Police and Chronic Mentally Ill

Police and Chronic Mentally Ill Individuals

The need for research into the intersection between policing responsibilities and chronic mentally ill Individuals is evidenced by the various prevalent areas of concern in this relationship, as it presently exists. As this section will discuss, while there are some practical and commonly accepted modes and methods within police protocol to deal with the problem of the mentally ill and particularly the homeless, this has not been refined or become integrated sufficiently to provide a fully comprehensive strategy and set of protocols to deal fully with the situation.

There are also many assertions that police treatment of the homeless and mentally ill is based in stereotypes, prejudice and a general lack of understanding of the complexity of mental illness. There is also the allegation that police arrests have exacerbated the problem in some cases through the increase of mentally disabled persons in prisons.

On the other hand are also many studies and reports which indicate that there have been positive advances in training in police departments with regard to the understanding of the problems and the nuances of the mentally ill. This is coupled with numerous reports of programs, protocols and initiatives that are indicative of increased police awareness and improved methodologies when dealing with these individuals. These two points-of-view will be explored in the present study.

A common view of this problem is as follows. In an article entitled, Mentally ill overwhelming police: report, the author states that, "A new groundbreaking report... painted a portrait of a police force overwhelmed with the needs of the mentally ill because the mental health system was failing them" (Mentally ill overwhelming police: report). This in one of many such reports and studies that refer to the increasing problematics of mentally ill and homeless people in larger urban centers - and to the concomitant problem of dealing with this problem from a legal and policing point-of-view. This problem is also fraught with misconceptions and stereotypes of the mentally affected person, which add to the complexity of the situation and highlights the inadequacies in protocol and methodology that have in many instances taken place between the police and the homeless and mentally ill.

The trajectory of the intersection between police work and dealing with the mentally ill will be explored in this section, with the central focus on the need for further research as well as the importance of this research in the present healthcare, legal and judicial environment.

At the outset it is important to note that the are a number of cardinal concepts that are essential in understanding the role and responsibility of modern policing in contemporary industrialized societies. The first concept refers to the view that "... The police institution originates with the people, depends on them for support, and, in effect, the people are the police and the police are the people." (Robinson, Scaglion & Olivero, 1994, p. 127) This refers to a more contemporary approach to the ethos of policing, where the emphasis is on interaction and symbiotic interdependence between the police and the community in the process of police functioning. This view has a specific bearing on the issue under discussion, as the mentally ill and homeless form an integral part of the community under police jurisdiction

Secondly, the primary focus of the police is to protect the majority of law - abiding people from the minority of criminal and law- breakers. (Robinson, Scaglion & Olivero, 1994, p. 127) the modern police, as an institution, have its origins "...in the need to do something about a real rise in crime and/or disorder..." (Emsley, 1999, p. 8). This view is equally important and brings to bear the primary function of the police - namely to protect the community from danger and harm in various ways.

However, these two aspects are not mutually exclusive and both play a role in that way that the homeless and the mentally ill are perceived and treated by the police. These two theoretical strands will form the fulcrum of the discussion of the relation between police work and treatment of the mentally ill in modern society.

A central point of debate in the literature and a facet that is strongly related to the present topic is that the role and functions of the police have changed in recent years due to the requirements and needs of contemporary society. A police officer's function is now seen as being much more than just 'keeping the peace" or in only applying the letter of the Law. This changing role will also be discussed in relation to the nature and of police function and their pertinence and applicability to the problematics of dealing with the mentally ill.

Overview

The problematic and complex situation with regard to the homeless and mentally ill individuals in our society is roughly summed up in the following assessment. "It is public-policy issues....Roughly one-third of America's homeless are...suffering from mental illnesses such as schizophrenia and manic depression... " (How'd, 1998). While the root cause of the increasing prevalence of mentally ill and homeless people on the streets of our cities can be ascribed to problems of policy and governmental decisions, yet this problem inevitably revolves to the jurisdiction and responsibility of the police and law enforcement officers. While the primary duty of these police officers is to enforce the law, this function is problematized by the grey areas and the uncertainty that often occurs when dealing with the mentally ill. The police officer is called upon to "...'do something' in situations involving mentally ill individuals,"... particularly when they exhibit the more frightening and disturbing signs of mental disorder" (Teplin L.A., 2000).

