The Problem of People with Mental Illness
Problems associated with people with mental illness pose a significant challenge for modern policing.
[1]
This guide begins by describing the problem and reviewing factors that
increase the challenges that police face in relation to the mentally
ill. It then identifies a series of questions that might help you
analyze your local policing problems associated with people with mental
illness. Finally, it reviews responses to the problems and what we know
about these from evaluative research and police practice.
Police officers frequently encounter people with mental
illness—approximately 5 percent of U.S. residents have a serious mental
illness,
§ and 10 to 15 percent of jailed people have severe mental illness.
[2] An estimated 7 percent of police contacts in jurisdictions with 100,000 or more people involve the mentally ill.
[3]
A three-city study found that 92 percent of patrol officers had at
least one encounter with a mentally ill person in crisis in the previous
month,
[4]
and officers averaged six such encounters per month. The Lincoln
(Nebraska) Police Department found that it handled over 1,500 mental
health investigation cases in 2002, and that it spent more time on these
cases than on injury traffic accidents, burglaries, or felony assaults.
[5] The New York City Police Department responds to about 150,000 “emotionally disturbed persons” calls per year.
[6]
It is important to recognize at the outset that mental illness is
not, in and of itself, a police problem. Obviously, it is a medical and
social services problem. However, a number of the problems caused by or
associated with people with mental illness often do become police
problems. These include crimes, suicides, disorder, and a variety of
calls for service. Moreover, the traditional police response to people
with mental illness has often been ineffective, and sometimes tragic.
Over the last decade, many police agencies have sought to improve
their response to incidents involving people with mental illness,
especially emergency mental health situations. These new developments,
however, have been targeted almost exclusively at improved handling of
individual incidents. Little attention has been devoted to developing or
implementing a comprehensive and preventive approach to the issue.
Police officers encounter people with mental illness in many
different types of situations, in roles that include criminal offenders,
disorderly persons, missing persons, complainants, victims, and persons
in need of care (see table). According to one Texas study,
[7] the five most frequent scenarios are as follows:
- A family member, friend, or other concerned person calls the police for help during a psychiatric emergency.
- A person with mental illness feels suicidal and calls the police as a cry for help.
- Police officers encounter a person with mental illness behaving inappropriately in public.
- Citizens call the police because they feel threatened by the
unusual behavior or the mere presence of a person with mental illness.
- A person with mental illness calls the police for help because of imagined threats.
Of these typical situations, ones involving the threat of suicide
were rated as the most difficult to handle. Each of the others listed
above was rated as somewhat difficult to handle. The two behaviors that
were rated as most problematic overall were threatening suicide and
nuisance behaviors.
| Roles of People with Mental Illness and Examples
|
| Role |
Examples |
| Offender |
- A person with mental illness commits a personal or property crime.
- A person with mental illness commits a drug crime.
- A person with mental illness threatens to commit suicide.
- A person with mental illness threatens to injure someone else
in the delusional belief that that person poses a threat to him or her.
- A person with mental illness threatens to injure police as a
means of forcing police to kill him (commonly called “suicide by cop”).
|
| Disorderly person |
- A family or community member reports annoying or disruptive behavior by a person with mental illness.
- A hospital, group home, or mental health facility calls for police assistance in controlling a person with mental illness.
- A police officer on patrol encounters a person with mental illness behaving in a disorderly manner.
|
| Missing person |
- A family member reports that a person with mental illness is missing.
- A group home or mental health institution reports that a person with mental illness walked away and/or is missing.
|
| Complainant |
- A person with mental illness calls the police to report real or imagined conditions or phenomena.
- A person with mental illness calls the police to complain about care received from family members or caretakers.
|
| Victim |
- A person with mental illness is the victim of a personal or property crime.
- A family member, caretaker, or service provider neglects or abuses a person with mental illness.
|
| Person in need of care |
- Police are asked to transport a person with mental illness to or from a hospital or mental health facility.
