The Role of Police in Providing Mental Health Services

This week we will be reviewing an academic article, The Police and Mental Health. We will then discuss the role that the Austin Police Department plays in responding to psychiatric emergencies in the Texas capital.

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In 1963, John F. Kennedy and the American Congress passed the Community Mental Health Act to support the deinstitutionalization of people with mental illness or intellectual disabilities. This led to a major shift away from long-stay, inpatient facilities, towards creating community-based outpatient facilities that upheld the dignity and self-determination of clients. The Americans with Disabilities Act (ADA) was passed in 1990 to further protect those with a physical or mental disability from discrimination. In fact, Olmstead vs. L.C. is a famous Supreme Court case which upheld the rights of people with disabilities and protected them from inappropriate institutionalization when outpatient services were available.

Due to this shift away from institutionalizing people with mental illness and fewer psychiatric hospitals, police departments and emergency dispatch have become the first line responders to mental health crises like suicidal outcries or psychotic episodes (Shapiro et al., 2014). These crises can be sensitive, or even dangerous, depending on the person’s mental status. However, the majority of police officers do not receive adequate training in working with people who have mental illnesses, which can lead to unnecessary arrest, the criminalization of mental illness or even the use of deadly force (Borum, 2000; Lamb, Weinberger & DeCuir, 2002).

Police officers have a large amount of discretion when deciding how to respond to people with mental illness. This problem is further exacerbated within communities that have limited community mental health services; in fact, a jail may be more equipped to provide mental health care than a community hospital or clinic can offer (Lamb, Weinberger & DeCuir, 2002). When police officers choose to arrest a mentally ill citizen due to lack of available mental health facilities, it is referred to as a “mercy booking” (Lamb, Weinberger & DeCuir, 2002; Shapiro et al., 2014). Accordingly, the three largest providers of inpatient psychiatric services in the US are jails (NPR, 2011).

In order to address the lack of mental health and crisis intervention training that police officers receive, police departments have started to collaborate with local mental health workers. Ideally, this collaboration would facilitate an accurate assessment of the person in crisis, and insure that people in distress are referred to the appropriate services. Additionally, the hope is that a mobile crisis team will not only reduce arrests, but also hospitalizations (Lamb, Weinberger & DeCuir, 2002).

A few different tactics are currently being implemented across the US, the Crisis Intervention Team (CIT) or “Memphis Model” being the most popular (Shapiro et al., 2014). The CIT model provides mental health training for designated police officers, who are then dispatched to respond to calls that involve a person with mental illness (Lamb, Weinberger & DeCuir, 2002). However, these designated police officers do not solely work with people with mental illness, and perform standard police duties in between crisis interventions (Boscerato et al., 2014). Therefore, some police officers may choose to arrest a person with mental illness due to familiarity with the criminal justice system, or to save time, as transportation and assessment at a psychiatric emergency facility can be time consuming (Lamb, Weinberger & DeCuir, 2002).

While limited data is available, some studies suggest that mobile crisis teams can reduce arrest rates down to 2% (Lamb, Shaner, Elliot, Decuir & Foltz, 2001). However, a full understanding of the impact of mobile crisis units is difficult due to the variability in program implementation and models. Either way, one major benefit to collaboration between police departments and community mental health services, particularly those provided by the department of mental health, is access to previous medical records and hospitalizations(Lamb, Weinberger & DeCuir, 2002). This information can help the crisis team approach the situation in an informed manner, and it can also aid in the intake process if a hospitalization is required.

The Role of Police in Responding to Mental Health Emergencies in Texas

texas flag_mapIn 1993, the Texas legislature passed a Health and Safety Code that required at least one designated officer per county be trained as a mental health “peace officer.” This designation requires a minimum of 40 hours of training in the identification and appropriate methods of responding to person with mental illness. Once a peace officer has completed the necessary training, he/she is able to apprehend, or hospitalize, a person with mental illness. It also allows the officer to transport a person with mental illness to a designated hospital for emergency psychiatric services.

