Monday, November 14, 2011
Over the last 40 years, fundamental changes in the mental health and law enforcement policies have brought criminal justice professionals into increasing contact with people who suffer from mental illness. Contact occurs along the entire spectrum of the criminal justice network. The police, who are the sentinels of the criminal justice system, interact frequently with the mentally ill. For example, in New York City, the police respond to a radio call involving the mentally ill every 6.5 minutes, according to criminologist James J. Fyfe. In 2000, Florida law enforcement officers handled more calls involving the mentally ill than burglary and aggravated assault investigations each.
Unfortunately, however, most law enforcement agencies are incapable of accessing available diversion programs to assist the mentally ill. The result: Street officers often arrest mentally ill subjects because few other options are readily available to handle their disruptive public behavior.
Based upon the stigma and fear of people who suffer from a mental illness, community members frequently call the police for assistance in mental-health-related incidents—especially when a subject’s actions are socially inappropriate, disruptive and threatening. The fact is, these days, there’s often no one else to call for aid but the police. So it’s unsurprising that an estimated 10% of law enforcement officers’ encounters with the public are with people who suffer from a mental illness. In a survey of recently hospitalized mental patients, 20% of the respondents reported that they had been detained or arrested by the police in the four months preceding their hospitalization.1
Although the majority of such encounters are handled without harm to the officers or civilians, law enforcement professionals regard these incidents as burdensome from both a policy and operational standpoint. Bottom line: Mental-health-related contacts consume an irregular share of law enforcement resources. Incidents involving contact with people suffering from serious mental illness usually require police officers to abandon their traditional practices, creating an inherent tension between their duty to enforce the law and maintain public order and to react promptly and sensitively to the plight of the subject in crisis.
Add to this the fact that many law enforcement agencies have grappled with high-profile cases that involved the use of force against the mentally ill. In the aftermath of such incidents, departments have been sued for neglecting to adopt policies and procedures that could have mitigated the use of such force against these people.
Capacity & Expectations
Although the duty of the police is to protect the welfare of disabled citizens—including the mentally ill—they must depend primarily on the staff of emergency rooms to handle psychiatric crises. Usually, officers must transport individuals experiencing psychiatric crisis to the ER and then remain there until the subject is accepted for evaluation, triaged and admitted. To protect public safety, police officers must often control these subjects in the waiting area while mental health professionals are called in to perform an assessment. From a time management perspective, delays in accessing care can diminish patrol strength and also lead to significant overtime expenses and delays. Officers may decide to arrest rather than seek emergency psychiatric admission for the subject.
Sometimes the expectations of the community are unrealistic. In fact, communities often expect their police officers to diagnose a person with mental illness and alleviate the subject’s distress—in short, to act as a trained mental health professional or “street-corner psychiatrist.” When officers are unable to fulfill that unreasonable expectation, a lawsuit can result.
Several civil cases against law enforcement professionals have been filed in local, state and federal courts alleging that police have mishandled incidents involving subjects with mental illness. As you know, law enforcement officers who act with no “malicious intent” and function within the scope of their employment, are generally free from legal liability in their contacts with the mentally ill. However, even in those circumstances, police chiefs can be held responsible for failing to provide officers with adequate mental health training. The two major civil complaints facing police departments today stem from our failure to train and supervise police officers in the proper handling of calls that involve people who suffer from mental illness.
Whether dispatched to the scene of a disorderly conduct or to a situation that poses a danger to self or others, officers must be prepared to deal with people with mental health issues. Therefore, police officers must be trained to perform three important functions:
- To contain, control or arrest the subject without using excessive force or other actions that could aggravate the subject’s mental health condition;
- To defuse the situation by redirecting the subject from intent to harm themselves or others; and
- To facilitate diversionary referrals and access to mental health services.
The commission of these functions has been the goal of numerous training and policy initiatives to help police officers respond more empathetically, safely and professionally to calls for service involving mental illness. In fact, law enforcement practices regarding encounters with the mentally ill have improved considerably over the past three decades. Today’s response to mental health crisis calls provide a combined training and practical approach that includes diversionary tactics, referrals for service and collaboration between police departments and mental health agencies.
Strategies That Work
The most commonly known, as well as one of the first specialized police responses to mental illness, began in 1988 in Memphis, Tenn. In the wake of a high-profile police shooting of a man with schizophrenia, the police department collaborated with the National Alliance for the Mentally Ill to establish the first police-based Crisis Intervention Team (CIT). The Memphis CIT dispatches a specially trained uniformed officer, when available, as either a primary or secondary responder to every call in which mental illness is believed to be an essential factor. Research on CITs is limited, but promising. What we do know is that programs like this provide police officers with an option in the way they deal with mental health crisis calls.
In January 1993, the Los Angeles County Department of Mental Health (LACDMH) and the LAPD created the Mental Evaluation Unit (MEU) operation. By committing personnel and resources to staff what is termed the System-wide Mental Assessment Response Team (SMART) within the City of Los Angeles, the MEU provides a holistic approach to managing calls for service involving persons suffering from a mental illness or a mental health crisis. Each SMART unit consists of a well-trained mental health clinician and a law enforcement expert. By pairing their expertise, officers learn to think like a mental health clinician. Likewise, mental health clinicians begin to understand the role of law enforcement. Officers and clinicians develop management schemes that employ an array of options, from referrals for service to hospitalization and/or management of the subject within the jail system.
In 2005, the Case Assessment Management Program (CAMP) was added to the MEU and the Mental Illness Project as a specialized mental illness investigative follow-up team. CAMP is staffed by sworn investigators and LACDMH clinicians. Its primary function is to identify those persons suffering from a mental illness who are recidivist high users of emergency services and/or who are at risk for violent encounters with police officers. CAMP was the first co-deployed mental illness follow-up investigative team in the nation.
The MEU strategy has been a national model for several years and has been referenced in several governmental publications on model programs noted for innovations, published by the Department of Justice, Bureau of Justice Assistance. Over the years the MEU/SMART/CAMP approaches have been visited and emulated by many law enforcement agencies, including agencies from Canada and Australia, as well as prominent security consultants—all seeking to implement a form of SMART and CAMP for contracted national and foreign jurisdictions. In October 2010, the Council of State Governments Justice Center and the Bureau of Justice Assistance (BJA) selected MEU as one of six learning sites for the Specialized Policing Responses: Law Enforcement/Mental Health Learning Sites project.
The above programs illustrate how law enforcement continues to make strides in dealing with a longstanding problem within our communities. Remember: People who suffer mental illness have often been shunned from society and by their own families. It’s a credit to our profession that law enforcement has continued to meet the demands of the mentally ill population with empathy, compassion and respect.
1. Swartz MS, Swanson JW, Hiday VA et al. “Violence and Severe Mental Illness: The effects of substance abuse and nonadherence to medication.” Am J Psychiatry. 1998;155:226–231.