Stanford Ethics Team Examines Intersection of Homelessness, Mental Illness, Police Conduct

Abstract

Back to table of contents Previous article Next article Clinical & ResearchFull AccessStanford Ethics Team Examines Intersection of Homelessness, Mental Illness, Police ConductMark MoranMark MoranSearch for more papers by this authorPublished Online:26 Sep 2022https://doi.org/10.1176/appi.pn.2022.10.10.25AbstractA team at Stanford University hopes to identify patterns of interactions and outcomes when police encounter people with mental illness with the goal of developing policies and best practices that can mitigate harm and avoid negative outcomes.In a searing essay titled “Living With Schizophrenia,” written in 2012 for an adult education class, Deborah Danner—an African American woman with schizophrenia living in New York City—wrote something that would prove sadly prophetic: “We are all aware of the all-too-frequent news stories about the mentally ill who come up against law enforcement instead of mental health professionals and end up dead.”Four years later, on October 18, 2016, Danner was shot and killed by a New York City policeman in her apartment in the Bronx after Danner’s neighbors had complained that she was acting erratically. The officer who shot her was charged with second-degree murder but was later acquitted.Tragedies like the shooting of Deborah Danner have become more common as law enforcement officers have increasingly become the first responders to mental health emergencies; in the decades since deinstitutionalization, homeless mentally ill individuals may have become especially vulnerable. Yet the scope and nature of encounters between police and those with mental illness—how often they happen and the variables that result in good or bad outcomes—are poorly understood.According to Fatal Force, a Washington Post project to log fatal shootings by on-duty police officers in the United States, as of August 23, 1,624 individuals with mental illness had been killed by police since the Post began the project in 2015. That’s 26% of all shooting deaths logged by Fatal Force, suggesting that people with mental illness are overrepresented. Of those, 255 have been African American. However, the number of victims with mental illness may be higher—the information is derived from media and police reports—and homelessness is not included as a variable.“Our ability to care for our patients, and our ability to support the broader public mental health of everyone in our society, is deeply wrapped up in how the criminal justice system treats people,” says Laura Roberts, M.D., M.A.Now, the ethics research team at Stanford University, led by Laura Roberts, M.D., M.A., is seeking to better understand the intersection between homelessness, mental illness, and law enforcement. Roberts is chair and the Katharine Dexter McCormick and Stanley McCormick Memorial Professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. She is also editor in chief of books at APA Publishing.With funding from the Elizabeth Dollard Charitable Trust, Roberts and her team hope to identify patterns in policing when law enforcement officers encounter people who are mentally ill or who are unhoused, with the goal of developing policies and best practices that can mitigate harms.Psychiatrist Stuart Yudofsky, M.D., a trustee of the Elizabeth Dollard Charitable Trust, told Psychiatric News that the foundation has provided Roberts’ team with a two-year grant to pursue this work.Yudofsky noted this issue has roots going back decades to the deinstitutionalization of people with mental illness and the failure to provide sufficient resources to treat people with severe and persistent mental illness in the community.The result is that police are frequently the first responders to someone in crisis—a situation for which they are not always trained. “Laura’s team will review the existing literature and know what questions to ask to get some data about where the flashpoints are” that lead to bad outcomes, he said.Deborah Danner’s death and the publication of her essay prompted a 2018 editorial by Roberts and colleagues in Academic Psychiatry, calling for evidence-based strategies to help law enforcement officers who have been forced to assume the role of first responders in difficult situations with individuals living with mental illness.“Though I didn’t know her, I carry the story of Deborah Danner with me every day, and I wish it were a rare story of tragedy,” Roberts told Psychiatric News. “It is not. Many people with lived experience of mental illness have encounters with the criminal justice system and with members of law enforcement. Addressing challenges faced by people with mental illness or people in crisis situations is an undeniably difficult part of the work of members of law enforcement. Not all interactions between people with mental disorders and law enforcement are negative. But we have too many examples where encounters between law enforcement and people with mental illness have been mishandled—including situations with fatal consequences.”Team to Develop Case StudiesAs part of the research effort to understand the intersection of mental illness, homelessness, and police violence, Roberts’ team is collaborating with the California Reporting Project (CRP), a consortium of California journalistic outlets devoted to building a database of police misconduct in the state (“California Reporting Project Seeks Records of Injury, Death in Police Encounters”).The Stanford team is undertaking a systematic review of case files assembled by the CRP to identify individual cases in which law enforcement officers engaged with an individual who was, at minimum, perceived to be mentally ill and possibly homeless. “Reading and reviewing those case files and noting features and outcomes of those incidents allow us to better understand how police engage with these populations and to look at individual case studies when things went well or when things went poorly,” Roberts said.For instance, Roberts’ team reported that a preliminary review of case files highlights instances in which the need of law enforcement to control or contain a situation is in conflict with best practices for dealing with people living with mental illness.Ultimately, Roberts and colleagues hope to develop case studies that will be de-identified and published so that a variety of stakeholders—clinicians, law enforcement officers, policymakers, and individuals living with mental illness and/or homelessness themselves—can better understand the kinds of situations that end in use of force and develop best practices to avoid those outcomes.Honoring Deborah DannerRoberts said that the effort should be of interest to psychiatrists everywhere. “Psychiatrists often work closely with law enforcement officers and engage with the criminal justice system,” she said. “In the decades since deinstitutionalization, the working relationship between psychiatrists and members of law enforcement has in many ways expanded, with the shared responsibility to determine if individuals are a danger to themselves or others.”Deborah Danner’s essay is a harrowing account of her own travail as a person living with schizophrenia. It is also a deeply thoughtful meditation on the adversities confronting her brothers and sisters with serious mental illness—stigma, especially, but also the inadequacies that would contribute to her own death by police. Her essay included a “wish list” that called for better training of police officers, mental health care and housing support for people who are homeless and mentally ill, community support for mentally ill individuals after incarceration, and a system for identifying youth at risk for mental illness.Today Roberts hopes that the effort to better understand what happens when police encounter people with mental illness will honor the memory of Danner.“Our ability to care for our patients, and our ability to support the broader public mental health of everyone in our society, is deeply wrapped up in how the criminal justice system treats people. We hope our work on these questions can help shed some light on those dynamics and that the psychiatric profession can be an important part of meaningful solutions.” ■ResourcesFatal Force Database“The Death of Deborah Danner”California Reporting Project“The Deborah Danner Story: Officer-Involved Deaths of People Living with Mental Illness” ISSUES NewArchived