For Some, Mental Health is A Death Sentence: How Reforming a Police Officer’s Role in Responding to Mental Health Crises May Save Lives

Introduction

The standard model of policing in America has operated under the label of “enforcement;” an over-generalized classification of “reactive strategies to suppress crime” that have been observed as often leading to unnecessary death and high rates of incarceration (Weisburd and Eck 116). Enforcement of the law has and remains a police officer’s primary duty. That a police officer should negate this purpose and not pursue actions of deterrence when responding to criminal behavior is criticized by some who would suggest that adjusting a police officer’s duties would result in rising crime rates, a society ruled by anarchy, and loss of life. What these critics fail to mention is the justifiable argument that a reprehensible loss of life is already taking place under the scope of current police practices. The standard model of policing, designed to punish those who commit felonies intending to make communities safer places to live, suggests that the “legitimate” authority of a police officer is found in their “law enforcement powers” (117). However, the enforcement mentality, largely sustained by how police officers are trained to do their job, is not a one-size-fits-all approach to every situation a police officer finds themselves responding to during a typical 911 call. “There is little evidence to suggest that [the] standard model of policing [leads] to communities that feel and are safer” (126). Understanding the endemic nature of mental health events is the underlying knowledge that motivates my argument that an enforcement approach is not suitable for every 911 call. Weisburd and Eck conclude “research evidence does support continued investment in police innovations and for the expansion of the toolbox of policing beyond simple law enforcement” (126). As a matter of public health and safety, police must not approach every situation with an aggressive, deterrence-oriented set of behavior tactics. Not every situation requires it. An individual experiencing a mental health crisis does not require aggressive uses-of-force as a treatment method. The very nature of their experience demands the opposite. If an individual experiencing a mental health crisis has not committed a violent crime but is nonetheless subject to having the police called as a result of their behavior, it is not difficult to comprehend that the enforcer role often associated with police would exacerbate the person’s already heightened emotional state. Changing the necessary public service required for dispatch in the event of a mental health crisis calls for taking this responsibility away from the police altogether and handing it off to parties better suited for handling such events. In this paper I will explain in further detail who these entities could be and how asking less of the police in this context would lend a hand in building a more equitable criminal justice system.

Issue

Police officers are not equipped to adequately respond to the variety of situations our society demands they are held responsible for. The fact of the matter is that “police are called to respond for minor disturbances, dispute mediation, traffic collisions, and other events that rarely need the attention of a sworn officer” (Vermeer et al. 3). Scenarios such as the ones laid out here do not, by their very nature, require enforcement. The tripping of an alarm is not always perpetrated by a malicious person in need of severe punishment for criminal activity. The same goes for low-level property crimes such as theft or larceny. Yet, we see persistent instances of lethal interactions with police that escalate beyond the necessary scope of a low-level or even non-criminal encounter. Researchers at Rowan University’s Department of Law and Justice Studies and The School of Criminology and Criminal Justice at The University of Nebraska Omaha found that “there are many documented cases of people being killed by police in situations in which there was no probable cause to make an arrest” (Shjarback and Nix 3). For this paper, I’ll use mental health events to fit this criterion. Given that “communities have opted to reduce funding for mental health treatment infrastructure,” the responsibility for dealing with mental health events has fallen on the shoulders of police officers trained solely in enforcement techniques rather than empathy-forward approaches (Vermeer et al. 3). This presents an issue because “the ability to manage the [potentially dangerous mental health crisis] might be diminished because the individual in crisis observes an armed individual approaching them” (4). One can make the logical assumption that this scenario would not end well for either the individual in crisis or the “officer trained extensively in use of force [who] might deal daily with threats to their own safety” (4). The likelihood of aggravating an already tense situation increases dramatically when an armed police officer whose sole occupational duty is law enforcement responds to an emergency call prompted by a mental health event. Police officers are unprepared, unequipped, and ill-informed on how to properly respond to a “potentially dangerous mental health crisis” (4). “A November 2016 study published in the American Journal of Preventative Medicine estimated that 20 to 50 percent of fatal encounters with law enforcement involved an individual with a mental illness” (White Bird Clinic 1). An individual experiencing a mental health event more likely than not is best suited to receive professional medical help; aid that is centered on compassion, de-escalation, and empathy. Police officers as enforcers do not fit this role. They cannot be both enforcers and caretakers at the same time. “Many law enforcement practitioners would agree that they are being asked to play too many — sometimes clashing — roles in society, and this often makes the job of a police officer difficult, if not impossible.” (12). Reforming this aspect of a police officer’s responsibility requires a community-wide effort to raise the issue to the highest levels of government where effective policy changes can take place. Collaboration between lawmakers, community members, and police officers is vital to making progressive change in this area. In the following section, I’ll detail a policy proposal that would achieve this end.

