With the state's psychiatric hospitals crowded and local mental health programs struggling from years of budget cuts, police officers across the state have found themselves on the front lines of the state's mental health crisis, police and advocates say.
They can be called on to perform a range of services - as simple as checking the apartment of someone who's dropped out of sight, to as complicated as returning a person to the state hospital who has not followed the terms of a conditional discharge.
Most times, the calls are routine and nothing comes of them, said police Lt. Ron Mello, who heads up a Manchester Police Department unit that specializes in calls involving the mentally ill.
But other times, the results can be traumatic. In 2011, police were involved in five shootings that involved confrontations with someone suffering from some form of behavioral illness. In four, people died from police shootings ruled justified.
And earlier this year, two violent outbreaks involving mentally ill people at the Elliot Hospital resulted in serious, life-altering injuries to hospital employees and a patient.
"The reality is, the police ended up on the front line dealing with people who have mental illness when the system lost its ability to treat mental illness in a humane way," said Ken Norton, executive director of the National Alliance on Mental Illness.
Local police departments said they could not easily provide statistics about how many of their calls stem from a behavioral or psychiatric illness. Police calls aren't flagged as dealing with an underlying psychiatric issue. For example, a call about disorderly conduct may be about someone who is manic and not taking medications, or it could be about someone upset over a football game.
Nashua sorted out numbers for involuntary commitments. Over the last five years, it had a median number of 15 commitments per year. But Lt. E.Z. Paulson said that number does not include follow-up commitments that a family would pursue after an arrest.
Norton's non-profit advocacy group has partnered with numerous police departments to provide training opportunities. And over the years it has prodded the New Hampshire Police Academy to increase training about mental illness for raw recruits.
In the 1980s, Police Academy training amounted to two hours, Norton said. Now, full-time officers must undertake 16 hours of mental health training at the Police Academy, with another seven hours of training about autism, hearing limitations and elderly neglect, according to Capt. Mark G. Bodanza of New Hampshire Police Standards and Training.
Training is important because often a police officer must rely on techniques that can be the opposite of standard procedures, Norton and Mello said:
. No lights and sirens.
. No command or authoritative voice. An officer should introduce himself, explain why he is there and engage in conversation.
. Keep your distance. Don't touch the person. Back away if he becomes more agitated.
"It's really all about being a calming influence," Mello said. "If you have a lot of officers and lights and sirens, it can make things worse."
He said only about 5 percent of cases result in action such as an arrest or involuntary commitment. But he cautioned that a police officer still has to be cognizant of his safety and the safety of others.
While additional training is available, it's up to police departments how far to take it.
Two years ago, Manchester joined Rochester in launching Crisis Intervention Team training for select officers. Concord has since instituted a CIT, Norton said.
In Manchester, 23 officers have gone through the training, meaning there is usually one specially trained officer on each shift. Mello said the training involves 40 hours of instruction and another eight hours a year to maintain certification.
CIT members are taught to recognize different mental illnesses, their symptoms and their treatments. The officers have relationships with the local mental health clinic.
But other departments don't go so far.
Hudson police, who have come under criticism for their handling of a suicide earlier this year, relies on the training from the Police Academy, said Chief Jason Lavoie. He said his 42-person department is too small to man a crisis intervention team; the local hospitals provide resources when necessary, he said.
In Nashua, recruits receive an in-house training session by a local mental health clinic. And then every other year every officer receives "roll-call training" - an update on the latest trends and techniques, said Paulson, who oversees training for the department.
"Right now, it appears to be working for us," said Nashua Lt. Denis Linehan.
Meanwhile, the New Hampshire State Police is only now developing an in-service training program for its 225 uniformed troopers, said Lt. Nicole Armaganian. She said police are working with NAMI to develop the training regimen.
"We as a division understand the problem of those suffering with mental illness is increasing," Armaganian said.
Speaking anecdotally, police said they haven't seen a big jump in calls related to mental illness over the last several years. "I don't think it's getting better or worse, but what's obvious in this state is the lack of beds," Mello said.
Linehan in Nashua said police officers recognize that part of their job involves answering calls involving someone with psychiatric problems. Sometimes the officers struggle to understand what happens once they arrange for a distraught person to get services, Linehan said.
"If anything, the guys might be frustrated if they deal with someone on Thursday," he said, "and they're dealing with him again on Friday."