The Role of Law Enforcement in Mental Health Crisis Intervention
As the importance of mental health and the prevalence of mental illness become more widely acknowledged, the difficulties in providing appropriate social services also become increasingly apparent. In the case of mental health crises, a recourse for many members of the public is calling law enforcement. Police have been described as “de facto mental health providers,” “key front-line responders in mental health emergencies,” and ‘‘society’s de facto 24/7 mental health workers’’ (Shapiro et al., 2014, p. 1). In the absence of a holistic crisis care system utilizing well-staffed crisis hotlines, public education on mental health first aid, civilian crisis intervention, and alternatives to hospitalization, calling 911 has become a default option. Concerns are not limited to American contexts. Internationally, mental health-related crisis calls range from 3% to 16% of call volumes (Marcus & Stergiopoulos, 2021).
The lack of mental health crisis infrastructure has resulted in almost 130 million people in the United States living in areas with a shortage of mental health providers (Selsky & Willinham, 2022). Systemic lack of support contributes to the struggles of individuals who reach the point of crisis. Soberingly, limited law enforcement resources including training and time frequently lead to the use of deadly force. Estimates suggest that at least 25% to 50% of fatal encounters with police in the US involved individuals displaying signs of mental illness (Mather & Queally, 2016; Applebaum, 2015; Lowery et al., 2015). This demographic is disproportionately associated with lower education and socioeconomic status, substance use and mood disorders, Black or African American race, and female sex (Kunzmann, 2023).
Criminalization of those in crisis represents an additional concern, whereby arrests and charges of minor crimes result in spending time in jail rather than going to hospitals or psychiatric care. This can often be caused by police attempts to avoid the significant time investment of locating and escorting individuals to these facilities (Shapiro et al., 2014).
The Variety of Crisis Calls
The nature of crisis calls varies greatly, with the most commonly recognized incidents involving perceived dangerous behaviors in public that are exacerbated by mental illness. Alternatively, families may involve law enforcement in private situations where a loved one is demonstrating erratic behavior or experiencing a psychotic break (Denis & Wyton, 2023). Other times distress calls involve individuals with suicidal ideation or desire to self harm (Tan, 2022). In some areas there has been an increase in contact from youth overwhelmed by suicidal thoughts, gender identity stressors, and cyber-bullying. Troublingly, some officers report observing youth preferring internet interactions to the support of friends and family, further reinforcing feelings of desperation (Leavensworth, 2023).
Police involvement can escalate crisis situations and increase feelings of distress due to the implications that something criminal is happening. Officers may interpret distress as resistance, and those in dire need are transformed into dangers to society facing potential arrest. Unfortunately, a common thread is the police assumption that such behavior is caused by use of narcotics (Price, 2023).
Positive Developments
Recently due to increasing public pressure, local agencies and police departments have made concerted efforts to respond to systemic failures. The most common programs involve police training, hiring of designated crisis police, partnership with local mental health providers, remote access to clinicians, and crisis teams comprised of solely frontline workers. These five formulations are explored below.
Police Officer Training
Starting in 1988, the National Alliance on Mental Illness (NAMI) developed the Crisis Intervention Team (CIT) training program made available to all interested police departments. Thus far 2,700 out of the 18,000 police departments in the United States have partnered with NAMI. Graduation from the CIT program requires 40 training hours and includes psycho-education from doctors, civilian testimonies, and collaboration with local mental health providers and hospitals. Protocols are established for peaceful welfare checks and transportation to emergency rooms, detoxification units, and other psychiatric facilities. Officers also learn de-escalation skills including asking open-ended questions, assessment techniques, interpreting body language, and non-violently securing the safety of a scene.
The use of CITs continues to spread. In Little Rock, Arkansas, local ordinances require at least 20% of a police department’s force to receive CIT training (Price, 2023). In the community of 21,849 people in Pascagoula, Mississippi, where police receive roughly 65 calls per day involving mental health crises, three more officers have recently completed the training (Poole, 2023). In New Hampsire, police academies plan to incorporate CIT training into its curriculum by the end of the year (Gopalakrishnan, 2023). Notably, in Memphis, Tennessee where the program was first implemented, it has proven cost effective and helpful in returning police focus to actual crime (National Alliance on Mental Illness, 2023).
