Police not adequately trained on mental health: Column
As systems struggle, U.S. would do well to borrow from U.K. program that puts nurses, cops on calls together
Since Deborah Danner was killed by law enforcement in her New York apartment on Oct. 18, police in the U.S. have killed at least 10 other people whose behavior may have been connected to a mental health issue. A recent report by the Ruderman Family Foundation estimated that up to half of the people killed by police in America are disabled in some way, and a good number of them suffer from some sort of mental illness. While the majority of these killings may be legally justified, this is still a tragic outcome that demands steps be taken to reduce the likelihood of these deadly encounters.
Many departments lack adequate training to show cops how to deal safely and effectively with someone experiencing a mental health crisis. Officers are frequently forced to rely on general training and previous experience. Unfortunately, much of that training relies on a command-and-control approach that can lead to dangerous escalations in the use of force.
Good training programs give police tools for identifying the nature of the crisis and for resolving the situation with a minimum of force. Much of this training, however, runs directly counter to the command-and-control approach, creating a dangerous dilemma for officers who must decide which training to follow in volatile situations.
In the U.S., a few departments have tried to overcome this problem by utilizing a version of the Memphis Model, in which specific officers receive intensive training and are dispatched regularly to calls involving a mental health crisis. In addition, the research shows that less force is used and incarceration rates decline when there are places other than jail to take someone in crisis.
Experimental system in U.K. works, struggles
Some police departments in Great Britain went further with Street Triage, a pilot program tested as far back as 2013 that put nurse practitioners in police cars to help respond to calls that involved a mental health crisis. In some places, medical professionals provided remote support for officers who were in the field. The nurses could access patient records and use their own community-based experience to talk to officers and guide their actions from police dispatch rooms. Police learned about what they may encounter in the field and got real-time advice from professionals about appropriate courses of action.
Street Triage relied on a robust mental-health system that emphasizes prevention and crisis management. The majority of emergency calls involving mental-health crises in the United Kingdom are routed to mental-health professionals, not the police. A trained operator assesses the call and decides whether to route it to police or directly to someone who can provide mental health care. Calls that involve violence or the threat of violence are routed to police. Under the Street Triage program, officers were often paired with in-house nurses who rode with them to answer the call.
Local communities have designated places of safety that can accept people in crisis 24 hours a day, even if they are combative or under the influence of drugs or alcohol.
Overall, the pilot program was a success, led to fewer detentions and has expanded to more police departments.
But the U.K. system is also under threat. Tighter budgets have meant that many community-based support services have been eliminated, more mentally ill people end up untreated and even homeless, and police end up being called in more often to deal with inevitable crisis situations.
Police leaders in the U.S. and U.K. are increasingly speaking out about the lack of services and the limitations of relying on police to make up the difference.
Shaun Sawyer, chief constable of Devon and Cornwall Police, located in England, recently threatened to sue the National Health Service over the inadequacy of mental health services, which has forced him to hold people in police custody longer than is medically or legally warranted.
In 2014, the city of Madison, Wis., decided to sue the state for closing down the Mendota Mental Health Institute to people in police custody, which increased the burden on local police. In February, a judge dismissed the suit, forcing officers to continue to transport inmates with mental health issues to a facility across the state, which stresses the police department's financial and personnel resources.
“Feedback I get from my officers is that the unique challenges presented in these calls are going to result in more tragic outcomes," Mike Koval, chief of Madison Police Department, wrote on his blog, "unless or until there is a commitment to provide more pro-active, pre-emptive, and collaborative interventions BEFORE an individual's mental health issues have declined to critical levels.”
Put money where the mental illness is
Former Town of New Windsor Police Department chief Michael Biasotti backed measures calling for increased funding for mental-health services, pointing out the irrationality of there being hundreds of thousands of people with mental illness in prisons and jails. Approximately 56% of state prisoners, 45% of federal prisons and 64% of jail inmates have been diagnosed with a mental illness.
Biasotti received an award for his police work with the mentally ill. During that speech, he noted that a real diversion program “would be expanding services to the seriously mentally ill, and getting treatment before the police are at your door, before you are standing before a judge, and before you find yourself in jail. … Increased services means less involvement with the criminal justice system and improved quality of life for those with mental illness and their families.”
Sir Peter Fahy, former chief constable of Britain's Greater Manchester Police, argued in an Express news article about an incident in his district that ultimately, police are "often not the right people to be dealing with (the mentally ill). I think sometimes the presence of a uniformed officer with handcuffs and body armor is likely to make the situation worse. These are vulnerable people, and this is a medical issue.”
If we want to avoid tragic outcomes for people with mental illness, we must build robust community-based mental health services that work to stabilize people and respond to their problems, relying on police in only the most extreme circumstances. Adequate training and support, while necessary, will not be able to overcome the lack of mental health services and will invariable result in arrests, detentions and deaths that could otherwise have been prevented.
Alex S. Vitale is associate professor of sociology at Brooklyn College and author of City of Disorder: How the Quality of Life Campaign Transformed New York Politics. He sits on the New York State Advisory Committee of the U.S. Commission on Civil Rights and is international adviser to the Keele Police Academic Consortium.
Owen West is chief superintendent of the West Yorkshire Police. He is a graduate of the Cambridge University Police Executive Program and a research fellow at the Keele Police Academic Consortium.