When I signed up to be a cop 37 years ago, I had no plans to go into the medical field, and, generally speaking, neither have most of the thousands of cops I've recruited, trained, and worked with since then. But as they walk their beats, cops deal with a lot of illness. Specifically, I'm referring to mental illness, and, with some exceptions, politicians and law enforcement brass are not sufficiently preparing cops to handle it or providing the broader public service support needed to address this uniquely difficult, and increasingly common, challenge.
The stats are staggering. As many as a quarter of inmates have a psychotic disorder and more than half have mental health problems, according to Department of Justice statistics. The number of police shootings that involve a person with a history of mental illness might also be in the 50 percent range, as a2012 Portland Press Herald investigation indicated, though the data are spotty. Whatever the precise numbers are, the volume of encounters, and, particularly, violent encounters, with the mentally ill is disproportionately large.
Anecdotally, it seems that policing situations that go sideways are more likely to involve people suffering mental illness. This is something I've observed for years and talked about when I testified before Congress a decade ago:
It is clear that without proper training on how to respond to these individuals, law enforcement officers may not be able to appropriately handle the situation. These contacts have a great potential for rapid escalation of both threat and force. Minor situations can easily escalate into a violent confrontation that jeopardizes the safety of both the officers and the individual. While police have generally won in the courts when it comes to use-of-force cases involving the mentally ill, the court of public opinion has been less forgiving. We've seen more of this in recent years as the media have begun to shine a spotlight on the issue, highlighted by numerous prominent national media stories critical of the law enforcement responses.
So the question I've been asking myself – and the cops who have participated in our trainings – is, regardless of whether we can win in court, how do we go about addressing the undeniable problem of improving public safety for both the mentally ill folks we face and the officers who face them.
As a starting point, the public does not accept the simplistic answer: We deal with them the way we deal with anyone else. If someone breaks the law we arrest them, using whatever appropriate and constitutional means are necessary, regardless of their mental health status.
That's not to say that we should play doctor. In fact, I don't have better advice for the cop who is on his or her beat today and encounters a potentially mentally ill person in an incident that gets violent. If nothing else were to change then the answer is to address the situation as you would any: ---with the minimal force required to prevent an immediate threat. That is, whether the officers' actions are "objectively reasonable" in light "the facts and circumstances confronting them, without regard to their underlying intent and motivation.
The reason that answer is not good enough is because it is not working - too many mentally ill citizens end up in jail, injured or dead because we (the big "we": society) haven't made the effort to find a better answer to this growing problem. The job of policymakers and law enforcement leaders is to help us get on the path toward better results.
This brings me to my list of what needs to be done to reduce the number of use-of-force incidents with the mentally ill, and, over the long haul, reduce the number of mentally ill persons behind bars.
1. Collaboration between police departments, the mental health system, and the mental health advocacy community needs to become a priority for communities and a basic principle of modern law enforcement.
It is not just instinct that leads me to this primary conclusion, though it sure seems obvious when you start talking about the issue. The research shows that police departments that have active relationships with mental health partners get better results. But, in most communities, these relationships are not strong enough and the public policy and budgetary support are not sufficient. I cannot understand why every Mayor in the country hasn't begun the process of bringing the parties together to formulate strategies for collaboration. I am pretty certain that cops' jobs will be easier, the mentally ill will be safer, and the taxpayer will save money when we start approaching law enforcement and mental health as a collective responsibility rather than forcing police to be the first and last responder.
2. Provide more training for officers in the identification of and interaction with mentally ill persons.
Over the past 25 years, "crisis intervention training" (CIT) to help first responders become more effective when dealing with mental health crises have taken hold. It, or something like it, exists to some degree in about 70 percent of departments across the country. However, we spend very little time on these trainings, especially given the increase in the percentage of encounters cops have with the mentally ill. According to the Police Executive Research Forum, only eight percent of recruit training and nine percent of in-service hours are spent on crisis intervention. As the volume of mental health-related incidents for cops continues to grow, the amount of training in that area must as well.
One interesting thing to note here, is that despite the sense that getting this training helps officers, research shows that cops still feel that they don't have the information regarding what resources are available in their community once they've identified mental illness as an issue. This is why better collaboration remains a top priority item to address.
3. Devote more money for mental health services.
As a former Sheriff, I know the risk of ever uttering support for giving money to other agencies: 100 percent of your deputies will point out that, "you know, the department could use that money, too, boss." But I go back to my own experience and the cost of running jails that were forced to double as mental health facilities. As I told Congress back in 2004:
Providing medical care for these individuals in a jail setting is a tremendous concern as well. The Tuscaloosa County Jail houses approximately 600 inmates. At any given time, roughly 40 per cent of the jail population is on some type of psychotropic medication. The vast majority of those are on multiple medications. In the final quarter of last year, the cost of those medications cost my office and the taxpayers of Tuscaloosa almost $75,000. Additional costs are incurred because the staff at the jail has to be extra vigilant in monitoring mentally ill individuals. Frequently they are on suicide watch, which requires additional detention officers to monitor them, thus increasing manpower needs and costs.
A mentally ill person in jail receives very basic and limited mental health 'assistance'. I would hesitate to call it treatment. The fact is that they receive far less mental health care than they need and are subsequently released back into society without either a safety net or a system in place to ensure compliance with a treatment plan. Frequently, the cycle is simply repeated over and over again with the mentally ill being arrested after they have failed to keep up with their prescribed medication regimen.
In the long run it costs much more for law enforcement institutions to provide mental health services than it would cost for mental health providers and institutions to do so. The reason it has become so critical that we spend more time and money on collaboration and training - and the reason we have to have this conversation at all - is that we spend too little money dealing with mental health the right way, with medical professionals rather than cops. That's good public policy!
I'll let the pundits argue about why we do such a poor job of addressing the medical side of mental health. But, while I'm not a political prognosticator, I am afraid that my call for getting politicians to devote more resources to these services will go largely ignored. As a result, I'm convinced that we have to do a better job preparing police for their inevitable interactions with people who have mental illnesses.
Ted Sexton, Executive Vice President of UNIT Solutions, is also the retired Sheriff of Tuscaloosa County, a former National Sheriff's Association "Sheriff of the Year," and former Assistant Secretary at the U.S. Department of Homeland Security.