The issue of the correct procedure between the police officer and the mentally ill individual is complicated and compounded by a number of factors. The first of these which has already been alluded to, is the fact that in many cities and urban centers responding to the mentally ill has become a task that has fallen to the police to an increasing extent in recent years - whereas in the past this would have been dealt with by the various intuitional authorities. As one study on this subject notes

Several factors have increased the likelihood of police encounters:

deinstitutionalization in the 1960's, cutbacks in Federal mental health funding, and changes in the legal code governing patient rights and affirming the right of a mentally ill person to live in the community without psychiatric treatment. (Teplin L.A., 2000)

These are central issues that will not be belabored but which form an important part of the background and contributes to the case for further research into this field of inquiry. A second issue that is also significant in the overall understanding of the present situation is that, " at the same time, society's tolerance of mentally ill persons in the community is limited. Given the stereotype of mentally disordered people as dangerous..." (Teplin L.A., 2000)

This brings into play the stereotypes and prejudices that exist within the community, as well as in the police force, which adds another layer of complexity to dealing with the problem and in finding appropriate outcomes.

To further exacerbate the situation, studies show that the downsizing of mental institutions and the release of patients back into the community that occurred in the 1960s did not always live up to theoretical or practical expectations. As one report states, the money saved by hospital closings was to be put into outpatient community programs. However, the money did not end up in the community. Instead, states rebudgeted the savings, and many mentally ill people found themselves without appropriate social services and support systems. Without monitoring, many stopped taking their medication, while others continued with medications that had severe side effects and quickly became outmoded. This resulted in many unstable individuals living in the community with their families who were unprepared for the role of caretaker, or in the too few halfway houses and group homes, or on the street. (Vickers B. 2000)

The task of dealing with this situation on the streets and in the urban areas fell to a large extent on the shoulders of the police force. "Officers were serving as frontline mental health workers" (Vickers B. 2000). Badawi (2002) points out a number of aspects and statistics that serve to highlight the situation with regard to policing demands and responsibilities.

Mentally ill homeless people impoverished, and many are not receiving benefits for which they may be eligible. Their social support and family networks are usually unraveled.

They are twice as likely as other homeless people to be arrested or jailed, mostly for misdemeanors.

The majority have had prior contact with the mental health system. These experiences were not always positive. They may have been hospitalized involuntarily or given treatment services or medications they did not feel were of benefit. (Badawi, 2002)

All of these aspects add the problematics of police intervention and actions in dealing with individual cases.

The realities of policing the homeless mentally ill

In a study entitled Police Encounters with Individuals with Mental Illness in the Capital District (2005), Nathan Meehan states that it is often case that police encounters with mental ill individuals can result in various degrees of misunderstanding, stigma and stereotypes. As this study points out, these encounters can lead to negative situations and even to death, injuries and legal issues.

In essence, the relationship and involvement of the police from a formal point-of-view is based on two common law principles. These are, the facility and the responsibility of the police to protect the safety and welfare of the public, and secondly the principle of parens patriae, which dictates protection for disabled citizens such as mentally ill persons. (Teplin L.A., 2000)

Usually mental health codes are specified as to the degree of involvement of the police with the mentally ill. These "...instruct police to initiate a psychiatric emergency apprehension whenever the person is either dangerous to self or others or is unable to provide for basic physical needs so as to protect him/herself from serious harm" (Teplin L.A., 2000).