Policy Proposal

In 1989, the city of Eugene, Oregon implemented “The Crisis Assistance Helping Out on the Streets (CAHOOTS) program” (Vermeer, et al. 7). This program dispatches teams “composed of a medic and a behavioral health crisis worker” that respond to “a variety of calls regarding nonviolent situations with a behavioral health component” (7). These team members aren’t trained in law enforcement; the very nature of their work prioritizes an empathy-forward approach as I’ve mentioned previously. According to the CAHOOTS program’s media guide, “team members complete over 500 hours of training that emphasizes de-escalation and crisis intervention to resolve situations where a social service response is more appropriate than a police response” (White Bird Clinic 2). That armed police are best suited to de-escalate a scenario in which an individual’s heightened emotional state is a shortened fuse subject to blow at any moment is a radically misunderstood way of examining the police officer’s role in society. It’s also a contentious perspective that lacks compassion and does nothing but bolsters the longstanding view of police officers as drill sergeant-like antagonists of the most vulnerable members of society. Though it may sound radical and is susceptible to manipulation by critical media outlets and bumper sticker slogans, the fact of the matter is that police must concede the responsibility of responding to mental health events altogether. It is not within the scope of their training to be the handlers of such events. Instead, police must be relegated to a supportive role — only when called upon — and instead let behavioral health professionals take the lead. The system used by CAHOOTS is an excellent model “offer[ing] a service that responds to non-violent crises, so police don’t have to” (4). Still in use after thirty-one years, CAHOOTS set the bar for a community policing initiative that is proven to save taxpayer money, reduce the number of mental health-related police shootings, and direct mental health patients to proper care facilities rather than occupying more space in jails and prisons. Three decades of on-the-ground practice has shown significant cost savings to the medical system:

CAHOOTS is also able to attend to non-emergency medical calls that would have otherwise been responded to by Emergency Medical Services (EMS). CAHOOTS can respond to suicide or self-harm calls, calls for basic medical treatment such as wound cleaning, and provide assistance for clients who are presenting as disoriented or delusional with an alert and oriented level of less than 4, or who have other symptoms of psychosis. Treating these symptoms in the field prevents infections, which are common in homeless populations (as many have no way of keeping wounds clean). This in turn keeps patients out of the emergency room in the long term. In 2019, the CAHOOTS program saved roughly $14 million in emergency medical systems costs, including ambulance transport and emergency room services. (5)

States could learn a lot from the CAHOOTS program and would benefit themselves to replicate its services. This model would improve community-police relations, enhance public safety, save millions of dollars in taxpayer money and medical service costs, and ultimately reduce the number of fatal police encounters with individuals experiencing a mental health crisis.

Conclusion

Taking a moment to pause and ask ourselves what it means to defund the police is the first step in making progressive change. Given that there are a plentiful number of areas in which police reform is needed, a significant change to the criminal justice system in America will require time and thoughtful effort at shaping policy that will improve police-community relations and heal generations of harmful practices. “As protests against police use of force and perceptions of systemic racism have swept the nation and the world following the killing of George Floyd in Minneapolis, Minnesota, there has been a renewal of the national conversation about systemic problems in the U.S. criminal justice system” (Vermeer et al. 2). Mental health crises are just one example of where change is needed in how police respond to calls for service in our communities. Overwhelming statistical evidence reveals that fatal police shootings often involve some sort of mental health aspect linked to the victim. Furthermore, the core function of police in society — to enforce the law — emphasizes forceful and aggressive tactics intended to subdue lawbreakers and keep communities safe. But enforcement is not a substitute for treatment and does not always improve community safety. Some may argue that police should be trained in behavioral de-escalation techniques, but I contend that responding to mental health events must be a responsibility delegated elsewhere and taken out of the hands of police entirely. Perceptions of police as the antagonists of the most vulnerable members of society can exacerbate tensions and prompt individuals suffering from a mental illness to act irrationally when confronted by an armed officer. This is why more American jurisdictions must adopt a model like that of The Crisis Assistance Helping Out on the Streets (CAHOOTS) program. Aid to the most vulnerable must emphasize compassion, de-escalation, and empathy rather than contentious enforcement. If we allow police to focus their efforts elsewhere, on matters more suitable to their training, not only will taxpayer money and costs associated with medical services be saved, but human lives could be preserved in the process.

References:

Shjarback, John A., and Justin Nix. (2020). Considering violence against police by citizen race/ethnicity to contextualize representation in officer-involved shootings. Journal of Criminal Justice, 66 (101653). https://doi.org/10.1016/j.jcrimjus.2019.101653.

Vermeer, Michael J.D., Woods, Dulani., and Brian A. Jackson. (2020). Would Law Enforcement Leaders Support Defunding the Police? Probably — If Communities Ask Police to Solve Fewer Problems. Santa Monica, CA: RAND Corporation. https://doi.org/10.7249/PEA108-1.

Weisburd, David and John E. Eck. (2004). What Can Police Do to Reduce Crime, Disorder, and Fear? The Annals of the American Academy of Political and Social Science, 593, pp. 42–65. https://cebcp.org/wp-content/publications/WeisburdEck04.pdf.

White Bird Clinic. (2020). Crisis Assistance Helping Out on The Streets Media Guide 2020. Eugene, Oregon, 2020. https://whitebirdclinic.org/wp-content/uploads/2020/06/CAHOOTS-Media-Guide-20200626.pdf.