Police calls for service sometimes involve the police interacting with and responding to people with mental illness. The dismantling of state mental hospitals, the changing mentally ill population, the tightening of requirements for receiving mental health support, and the offering of limited psychological services are bringing the police into contact with more people with mental illness. Police-invoked law enforcement, police-invoked order maintenance, citizen-invoked law enforcement, and citizen-invoked order maintenance are four types of police interactions with the mentally ill who violate the law. They involve the police either initiating or responding to a call for service and either enforcing the law or maintaining social order.
How the police employ their work-style attitudes and exercise their discretionary power has an impact on the outcomes of police interactions with people with mental illness. Custodial police decisions are arrest, involuntary emergency evaluation, or involuntary commitment. Noncustodial decisions are counseling, release and referral, or voluntary emergency evaluation. The police are receiving some training in these alternatives for handling people with mental illness. In some contacts with the mentally ill, police agencies that have specially trained mental health crisis teams deploy them to carry out custodial or noncustodial options to resolve police calls for service.
Prevalence and Situational Profile
Researchers have estimated that between 5% and 10% of police-citizen contacts involve people with mental illness. These numbers reflect an increase since the 1960s deinstitutionalization of state psychiatric hospitals that housed the mentally ill, offered them some treatment, kept them safe, and protected the public from the real or perceived danger of coming into contact with them. Overcrowded and poor living conditions, the insensitive treatment of the mentally ill, the economic expense of housing them, the availability of psychotropic medications such as chlorpromazine (Thorazine), the tightening of involuntary commitment procedures, and the creation of community mental health centers were the factors that shaped the deinstitutionalization movement.
The closing of many state psychiatric facilities resulted in the displacement of people with mental illness—from living in locked state warehouses to living in open community settings such as group homes, family residences, halfway houses, nursing homes, and homeless shelters that offer different levels of care. Researchers estimate that 1 of every 10 persons has some form of mental illness and that between 1 and 4 million persons in the United States have a serious mental illness.
Police contacts with the mentally ill often occur in the home. Interactions with them also occur in the streets, at halfway houses, at mental health agencies, and in public buildings. Police encounters are increasing during the night and weekend hours because mental health resources are usually unavailable at such times. Behaviors that the mentally ill frequently demonstrate during their contacts with the police include confusion, unusual or bizarre mannerisms, and aggression. Empirical investigations suggest a link between mental illness and criminal behavior. For example, persons who suffer from bipolar disorder or schizophrenia are more likely to express antisocial behaviors that society criminalizes. Most mentally ill offenders are under the influence of alcohol or drugs when they commit crimes. There is some increased risk of mentally ill individuals becoming violent.
Because many people with mental illness now languish in a variety of community settings with too few mental heath treatment centers available, they routinely encounter the police when they manifest abnormal behaviors that require police attention.
Types of Police Interactions with the Mentally Ill
The police are responsible for safeguarding the well-being of the community. They fulfill this responsibility by enforcing laws and maintaining social order and, thus, most often respond to persons with mental illness when such persons display behaviors that rise to a level that society criminalizes. Responses may originate from police-invoked law enforcement, police-invoked order maintenance, citizen-invoked law enforcement, or citizen-invoked order maintenance.
Police-invoked law enforcement is a self-initiated response by an officer to a violation of the law by a mentally ill person. The law violation and police department policies and procedures force the officer to make contact with the mentally ill law violator.
Police-invoked order maintenance is also a self-initiated officer contact with a person with mental illness who violates the law. But in this situation, the law-violating behavior is of a less serious kind. It reflects a social order disturbance that tends to be noninjurious to others, such as public drunkenness and vagrancy.
A police call for service that originates from a complaint by a citizen can bring an officer into contact with a person with mental illness. Citizen-invoked law enforcement involves a citizen reporting that a mentally ill person has violated the law. Similarly, citizen-invoked order maintenance also involves a citizen calling for police service, but like police-invoked order maintenance, it involves law-violating behaviors that are of a less serious nature, occur less often, happen at unexpected times, and take place usually in the private homes of citizens (e.g., verbal arguments).
Whether the police are initiating or responding to calls for service or whether they are enforcing laws or maintaining social order, their work-style attitudes and use of discretion have an impact on the way they actually handle situations involving mentally ill individuals.
Police Handling of the Mentally Ill
Not all police-citizen contacts have an absolute set of official rules and procedures on how best to handle them, especially police contacts with the mentally ill whose behaviors amount to some infraction of the law. Although there is some official guidance that stems from the law, policy, training, and supervision, the police have some leeway or discretion in deciding on a response option from a range of possible responses available in a given law-violating police intervention situation. For example, in police-invoked situations with mentally ill law violators, there are no demands by citizens for the police to invoke the law mechanically. The police are free to exercise their work-style attitudes, which include some attitudes toward, perceptions of, and assumptions about people with mental illness. Thus, the mentally ill person who demonstrates public drunkenness is most vulnerable to an officer’s discretionary power.
