First responders, and especially police officers, often find themselves in impossible situations when they respond to calls: crime scenes, disputes, and other disturbances where no single outcome they produce is the “right” move, at least in the public’s eye. Calls involving citizens with mental health issues have high potential to compound this problem. Indeed, mental health situations in which officers are determined to have legal justification for their actions can still spark outrage, straining relationships between departments and communities and leaving both sides questioning what, if anything, could have been done differently.
A failing mental health system only complicates matters. With hundreds of thousands of people diagnosed with some form of mental illness at home instead of receiving the treatment they require, incidence rates between police and this underserved segment of the population naturally rise. Combined with the understandable individual and departmental frustrations that can arise from this outcome, erratic behavior from suspects themselves, and the mutual misunderstandings that can arise in interactions with the mentally ill, and you get what can best be described as a no-win situation for police, the mentally ill, their family members, and everyone else impacted by the realities of the situation.
This is not a new problem. Police have long struggled with effective ways to tailor standard training, skills, and protocol to mental health situations. And though no one individual solution for such a varied problem exists, specialized training – applied, at times, with alterations to department culture – seems to be the best, most realistic answer for the time being.
Training, new models provide alternatives to standard policing in mental health situations
Suggesting that “a lack of training” is to blame when police rightfully detain (or use justified force against) a mentally ill suspect is perhaps a bit misleading – officers in mental health situations are doing what their training and experience tell them to do. By the same token, it’s hard to say departments or individual officers should be sanctioned for following that training and attempting to keep themselves, their fellow officers, and the citizenry at large safe.
Providing specialized training beyond the scope of standard policing skills is hardly a new idea. From investigating computer crimes to performing tactical breaches, departments large and small train specific officers for highly specific tasks.
Combine these ideas with the notion that tragedy must sometimes be the catalyst for change and we have the Crisis Intervention Team (CIT) model, sometimes called the “Memphis Model.” Developed after a 1987 incident in which Memphis police fatally shot a knife-wielding, mentally disturbed suspect, CIT is perhaps the best-known tool for departments looking to change their approach to mental health situations. It’s arguably one of the most effective, too. National Alliance on Mental Illness (NAMI) statistics, for example, say officer injuries stemming from ‘mental disturbance’ calls dropped by 80 percent in Memphis after the implementation of CIT, all while dropping the “census of mentally ill individuals” in the city’s jail from 12 percent to three percent, according to CIT International figures.
The model itself is fairly simple: Officers take 40 hours of “intensive training,” according to the above-linked NAMI resource, including roleplaying, training from mental health experts, and de-escalation technique training. Upon completion of this training, these officers are given preferential deployment to calls in which mental health is a known factor, lending their expertise to situations where standard policing might not provide the best outcome. With the previously mentioned success figures and disproportionate number of interactions with the mentally ill, it is little surprise that departments across the country have embraced CIT and similar models. One 2013 study, for instance, suggests most states serve at least some of their population with CIT-trained officers, with only five reporting a zero-percent service rate.
CIT isn’t the only option departments have to improve mental health-related outcomes, however. Dealing with high volumes of mental health calls, the Los Angeles Police Department devised a different system: the Mental Evaluation Unit, a system in which officers and mental health experts work together on calls related to mental health problems. This system, praised as a “model for the nation,” gives mentally ill suspects direct access to a professional from the onset and better access to the LA community’s mental health system after initial contact. By “[diverting] hundreds of people each year to treatment instead of jail,” as the above-linked resource notes, the city saves significant amounts of money, fosters goodwill with the population, and, most importantly, gives people in bad situations access to help, all while freeing other officers to address situations better matched to their skills.
Finding funds to secure mental health training is an obstacle
Of course, performance isn’t the only consideration a department (or the state it serves, for that matter) must make when deciding what mental health solutions they will employ. Money is an ever-present factor as well. Whether a department is hiring clinicians, sending officers to intensive training, or deploying some other measure, the funds to make it happen have to come from somewhere.
