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Emergency Response and the Mentaly Ill

Written by Kelly Sharp

According to the National Institute of Mental Health, 26.2 percent of Americans age 18 and older have some kind of mental disorder in any given year, with 6 percent suffering from a serious mental illness. Mental disorders are the leading cause of disability in the U.S., and many people suffer from more than one. For officers, this means that one in 17 people they contact may be mentally ill.

Most of these people are on medication and function quite well in society. They are parents, friends and family members. They hold down good jobs, go to church and play baseball with their kids. They simply have an illness that is easily treatable. Others, either due to their inability to care for themselves or lack of medical and social services, may be homeless and friendless. It is this group who law enforcement is most familiar with and who may be most challenging when contacted. While very few encounters end in violence, many end in a feeling of hopelessness for officers.

Often after encountering someone who is mentally ill, the officer walks away wondering why. Why are these people homeless? Why do I have to deal with them? What am I supposed to do with them? Why can’t we just put them somewhere?

In the past, those with mental illnesses were simply rounded up and put into institutions. Ideally, they would have been well cared for by dedicated doctors and nurses, but the reality was far different. Institutions were underfunded and prisonlike, offering little hope for treatment and reintegration into society. Movies like “One Flew over the Cuckoo’s Nest” and Erving Goffman’s 1961 book “Asylums: the Social Situation of Mental Patients and Other Inmates” cast these facilities as little more than warehouses where patients were medicated and tortured.

The 1960s launched great societal change in America. Civil and human rights became the rallying cry, and this quickly extended to include the rights of the mentally ill. The Community Mental Health Centers Act was signed into law by President Kennedy on Oct. 31, 1963. The grand design behind this law was to create community-based centers where the mentally ill could be cared for in a more homelike setting, rather than in the prisonlike institutions they had known up to that point.

According to Saul Feldman in his 2003 article “Reflections on the 40th Anniversary of the U.S. Community Mental Health Centers Act” in the Australian and New Zealand Journal of Psychiatry, “The president said: ‘under this legislation, custodial mental institutions will be replaced by therapeutic centres. It should be possible, within a decade or two, to reduce the number of patients in mental institutions by 50% or more. The new law provides the tools with which we can accomplish this.’”

This new law seemed to start on a hopeful note. Within five years, the number of mentally ill people in state hospitals dropped by 35 percent. However, the momentum could not be maintained. Feldman said, “It is clear that what was supposed to happen did not, that the funds from the states that were supposed to follow patients from the hospital into the community did not, at least certainly not enough to provide sheltered housing and treatment for them.”

Instead of being re-integrated into society, these patients were simply dumped into the streets. While many of those unable to care for themselves became homeless, others went home to families who had no idea how to help them. Desperate for some kind of help, these families increasingly turned to law enforcement officers, who were woefully unprepared for dealing with the problems of the mentally ill.

Forty years later, America is still struggling with the challenge of helping the mentally ill. The mentally ill and their families are still turning to police for help, and officers are still feeling hopeless. Understanding the history behind this challenge may help administrators begin to form answers to the questions that start with “why?” Most of all, it can clarify the nature of the emergency response.

Are They Really Dangerous?

When a transient who has been yelling at a tree suddenly turns and rushes at an officer with a knife, the officer probably won’t wait to ask if a mental illness is making the person aggressive. He will simply respond as he would to anyone being threatening.

But most officer interactions with the mentally ill do not end violently. Yes, the person may be screaming at a tree, but that doesn’t always mean he is a threat to the officer or nearby citizens. The outcome of the contact may ultimately be determined by the officer’s understanding of mental illness. Unfortunately, many officers may be under the impression that the mentally ill are more violent than a “normal” person. But is that true? Not necessarily.

The FBI Uniform Crime Reporting Statistics show that in 2009, 1,146 officers were injured while handling persons with mental illness. This compares to 18,672 officers injured during disturbance calls, almost 5,500 harmed during traffic stops, and more than 5,000 harmed while investigating suspicious persons or circumstances.

And these numbers are not just a fluke. In the Justice Center publication Law Enforcement Responses to People with Mental Illnesses: a Guide to Research Informed Policy and Practice, Reuland, Schwarzfeld and Draper reviewed a 10-year period based on FBI UCRS stats and found that “handling persons with mental illness” made up only 1.8 percent of all assaults on officers. Even the Treatment Advocacy Center, an organization dedicated to helping the mentally ill, shows fewer than 600 incidents between officers and the mentally ill over a 10-year period.

So where does this perception of violence come from? The IACP’s June 2010 report Building Safer Communities: Improving Police Response to Persons with Mental Illness states that “people with mental illness are stigmatized by false association between violence and mental illness that has been promoted by the news entertainment media.”

Many officers on the road will cry foul, relating story after story in which a mentally ill person was violent. But if officers were asked to list every person who became violent with them, would those with mental illness be in the majority? Or do officers remember them simply because they were mentally ill?

The IACP says its research shows most of those who are violent are not mentally ill, and those with mental illness are much more likely to be victims rather than suspects. So who is right? Could it be that officers expect the mentally ill to be violent, so when they are it’s a self-fulfilling prophecy?

Most would argue that it is unfair to ask officers to play sidewalk psychologists in the first place. For officers to have to determine whether someone they’re talking to is mentally ill, a substance abuser or just having a bad day is too much to ask. The specific challenges of the mentally ill are a national problem and should be addressed as such.

Unfortunately, the reality is that in this world of budget cuts, working with the mentally ill is going to remain a police problem. Safety for the officer and the mentally ill person needs to be the number one priority, and that means ensuring officers have the skills needed to de-escalate a mental health crisis situation whenever possible.

Reuland, et al. state that “For law enforcement policymakers, the critical question is not whether people with mental illnesses are dangerous, but how best to maintain safety when violent or dangerous behavior results in calls to law enforcement.” The IACP seems to agree.

As part of the Law Enforcement Action Agenda, the IACP recommends reviewing training criteria; developing mental health response resources; and establishing cross-training opportunities for mental health professionals, officers, those with mental illness and family members. But the change must begin by adjusting the mindset of some officers that the mentally ill as a group are more dangerous than they actually are.

Kelly Sharp is a partner in Workplace Consulting NW, LLC, which provides a variety of training and management classes. In addition, she has worked as a 9-1-1 training officer and dispatcher for 16 years. She can be reached at kellysharp@wpcnw.com.

Published in Law and Order, Jun 2011

Rating : 5.7


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Military Retired

By Dave M

Excellent Article showing all sides of the issue!

Submitted Aug 10 at 1:42 AM

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