People with Mental Illness

by Gary Cordner

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.

§ Unfortunately there is not one standard definition of mental illness. Medical doctors, research scientists, psychiatrists, psychologists, and social workers define it differently depending on whether their focus is more on organic conditions, personality, or behavior. One working consensus definition designed for policy makers is “Mental illness is a biopsychosocial brain disorder characterized by dysfunctional thoughts, feelings, and/or behaviors that meet DSMIV diagnostic criteria” (Kelly, 2002). The same report identifies the main examples of serious mental illness as:

• All cases of schizophrenia (a psychotic disorder)
• Severe cases of major depression and bipolar disorder (mood disorders)
• Severe cases of panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder (anxiety disorders)
• Severe cases of attention deficit/ hyperactivity disorder (typically, a childhood disorder)
• Severe cases of anorexia nervosa (an eating disorder).

Timothy A. Kelly (2002) “A Policymaker’s Guide to Mental Illness.” Washington, DC: The Heritage Foundation.

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.

Common Situations

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.

Dangerousness

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.

Harms

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.

Related Problems

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/