Essays academic service

Protocols should be set in handling mentally challenged individuals by the police

  • CIT officers are trained to uses de-escalation techniques if necessary and assess if referral to services or transport for mental health evaluation is appropriate;
  • Trust in the law;
  • Literature review and international survey.

Find articles by Jennifer D. Watson Find articles by Amy C. The contentious history of police attitudes and practices surrounding encounters with people affected by mental illnesses can be understood through the lens of this wider push toward guardianship.

At least as far back as the de-institutionalization of mental health care and the profound lack of community-based resources to fill service deficits, the role of police as mental health interventionists has been controversial and complex. This paper reviews the first wave of reform efforts designed to re-shape police sensibilities and practices in the handling of mental health-related encounters. We argue that such efforts, centred on specialized training and cooperative agreements with the health care sector, have advanced a guardian mindset through improved knowledge and attitudes about mental health vulnerabilities and needs.

Protocols should be set in handling mentally challenged individuals by the police on the progress made, we suggest there are critical opportunities for a new wave of efforts that can further advance the guardianship agenda. We highlight three such opportunities: The urgency of this call stems from a series of tragic police encounters that have illuminated deep ruptures between police and communities across the nation. Those critical of police as mental health interventionists have for decades urged a shift in mindset toward health and welfare-oriented values during routine order maintenance and crime control activities that sometimes include the handling of crisis situations exacerbated by substance use and misuse.

Efforts to transform police decision-making within a public health frame are correspondingly decades old, with the first wave of reforms initiated in the 1980s in the wake of fatal encounters that could have ended differently.

In the ensuing decades, reformers set out to re-shape the policing ethos in a way that embraced their expanded public health role. This paper reviews this story of reform efforts and looks into the future. It takes stock of what has been accomplished in fostering a guardian mindset in the handling of mental-health related encounters.

It then explores critical opportunities for protocols should be set in handling mentally challenged individuals by the police the next wave of transformation needed to more fully align the missions of law enforcement and public health. In this paper, we make the argument for three needed areas of progress which tie in to wider developments in evidence-based policing and community trust-building. An important theme across this research was the observation that police were first and foremost situational problem-solvers.

The handling of mental health-related encounters was no different. Bittner showed us that officers experienced a rather profound tension between what they were authorized to do in handling situations and what they often chose to do to dispose of matters and move on to the next problem.

As the effects of de-institutionalization accumulated, police experienced the work burden associated with gaps in community resources, coupled with increasingly stringent civil commitment criteria that limited their dispositional options Wood et al. Echoing Bittner, Teplin and Pruett found that officers generally preferred to handle matters informally. However, there was a disproportionate use of arrest with individuals manifesting signs of mental illness 1992. Arrest, in such cases, was often perceived as the only means of bringing a situation under control.

As well, arrest was sometimes the only option available when the criteria for civil commitment were not met and citizens were demanding that something be done to bring peace. The implementation of the Patient Protection and Affordable Care Act 2010 has expanded access, but falls well short of a guarantee.

Thus, for many, jail and prison are the only places they are able to access psychiatric care. In this light, the criminalization of mental illness Slate et al. At the same time, however, the manner in which police handled mental health-related encounters came under increased scrutiny during the late decades of the 20th century. This cumulative set of events sparked a concern with the mindset of police in relation to their roles as health interventionists.

Using the current language of the Task Force on 21st Century Policing, questions were raised about whether officers truly embraced a guardian mindset in their dealings with people experiencing mental illnesses. In the next section, we review efforts to transform the policing ethos and improve police decision-making during encounters. The first wave of police reform The increased scrutiny that began in the final decades of the 20th Century stimulated attention to the development of strategies to improve officer training and models of interagency cooperation to support safer and more effective responses to persons with mental illnesses.

Several models emerged in the United States. A survey of police agencies conducted in the late 1990s Borum et al 19981999 found that these models tended to fall onto one of three categories: While research on models that fall within the first two categories is scant, there is a growing literature on the Crisis Intervention Team CIT model, which is a police-based model that includes specialized training for officers and significant cross-system and community collaboration Compton et al 2008.

