When Health and Police Sectors Collaborate to Improve Access to Mental Health Care: A Qualitative Study on the Implementation of a Mixed Healthcare and Police Team

Mental health care among marginalized populations in the United States

BackgroundPolice officers constitute a work force at high risk due to their highly demanding work conditions. In a realistic paradigm, these conditions, and other determinants of their psychological health, can be linked to a multitude of variables that interplay altogether. However, current literature that simultaneously models–quantitatively from observed data–such a multitude of variables is sparse. This study took upon this objective to further theoretical and applied understandings through a measurement framework on empirical data, and allow the data to drive some features of model development, such as variable groupings into factors, and paths between factors.MethodsA total of 1312 officers from various police bureaus fully responded to a questionnaire composed of validated instruments for assessing factors related to psychological and occupational health, consisting of more than 25 variables. Statistical analyses were performed in progressing complexity, namely t-tests, correlations, multiple regression, factor analysis, and path analysis with latent factors.ResultsThe regression analysis identified 10 significant variables, in which decision latitude, organizational justice, and work recognition/meaning were the most protective, and these 10 variables coincided with those found significant in the t-test and correlational results. In higher complexity, the latent path analysis resulted in a model of 6 factors: Psychological Health, Organizational Constraints, Trauma Exposure, Perceived Resources, Sense of Agency, and Esteem. Organizational Constraints (β = -0.32, inferred by psychological demands and role conflict), Perceived Resources (β = 0.31, social support, a self/work-esteem subfactor, and organizational justice), Sense of Agency (β = 0.30, decision latitude, hierarchical position, right to carry a firearm), and Trauma Exposure (β = -0.14, frequency/time since event, used a firearm, years of service) were found significantly associated with Psychological Health. Within each factor, specific variables could be identified as the most associated, such as role conflict for constraints, self/work-esteem for resources, decision latitude for agency, and frequency of and time since trauma for trauma exposure. Our results therefore encourage us to take into account not only agency, but also past professional experiences in models for managing well-being.ConclusionsProviding police officers with social support at work, recognition, work meaning, fair proceedings and pay (organizational justice, especially for female and young officers), decision-making power (decision latitude), and minimizing conflictual information and procedures (role conflict) is of utmost importance. Officers with higher years of service, working in lower population cities, and who recently used their firearm, should be considered for trauma counseling. The degree of psychological demands of police officers should be regularly assessed, and reduced if possible. Reminders of support and integration in the force for officers with variables linked to a perceived lack of agency may be useful in their facing work challenges. Future integrative modeling research may be crucial to better understanding the relative contribution of each variable and their interplay in realistic settings, providing also a framework for measurement.

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.

