Another State of Mind

Written by Niki D'Andrea Category: Hot Topics Issue: December 2014
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Recent officer-involved shootings of mentally ill subjects spur a hard look at Arizona’s police training and need for mental-health care system reform.

A 50-year-old Phoenix grandfather is killed by a gunshot to the head, while holding his grandson in his arms. A 26-year-old army veteran and father of three is fatally shot after roaming the streets of Fountain Hills naked. A 35-year-old man in Scottsdale carrying his 2-year-old daughter is shot in the back, leaving him a paraplegic. A 50-year-old woman in Maryvale dies after sustaining a gunshot to her chest. All of these tragic cases share two common denominators: The shooters were law enforcement officers, and the victims were mentally ill.

Though no federal agency keeps statistics on officer-involved shootings nationwide, independent and academic analysis of data from about 750 self-reporting police agencies indicates Arizona consistently ranks among the top 10 deadliest states for officer-involved shootings (see sidebar on page 27) – a meaningful statistic in the wake of the Michael Brown shooting in Ferguson, Missouri this past August, which captured national headlines and reignited the debate about race relations and law enforcement. In Arizona, on the other hand, some of the most provocative cases of officer-involved shootings involve a different minority group: the mentally ill. The state’s various law enforcement agencies respond to thousands of calls every year involving someone with a mental-health issue. Over the past six years, there have been numerous cases locally of officer-involved shootings of the mentally ill; some of them led to lawsuits that resulted in multimillion-dollar judgments against Valley police departments.

Following the fatal shooting of mentally ill Maryvale resident Michelle Cusseaux by Phoenix police on August 14 –  five days after the Ferguson shooting – the issue of deadly-force protocols took on added urgency in the Valley. Numerous solutions have been offered, from community activists calling for independent investigations of the shootings to police departments examining and improving their training. On the state level, legislators are pushing bills to reform Arizona’s ailing and budget-slashed mental-health care system – which will be given a huge, court-mandated boost by the end of 2016, thanks to the settlement this year of Arnold v. Sarn, a decades-old class action lawsuit which alleged Arizona failed to provide a comprehensive community mental-health care system as required by law.

For now, it looks like Valley police departments will continue to shoulder most of the burden for subduing mentally ill individuals – but are we setting them up for failure? In September, Maricopa County Attorney Bill Montgomery called a press conference with police chiefs from departments around the Valley to discuss how their officers handle encounters with the mentally ill. Noting the need for expanded mental-health care services and the funding to come from Arnold v. Sarn, Montgomery then questioned the practice of having police officers serve court orders to transfer individuals to mental-health treatment facilities: “Up until this point, the default provider of mental-health services, not just here in Maricopa County, Arizona – but really across the nation – is the criminal justice system, and that’s not just.”

Excessive Forces Beyond Our Control
Roughly a third of the calls to Tucson police involve mentally ill individuals, according to Tucson Police Chief Roberto Villaseñor. Phoenix Police Chief Daniel Garcia says his department received 4,500 calls in 2013 in which a person exhibited behavior deemed a danger to themselves or others, and said there were an additional 4,000 encounters between police and the mentally ill on the street. Phoenix Law Enforcement Agency (PLEA) Secretary Franklin Marino says the Phoenix Police Department performs an average of 10 court-ordered “mental-health pickups” per day. That’s 3,650 “mental-health pickups” per year by Phoenix PD alone. Sometimes, those pickups take tragic turns.

Around 3 p.m. on August 14, 2014, Phoenix police officers knocked on the door of Michelle Cusseaux’s apartment near 55th and Clarendon avenues. Cusseaux’s mother, Frances Garrett, had called a mental-health facility to get inpatient treatment for her 50-year-old daughter, who she said suffered from schizophrenia and bipolar disorder. Police were there to serve the emergency mental-health pickup order and transfer Cusseaux to a treatment facility.

According to reports, Cusseaux opened the door and stood on the threshold, but refused to come out, retreating back inside and slamming the door behind her. When officers pried the door open, Cusseaux was standing a couple feet from them with a claw hammer raised above her head. Officers reported she began to charge them.

