One year after Daniel Prude’s death, has mental health care for people of color changed?
It's been a year since Daniel Prude died after Rochester police officers restrained him during a mental health arrest. He had been rendered brain-dead during the March 23 arrest and was taken off life support a week later.
What happened to Prude reignited an already active movement for racial justice, this time focusing on mental health and policing.
Some police officers receive crisis intervention team, or CIT, training. It's a program that’s been in place since 2004.
But former city police chief Cedric Alexander, who is now a psychologist and a consultant, said he believes that police in general are ill-equipped to answer mental health calls.
“It is a check-the-box program because if it was anything more than that, we would not see incidents that end up the way we do, such as with Daniel Prude,” Alexander said.
According to the National Alliance of Mental Illness, people in psychiatric distress are more likely to encounter police than get medical help. Mental Health America states that just over 1 million people with mental illness are incarcerated each year in the U.S.
For context, more than half of incarcerated people are Black and Hispanic, despite making up 30% of the general population.
“That’s across this country,” Alexander said. “We’re responding to calls with people who have mental health conditions and we’re putting them in jails as opposed to getting them to facilities where they can be helped and there can be ongoing help.”
There are efforts underway to change this approach.
Responding to mental health crises
In Rochester and Monroe County, there are three crisis response teams that work in tandem with the police: PIC, FIT, and FACIT.
Both the county’s Forensic Intervention Team, FIT, and the city’s Person in Crisis team, PIC, will more than double in size in the coming months. FACIT, or the Family and Crisis Intervention Team, run by the city, provides follow-up counseling to people involved in domestic disputes, and mental health crises, and connects them to other services.
There's also a state-mandated move to reform policing. Gov. Andrew Cuomo issued an executive order last year that required every municipality to create and adopt a police reform plan by April 1 or risk losing funding.
On Tuesday, Rochester City Council voted 5-3 to pass its plan, which includes several recommendations on changing how police respond to mental health calls.
Among them are increasing the number of officers with CIT training, expanding mental health awareness training, and increasing funding for "first responder systems that appropriately replace or supplement police with social workers, mental health providers, and other non-police personnel."
But what if police weren’t first responders to a mental health call? What if mental health were treated as a matter of public health rather than public safety?
“If we do a good job, we will seldom have these examples of people in these massive moments of crisis,” said state Sen. Samra Brouk, who is chair of the state Senate's committee on mental health. This year is the first time there's been a standalone committee on the topic.
Public health vs. public safety
Earlier this year, Brouk and state Assemblymember Harry Bronson introduced a bill that would create a statewide network of crisis responders. It’s called “Daniel’s Law,” named after Daniel Prude.
If enacted, it would bar police from being first responders to mental health calls and create state and regional councils that would oversee psychiatric emergency response teams.
“They become the first line of response in one of these emergencies, and they decide who it needs to go to if they can’t handle it themselves,” Brouk said.
An incident earlier this month raised more questions about how police handle mental health crises.
Tyshon Jones, a 29-year-old Black man, was cutting himself outside of a homeless shelter on March 10. When Rochester police responded, body camera footage showed he pursued an officer while holding a kitchen knife. When he didn't respond to orders to stop, he was shot five times.
Less lethal means of disarming him were not used.
A few days later, the Rev. Myra Brown, pastor at Spiritus Christi Church, said during a news conference that Jones’ mental health struggle became a death sentence for him.
"The system failed him, it failed his parents, it failed his community. It fails us every day," Brown said.
Daniel’s Law is still a bill, but it’s part of a larger push from advocates and activists for a total reconstruction of how mental illness is viewed and how crisis is treated.
In Prude’s case, his brother, Joe, made two calls to 911. The first was for a police escort to Strong Memorial Hospital for a psychiatric evaluation.After a couple of hours, Prude was released.
Later that night, he ran away from his brother's house. Again, Joe Prude called 911. Before police encountered Daniel, an officer arrived at Joe's porch to take down more information.