If, for example, the officer holds a legalistic perspective about policing—preoccupied with arresting law violators and performing to the letter of the law, then custodial police options such as arrest, involuntary emergency evaluation, or involuntary commitment are likely outcomes. If, however, the officer uses a problem-solving policing style—concerned about finding permanent solutions to problems, then noncustodial options such as counseling, release, and referral or voluntary emergency evaluation are attractive because they offer the person with mental illness some needed mental health treatment, thereby reducing future police contacts.
Citizen-invoked calls for police service routinely carry with them less opportunity for the police to exercise their discretion. The police concentrate their work effort on responding to citizens’ complaints and meeting citizens’ needs. For example, a citizen may want an officer to arrest a mentally ill person who assaulted him or her. This situation gives the officer little chance to make a discretionary decision such as suggesting a voluntary emergency mental health evaluation. In a different situation, for example, the citizen may not want to press charges for assault. The officer could make an intervention decision that calls for releasing the offender and making a mental health referral. Normally, though, the officer will choose an option that satisfies both police and citizen interests in citizen-invoked interactions with the mentally ill.
Most police officers receive some education and training in the handling of people with mental illness. Basic recruit training hours can range from roughly 0 to 41. Fewer police officers receive continuing education at the in-service level. Among those that do, some receive information at roll call, and others get it during formal annual blocks of instruction. Training time varies from a recommended 16-hour block devoted to mental illness.
The content of police training varies at both the recruit and the in-service training levels. Sources of training curricula are the agency itself, the state commission on peace officers’ standards and training, profit and nonprofit organizations, and local mental health professionals. Police officers or mental health professionals, or both, usually deliver the training. One formal and well-recognized training curriculum developed by the Police Executive Research Forum includes seven learning modules that address police responses to people with mental illness. Generally, police officers learn to recognize their attitudes toward, perceptions of, and assumptions about the mentally ill and to dispel their misconceptions about them. Mental illness is not a crime, and people having mental illness live in their communities, have professional vocations, and call for police services.
The police learn to recognize specific symptoms and forms of mental illness, such as schizophrenia and mood, anxiety, and dissociative and personality disorders. They learn to employ techniques to handle them effectively. For example, an officer encounters a mentally ill person whose speech is high-speed and nonstop and uncontrollable and meaningless. This behavior signals to the officer that the person is in a state of high arousal and has an anxiety disorder. The officer interrupts the person’s speech by asking a series of questions—for example, What is your name? How old are you? Where do you live? Where do you work? What the officer expects is to break the person’s pattern of compulsive behavior and control it to some extent.
Not all police interactions with the mentally ill require arrests. The police learn both custodial and noncustodial alternatives to respond to people with mental illness whose behaviors amount to some infraction of the law. They learn community, problem-oriented strategies to resolve problems related to the mentally ill. Handling such problems, however, sometimes involves using specialized mental health crisis teams.
Some police agencies report having specially trained teams that respond to calls for service involving mentally ill persons in crisis. Police agencies that employ a team approach generally adopt one of three models: police-based response (only specially trained police officers), police/mental health-based response (both police officers and mental health professionals), or mental-health-based response (only mental health professionals). Current research suggests that most police agencies deploy a team composed of only specially trained police. Despite variations in using particular response teams, team members are receiving the specially needed training to respond to people with mental illness.
Police department policies on contacts with people with mental illness have helped departments standardize the nature of their officers’ responses while giving officers flexibility to meet the needs of people with mental illness. Although people who have mental illness may commit a crime, be a victim of crime, or report a crime, police responses to encounters with them have improved with training.
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- Hails, J., & Borum, R. (2003). Police training and specialized approaches to respond to people with mental illness. Crime and Delinquency, 49(1), 52-61.
- Jennings, W. G., & Hudak, E. J. (2005). Police responses to persons with mental illness. In R. G. Dunham & G. P. Alpert (Eds.), Critical issues in policing: Contemporary readings (5th ed., pp. 115-128). Long Grove, IL: Waveland.
- Patch, P. C., & Arrigo, B. A. (1999). Police officer attitudes and use of discretion in situations involving the mentally ill. International Journal of Law and Psychiatry, 22(1), 23-35.
- Police Executive Research Forum. (1997). The police response to people with mental illness. Washington, DC: Police Executive Research Forum.