Applying Procedural Justice Theory to Law Enforcement's Response to Persons With Mental Illness

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.

State Mental Health Policy: Statewide Implementation of the Crisis Intervention Team Program: The Ohio Model

This study tested a hypothesized inverse correlation between the number of crisis intervention team (CIT) officers and the number of Special Weapons and Tactics (SWAT) callouts in an urban police department. Data for the number of accrued CIT-trained officers were combined with administrative data on the number of SWAT callouts during 27 four-month intervals. There were no significant correlations for the relationships examined, and implementation of CIT training was not associated with a decrease in SWAT callouts. Although the CIT model may yield important benefits in other domains, this study found no evidence of declining SWAT utilization as the number of CIT-trained officers accrued. The absence of association is likely due to the relatively low prevalence of SWAT use and the very different nature of CIT versus SWAT responses.

New Models of Collaboration Between Criminal Justice and Mental Health Systems

Improving police response to mentally ill people.

Toward Successful Postbooking Diversion: What Are the Next Steps?

The authors make the case for expanding the national discussion of inpatient psychiatric beds to recognize and incorporate other vital components of the continuum of care in order to improve outcomes for individuals with serious mental illness. They review the varied terminology applied to psychiatric beds and describe how the location of these beds has changed from primarily state hospitals to the criminal justice system, emergency departments, inpatient units, and the community. The authors propose 10 recommendations related to beds or to contextual issues regarding them. The recommendations address issues of mental illness terminology, criminal and juvenile justice diversion, the Emergency Medical Treatment and Labor Act, mental health technology, and the mental health workforce, among others. Each recommendation is based on findings from publicly available data and clinical observation and is intended to reduce the human and economic costs associated with severe mental illness by promoting a robust, interconnected, and evidence-based system of care that goes beyond beds.

This paper presents an analysis of and recommendations for improving the relationship between the mental health and criminal justice systems in Charlottesville and Albemarle County, Virginia. The project team used data analysis, detailed process modeling, and stakeholder discussions to identify three major problems in the current system for managing the needs of people with mental illness, also referred to as consumers. First, encounters between consumers and law enforcement or mental health personnel resulted in unnecessary safety risks. Second, the limited resources of both the criminal justice and mental health systems were consumed from ineffective responses to consumers' needs. Third, when an individual with mental illness moved from one agency to another, they often experienced gaps in treatment which caused a crisis situation to develop, requiring police involvement. To address these problems, the project team recommends that the city and county re-align their existing resources into a collaborative crisis intervention system (CIS). The CIS would seek to improve the coordination between agencies in the criminal justice and mental health systems; it would be able to handle both the acute needs of consumers in crisis and minimize the potential for crisis situations to develop by providing long-term stability. In addition to using these systems' limited resources effectively and efficiently, the development of a CIS would enhance the quality of life for the region's consumers and benefit the community as a whole. This project was conducted by University of Virginia students as an evaluation team for the crisis intervention team (CIT) taskforce, a diverse group of local representatives from both the mental health and criminal justice systems who are advocates for improving the relationship between the systems.

Police Use of the Taser With People With Mental Illness in Crisis

Frontline Reports

Gender Differences in Police Encounters Among Persons With and Without Serious Mental Illness

This study examined the rates, patterns, and types of police contacts among men and women with and without serious mental illness. Data on type of contact, type and number of offenses, dispositions, and repeat offenses were extracted from an administrative database of all police encounters in a midsized Canadian city over a six-year period (N=767,365). Men and women with serious mental illness represented, respectively, .5% and .4% of men and women who had at least one contact with the police; however, they were involved in 3.2% and 3.0% of all interactions, respectively. Persons with mental illness were more likely than those without mental illness to be in contact with police as suspected offenders, to have a greater number of offenses, to reoffend more quickly, and to be formally charged for a suspected offense. Among persons without mental illness in contact with police, men were much more likely than women to be offenders, to have a greater number of offenses, and to reoffend more quickly. Among persons with mental illness, however, the gender gap for these measures was significantly smaller. More resources should be allocated to support persons with mental illness in the community because they tend to have high rates of repeated police contacts for a variety of offenses. The findings highlight the need for gender-specific intervention programs. Administrative databases can be useful tools in examining police contacts among persons with mental illness and monitoring change after policy and program implementation for those at risk of police encounters.

