Thursday, March 10, 2016

Building on the Evidence: Guiding Policy and Research on Police Encounters with Persons with Mental Illnesses

...During this time of national concern about excessive use of force by police, a range of stakeholders—including communities, federal and state governments, and law enforcement—seek improvements in community partnership, accountability, transparency, and skillful restraint to begin reversing the problems of excessive police use of force, including as they affect persons with mental illnesses. Prevention-oriented policies and programs that offer tools for improving de-escalation of potentially dangerous encounters with persons in a mental-health crisis could help minimize risk for injury during police encounters for all parties involved and reduce the likelihood that force will be needed at all. As an example, a recent trend in state law making broadens police authority to remove guns from persons who are considered to be in danger of harming themselves or others but who have not committed a criminal act and are not prohibited from gun ownership. Connecticut, Indiana, and California are three states with different versions of a law in place to remove guns from potentially dangerous persons. A benefit of this policy approach to managing potential dangerousness among persons in crisis is in removing the focus from mental illnesses per se and placing it instead on demonstrated behaviors by any member of the community that suggest heightened risk. This conceptual and operational shift in focus from mental illnesses to dangerousness is important for reducing stigma around mental illnesses, both in the community and among law enforcement officers.

There has also been increased awareness in law enforcement communities of the need for more in-depth officer training in de-escalation. The New York Times reported on a recent survey conducted by the Police Executive Research Forum (PERF) that highlighted the tradition of a disproportionate focus on training in use of force rather than de-escalation techniques and estimated the following median number of hours spent in various training areas: firearms = 58 hours, defensive tactics = 49 hours, de-escalation = 8 hours, and crisis intervention = 8 hours (). PERF asserted that some large police departments support the idea of a new approach to training that focuses more heavily on teaching officers the necessary skills to defuse tense situations and avoid violent confrontations; but other departments are resistant. Persons with mental illnesses would undoubtedly benefit during their encounters with police who had more comprehensive training in de-escalation and potentially reduce their chances not only of injury during those encounters but also of being subject to police use of force at all.

Certain jurisdictions have had strong success in implementing prevention-oriented models that include specialized officer response to persons with mental illnesses like CIT. Other successful additions to the community infrastructure provide officers with an alternative to taking a person in crisis to the emergency department or jail. San Antonio, Texas, paired CIT training with a newly constructed Restoration Center, a facility with a 16-bed psychiatric unit, a medical clinic, and a “sobering room” where police can drop off people who are intoxicated rather than taking them to jail. The city reports related savings for the police department of $600,000 a year in overtime pay alone; undoubtedly, many encounters that would have involved use offorce and possible injury were averted.

 also call for policy improvements in consistency, quality, and availability of data on encounters during which police use force and the surrounding circumstances, including measures that thoroughly describe the circumstances of a person’s mental-health crisis. While a range of community and government stakeholders are engaged, now is an especially important time to develop and institute progressive policies in an effort to increase accountability for what takes place during police encounters. New policies that require detailed reporting of police use-of-force incidents would also facilitate further rigorous research on the effectiveness of CIT, preemptive gun seizure laws, and other approaches to mitigating dangerousness in encounters with persons in mental-health crisis. To ensure that new reporting policies are sustainable, however, jurisdictions would need to give careful consideration to issues around their implementation. Challenges to be addressed include the acceptability of such policies among police department leadership and their officers, as well as the feasibility of additional reporting and paperwork for officers and data management for administration.

 offer salient new evidence about risk for injury during police encounters involving persons with mental illnesses in which force is used. Their study lays a foundation for further research that should extend to include non-CIT police officers to learn more about both CIT-specific outcomes and any unobserved elevated risk for injury during police encounters with persons with mental illnesses. Policy response to these concerns can begin now, starting with improved reporting on police encounters with persons with mental illnesses and a rigorous focus on building officers’ skills in de-escalation...

Full article at:

By: Allison G. Robertson, 
Direct correspondence to Allison G. Robertson, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Brightleaf Square, Ste 23B, Durham, NC 27701 (Email:
Allison G. Robertson is an assistant professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. She received a Ph.D. in health policy and management from the University of North Carolina—Chapel Hill and an MPH in health management and policy from the University of Michigan at Ann Arbor. Professor Robertson conducts mental health law, policy, and services research, with a particular focus on the problem of criminal justice involvement among adults with serious mental illnesses. She is currently the principal investigator on a study of gender differences in a statewide jail-diversion program, principal investigator on a study of medication-assisted treatment for justice-involved adults with co-occurring mental health and substance use disorders, and an investigator on two multisite studies on gun control laws, mental illness, and prevention of violence.

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