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

Images of a young girl holding a knife were recently broadcast across television stations in Australia. The story described how Courtney Topic, a 22-year-old woman from the western suburbs of Sydney, Australia, was tasered and shot dead by police only 5 min from her family home. Prior to the shooting, Courtney, diagnosed in the past with Asperger's syndrome, left a takeaway restaurant and entered a street where she was pictured holding a soft drink cup in one hand and a large knife in the other. Minutes later, she was dead. Courtney leaves behind devastated parents and three siblings. This occurred on 10 February 2015. In the Australian context, the deinstitionalization movement, which saw the care of individuals with mental illness moved to the community often without the requisite resources, means that police officers are now the first and often only responders to mental health crises in the community (Clifford 2010; Sced 2006). Media reports for New South Wales alone indicate that police were 'tasked' to almost 43 000 mental health incidents in 2013; approximately 118 calls per day (The Daily Telegraph 2015). Sadly, such situations have become increasingly more common and more complicated (Clifford 2010), leaving police officers challenged and frustrated, often because of the perceived threat associated with individuals with a mental illness. As a consequence of this perceived threat and the police callouts related to mental health incidents, rates of fatal shootings of individuals with mental illness are now problematic in Australia and across many other countries. Fortunately, shootings by police remain relatively rare in Australia, although higher in Victoria than other states. In Victoria, it has been noted that the prevalence of police shootings, '… has aroused significant public disquiet' (Chappell 2008; p. 41). Between 1989–2011, there were 105 fatal shootings involving police, 44 (42%) of which involved the deceased having some form of mental illness, with psychotic disorders such as schizophrenia being the most common (59%) (Australian Institute of Criminology 2013). Even though police have been provided with new and less coercive techniques to disarm or disable people, shootings of individuals with a mental illness continue to be an issue of concern, nationally and internationally. Chappell (2008) argues that the use of force by police officers, especially deadly force, is a reflection of an individual's commitment to civil liberty, primarily the civil liberties of the citizens they are expected to protect. Despite international law enforcement norms stressing the use of non-violent means prior to the use of force or firearms, we continue to witness the shooting of individuals with a mental illness across the globe. Many of us have been required to disarm clients of a variety of weapons during our careers as mental health nurses. Thankfully, for most of us, these dangerous episodes have ended without harm to either party; resolution of such situations without tragic outcomes is not an unreasonable expectation (McDermott 2009). So why then do police shootings of individuals with a mental illness continue? Members of the community often perceive individuals with a mental illness as dangerous, and police officers are no different. As a result, police officers respond to individuals with a mental illness as persons of threat, often leading to unfortunate outcomes. In addition, police training for critical incidents involving threat enforces the need to shoot at the 'centre of seen mass' as the most appropriate way to defuse such situations (Meadows 2015). In cases where an armed person continues to threaten police officers, it is considered appropriate for the officer to pull a gun and to shoot at the centre of that threat in order to end the situation (Meadows 2015). Unfortunately, for individuals with a mental illness, many of whom become distressed or confused when under threat leading them to react in unpredictable ways, the end of the situation increasingly involves a fatal shooting. Police have a stressful job and in most cases conduct themselves in a professional manner (Chappell 2008). What is often lost in situations like the one described above is the impact on the police officers. Police officers involved in fatal shootings often never fully recover (Carroll 2005); their lives will never be the same after the incident. In addition, of course let us not forget the impact on the families of both shooter and victim; surely their lives would never be the same again. Experience demonstrates the best responses to people experiencing mental health crises in the community involve multi-agency cooperation and collaboration at local, regional, and national levels. Ensuring cooperation across health, welfare, community support, and emergency services and the provision of professional, timely, and safe responses to people who have a mental illness and their carers is not the sole responsibility of police. It is a whole-of-government issue requiring whole-of-government consideration and response. Deinstitutionalization and the subsequent inadequate provision of community-based mental health services have substantially contributed to the present crisis, a crisis that is shared with many countries. It reflects inadequate planning and service provision following deinstitutionalization and a lack of foresight by policy makers regarding the impact of these changes upon police services (Cotton & Coleman 2010; Teplin & Pruett 1992). Deinstitutionalization and the limited mental health services in the community have increasingly generated an expectation that the criminal justice system can deal with those who have a mental illness (or multiple illnesses) in an appropriate way. Arguably, these people should not be in the criminal justice system at all but rather should be dealt with by the health-care system. Indeed, significant numbers of those dealt with by the criminal justice system are suffering from (frequently) untreated or poorly managed mental illness. Ever increasingly, police are called to situations involving people with a mental illness and are required to intervene in some way. Research suggests that those with mental illness are three times more likely to interact with police than the general population (Cotton & Coleman 2010), and that 20–40% of those with a severe mental illness will be arrested in their lifetime (McLean & Marshall 2010). Their actions towards some of the most disenfranchised, marginalized, and powerless in society (people with a mental illness) is a sad and sorry reflection of past decisions to deinstitutionalize vulnerable mental health patients without societal investment in supports. We hope this editorial raises awareness about the issues involved in the fatal shootings of individuals with a mental illness and about the perceived threat that individuals with a mental illness pose to society. Our ultimate aim is to argue for enhanced support of police officers so they are better prepared to manage individuals with a mental illness in the community, and for innovative and collaborative care partnerships between police and mental health nurses. Hopefully, these strategies will result in practices that will reduce the number of police shootings of individuals with a mental illness in the future.

