Law Enforcement – Mental Health Collaboration

November 28, 2015 In a recent post the issue of mental illness and police use of force has been the subject of scrutiny.  The pairing of police officers and mental health counselors is becoming a compelling option in some departments.  In a previous blog post I published an essay ostensibly denouncing the utility of these patrols in part because it presents a greater level of risk to police officers, ride-along psychotherapists, and the community at large (Sefton, 2015)

Over 100 persons with known mental illness were the victim of lethal force following a suicide by cop scenario or some other violent encounter resulting in the rapid escalation of the use of force continuum. Police officers train for these situations and are expected to meet force with force.  These encounters sometimes end up in a lethal force standoff where split second decisions can wind up in a deadly outcome.  As quickly as encounters may escalate, police are trained to de-escalate their use of force as the situation dictates.  The use of force must be fluid and officers in the field are expected to modulate the force they apply to the demands of the situation and be ready to respond to changing threat levels.

The current population of jail inmates is said to have a higher percentage of people suffering with mental illness than ever before.  Since the early 1970’s an effort has been made to deinstitutionalize those with severe mental illness leaving many to flounder in the streets.  The National Alliance for the Mentally Ill believe as many as 20 to 40 percent of prison inmates may have severe mental illness and may not be receiving the needed treatment to allow them to rehabilitate.

Police are increasingly linking up with mental health agencies as a way of diverting mentally ill person’s from jails into treatment for their emotional affliction. This is necessary to free police to serve the public interest more efficiently and safely. Treatment options are quite limited especially in rural communities who may be underserved by specialists in psychiatric emergencies.

British Psychological Society (BPS) photo

Police in Augusta, Maine have paired with crisis counselors two nights per week in order to provide support and expertise to police in the handling of mentally ill suspects with emphasis on de-escalating and diverting subjects from jail. Larger agencies routinely interface with mental health experts.  Courts across the country have in-house clinics that can provide up to date assessments of persons with suspected mental illness or risk for suicide and homicide.

In Massachusetts many smaller police agencies must pay overtime for police officers to sit in hospitals or outside of jail cells watching a mentally ill person who has been arrested.  Specifically, if a police officer arrests a person with a known history of suicidal ideation it has been policy among many agencies to provide an officer to monitor the prisoner to assure for a safe transfer to court. This is very expensive for small departments and takes a police officer off the road sometimes for 48 hours until the prisoner can be brought before a judge. Coupled with a high prevalence of cases of substance abuse and the growing menace of opioid addiction, police officers have their hands full with cases in which changes in mental status add to the complexity of decision-making and breadth of alternative dispositions.

This author was employed in an agency that generally deployed a single officer on duty.  When a mentally ill person was arrested the agency was forced to call in off duty personnel to transport and supervise the prisoner to assure for his or her safety.  This policy was implemented in any case of arrest whenever a person has ever had a documented history of depression with suicidal statements.  Across Massachusetts police dispatchers have access to a database of names of individuals with documented history of police interaction while mentally ill. This affords the police a heads up when a call goes out involving persons with a proclivity for suicidal behavior.  This protocol was not necessary and offered no help whatsoever to the person under arrest.  It resulted in emotionally vulnerable persons being held in custody longer than necessary out of fear that once released they would be at high risk of suicide and leave the police department liable and open to litigation.

The myths associated with mental illness – especially in the police service are abundant. For example, here in Massachusetts anyone arrested with a known history of suicidal threats needed to be watched while in custody – sometimes for one or two days until they could be brought before a judge. The question of suicidal risk should be made by psychologists and psychiatrists familiar with emergency mental health and crisis intervention.  Police officers are inherently apprehensive about legal action being brought against individual officers for decisions made because of a lack of understanding and training in dealing with those in crisis. District court judges have no greater training in suicide assessment and prevention than the cop on the beat and the decision about suicidal risk should not be left to them.  The police should turn to the experts whenever the question of risk for suicide arises and once evaluated the disposition may be straight forward gradually reducing the myths associated with this difficult population.

I agree with calls for added training for police officers in dealing with the mentally ill as a way of eliminating the myths that obfuscate decision-making and risk officer safety.  Agencies are making greater efforts to divert the mentally ill away from jails and the legal system whenever possible.  But for diversion to work well the city and county need to provide treatment programs at each point a mentally ill person comes into contact with the criminal justice system – from interactions with cops all the way through the courts, according to an NPR-Kaiser Health News report in July 2015. Our current system of liaison between mental health and law enforcement must be forged by greater cooperation and mutual understanding of the needs of those suffering from emotional illness such as depression, PTSD, and now a growing population of the addictions including alcohol and prescription pain killers.