CIT, sometimes called the Memphis Model, was first developed in Memphis, TN following the police shooting of a man who it turned out had been diagnosed with schizophrenia. However, it is not clear how many of these jurisdictions are implementing the full CIT model beyond the 40 hours of training.

Improving police interventions during mental health-related encounters: Past, present and future

While a randomized controlled trial of CIT effectiveness has yet to be conducted, there is a growing body of research that suggests CIT can impact important outcomes related to officer knowledge and attitudes, safety, diversion from arrest and linkage to services.

Overall, these findings are suggestive of a stronger guardianship orientation as a result of the training. In terms of safety outcomes, there is some evidence that suggests CIT may reduce use of force. While they did not have a comparison group, Skeem and Bibeau 2008 examined CIT call forms from the Las Vegas Police Department and found that CIT officers used less force than they legally could have when responding to persons with mental illnesses.

However, the studies that did not find an impact on arrests did find that CIT increased linkage to services hospital transport or other linkage Teller et al 2006 ; Watson et al 2010 suggesting that in some cases, CIT may be serving to link individuals to services instead of no intervention. The extent to which this may prevent future police contacts and arrests is unknown. Initially, CIT programs sought to train officers and develop relationships and workable protocols with psychiatric emergency receiving facilities, often times hospital emergency departments, so that officers could divert symptomatic individuals from arrest and to the hospital.


This includes establishment of crisis triage centres, respite beds and co-responder linkage teams. Like CIT, these models include mental health crisis response training and rely heavily on public health-law enforcement partnerships and collaboration. The Los Angeles Police Department is implementing a multi-layered approach that includes mental health crisis response training, co-responder teams, follow-up linkage teams and a crisis triage desk that officers are required to call for persons experiencing mental health crises.

The Madison Police Department utilizes mental health liaison officers that work within their assigned districts with mental health providers, advocates, families and consumers to proactively problem solve, address system issues, and link people to needed services. Other elements of their approach include the approximately 60 hours of crisis management and mental health intervention training that all officers receive in the academy, and ongoing work with community partners.

While we have growing research on the effectiveness of CIT, we do not have research to judge if it is better than other models or which model is most effective for specific outcomes, and most likely, no one size fits all.

What is clear is that there is growing acknowledgement of the guardian public health role that police play in responding to persons with mental illnesses, in crisis or otherwise. CIT and the other promising models recognize that while training officers is important, collaborating across systems is essential for ongoing problem-solving and the development of effective crisis response. Thus, while all officers should receive training related to recognizing mental illness and basic de-escalation skills, simply making CIT training mandatory for all officers, as some have suggested, is protocols should be set in handling mentally challenged individuals by the police to achieve the desired outcomes unless combined with collaboration and locally based problem solving.

We would also argue that there is an important role for officers who self-identify volunteer to serve a specialist role and take on additional responsibility for responding to mental health related calls and working across systems to provide effective crisis response. This could be as a CIT officer e. Madison, Wisconsinor a member of a co-responder team e.

Thus, there are calls for a next wave of real-world diversion models that look beyond immediate call resolutions toward long-term outcomes for ill or vulnerable individuals repeatedly encountering the police. We suggest that critical opportunities for improving police interventions with people affected by mental illness can be located within a wider narrative about the future of policing in the 21st century. This narrative centres on ways of achieving a balance between effective, evidence-based policing and high quality police encounters.

In the sections that follow, we outline three areas of focus that should constitute the next wave of interventions with people affected by mental illnesses: The theory of procedural justice arose in part out of a concern with the limits of deterrence and the threat of punishment as a mechanism for gaining voluntary compliance with legal authorities and the laws they enforce. The path to compliance is police legitimacy, which is enhanced when people experience police encounters as procedurally just.

The distinct value of procedural justice to mental health-related encounters has been explored in several studies, including one by Watson and colleagues 2007. Participants in the study reported feeling very vulnerable in encounters with police Watson et al, 2008 and perceived procedural justice was associated with lower levels of resistance, greater cooperation with police in the encounter and greater willingness to cooperate with police in the future.

Despite this initial work, questions about how precisely procedural justice is experienced during moments of crisis or behavioural disturbance merit further study.