An officer later identified as Sergeant Percy Dupra, a 19-year veteran of the force, fired one shot, striking Cusseaux in the chest. She later died at a local hospital. Dupra was placed on administrative leave – standard procedure in an officer-involved shooting – and Phoenix PD promptly launched an internal investigation. Their findings will ultimately be reviewed by the Maricopa County Attorney’s Office, also standard for officer-involved shootings. (As of press time, the Maricopa County Attorney’s Office had not received the Cusseaux case for review.)  Civil rights activists called for an independent investigation by a separate law enforcement entity – which is also being done, by the Arizona Department of Public Safety.

Cusseaux’s case triggered tons of public dialogue everywhere from press conferences to police blogs to social media spheres about police interactions with the mentally ill – whether they had sufficient training to de-escalate situations with disturbed subjects, if they were using excessive force, what should be done differently to create better outcomes when law enforcement encounter the mentally ill. And such encounters happen more often than one might think – every day of the year, according to officials. Not all of those encounters are lethal, obviously, but in the past six years, Arizona’s seen several high-profile police shootings of mentally ill individuals. One case involved Scottsdale police officer James Peters, who was implicated in seven officer-involved shootings from November 2002 to February 2012. Six of the shootings were fatal.

One of those fatalities was a 50-year-old mentally ill man named John Loxas. In February 2012, Scottsdale police responded to a call that Loxas was threatening his neighbors with a firearm while holding his 9-month-old grandson. When officers arrived at Loxas’ home near Vista Del Camino Park, Loxas was inside his house. Police demanded he come out, and Loxas appeared in the doorway with the infant in his arms, but refused to exit. As Loxas turned his back to reenter the house – still carrying his grandson – Peters reportedly thought he saw an object in Loxas’ hand and shot him in the head from 18 feet. Loxas was killed instantly and collapsed with the child in his arms (the infant was uninjured). Four months after the shooting, Peters applied for – and was approved to retire on – a still-undisclosed “accidental disability.” A City of Scottsdale spokesperson told Phoenix New Times Peters’ monthly pension check was around $4,500. In June 2013, a federal lawsuit filed against Scottsdale by the American Civil Liberties Union of Arizona on behalf of Loxas’ family was settled for $4.25 million. ACLU of Arizona legal director Dan Pochoda said, “We think it is of an amount that will be a deterrent and cause the City of Scottsdale to look at the way that police shootings have been handled.”

An officer-involved shooting case currently in litigation against Scottsdale is that of David Hulstedt. In 2008, officers responded to a 911 call from Hulstedt, who had a history of mental illness and demanded to see former Arizona Governor Janet Napolitano; the dispatcher heard yelling and a child crying in the background and marked the call high priority. When officers arrived at Hulstedt’s Scottsdale home, he refused to come out of the house and a standoff ensued. At some point, police allege, Hulstedt threatened to “pile drive” his 2-year-old daughter if negotiators didn’t send Hulstedt’s brother into the house. Thirty minutes into the standoff, Hulstedt emerged from his home, carrying his toddler daughter. He took a few steps toward officers, but then turned around and walked back toward his home, holding his daughter over his head. When Hulstedt did not comply with officers’ commands for him to put the child down, they fired a total of four shots at his back. Three bullets hit Hulstedt, causing him to drop his 2-year-old daughter headfirst onto the concrete, where she sustained a skull fracture. The incident left Hulstedt, then 35, paralyzed. He is seeking $40 million in damages. U.S. District Judge G. Murray Snow granted summary judgment to the Hulstedt family, but the defendants filed an appeal in the 9th circuit courts. The case was ongoing at press time.

Hard Beat
These are troubling cases, but law enforcement advocates caution against a rush to judgment.

Dr. Jeni McCutcheon is a board-certified psychologist in police and public safety psychology through the American Board of Professional Psychology, and has provided services to agencies including the Maricopa County Sheriff’s Office, the Arizona Department of Public Safety and the Arizona Department of Corrections. She says police officers face unique challenges when responding to calls involving a mentally ill person. “Communication may be difficult, as persons with serious mental illness may have symptoms such as delusions, hallucinations and impaired concentration. Comorbid substance use and abuse may also be present,” McCutcheon says. “While the majority of people with mental illness are not violent and dangerous, calls specifically with suicidal subjects may involve an increased level of danger for responding officers. Sometimes people attempt to commit ‘suicide by cop,’ where they intentionally or impulsively try to involve police in ending their life. In the process of doing so, they endanger others, including police officers.”