Back to table of contents Previous article Next article Professional NewsFull AccessUntreated Chronic Illness Blamed for High MortalityRich DalyRich DalySearch for more papers by this authorPublished Online:15 Aug 2008https://doi.org/10.1176/pn.43.16.0007Contrary to what may be a popular belief, a person with serious mental illness is more likely to die of a heart attack or complications from diabetes than by suicide.Misperceptions about the health care needs of people with mental illness extend even to health care professionals, which may be one of the reasons such patients are dying prematurely—25 to 30 years earlier than other Americans, according to federal health statistics. This gap in life expectancy is an increase from the 10- to 15-year mortality difference in the early 1990s between individuals with mental illness and others.To reverse this trend, advocates for people with mental illness recently called for federal intervention, including improving the tracking of these individuals' physical and mental health; removing obstacles to their receiving quality, integrated physical and mental health care; and encouraging primary care providers to work in close proximity in the same facility with mental health clinicians to improve provision of that care.“We have to get past the point of psychiatrists saying 'I don't do that internal medicine stuff,' and internists saying 'I don't want to take all of the time that people with mental illness need,'” said Joe Parks, M.D., medical director of psychiatric services for the Missouri Department of Mental Health.Parks and other mental health experts briefed congressional staff in June on the need for federal efforts to reverse the declining life expectancy for people with serious mental illness. The briefing was organized by the Senate Mental Health Caucus.It was Park's 2007 report that identified the lower life expectancy of people with serious mental illness compared with the general population and that dispelled the “suicide” stereotype behind the early deaths. Early deaths, Parks said, were largely due to untreated or undertreated nonmental chronic health conditions. Among the leading preventable medical conditions driving the increased morbidity and mortality in this population were metabolic disorders, cardiovascular disease, and diabetes mellitus.Park's research also found a high prevalence of modifiable risk factors, including obesity and smoking. Cigarette use, he noted, is so widespread among people with serious mental illness that they now smoke about 44 percent of all cigarettes sold in the United States. “We really need to focus on smoking because it is a big opportunity” to prevent disease and death, Parks said.The prevalence of risk factors among people with serious mental illness is exacerbated by poor health care access among this population and by the stigma they face—even from medical professionals, according to a consensus of the literature.Similar health disparities exist even in populations with broad access to health care, such as veterans, said Barbara Mauer, a health care consultant in Seattle. Mauer, who has studied the issue, blamed both the negative attitudes of health care providers toward mental illness and a failure to educate patients to seek both needed mental and primary health care.Research studies designed to address disparities between mental health care and general health care have found health improvements when nurse case managers coordinate both mental and physical care for each patient, while educating and giving patients new skills to better manage their own illnesses.Analysis of one nurse case manager pilot program found that medical problems were newly detected by staff in one-third of participating patients taken to a mental health facility for evaluation and treatment. At the same time, there was an increase in disease-prevention health care provided to these patients.Another pilot program approached the challenge of split—and therefore fragmented—mental and general health care from the behavioral health care side by placing nurse practitioners in mental health clinics. In one such program in Massachusetts, the nurse practitioners ensured that the mental health patients also received general health care services.A Colorado pilot program that is addressing health care providers' negative attitudes toward mental illness and improving access to care has found some success. The integrated care program in Summit County combined the staffs of a community health center and a mental health clinic to create “care teams” of general and mental health care providers within a facility that had previously emphasized general health care. The program provided training for the mental health staff in the common physical health care needs of people with mental illness and educated the general health care providers on signs that patients may also need mental health and substance abuse treatment.Among the biggest impacts of the program was the improved communication it encouraged between two traditionally separate organizations, to the extent that both were comfortable referring patients and seeking additional information from the other side of the program.“It's important to share our knowledge and share our ignorance,” said Helen Royal, a nurse in the program.Advocates at the congressional briefing said the federal government can encourage such pilot programs by including funds for them in their established grant programs.Also, the Community Mental Health Services Improvement Act (S 2182 and HR 5176) would create a new grant program through the Substance Abuse and Mental Health Services Administration (SAMHSA) to fund the co-location of primary care services within mental health organizations. The legislation, which would provide $50 million in grants for the first year of a five-year program, was included in draft legislation to reauthorize SAMHSA, but that legislation has stalled for the year.Supporters are optimistic that the grant program will be revived in Congress next year, along with efforts to require insurers to cover smoking cessation and obesity treatment programs.The text of S 2182 and HR 5176 can be accessed at<http://thomas.loc.gov> by searching on the bill numbers. ▪ ISSUES NewArchived