Designated Crisis Police
In other locales officers are specially hired as crisis police who dedicate their time to mental health-related calls. For example, in New Britain, Connecticut, the Navigator program is comprised of officers Jerzy Chmura and Bart Wichowski. The program began in 2022 when Wichowski received a master’s degree in mental health counseling after ten years in law enforcement. The officers travel in unmarked cars, wear plain clothes, and conceal their guns and badges with the aim of peacefully connecting those in crisis with appropriate services. Time is a valuable resource, as Wichowski reported they “may spend an entire shift on one person, trying to find the right option” (Leavensworth, 2023, para. 8).
Additionally, a 2019 documentary titled Ernie & Joe: Crisis Cops highlighted the efforts of crisis officers Ernie Stevens and Joe Smarro in in San Antonio, Texas to promote jail diversion (See Additional Resources). As leaders of the SAPD mental health unit, their advocacy efforts have included screenings of the film for police departments statewide (Porter, 2021).
Police and Co-responders
A third form of law enforcement crisis care involves partnership between officers and mental health providers responding to calls together. In California, new programs have been created that pair law enforcement with social workers and therapists as frontline response teams deployed by 911 dispatchers. Once police have determined the safety of a scene, clinicians assess the individuals to determine the most appropriate immediate care. Follow-up contact focuses efforts on avoiding forced hospitalization, which can be further traumatizing and expensive (Koseff, 2022). Clinicians are often sourced from local non-profits or behavioral health branches of the Department of Health and Human Services. Depending on funding, some programs run only on weekdays, requiring patrol officers to handle weekend and after-hours calls.
Remote Access to Clinicians
A fourth option that proves most cost-effective for some departments is remote access to mental health workers. For example, in Sanilac County, Michigan, local community mental health centers recently donated iPads to the sheriff’s office to enable video conferencing calls between clinicians and road patrol deputies. The therapists are also able communicate directly with those in crisis, acting as a third party that community members might more easily trust (Sands, 2023). These real-time resources have proven invaluable. As Sheriff Paul Rich describes, “We can pick up the phone if we have questions for each other. We can throw ideas back and forth” (Sands, 2023, para. 10).
Civilian-Led Mobile Response Teams
Finally, significant effort has been devoted nationwide to the development of mobile response teams comprised of social workers, therapists, and EMTs. The first mobile care program CAHOOTS was implemented in Eugene, Oregon in 1989 to divert low-level 911 calls to two-person teams of medics and crisis workers. The BHeard program in New York City is a current pilot program where dispatchers send mental health providers to handle emergencies deem nonviolent and mental health related (ABC7, 2023). In Stockton, California, teams of social workers, case managers, health workers and medical assistants travel throughout the city in vans equipped with basic medical supplies and food. A 2021 survey found that 36 of the 58 California counties offer such services, and last year the state granted $10 million toward expansion of these programs (Koseff, 2022).
Future Developments
Ultimately, law enforcement cannot remain the de facto resource for urgent mental health and mental illness needs. Interventions along the continuum of care services are needed. These must involve emphasizing public education, empowering families to rely less on crisis services, increasing funding for crisis hotlines, and providing community-based crisis stabilization beds as alternatives to hospitalization (Marcus & Stergiopoulos, 2021). For those who become caught up in the criminal system, more follow-up services also remain a vital need. In the meantime, public accountability following police brutality is compelling government agencies to increase support and funding for much-needed law enforcement programs.
