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Upping Our Game on Mental Illness

QUESTION:  How can law enforcement, especially at the localized level, become a more integral part in the various processes involved in helping the mentally ill, protecting society from potentially dangerous mentally ill individuals, and, in keeping with the current national debate on how best to keep guns out of the hands of those who should not have them, create a more efficient means of tracking and reporting those most dangerous individuals?

When the tragic effects of untreated or undertreated mental illness bursts into the public eye, whether in grand form on the national stage or something much less conspicuous and local, questions inevitably arise.  Why would someone do this?  What signs were missed?  How can we prevent – or at least lessen the chances – of such a thing happening again?  These questions are normal and good; looking for answers is what will drive creative solutions and, although we can never prevent every such tragedy, many of these solutions have already been producing excellent results in many jurisdictions.

The expansion of Crisis Intervention Teams (CITs) comprised of sworn officers with specialized training in how to recognize and respond to mental health crises, form relationships and build rapport with the mentally ill and their families, and partner with healthcare providers and community-based services continues offers promise of continued service provision.  New police recruits tend to have more education and experience than ever, whether from college, the military or prior work, or a combination, and are coming into the field with open minds and solid foundations for learning advanced skills.  Old stigmas and misunderstandings of what mental illness is and is not are falling away. 

But there is still so much we can do better.

The CIT models – as well as other models sharing the same essential mission even if they differ in the particulars of practice – generally exhibit success as long as they are taken seriously by their members and leadership.  But even if your agency does not employ an established and tested CIT (or similar) model it can still “up its game” and improve service to the mentally ill, their families, and the greater community.  And at the micro level, you as an individual officer (or perhaps the supervisor of a team of officers or investigators) can take personal responsibility to up your own game even if your department opts not to. 

A slightly different view of policing

If you are fortunate enough to have a specialized team of officers trained in CIT response, or happen to be one yourself, then the resources to meet that responsibility are within your reach.  But if not, there are still steps you can take that go a long way toward improving the service and protection you or your team provides.  These steps are:

Emphasizing law enforcement’s role in responding to the mentally ill

In last month’s column “Law Enforcement and the Mentally Ill” we wrote:

“Think about this:  How many of your calls, in one way or another, result from failure of one or more involved parties to exercise reasonable coping and problem solving skills?... How often are you simply presented, as a matter of course, with a list of medications someone is taking, or their clinical diagnosis, as either a reason your services are needed or “information you should know”?...”

“…Like it or not, the police are also (and increasingly) the first point of contact with those suffering from mental illness, who come to our attention not because they are evil but because they are hurting.  When that hurt exceeds their capacity to cope it often spills over into maladaptive behavior and becomes our problem to triage.  And sometimes that maladaptive behavior explodes onto others with shockingly destructive results.”

You, as the police, are going to be that “first point of contact” in numerous mental health crises during your career.  There will be countless more cases to which you’ll respond where mental illness may not be as obvious but nonetheless pays a central role in the dynamic.  Knowing how best to respond is really not merely helpful, it is your responsibility.

Emphasizing increased education on mental illness and best practice responses

Very simply, training for yourself or your subordinates is out there.  Go find it.  Almost every agency has the resources in-house (if the department is large) or through shared usually regionally-based law enforcement training units.  If you are having trouble finding the trainings you are looking for, the training budget is strapped, or staffing precludes getting away from the street for a while, start thinking creatively.

Look online for webinars, free MOOC classes, or simply advanced articles or book ideas about the various disorders you are likely to encounter.  Look inside your agency, as well.  It’s likely you have sworn or non-sworn personnel with backgrounds or formal education in psychology, social work, sociology (which a solid criminal justice degree should be heavily rooted in), or similar disciplines where an understanding of mental illness is stressed or the ability to research the topics you are interested in has been learned; see if they would be willingly tasked with researching and developing some in-house training for their peers.

Focus on those particular disorders you are likely to run into in the course of a tour:  depressive disorders, bipolar disorder, autism, psychosis and schizophrenia, etc. to start.  Contact your local chapter of the National Alliance on Mentally Illness; they will probably have multiple resources to refer you to, and will be thrilled for the law enforcement outreach.  No matter how you get it, seek as much education as you can.