Purpose This qualitative study explores Midwest, USA law enforcement officers' perspectives on mental health, job-related stress and the accessibility and effectiveness of available wellness resources. Design/methodology/approach Thirty-seven officers participated in confidential, semi-structured phone interviews. Thematic analysis was conducted by three researchers across four rounds of coding to ensure depth, rigor, and inter-rater reliability. Findings Key themes included pervasive mental health stigma, maladaptive and adaptive coping, barriers to help-seeking and leadership involvement. Officers emphasized the need for flexible, non-punitive mental health resources, including internal and external programs. Recommendations include expanding culturally competent, incentive-driven mental health supports; integrating mental health conversations into daily operations; securing funding for dedicated wellness staff and evaluators; sustained funding for law enforcement mental health and wellness initiatives, and specific mental health resources deemed helpful by participants. Research limitations/implications These findings contribute to the growing research that addresses the mental health crisis among police officers across the globe. They provide key insight into police officers' own, at times vulnerable, perspectives. Practical implications These findings highlight the urgent need to normalize mental health support and create diverse, proactive, stigma-reducing strategies within police agencies. Social implications This study underscores the urgent social need to reduce stigma around mental health in policing and promote a culture that encourages emotional well-being. Amplifying officer voices reveals how current structures often isolate officers and deter help-seeking, which can harm families, communities and workplace morale. The findings call for systemic changes that can strengthen officer resilience, improve public trust and support safer, more sustainable policing. Originality/value This research offers a rare, in-depth look at police officers' own narratives about mental health, collected through confidential interviews and analyzed with a rigorously collaborative coding process. Its focus on officers' lived experiences across gender and rank, including female perspectives often overlooked in policing research, adds a unique and underrepresented dimension to the study of law enforcement wellness.

Differences in HIV Care Between Patients With and Without Severe Mental Illness

This edition of the Australian Journal of Rural Health is a thematic issue with a special focus on rural mental health. In 1993, the Human Rights and Equal Opportunity Commission’s Human Rights and Mental Illness report (The Burdekin Report) focused public attention on many mental health problems including those in rural areas. 1 Two chapters of that report presented findings regarding people in rural and isolated areas and Aboriginal and Torres Strait Islander people. They highlighted issues including the distribution of services, difficulties for health professionals and historical and cultural issues regarding Aboriginal and Torres Strait Islander people. More recently, The Burden of Disease and Injury in Australia report found that mental illness is a major cause of morbidity and disability. 2 To date, there is little available research evidence detailing mental health morbidity and mortality patterns in rural and remote areas. As everywhere, environmental and cultural factors are likely to be key determinants of mental health in these areas. When asked, people in small rural communities describe a range of positive and negative aspects of the rural lifestyle that affect health and wellbeing. 3 Generally, however, they do not recognise the impact of the rural culture with its combination of close-knit communities emphasising mutual support, together with independence and self reliance. Often mental illness is seen as ‘weakness’ and those suffering more serious mental illnesses are stigmatised by the rural community. Three of the articles in this edition explore conceptual aspects of rural mental health. Wainer and Chesters 4 explore the distinction between mental illness and mental health in the rural context, drawing on historical perspectives and personal experiences of individual case examples. Subsequently, they describe the determinants of positive mental health in a rural context before concluding that there is a need for balanced social and economic developments as well as improved mental health services in rural and remote areas. Fuller et al. explore the ‘definition’ of mental health problems as perceived by people in rural and remote areas. 5 This research report confirms the reluctance of rural people to acknowledge mental health problems and the stigma associated with formal mental health services as well as the influence of rural and remote circumstances. The third conceptual article explores the gender roles and the emotional distress of women in urban, rural and remote areas of Queensland. 6 The study found that positive gender roles are more frequent in rural and remote areas and associated with lower levels of emotional distress. The authors’ conclusion is that an understanding of rural and remote mental health requires more sophisticated analysis than that based only on geographical location. The authors suggest that factors such as gender roles and other aspects of the rural culture may be important. Three of the articles are focused on clinical service delivery in rural and remote areas with a common emphasis on mutual support of rural health-care providers. Allison et al. evaluate a pilot clinical intervention in a rural setting. Their findings suggest that targeted short-term specialist interventions may often bring substantial improvements for mild to moderate mental health problems in rural and remote areas. 7 Malcolm, in her paper entitled A primary mental health-care model for rural Australia: Outcomes for doctors and the community, describes a successful mental health services delivery model with an emphasis on multidisciplinary teamwork in the rural setting. 8 Harvey describes the genesis and development of the rural psychologists’ network, which provides professional support and communication for counselling psychologists in rural and remote areas. 9 A recurring theme through several of the articles is the need for mental health service delivery models that are effective and successful in the context of rural community attitudes, geographically dispersed populations and serious workforce shortages. Local generalist nurses and doctors are the main providers of mental health care in small rural and remote communities. The quality and effectiveness of their services are likely to be enhanced where they are supported by distant specialist services and health-care providers. These specialist services and providers should fulfil a true consultant role, providing support, guidance and training to the on-the-ground practitioners in small communities. The final article in this thematic issue reports an initiative that is expected to assist workforce recruitment in the medium to long term. 10 The placement of nursing students in rural and remote mental health clinical attachments not only improves the students’ knowledge and understanding of rural and remote mental health issues, but is likely, in some cases, to raise the students’ interest in pursuing their careers in a rural setting. All the articles raise challenging questions that should stimulate considerable thought and discussion among readers. As always, letters to the editor responding to and debating issues raised by these articles are most welcome. I look forward to your comments.