Additional Resources
Ernie & Joe: Crisis Cops film: https://ernieandjoethefilm.com/
California 24/7 peer-run warm line: (855) 845-7415
https://www.mentalhealthsf.org/peer-run-warmline/
National 24/7 suicide hotline: 988
https://988lifeline.org/current-events/the-lifeline-and-988/
Article Sources
ABC7. (2023, February 15). Some US cities adopt pilot program that sends EMTs, social workers to mental health 911 calls. ABC7 Eyewitness News. https://abc7ny.com/mental-health-emt-social-worker-b-heard/12819969/
Applebaum, P. S. (2015). Can the Americans With Disabilities Act reduce the death toll from police encounters with persons with mental illness? Psychiatric Services, 66(10), 1012-1014. https://doi.org/10.1176/appi.ps.661005
Denis, J., & Wyton, M. (2023, February 14). Psychosis. Then gunshots from police. Inside Dani Cooper’s death. The Tyee. https://thetyee.ca/News/2023/02/14/Inside-Dani-Cooper-Death/
Gopalakrishnan, S. (2023, January 21). In New Hampshire, 16% of police officers are trained to handle mental health emergencies. Concord Monitor. https://www.concordmonitor.com/Police-officer-interaction-with-mentally-ill-individuals-49525156
Koseff, A. (2022, March 28). ‘People don’t think clearly in crisis:’ California law enforcement turns to mental health clinicians on toughest 911 calls. Cal Matters. https://calmatters.org/justice/criminal-justice/2022/03/mental-health-crisis-police/
Kunzmann, K. (2023, February 19). Psychiatric care fails when it becomes a law enforcement job. HCP Live. https://www.hcplive.com/view/psychiatric-care-fails-when-it-becomes-law-enforcement-job
Leavensworth, J. (2023, February 16). Crisis cops in New Britain help bridge gap between law enforcement and mental health. CT Insider. https://www.ctinsider.com/news/article/new-britain-crisis-cops-mental-health-17786118.php
Lowery, W., Kindy, K., Alexander, K., Tate, J., Jenkins, J., & Rich S. (2015, June 30). Distraught people, deadly results. Washington Post. www.washingtonpost.com/sf/investigative/2015/06/30/distraught-people-deadly-results
Marcus, N., & Stergiopoulos, V. (2021). Re-examining mental health crisis intervention: A rapid review comparing outcomes across police, co-responder and non-police models. Health and Social Care in the Community, 30, 1665-1679. https://doi.org/10.1111/hsc.13731
Mather, K., & Queally, J. (2016, March, 1). More than a third of people shot by L.A. police last year were mentally ill, LAPD report finds. Los Angeles Times. www.latimes.com/local/lanow/la-me-ln-lapd-use-of-force-report-20160301-story.html
National Alliance on Mental Illness. (2023). Crisis intervention team (CIT) programs. https://www.nami.org/Advocacy/Crisis-Intervention/Crisis-Intervention-Team-(CIT)-Programs
Poole, S. (2023, February 15). Three more Pascagoula police officers now trained in crisis intervention. WLOX. https://www.wlox.com/2023/02/16/three-more-pascagoula-police-officers-now-trained-crisis-intervention/
Porter, S. (2021, May 15). Eliot police to host screening of ‘Ernie & Joe’ film on mental health crises. Seacoastonline. https://www.seacoastonline.com/story/news/local/2021/05/15/eliot-me-police-screen-ernie-joe-film-mental-health-crises/5094121001/
Price, F. (2023, February 4). Deep dive into how LRPD assists people with mental illness. THV11. https://www.thv11.com/article/news/local/how-lrpd-responds-to-people-with-mental-illness/91-0f8f2317-1d78-40c6-8723-b28bed9d08a0
Sands, D. (2023, February 14). Michigan’s community mental health and law enforcement agencies team up to keep people out of jail. Second Wave Media. https://www.secondwavemedia.com/features/021423cmhjaildiversion.aspx
Selsky, A., & Willingham, L. (2022, September 2). How some encounters between police and people with mental illness can turn tragic. PBS.
Shapiro, G., Cusi, A., Kirst, M., O’Campo., P., Nakhost, A., & Stergiopoulos, V. (2014). Co-responding police-mental health programs: A review. Administration and Policy in Mental Health. https://doi.org/10.1007/s10488-014-0594-9
Tan, C. T. (2022, October 12). ‘We can figure this out’: Police, public and policymakers work to improve responses to mental health crises. Cronkite News. https://cronkitenews.azpbs.org/2022/10/12/police-responses-mental-health-crisis-calls-reexamined/