Connect with mental health providers and agencies in your community

Developing relationships with local healthcare providers and community organizations can have many benefits.  First, you may often find yourself there anyway, especially if they serve an acute population and frequently need police assistance.  Forging respectful relationships before and during initial calls for service makes easier subsequent calls.  This is mutually beneficial in an obvious way.  Beyond that, however, you can sometimes begin to build rapport with their clientele whom, let’s face it, you’ll likely have contact with in the future.  Rapport and banked trust up front can make those future contacts go more smoothly.  When you need their help, or they need yours, good working relationships increase the likelihood that help will come in timely and professional fashion.  And the possibility of mutual cooperation in training – and maybe even training each other – can meet the above “seek out education” goal.

Increase and improve your documentation and tracking efforts

Everyone has done it at some point and, if we’re all being truthful, probably at many points.  You’re running hot from call to call all day, four incomplete reports hanging over your head the boss is riding you to get done, the shift drawing to a close, and all you want to do is get out on time to make your kid’s softball game.  Such are the times it’s so easy to blow off or minimize the countless non-criminal calls for service that generate when the caller doesn’t know where else to turn, move on to the ones that most demand real police attention, and hope the radio stays quiet long enough to get caught up.

Sometimes that is completely appropriate.  But sometimes you miss the opportunity to do timely, valuable “soft policing” that may just prevent a future crime, or make your job easier in the long run.

Whatever documentation system your particular agencies use to record and track incidents – including incidents involving the seriously mentally ill that demand significant chucks of police time whether criminal in nature or not – they are useless if you don’t use them.  Often “low-grade” crimes (think disorderly conduct, minor vandalisms or very petty thefts, indirect or seemingly insignificant verbal assaults or threats) or trivial disputes, disturbances, or domestics get short shrift or “settled-at-scene/no complaints to be signed” clearances, and get cursory documentation, if at all.  These are the type of incidents where the “red flags” of an impending crisis or someone in need of intervention might be on full display, yet we miss or downplay them.

If you get information that someone with whom you’re dealing might be in the situation they are because of a mental health issue, or discern or suspect it yourself, then document it!  Most agencies classify their each of their calls or reports in some manner, including those for mental health, which allows for statistical collection and analysis – mine simply uses the numeric designators of the FBI’s Uniform Crime Reporting (UCR) system.   You may not have enough to force an evaluation, or to take any direct enforcement action, but you might be documenting an important piece of a bigger puzzle that will be important in the future.  It might be the piece that, although it appears innocuous now, triggers an intervention sooner to head off something much bigger later, clarifies a behavioral pattern for other officers/investigators or mental health professionals, or helps someone to overcome denial and see they need help.

There is also a tendency, once we determine or are told someone has mental illness, to hold them less accountable for criminal behavior.  Whether arrest is appropriate when someone with mental illness commits relatively minor crimes is debated in law enforcement, mental health, and corrections circles.   In our opinion, though, just because it’s debated doesn’t make it debatable.  We believe that, with only very rare exceptions, if you have probable cause to make an arrest then make it.  If someone’s mental illness is a mitigating factor, then that is for the court to address accordingly.  In fact, sometimes a failure to arrest is a disservice to your suspect, if being under the supervision of the court might be their best bet of getting the help they desperately need.  It might be the factor that heads off something much more serious.

Gun Control and the Mentally Ill, Revisited

So this brings us back to concerns we raised a couple months ago in “Gun Control and the Mentally Ill”:

“The second serious problem in trying to keep guns out of the hands of the mentally ill is how frustratingly vague or all-encompassing the definition might become.  Generally, only those who have been adjudicated severely mentally ill by a court or involuntarily committed to a psychiatric facility can be found unfit and barred from getting a gun and, as most of us who work in or with law enforcement knows, the bar is set very high for either category.”

That the “severely mentally ill” should probably not be allowed access to guns is pretty universally accepted among gun control foes and advocates alike.  Perhaps more appropriately, it should read “dangerously mentally ill” instead of severely, because “dangerously” is more specific than “severely” and, statistically speaking, the vast majority of mentally ill people – and even those with “severe” illnesses – are not dangerous!

When it comes to keeping weapons away from those who should not have them, careful documentation and judicious use of enforcement powers will help to identify and hold accountable those among us who truly are dangerous.  Ideally, it provides a path of due process to better protect us from the most dangerous (as well as to protect them from themselves), while shielding those who are not dangerous from unfairly or arbitrarily having their rights stripped.  And it can even provide a “path of redemption” for when someone takes the steps to get better.  As the way states regulate who should and should not be allowed to have firearms evolve, we should be central to how those decisions are made.

Law enforcement has an integral part to play – more integral than we maybe want to admit – when it comes to mental illness and community response.  It’s time we embrace the role more fully, and “up our game” to better serve and protect.