One such scenario played out this past July – a scenario in which the officer in question had no obvious recourse except to respond with lethal force. Approximately a month before the shooting of Cusseaux, Lt. Markley Johnson of the Maricopa County Sheriff’s Office responded to two calls about a naked man walking in traffic and behaving erratically. That man was Fountain Hills resident David Brandstetter, 26, a married father of three and former U.S. Army Ranger who was employed as an air-conditioning technician. Johnson encountered Brandstetter, still naked, on a residential street about a mile from his home. According to Johnson, Brandstetter opened the door of the deputy’s patrol car, jumped on top of him, punched him and reached for his firearm. At that point, Johnson fatally shot him. “Something may have caused this young man to take leave of his senses,” Maricopa County Sheriff Joe Arpaio said after the shooting. “It’s a sad situation all around. But regardless of the reason, the suspect’s actions left no alternative for my deputy.”

After officer-involved shootings, the involved officers often experience residual effects that require some form of counseling. And whenever an officer makes the decision to use lethal force, public scrutiny and judgment frequently follow. The outrage over the shooting of Cusseaux led PLEA Secretary Franklin Marino to write a blunt article in the news section on, titled “Mental Health is Not a Police Matter.” In it, he relays hearing someone on a local radio show say “Any cop that can’t disarm a 50-year-old woman with a hammer should get the hell off the force” and then emphasize the officer’s need for “proper training.”

“That same citizen that called the talk show might be surprised to know there actually is training to disarm a person with a claw hammer. The solution to any threat where serious injury or death is imminent is two rounds center mass,” Marino writes. “We aren’t trained or paid to engage in hand-to-hand combat with people that are attacking us with any type of weapon, be it blunt instrument, edged weapon or firearm. The bottom line is that we don’t meet lethal force with less lethal.”

McCutcheon says the public perception of police action is a critical stressor: “The public, especially with the increase of social media and networking, is quick to weigh in on police actions, largely never knowing the full facts or considering the perception of the officer(s) on the call.”

While there are no federal use-of-force protocols, the National Institute of Justice has the standard guideline that “Police officers should use only the amount of force necessary to control an incident, effect an arrest, or protect themselves or others from harm or death.”

To their credit, some Valley law enforcement entities – in the absence of clear federal guidelines – have attempted to set up protocols involving the use of force against mentally ill subjects, which vary from department to department. Tracey Wilkinson, supervisor of the Police Crisis Intervention section of Scottsdale Police Department, and coordinator of its Crisis Intervention Training (CIT) program, says their officers  receive “a number of different layers of training,” beginning at the police academy, and continuing in post-academy training provided by Scottsdale’s Police Crisis Intervention Program. There are also modular training sessions “every couple of years” that include how to handle crisis situations and mentally unstable individuals. Wilkinson says about 20 percent of the Scottsdale force has also completed Crisis Intervention Training (CIT), a 40-hour program introduced in Tennessee in 1988 and widely developed and adopted by law enforcement agencies nationwide, including the Phoenix and Mesa police departments.

“Part of the material that’s covered,” Wilkinson says, reading from a CIT manual, “are legal issues related to mental health, understanding psychiatric disorders, the family perspective, developmental disabilities, living with mental illness, hearing voices, court-ordered petition treatment and that process, homeless resources, the crisis system, de-escalation techniques, alcohol and drug assessment, active listening techniques – and then they also do scenarios, usually as part of the last day of the training program.”

Marino offers a firsthand take on the training, which he completed several years ago. One of the more unnerving aspects was wearing headphones and listening to an audio recording that simulated the voices in a schizophrenic’s head. It “actually creeped me out and had me ready to yank the headphones off after the first two minutes,” Marino wrote.

“This was a 40-hour course involving lecture, interaction, video and audio presentations, as well as a practiced exercise to put it all together,” Marino added. “CIT wasn’t a two hour ‘shake and bake’ training session thrown together in haste so the department could say all of patrol had been through mental health training.”

