Reporting from Reno — The woman slouched on the steps of the rundown motel, her hair mussed, her pinkish outfit rumpled, her expression perplexed. Health officials were combing the brick-facade building where she lived for bed bugs as part of a multi-agency raid, while police banged on door after door, hunting for ex-felons.
Police Officer Patrick O'Bryan and state mental health counselor Randee Hill approached her. "How you doing?" Hill asked.
"Not so good," the woman answered. Her room lacked plumbing and heat. Her cat, Egyptian, had gone missing amid soiled blankets and McDonald's wrappers. And she repeatedly referred to the cat as a jaguar.
Hill and O'Bryan had previously run across the woman, who struggled with a fuzzy mind and a tendency to lash out at authorities. When they ducked into Room 20, they found a rotten mix of litter box and ashtray, including a red purse fat with cigarette butts. The cable channel HLN flickered on a TV, where disinfectant wipes gathered dust.
"Oh my gosh," Hill said in a near-whisper.
"We shouldn't stand here for too long," O'Bryan said.
O'Bryan and Hill are part of a program on the front lines of the nation's struggle to help the severely mentally ill, which experts said is likely to become more difficult as states slash mental health funding. Already starved for services, troubled citizens sometimes tumble into homelessness and alcoholism and tussle violently with police, who are usually ill-equipped to help them.
Reno police have responded by pairing officers with counselors in hope of creating a more nuanced approach to handling the mentally ill, as opposed to intervening only when they commit crimes or are a threat to themselves.
In the case of the woman in Room 20, their goal was to coax her into new living quarters, but in a way that wouldn't set her off.
The need for mental health expertise has been apparent to O'Bryan since he served on a bicycle unit that patrolled Reno's downtown of neon-trimmed casinos and fleabag motels. He fumed about the uselessness of arresting the same people over and over.
A few years ago, he and a fellow officer calculated how much it cost over a decade to repeatedly pick up Murray Barr, a congenial homeless man whose taste for vodka abated only during a short-term treatment program. There was nowhere to send him long-term, and he died of intestinal bleeding in 2005. The New Yorker featured their tally in a story called "Million-Dollar Murray."
But nationwide mental health budgets have been under attack. Since 2009, cash-strapped states have slashed nearly $2 billion from psychiatric programs, according to the National Alliance on Mental Illness, and more cuts are anticipated.
"Unfortunately, we're going to have a national experiment," said Melissa Reuland, a senior consultant at the Council of State Governments.
In Nevada, where the state budget is still being formalized, millions of dollars in cuts are expected to mental health services. The state's suicide rate is among the nation's highest, as is the percentage of adults reporting poor mental health. Foreclosures and joblessness and the despair linked to them are so rampant that banks have reported suicide threats to Reno police.
Harold Cook, who runs the state division that oversees mental health programs, said a smaller budget would help them run more efficiently.
"I don't want people to think the world is coming to an end," Cook said. However, advocates said Nevada's fend-for-yourself culture has long starved social services, and new cuts could put even more pressure on resource-thin police.
Though many Reno officers are trained to deal with the mentally ill, in hope of avoiding brawls and steering them to services, O'Bryan launched a cop-counselor team in 2009 that had proved successful in other cities. The Mobile Outreach Safety Team, the first in Nevada, responds to emergencies, but also tries to nudge the chronically troubled into treatment. Essentially, it applies the "broken windows" theory of policing to mental health: Addressing low-level problems could head off larger ones.
Two state counselors, Hill and Lisa Leatham, usually team up with O'Bryan, though his retirement this month means they will partner with other officers. In January, the team helped calm a fugitive threatening to jump from the Sands Regency hotel for three hours. The man, who had been accused of sexual assault, lurched toward the window. And stopped. And lurched again. Leatham tracked down his ex-girlfriend by phone and had her reassure him that she cared. He surrendered.
On a recent May morning, O'Bryan was greeted with a voice mail from a schizophrenic who claimed she'd been sexually assaulted and an email from another troubled woman who rambled about Albuquerque, Sacramento and the Crips gang. A man had left a handwritten screed at the police station, in which he said 10 CIA agents were protecting him and demanded a "monogamous, pretty" woman.