationwide effort called pre-booking jail diversion, which aims to get the mentally ill in crises linked with treatment, rather than getting them into the judicial system and potentially behind bars.

HPD's jail diversion program has partnered with hospitals and the state Health Department to try to get services to the mentally ill. Pre-booking jail diversion often means that someone can't be compelled to get services, though they can be involuntarily transported to the hospital for a psychiatric evaluation.

But Christopher said that once someone is transported for a psychiatric evaluation, that person often decides to accept state mental health services.

There are also several post-booking jail diversion programs in the Islands, in which people can be required to undergo treatment as a condition of their release.

Though training on mental illness is becoming standard procedure at police departments across the country, having on-call psychologists is not.

Christopher said Honolulu is one of only a handful of cities that have psychologists available around the clock to assist in emergencies involving the mentally ill. The psychologists can help officers determine whether mental health crisis workers are needed on the scene.

They can also decide whether to transport someone to the hospital.

Last year, the HPD psychologists received about 1,500 emergency calls from officers in the field. That total is an increase of about 100 calls from the previous year. The rise in calls has been attributed to more awareness of department policy, not necessarily more situations involving the mentally ill.

But the psychologists estimate that they should be getting about 4,500 calls a year.

That figure assumes that only a small fraction of the 19,000 to 26,000 situations each year involving the mentally ill would require the guidance of a police psychologist.

Situations that require such a call include someone who appears to be a threat to themselves or others. Other instances such as asking someone who appears to be mentally ill to leave a park or bus stop might not require a call to a psychologist.

WOMAN SHOT

HPD could not immediately say whether a psychologist was called to the April 3 incident in which police shot the 45-year-old woman. Police were responding to a report of a woman screaming and crying at the intersection of South King Street and Kalakaua Avenue. The woman was shot when she allegedly lunged at police with a metal rod and skewer.

Christopher would not comment on the incident because he was not involved.

In 2007, HPD officers started getting training on mental health issues, with classes familiarizing officers on different types of mental illnesses and how to determine when someone might be mentally unstable. No mental health training was offered last year because of budgeting and other issues, but classes started up again in January.

The training this year is more in-depth, Christopher said, and centers on what officers can do to calm a mentally ill person. Over the course of the year, every officer on O'ahu will attend the three-hour course to learn the best ways to act around people who may be suffering from delusions or paranoia.

Christopher said a key component of the training is teaching officers to keep their cool — even in frustrating situations — and how to make someone who is mentally unstable feel more secure, such as moving slowly and giving them room.

In several Mainland cities, police officers can get special certifications after completing at least 40 hours of course work.

Christopher said that since HPD doesn't have the resources to offer such intensive training, it has broken that training into smaller parts.

It has also spread the message to many more police officers and recruits.

In addition to the training, the HPD psychologists are also developing scenario-based training, which would include officers being put in mock situations involving people who are not in their right mind. That training could start as early as this year, but it's unclear how many officers would be involved.

Christopher said the HPD training recognizes that situations involving people with severe mental illnesses should be dealt with somewhat differently. But, he added, that it doesn't teach officers to throw their other training out, including on the proper use of force.

"Police have a very detailed response in terms of escalation of force," he said. "If a person is mentally unstable, that response is not adequate. This is an alternative."