State Mental Health Policy: Mental Health Transformation: Moving Toward a Public Health, Early-Intervention Approach in Texas

Accessible summary What is known on the subject? People with serious mental illnesses are overrepresented in the criminal justice system. Interventions such as Crisis Intervention Teams and Co‐responder Teams may improve police officers' ability to provide effective response. There is still a gap in our knowledge of the nature of the situations officers are responding to and their perceptions of what is needed for effective response. What this paper adds to existing knowledge? This paper provides insight into officer perceptions and experiences of the mental health‐related calls they respond to involving youth, adults and families. Officers often refer to people in crisis as having “gone off meds” but also recognize more complex factors at the individual level (e.g., co‐occurring issues), family level (challenges of caring for a loved one with mental illness) and community level (deficiencies in health and social resources to address long‐term unmet needs). Deficiencies in the resources needed to address the unmet needs of people and their families frustrate officers' desires to make a difference and effect long‐term outcomes. What are the implications for practice? Findings underscore the need for cities and communities to develop alternatives to emergency departments which, in the long term, may provide the best hope for reducing the reliance on police as mental health interventionists. Formal collaborations between the law enforcement community and the mental health nursing community could be focused towards this end. Findings provoke the larger question of what should “count” as good police work in the face of deficient community health systems. Practitioners should consider the distinction between police effectiveness and “whole system” effectiveness. Police officers could be held to account for “principled encounters” that are resolved in ways that reduce immediate harm, avoid stigma and advance procedural justice, but the full impact of their effects is contingent on the capacity of the wider system to do its job. Mental health nurses are well positioned to assist with officer training and provide support to officers responding to mental health‐related situations. Abstract Introduction Data on fatal outcomes of police encounters, combined with evidence on the criminalization of people with mental illnesses, reveal a grave need to improve outcomes for individuals with mental illnesses who come into contact with police. Current efforts are hampered by a lack of in‐depth knowledge about the nature of nature and context of these encounters. Aim/Question Building on previous findings from a larger study on the nature and outcomes of mental health‐related encounters with police in Chicago, this paper examines officer perspectives on the unmet needs of individuals and their families and the ways in which the mental health and social system environment constrain officers' abilities to be responsive to them. Methods Findings are drawn from qualitative data produced through 36 “ride‐alongs” with police officers. Field researchers conducted open‐ended observations of police work during routine shifts and carried out interviews with officers—according to a ride‐along question guide—during periods of inactivity or between calls for service to ask about experiences of mental health‐related calls. Field notes describing their observations and ride‐along interviews were analysed inductively using a combination of open and focused coding. Results Officers responded to a variety of mental health‐related calls revealing complex, unmet needs at individual and family levels. A common theme related to officers' perceptions that “going off meds,” combined with other situational factors, resulted in police being involved in behavioural health situations. The data also revealed broader aspects of the health and social system that, in officers' minds, constrain their ability to effect positive outcomes for people and their families, especially in the long term. Discussion Findings beg the larger question of what it is we, as a society, should expect of police in the handling of mental health‐related calls, given their concerns with the wider health and social service system that they experience as deficient. At the same time, the view that “going off meds” is a common trigger of mental health‐related events should be interpreted with care, as it may signal or perhaps serve as a shorthand for more complex health and social needs that could be obscured by a pharmacological or medicalized perspective on mental illness. This is an important area of future inquiry for research at the intersection of policing and mental health nursing. Implications for practice The contribution of police to the wellness and recovery of people and their families is constrained by the ability of the community health and social service system to do its job. A wave of new initiatives designed to enhance the interface between police and the medical community holds out hope for alleviating officers' concerns about whether they can work in tandem with the rest of the system to make a difference. For now, we suggest that what we can expect of police is to implement “principled encounters” that ensure public safety while achieving harm reduction, self‐determination and the reduction of stigma. Mental health nurses are well positioned to assist with officer training and provide support to officers responding to mental health‐related situations. However, the fields of policing and nursing practice may not yet fully understand the individual, family and community dynamics driving calls for police service. The notion of “gone off meds” should be interrogated as a potential trope that obscures a whole‐of‐person approach and whole‐system approach to mental health crisis response and care.

The likelihood of arrest appeared substantial among persons with severe mental illness, but the bulk of offending appeared concentrated in a small group of persons and among persons with sociodemographic features similar to those of offenders in the general population. Data such as these could provide a platform for designing jail diversion and other services to reduce both initial and repeat offending among persons with serious mental illness.