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

Background/Objectives: Integrating behavioral health and primary care services is a national public health priority in the US, especially in underserved settings like northern Arizona. This healthcare delivery model is crucial to meet the mental and physical health needs of people with SU/SUDs, particularly those belonging to culturally diverse populations. In collaboration with a behavioral health center in northern Arizona, the current study aimed to assess the perspectives of providers and administrative staff on the implementation of integrated primary care (IPC) services for people with SU/SUDs. Methods: In February 2023, twelve healthcare providers and administrative staff from diverse educational backgrounds were recruited using purposive sampling to capture a range of perspectives on IPC implementation at the behavioral health center. Participants completed individual, semi-structured interviews conducted via Zoom, which were audio recorded and lasted approximately 30 min. The interview recordings were transcribed verbatim using Trint Software, and analyzed on Google Docs using applied thematic analysis. Two researchers coded the transcripts, iteratively developing and refining themes through multiple cycles of review and team discussions. Additional team members provided feedback and verified the themes, with consensus reached through collaborative meetings. This rigorous, iterative approach ensured the reliability and validity of the final thematic framework. Results: We found that IPC supports SU/SUDs recovery by providing holistic care that integrates medical, mental health, and addiction services while addressing social and co-occurring needs. It fosters an empathetic environment where clients do not need to repeatedly disclose their SU/SUDs, improves access to preventive care, and offers continuous support and education. Implementation barriers included workforce shortages, limited internal communication, and insufficient interdisciplinary training. Gaps in culturally centered care were identified, including reliance on Western models, limited representation of Native American and sexual and gender minority staff, and inconsistent use of inclusive practices such as pronouns, traditional healing, and trauma-informed approaches. Additionally, community partnerships with multisectoral organizations help clients access supportive resources beyond the facility, including vision care, clothing, and dental services. Conclusions: The implementation of IPC was seen as important to support the behavioral health center in northern Arizona to foster an empathetic environment where clients with SU/SUDs can have their mental, physical, and social needs addressed, either within the facility or through community partnerships, thereby supporting their recovery. However, progress is hindered by barriers such as workforce shortages, limited internal communication, and insufficient interdisciplinary care training. Additionally, despite regular cultural competency training, gaps remain in culturally centered care for underserved populations, particularly Native American and sexual and gender minority clients.