“When the doctor called me and told me that they released him, I’m saying how are you going to sit here telling me you’re going to release him when he was over here telling me he was going to hurt himself? C’mon, you don’t want someone to do that,” Joe Prude told the officer.
So why wasn’t Daniel Prude admitted to a psychiatric hospital the first time?
The county’s mental health office, two state agencies, and the Joint Commission of Hospital Accreditations have all investigated Prude’s treatment at Strong Hospital.
In a statement, the University of Rochester Medical Center, which operates Strong, said the investigations found that Prude's care was medically appropriate.
Beyond the ongoing problem with crisis responses, when it comes to mental health care, advocate Melanie Funchess said it’s often not a safe space for Black people, either.
“The services are not designed for us at all,” Funchess said. “The vast majority of people delivering those services, not only do they not have any, let’s say, theoretical knowledge of who we are as a people, they don’t have any lived experience.”
According to the 2019 National Healthcare Quality and Disparities Report, about 70% of people of color in the U.S. are not receiving necessary mental health treatment.
One of the many reasons outlined is that fewer than 20% of mental health practitioners are people of color. Part of the proposed solution is to recruit and train more people from diverse backgrounds.
Representation in mental health care
Telva Olivares, a Latina psychiatrist with URMC, runs Lazos Fuertes, a mental health outpatient clinic for Spanish speakers. She said that in the more than 20 years she’s been doing this work, she’s noticed a trend among many of her patients.
“Oftentimes, Latinos’ expression of distress has been overmedicalized,” Olivares said. “And sometimes I see patients for the first time that are overmedicated.”
Olivares said she's seen cases where patients have been prescribed potent antipsychotics, used to treat hallucinations and delusions, or given strong drugs that induce sleep -- medicines they may not have needed.
“So we’ve been able to take people off medications, and we find that people in our patient population have suffered from a lot of trauma and a lot of mistrust,” she said.
Having a bicultural space for these patients helps to improve their quality of care, she said.
But for many people of color with a mental illness, there are significant barriers to getting high-quality care -- cost, stigma, fragmented services, mistrust of providers.
It can be damaging to see a therapist who doesn’t understand you as a person, Funchess said.
“If I’m just tired and I’m worn and I’m traumatized and I’ve got to walk in to my therapist and have to figure out how to explain and then worry if they’re going to see this as real... why go?” she said.
For Funchess, she said there needs to be better training in cultural sensitivity, and it needs to be anti-racist.
In the wake of the Black Lives Matter movement, URMC created a five-year plan to do just that.
A path forward
The plan is influenced by the Black Physicians Network and White Coats for Black Lives. It includes updating policies and recruiting and promoting more people of color.
Part of it involves training medical staff to notice racial bias using Theatre of the Oppressed techniques. That means working with actors to role-play standard interactions so that staff can gain insight from the patient’s perspective.
“We plan to have a Black male as one of our simulated patients, and he’s going to give the feedback to our group of how he feels immediately when we walk into the room,” said Courtney Blackwood, who leads the initiative.
Blackwood, the director of psychiatric nursing at URMC, hopes that in the exercise, doctors will be honest about their own feelings when entering a room with a Black man having a mental health crisis.
“We recognize as an institution that we have to change, and we have to become better as practitioners and understand that structural racism does play a role,” she said.
It’s part of a larger shift toward a more inclusive and equitable approach to mental health care, Blackwood said.
But there’s still a lot of work to do. Structural racism in psychology goes back centuries.
The American Psychological Association says while there is little direct research into the generational effect of slavery and racial oppression, the impacts of that injustice are visible today.
“We survived Jim Crow, we survived enslavement, we survived the Middle Passage, we are the descendents of the ones that lived,” Funchess said. “We’ve seen horror after horror after horror after horror, and what we know from science is that that, epidemiologically, that stuff stays with us.”