(Jan. 17, 2018) It has been more than two years since the Treatment Advocacy Center published its landmark report on the overlooked and undercounted role of serious mental illness in fatal law enforcement encounters. The report highlights the dearth of official data in law enforcement homicide reporting and the often overlooked role and disproportionate impact of mental illness on fatal law enforcement encounters. It then made recommendations to lawmakers on how to improve reporting and data collection for arrest-related deaths.
Despite the national attention on this issue, new data from the Washington Post suggests no improvements have been made. They found that there were almost 1,000 arrest-related deaths in 2017 and that more than one quarter of those victims had some form of mental illness. "The lack of appreciable change in the numbers is a depressing sign that, though much attention has been focused on this issue in the past three years, authorities are falling short in devising and implementing solutions," according to the Washington Post editorial board.
Across the country, the unavailability of appropriate psychiatric treatment has forced people with mental illnesses into unnecessary-- and too often dangerous--encounters with law enforcement officers, rather than medical personnel. Solutions for improving outcomes of police encounters with individuals who have serious mental illness have also been examined in academic literature. Recommended models from academic studies include crisis intervention training (CIT) and law enforcement and mental health co-response teams. New research from Albuquerque, New Mexico, suggests that partnerships between law enforcement and mental health professionals are key in order to improve outcomes and reduce the tragedies that are a result of this tendency towards the criminalization of mental illness.
Scope of the problem
Nils Rosenbaum, MD, Mauricio Tohen, MD, and Detective Mathew Tinney, from the Albuquerque Police Department, published the results of their partnership in 2017 in a report in the American Journal of Psychiatry. They also included recommendations to other jurisdictions to consider adopting their practices.
As a mid-size city, Albuquerque's Police Department had more than 488,000 calls in 2014, according to the article. National estimates indicate that between 3% and 10% of police calls involve people with mental illness, but a survey of Albuquerque police officers showed that officers believed that one-third of their calls involved people with mental illness. Therefore, Albuquerque officers are responding to anywhere between 14,500 and 146,400 calls involving individuals with mental illness in a single year.
"More emergency mental health evaluations are done by law enforcement than by three of the largest psychiatric emergency departments combined," according to the report. In addition, 20% of the most serious mental health cases seen at the University of New Mexico Hospital's psychiatric emergency department are brought in by the Albuquerque Police Department.
Evidence-based solutions
In order to provide better responses to individuals with mental illness, the Albuquerque Police Department employs a full-time psychiatrist. In addition, the police department has also expanded its use of its crisis intervention unit - a unit of CIT trained officers who collaborate with the psychiatrist on staff as well as with local mental health services in the community.
According to the report, since the expansion of the program in 2014, police use of force and officer-involved shootings have decreased. In 2015, the report found that less than 2% of encounters resulted in use of force by a police officer, and, in addition, less than 2% of mental health coded calls resulted in arrest while 80% resulted in transport to a hospital.
The addition of a psychiatrist to the response team has added important value to serve the community. More than 15% of patients evaluated by the psychiatrist in the field were brought to the hospital, and of those, 89% were admitted. Individuals not admitted are provided follow-up care in the community.
Recommendations for applying solutions
Albuquerque Police Department attributes the success of the program to three elements: inclusive collaboration, training and coordinated responses.
With the help of a program coordinator, the CIT program collaborates with local mental health service providers, corrections departments, homeless service providers, peers and family. Training includes both foundational as well as advanced knowledge courses that includes safety, reducing stigmatization and finding resources. Finally, the coordinated response of law enforcement, CIT trained officers and the psychiatrist on staff forms the foundation of the effective partnership.
As Rosenbaum so accurately writes, "increased collaboration between psychiatrists and law enforcement will help prevent situations in which police officers are placed in the awful position of having to use lethal force against a person with mental illness."
Elizabeth Sinclair
Research Associate
References:
- Rosenbaum, N. et al. (June 2017). Collaborating to reduce tragedy and improve outcomes: Law enforcement, psychiatry, and people living with mental illness. American Journal of Psychiatry.
- Sullivan, J. et al. (January 2018). Nationwide, police shot and killed almost 1,000 people in 2017. Washington Post.