Police officers as first responders to acute mental health crisis in the community, commonly transport people in mental health crisis to a hospital emergency department. However, emergency departments are not the optimal environments to provide assessment and care to those experiencing mental health crises. In 2012, the Northern Police and Clinician Emergency Response (NPACER) team combining police and mental health clinicians was created to reduce behavioural escalation and provide better outcomes for people with mental health needs through diversion to appropriate mental health and community services. The aim of this study was to describe the perceptions of major stakeholders on the ability of the team to reduce behavioural escalation and improve the service utilization of people in mental health crisis. Responses of a purposive sample of 17 people (carer or consumer advisors, mental health or emergency department staff, and police or ambulance officers) who had knowledge of, or had interfaced with, the NPACER were thematically analyzed after one-to-one semistructured interviews. Themes emerged about the challenge created by a stand-alone police response, with the collaborative strengths of the NPACER (communication, information sharing, and knowledge/skill development) seen as the solution. Themes on improvements in service utilization were revealed at the point of community contact, in police stations, transition through the emergency department, and admission to acute inpatient units. The NPACER enabled emergency department diversion, direct access to inpatient mental health services, reduced police officer 'down-time', improved interagency collaboration and knowledge transfer, and improvements in service utilization and transition.

CAHOOTS, a thirty-year-old Oregon program, has reduced calls to police and saved money. Now it's going national.

Law enforcer or social worker? Exploration of the role of police in responding to persons with mental illness

Back to table of contents Previous article Next article LetterFull AccessLetterElaine Boyd R.N., M.A.Elaine Boyd R.N., M.A.Search for more papers by this authorPublished Online:1 Dec 2006https://doi.org/10.1176/ps.2006.57.12.1811AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Appropriate Use of Police Officers?To the Editor: A column in the November issue ( 1 ) and a research report in the February issue ( 2 ) describe crisis intervention training (CIT) for police officers in Ohio. These reports are important because they offer a possible solution to the dilemma of sending police officers to interact with mental health patients in critical situations. As a psychiatric nurse and the wife of a police lieutenant, I appreciate the authors' attempt to address this problem. Their emphasis on encouraging partnerships between law enforcement and mental health providers is a progressive approach. The Ohio CIT program trains officers to recognize persons who are experiencing acute symptoms of mental illness and provides them with deescalation tools. Officers are also informed about available community resources. The authors describe an alternative paradigm that would benefit the health care and law enforcement communities and, more importantly, place responsibility for the care of these patients in more appropriate hands. A crisis intervention model could be developed in which dispatchers are trained to identify mental disturbance calls and dispatch emergency medical technicians and paramedics.A primary concern, however, involves training police officers to handle mental health crises. Police officers are not health care providers. A 40-hour course will provide much-needed information but should not be viewed as a solution to the emergency needs of mental health clients. The study in the February issue demonstrated an increase in the number of dispatch calls "related to mental disturbances" after the training. Heightened awareness of mental health issues among dispatchers as a result of the CIT training is the likely explanation. However, the dispatchers were given no additional training about how to triage these individuals appropriately. Dispatchers need to be trained to evaluate the situation by asking the correct questions and reporting the right information to the most appropriate emergency medical technicians and paramedics.Law enforcement officers are being assigned greater responsibility in our communities. In addition to providing for the safety of citizens and property, many are required to participate in activities such as Drug Abuse Resistance Education, community policing, Neighborhood Watch, bioterrorism preparation, and public education. Is it the best use of training dollars to prepare law enforcement officers to become experts in dealing with health care conditions? Paramedics have the background to deal with acutely ill patients. The Emergency Medical Technician Paramedic: National Standard Curriculum ( 3 ), a course for paramedics offered by the National Highway Transportation Safety Administration, covers topics such as communication, clinical decision making, and management of the combative mental health client, which provide a foundation for handling mental disturbance calls. Educational standards for police officers differ between states. However, a review of training options for police officers, including degree programs at Missouri Southern State University and training offered by California Peace Officer Standards and Training ( 4 ) and the New York Police Department ( 5 ), reveals that most offer little or no education about persons with mental illness. Dispatching police officers to determine whether patients require emergency treatment, placement, or arrest further criminalizes and demoralizes persons with mental illness. Emergency medical service personnel are the appropriate resource for crisis intervention for the mental health client. Ms. Boyd is a psychiatric nurse at Crittenton Children's Center, Kansas City, Missouri.