That’s not something any department can really say anyway. Most police forces – including those in Phoenix and Scottsdale – report about only 20 to 25 percent of their officers complete CIT. “The target is about 25 percent, as a general rule. As a minimum,” Wilkinson says.

But some say police training is only one piece of the puzzle. “I think the question is not just ‘How do police respond?’” McCutcheon says. “I think the questions are – how do we as a society respond? How do we provide services to persons with mental illness? Do we have adequate services to care for persons with mental illnesses? Can we engage people to utilize these services? Can we be compassionate toward police agencies and our first responders, not judging and playing Monday-morning quarterback to their responses?”

Help, Not Handcuffs
The class action lawsuit Arnold v. Sarn was old enough to drink by the time it was finally settled this past January. Filed in 1981 by mental-health advocates, the suit alleged the Arizona Department of Health Services (ADHS) and Maricopa County failed to provide a comprehensive community mental-health care system as required by law. A trial court entered judgment in 1986, finding the defendants violated their statutory duty. The Supreme Court affirmed that decision in 1989, but it wasn’t until September that Maricopa County Superior Court Judge Edward Bassett committed the case to the history books, after the plaintiffs reached an agreement with officials at ADHS, Maricopa County and the office of the Governor that includes an increase of services for community treatment, employment, housing and peer and family services.

Such expanded services are badly needed. All mental-health pickups by police are bound for one of only two mental-health facilities in all of Maricopa County where people can be committed against their wills for emergency psychiatric evaluation – one is the Urgent Psychiatric Care Center at 903 N. Third Street in Central Phoenix; the other is the Psychiatric Recovery Center across town on 99th Avenue in Peoria. “The folks down there work very hard to provide quick assistance,” Wilkinson of Scottsdale PD says. “But when you’ve got two places handling all of Maricopa County, it can be overwhelming.”

Lauded by all parties as the first step in the much-needed reform of Arizona’s mental-health care system, the settlement of Arnold vs. Sarn is a big potential impetus for change to a system long-suffering from budget cuts. When the settlement was officially announced in September, Governor Jan Brewer, whose mentally ill son Ron has been committed to the Arizona State Hospital for more than two decades, released a statement saying, “Having served in public office for more than three decades, I have been greatly invested and involved in making sure our seriously mentally ill citizens are provided quality care and services they deserve. It has been a long and often contentious road, but today, we celebrate the official end of Arnold v. Sarn – and, most importantly, the future that now includes a model community-based behavioral health system for the people of Arizona.”

The increase in services to Arizona’s mental-health care system under the terms of the settlement will be funded by $37.8 million from the state’s general fund, and legally must be completed by the end of fiscal year 2016. There is hope that once services are increased and the system improves, so too will outcomes for the mentally ill when they encounter law enforcement.

Maricopa County Attorney Bill Montgomery says officers serving mental-health pickup orders need more information about individuals who have been in the county’s mental-health court and may pose a danger. Montgomery suggested the Department of Public Safety could create a database of mental-health adjudications for this purpose, an idea that’s been met with mixed reviews. While the repository would only have records on individuals who have been deemed mentally ill in court, medical health professionals say privacy and confidentiality of medical records are still key issues. “There is, and rightly so as upheld by law, an individual’s right to have their private medical details remain private,” McCutcheon says.  

This year, Democratic Congressman Ron Barber introduced H.R. 4574, the Strengthening Mental Health in Our Communities Act of 2014. A spokesman said Barber was unavailable for an interview, but according to a summary on Barber’s website, the act would, among other things, “support the development of curricula for police academies and orientations,” provide special courts and treatment for veterans suffering from conditions like PTSD and mental illness, and “increase focus” on mental-health programs in the corrections system.

Across Arizona, individual agencies are exploring more ways to improve their interactions with the mentally ill. In January, the Tucson Police Department launched a new mental-health unit based on CIT, whose job is to transport mentally ill subjects to the new Crisis Response Center for evaluation and treatment. (Before the CRC opened, TPD brought all subjects to the county jail.) TPD’s new crisis intervention unit is modeled after that of the Pima County Sheriff’s Office.