Then in 2005, the Texas Senate passed Senate Bill 1473, dubbed the Bob Meadours Act, which requires training in “de-escalation and crisis intervention techniques to facilitate interaction with persons with mental impairments.” Bob Meadours was Texas resident with bipolar disorder that was shot and killed by officers during a response to a 911 call in which the mother called and requested mental health care workers to help her respond to a psychiatric emergency (Khanna, 2004).

Accordingly, Austin provides two options for crisis and emergency services: the Austin Crisis Intervention team (CIT) through the Austin Police Department (APD) and a Mobile Crisis Outreach Team (MCOT) through Austin Travis County Integral Care (ATCIC). The main difference between these crisis services is the level of emergency; immediate emergencies are handled by the CIT team, while less immediate psychiatric crises are handled by the MCOT. However, for Travis County residents that live outside of Austin,  there is also a Travis County Crisis Intervention Team (CIT).

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While the creation of CIT teams is a direct response to the 1993 Health and Saftey Code and the 2005 Bob Meadours Act, there are still limitations of the crisis response programs currently in place. Requiring one peace officer per county may not be adequate in terms of the need of each county. In fact, some studies suggest that people with mental illness are at higher risk of being shot by police officers, and make up 58% of police shootings (Torrey, Kennard, Eslinger, Biasotti, & Fuller, 2013; US Department of Justice, 2014). In fact, a Dallas resident with schizophrenia, Jason Harrison, was shot by police officers in June 2014 while responding to a 911 call (WARNING: the attached link includes a video with graphic content). Therefore, it may be beneficial for all police officers to receive training in crisis management and mental health emergencies, not only county peace officers.

References

Borum, R. (2000). Improving high risk encounters between people with mental illness and police. Journal of the American Academy of Psychiatry and the Law,28.

Boscarato, K., Lee, S., Kroschel, J., Hollander, Y., Brennan, A., & Warren, N. (2014). Consumer experience of formal crisis‐response services and preferred methods of crisis intervention. International journal of mental health nursing,23(4), 287-295.

Khanna, R. (2004). Bob Meadours. Houston Chronicle. Retrieved from http://www.chron.com/news/article/Bob-Meadours-1478583.php

Lamb, H. R., Shaner, R., Elliott, D. M., Decuir, W. J., & Foltz, J. T. (2001). Outcome for psychiatric emergency patients seen by an outreach police–mental health team. New directions for mental health services, 2001(90), 67-76.

Lamb, H. R., Weinberger, L. E., & DeCuir Jr, W. J. (2002). The police and mental health. Psychiatric Services, 53(10), 1266-1271. 

National Public Radio. (2011). Nation’s Jails Struggle with Mentally Ill Prisoners. Retrieved from: http://www.npr.org/2011/09/04/140167676/nations-jails-struggle-with-mentally-ill-prisoners

Texas Legislature. (1993). Health and Safety Code, Title 7: Mental Health and Mental Retardation, Subtitle C, Texas Mental Health Code, Chapter 573 Emergency Detention. Retrieved from http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.573.htm

Torrey, E. F., Kennard, A. D., Eslinger, D. F., Biasotti, M. C., & Fuller, D. A. (2013). Justifiable Homicides by Law Enforcement Officers What is the Role of Mental Illness? Treatment Advocacy Center. Retrieved from http://tacreports.org/storage/documents/2013-justifiable-homicides.pdf

Shapiro, G. K., Cusi, A., Kirst, M., O’Campo, P., Nakhost, A., & Stergiopoulos, V. (2014). Co-responding Police-Mental Health Programs: A Review.Administration and Policy in Mental Health and Mental Health Services Research, 1-15.

US Department of Justice. (2014). Letter to Albuquerque Police Department. Retrieved from http://www.justice.gov/crt/about/spl/documents/apd_findings_4-10-14.pdf

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