Illinois provides an interesting take on this concept. The state’s insistence on dealing with mental health policing issues during a budget crunch made headlines in 2015, as did the cancellation of “hundreds of classes” when the funds ran out in November of that year. In this instance, the cancellation came as the result of political disagreement over budgeting, but is a prime example of how fiscal matters beyond a department’s control may have a serious impact on the quality of service (and related training) that department can provide.
At the city level, we see the opposite end of this spectrum in Illinois – and another look at how tragedy can cause substantial change within a department. Facing political backlash over a controversial mental health-related shooting, Chicago Mayor Rahm Emmanuel recently announced sweeping additions to mental health training for city police and 911 operators, including a 50 percent increase in officers receiving CIT training. Providing more officers with this capability should increase diversions and reduce “revolving door” jailing for mentally ill suspects, introducing the same cyclical benefits other cities implementing CIT and other measures have seen.
Possibly spurred by increased contact with mentally ill suspects, other cities and states are opening their pocketbooks to allow departments more access to mental health training. For example, Indiana’s SB 380, signed into law in 2015, “requires [training academies] to include an overview of crisis intervention team (CIT) training model in initial training” and establishes an outside “technical assistance center for crisis intervention teams” to find grant funding and provide assistance; Maryland’s SB 321, on the other hand, requires the creation of specially trained behavioral health units “of at least six officers” within all county and city departments.
Mental health calls affect all first responders
Going back to Chicago’s example, the mandate expanding 911 operator training is another crucial measure. As the first point of contact for many interactions between police and mentally ill persons, dispatchers decide who responds to calls, making their ability to spot mental health issues and direct the right people to them a potential turning point in the interaction before it ever starts – all over the phone.
CIT training could be one key here, especially if a dispatcher has CIT-trained officers at his or her disposal. Simply training dispatchers to “sniff out” a potential mental health issue – one article mentions a roleplay in which the “caller” reports a mysterious green box in his yard, among other training exercises in a 40-hour course – strengthens a department’s overall mental health efforts. Since many departments are not directly connected to their 911 dispatch offices, however, this could take a higher level of coordination and possibly require city- or state-level coordination to come together.
Then there are the EMS and firefighters, both of whom see their work impacted or outright disrupted by frequent mental health calls. As the previously linked resource notes, many “frequent utilizers” of 911 systems – several of these utilizations being unnecessary – suffer some sort of mental health problem, making it hard for first responders to determine which calls from this group are legitimate and which may simply waste time and resources. While responders in most districts have a responsibility to answer all calls, figuring out what tools and which personnel best fit a given caller’s real needs could represent a huge savings in time, money, and manpower.
Community paramedic programs may be one answer for EMS services in particular. One such pilot program has cut down on unnecessary ER visits and lost reimbursements by having paramedics call a “crisis intervention group” for callers upon arrival; this group, staffed by mental health professionals, helps determine any potential risk for the caller over the phone and, if necessary, provides intervention group-based transport to a mental health facility (as opposed to an ambulance ride to the hospital) once the caller refuses initial ambulance service.
The same customized approach has seen some success in the fire service. Instead of deploying traditional trucks and ambulances to mental health scenes, a fire and EMS department in Arizona has begun deploying specialized SUVs staffed with mental health professionals. Besides reducing the embarrassment and burdensome feeling people in crisis experience when calling a traditional ambulance, the article echoes a common refrain in mental health-tailored services: Giving mentally ill patients treatment and access to treatment instead of shoehorning them into practices and procedures that don’t suit their specific needs.
Mental health: A multifaceted problem for first responders
As stated before, no one solution works for every department’s unique needs regarding mental health response. Transporting suspects and patients, particularly in rural areas and states where police are required to provide transport, can be a serious area of concern: Where do you take people when local resources aren’t available? Some onlookers – including officers within departments employing revamped mental health efforts – also wonder why one person who breaks a given law should be given different treatment than another.
Still, to the officers tasked with responding to disproportionate numbers of mental health calls, it’s clear something needs to be done. By tailoring departmental practices to the specific needs of their citizenry, police departments are better equipped to help them – and better equipped to remove repeat offenses and offenders, among other problems common to mental health callers, from the docket. Whether discussing dollars saved or lives improved, that makes changing policy and increasing training a viable and important topic.