Wilkinson says her team at Scottsdale PD includes a CIT law enforcement coordinator, a mental-health coordinator and a police captain. “[We’re] really looking to strengthen the program, the CIT program here in Scottsdale,” she says. “We’re looking at it and saying, ‘Is this something we can also expand to other individuals in the department – detention, communications personnel, etc.,” adding there are also seven behavioral and mental-health professionals who work for SPD.

The day after the death of Michelle Cusseaux, Phoenix Police Chief Daniel Garcia issued a statement that read, in part, “Effective immediately, I have assigned a police commander to the Arizona Law Enforcement Academy to assist with training officers on how to work with those in our community who have mental health-related issues. I have ordered a complete review of our mental health pickup procedures and an analysis of the department’s training requirements. We will work with mental health providers to develop and recommend improvements to our procedures.”

Garcia went on to announce the department would purchase additional cameras for officers to wear on their uniforms, and that Phoenix PD had partnered with Arizona State University’s Center for Violence Prevention and Community Safety on a study to analyze officer-involved shootings over the past five years. The center’s director, David Choate, says the goal of aggregating and analyzing the data is to find patterns and trends in officer-involved shootings that could provide insight for retraining and improved tactics. The research, which was awaiting approval for federal funding at press time, is “a value to the public, and a value to officers in the line of duty,” Choate says. “It’s a critically important issue for policing, and the communities they serve.”

Choate points out the study is not a reaction to recent events; Phoenix PD approached the center on their own and proposed the study back in January. “To the Phoenix Police Department’s credit, they started looking at this issue a while back,” he says.

A Process Re-Thought
At the September press conference with Bill Montgomery, Mesa Police Chief Frank Milstead said his department was planning a pilot program for mental-health transfer orders that would pair a firefighter who had medical knowledge of the individual with a police officer when serving the order. They would not use patrol cars for pickups, in an attempt to make it less of a police situation for the subject. “This is more of a health care issue than it is a law enforcement issue,” Milstead added.  

In late October, Phoenix Police Chief Daniel Garcia held a press conference with Phoenix Mayor Greg Stanton and Justin Chase, CEO of the Crisis Response Network, and announced the creation of a Mental Health Advisory Board. The board will meet with Phoenix PD quarterly to discuss policies and procedures. Garcia spoke about further reforms including supervision by a specially-trained sergeant during court-ordered pickups of the mentally ill, requiring mental-health awareness training for 1,300 patrol officers and more involvement with mobile crisis response teams. Garcia also announced there will be more involvement by mental-health professionals and less police involvement in mental-health episodes, until a patient becomes a danger.  

Some say police should not be the de facto servers of mental-health transfer orders at all. Phoenix Law Enforcement Association President Joe Clure told the Arizona Republic, “We believe that true medical professionals with real medical training should do these pickups, and if they are in fear of their safety, then by all means, we will support them.”

PLEA Secretary Franklin Marino echoed the sentiment on the organization’s website. “Since the vast majority of these calls are uneventful, my suggestion would be that we go back to the days of ‘the nice young men in their clean white coats’ and have medical and mental-health specialists do the pickups and call us in the event they need police assistance, instead of vice-versa.”


Top 10 Officer-Involved Shooting Fatality rates, By state
Deaths per 1 million residents, based on data for 2013.
Ten states did not report any OIS fatalities that year.
*denotes one or more shooting fatalities reportedly involved a subject with mental-health issues

Oklahoma: 2.89
Washington: 2.57
Arizona: 1.82*
Wyoming: 1.72
West Virginia: 1.58
Colorado: 1.53*
New Mexico: 1.43*
California: 1.38*
Maryland and Alaska: 1.35
Missouri: 1.33

Sources: Associated Press; Bureau of Justice Statistics; various city media outlets



U.S. cities with the 10 highest officer-involved shooting rates per capita, based on data for 2011.

1. Fresno, CA
2. Tucson, AZ
3. Aurora, CO
4. Oakland, CA
5. San Jose, CA
6. Albuquerque, NM
7. Mesa, AZ
8. Jacksonville, FL
9. Syracuse, NY
10. Orlando, FL

Source: “Police Involved Shooting Statistics: A National One-Year Summary,”