Furthermore, less is known about how best to support officers in providing procedurally just responses to people experiencing mental or behavioural health crises. CIT training is believed to facilitate more compassionate and procedurally just responses; however, this has not been directly tested. The question of whether or not mode of conveyance links conceptually to experiences of dignity may provide a useful line of inquiry. Validated survey instruments for measuring procedural justice are publically available for use in replication studies Murphy, 2009 ; Tyler, 2006but surveys may not be optimal methods at least exclusively for testing and refining the theory with people affected by mental illnesses.

Ethnographic and interview-based studies are also necessary as methods to validate existing procedural justice constructs and measures. Findings from this initial work has important implications not only for the specialized training of police, but also for other emergency responders, medical personnel, outreach workers and others intervening at some point during an encounter.

In short, an explicit commitment to enhancing experiences of procedural justice during mental health-related encounters could help to build on the gains achieved by CIT and CIT-enhanced programs in fostering a guardian ethos among police. Building the evidence through integrated data protocols should be set in handling mentally challenged individuals by the police As mentioned above, the extent to which CIT may prevent future police contacts and arrests is unknown.

At present, police decision-making is guided in large part by situational circumstances, including their local knowledge of the person, the community context including available resourcesany associated criminal behaviour, and imminent safety and security considerations Morabito, 2007.

This fragmented system problem therefore contributes to the view that officers can, at best, decide upon a provisional solution that avoids criminalization.


Since multiple vulnerabilities do overlap Normore et al. Inspiration can be drawn from current efforts at linking data systems and identifying those with acute vulnerabilities.

For instance, in the U. These data, in conjunction with other analyses performed globally Eriksson et al. Clearly, there is a minefield of privacy issues related to cross system data-sharing, but they are not insurmountable. Understanding where public health problems cluster, and why, has been at the heart of epidemiologic inquiry. Their analysis confirmed the hypothesis that mental health-related calls at least calls that resulted in police transport are not equally distributed across the city.

Although the narcotics crime data collected by police illuminates street segments where drug-related crime is concentrated, Hibdon and Groff show that geo-referenced EMS data can help paint a fuller, more varied and richer picture of the spatial distribution of drug use and addiction. Future studies of hot spots or hot places of vulnerability can help police agencies specifically and first responder communities more generally understand the spatial relationships between crime, mental health and substance use vulnerabilities.

This geographic perspective can be used to inform cross-sector place-based interventions designed to align public safety and public health objectives. Although public health advocates are familiar with place-based approaches such as the establishment of needle and syringe programs for injection drug users Werb et al.

Such interventions could include the targeted deployment of CIT or other specialist police officers in conjunction with intensive case management, outreach and follow-up services at vulnerable hot spots.

Conclusion In the spirit of a wider commitment to strengthen a guardian mindset in policing, strides have been made in shifting the knowledge and attitudes of officers in their role as mental health interventionists. Cultural change in policing is invariably challenging, policing styles and occupational stereotypes do vary across officers and organizations Wilson, 1968and departmental missions and philosophies can oscillate with political regime change.

Nevertheless, programs like CIT and its variants have spurred a generation of more sensitive and reflective officers. CIT-trained officers are now protocols should be set in handling mentally challenged individuals by the police skilled at choosing carefully from a repertoire of diversionary and non-punitive options in their handling of mental health-related encounters.

There is hope in the idea that the tide of re-institutionalization through criminal justice is slowly being reversed. Notwithstanding this progress, the cross-system environments within which officers perform their work can militate against their desire to affect better outcomes for people affected by mental illnesses. Although police operate at the nexus point of law enforcement, mental health and social services, there are insufficient cross-sector arrangements for governing their work.

Police continue to operate in an institutional vacuum, unclear whether their efforts to assist people in crisis yield meaningful public health and safety outcomes. Optimism can be drawn from the knowledge that the fields of policing and public health are beginning to align. A scholarly commitment to integrating theories and methods, combined with a cross-system commitment to reducing fragmentation, can lead to improved long-outcomes for those with mental health and co-occurring vulnerabilities.

American Journal of Public Health. The policeman in the community.