- Police encounter a person with mental illness who is
neglecting his or her own basic needs (food, clothing, shelter,
medication, etc.).
|
These are the most common situations in which police encounter people
with mental illness. It is important to realize, though, that when
police officers handle some of these situations they do not always
realize that mental illness is involved (such as a shoplifting or a
disorderly person). Officers may try to handle the situation as usual
(by giving directions, issuing commands, or making an arrest, for
example) but not get the cooperation or compliance expected, sometimes
leading to escalating tension. This highlights the importance of
training in mental illness recognition as well as crisis management
techniques.
A fairly common perception is that people with mental illness are
disproportionately involved in violent crime. This is true in one
respect but not in another. A small subset of people with mental
illness, those who are actively experiencing serious psychotic symptoms,
are more violent than the general population. Research suggests several
factors associated with this group’s violent behavior, including drug
and alcohol abuse, noncompliance with medication requirements, and
biological or biochemical disorders.
[8]
In general, however, “violent and criminal acts directly attributable
to mental illness account for a very small proportion of all such acts
in the United States. Most persons with mental illness are not
criminals, and of those who are, most are not violent.”
[9]
Police interactions with people with mental illness can be dangerous,
but usually are not. In the United States, 982 of 58,066 police
officers assaulted in 2002, and 15 of 636 police officers feloniously
killed from 1993 to 2002, had “mentally deranged” assailants.
[10]
These represent one out of every 59 assaults on officers and one out of
every 42 officers feloniously killed—relatively small portions of all
officers assaulted and killed.
Encounters with police are more likely to be dangerous for people
with mental illness than for the police. An early study found that an
average of nine New York City police shootings per year between 1971 and
1975 involved emotionally disturbed people.
[11] Between 1994 and 1999, Los Angeles officers shot 37 people during encounters with people with mental illness, killing 25.
[12]
A review of shootings by the police from 1998 to 2001 in the United
Kingdom indicated that almost half (11 out of 24) involved someone with a
known history of mental health problems.
[13] It is estimated that people with severe mental illness are four times more likely to be killed by police.
[14]
Serious injury and death of people with mental illness at the hands of
the police are especially tragic, for obvious reasons. Reduction of such
injuries and deaths should be a high-priority objective for every
police agency.
The harms associated with the police handling of people with mental
illness are implicit in the situations and examples the table provides,
but deserve some discussion. A person with mental illness may harm other
citizens by committing personal or property crimes or engaging in
disorderly and disruptive behavior. Alternatively, a person with mental
illness may be harmed as a crime victim, as an abused family member or
patient, as a person who suffers through self-neglect, or as a person
whose mental health problem has left him or her erroneously subjected to
criminal charges and jail confinement. Society in general may be harmed
if excessive police, criminal justice, and/or medical resources are
consumed by problems associated with people with mental illness.
It is important to keep the concept of harm in mind when addressing
this particular problem, because there is a tendency to simply define
people with mental illness as the problem, and getting them out of sight
as the solution. In contrast to most police problems, however, this is
not one that involves wholly voluntary behavior— rather, it involves
behavior that medical conditions cause or compound. Consequently, police
have to be careful not to blame people with mental illness, but instead
focus on behavior that causes harm to self or others.
The police problem of people with mental illness is closely
connected to three other problems noted below. This guide does not
specifically address these problems, but addressing people with mental
illness in your jurisdiction may require that you take on these
problems, as well:
- homelessness
- drug abuse
- alcohol abuse
The people the police encounter who have mental health problems or
emergencies are also frequently homeless. For example, a Honolulu study
found that 74 percent of law violators who the police believed to have a
mental disorder were also homeless.
[15]
In London, about 30 percent of minor offenders referred for admission
to a station-house diversion program for the “mentally disordered” were
living on the streets.
[16]
Similarly, the people with mental illness the police encounter are
likely to have substance abuse problems. About three-quarters of jail
and prison inmates with mental illness also have a substance abuse
problem.
[17] Current substance abuse was identified for about half of psychiatric emergency room referrals in New York State,
[18]
and nearly two-thirds of psychiatric emergency patients evaluated by a
police-mental health outreach team in Los Angeles were known to be
serious substance abusers.
[19]
http://www.popcenter.org/problems/mental_illness/
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