While there are legal parameters to the involvement of the police with the mentally ill, these procedures cannot dictate the response that the police officer might have to the different types of situations that may occur. In other words, there are few prescribed and definitive procedural rules. Even more importantly, in many case there has been little or no training in how to deal with the mentally ill - although this is an aspect that is being dealt with in many areas today

In summary, there is in reality an emphasis on the fact that the police officer is required to exercise the appropriate and necessary discretion in dealing with encounters with the mentally ill. However, the literature indicates that this is an area that has not yet been adequately addressed in terms of training -especially with regard to the eradication of various prejudices and stereotypes relating to the homeless and the mentally ill. These aspects are seen to be in need of improvement.

The police officer encountering a mentally ill and irrational person has a limited number of choices. He or she can transport the person to a mental hospital; arrest the person or resolve the matter informally. (Teplin L.A., 2000)

These options are limited and limiting. For example, choosing to transport the individual to a mental hospital necessitates a certain amount of training in ascertaining the individual's condition also necessities a great amount of bureaucracy and legal 'red-tape'. In a well - known study of police officer decisions in encountering mentally ill individuals by Egon Bittner (1967) it was found that "....the police reluctantly made psychiatric referrals and initiated hospitalization only when the individual was causing or might cause serious trouble. Even so, officers resorted to a mental hospital only in the absence of other alternatives" (Teplin L.A., 2000). Later studies also found that the police tended to try to deal with these situations informally and not through legal or psychiatric channels. This raises the question of training and the preparedness of the police officer to deal with these situations. One study found that police officers resolved situations informally in 72% of the cases, made an arrest in 16% of the cases, and initiated emergency hospitalization in 12% of the cases. (Teplin L.A., 2000)

Another issue that of impacts on this subject is the assertion that police officer are too quick to arrest mentally ill individuals and that this had led to an increase of these individuals in the prison system - a situation that has negative outcomes from a healthcare and psychiatric point-of-view. The underlying causative factors are important to understand by the police officer. As Sigurdson, (2000) states, "

There also are many reasons why major mental illnesses themselves leave individuals vulnerable to incarceration (and homelessness). When untreated, these illnesses impair judgment, thinking and mood. Individuals may be incapable of finding and keeping adequate employment or accessing mental health services. Disordered thinking leads to the mistrust of normal support systems, such as families, churches and the mental health system... Paranoid delusions can lead to criminal behavior (Sigurdson, 2000, p. 70)

The above quotation indicates the subtleties of this problem and the level to which the police officer has to be sensitized to the predicament of the mentally ill person. This again leads to the question of adequate research and training.

Considering the above views, many critics are alarmed at the number of mentally ill persons who are incarcerated. This is due to the fact that, "Law enforcement and judicial practices also contribute to the large numbers of mentally ill men and women in jails and prisons. There is evidence that police arrest mentally ill persons more often than they arrest the general public" (Sigurdson, 2000, p. 70).

On the other hand, there are also indications that police officers are learning how to deal with situations involving the mentally ill in a more integrated and comprehensive way. As Sigurdson (2000) notes, "In many communities, the police are considered more capable of responding efficiently to a mental health crisis than is the local mental health system" (p. 70). There is also an increase 'mercy bookings' and efforts to provide safety and shelter for the indigent.

However, a factor emphasized in much of the literature is that the large number of mentally ill people who are being incarcerated is largely due to "...our current restrictive civil commitment processes" (Sigurdson, 2000, p. 70).

It is also useful to examine the reasons given by police officers for arresting mentally ill and homeless people. This provides and indication as well of the underlying problem areas and fault lines in the system. A study by Teplin (2000) found that there were three main situations in which the police resorted to arrest.

When an individual was thought to be either unacceptable to the hospital or when his or her symptoms made him fall through the cracks of various caretaking systems.

When the police felt it was likely that the person would continue to cause a problem if something were not done.

When the situation, if unchecked, would escalate and require further police assistance (Teplin L.A., 2000)

Importantly, the study also points out that are many "grey areas" when it is difficult to decide between common disorderly behavior and mentally disordered behavior. This one again emphasizes the importance of further research into the implementation of proper training in the identification of mental disorders.

The expansion of policing functions

The above discussion has served to illustrate some of the obstacles and problems relating to the interaction between the police and the emotionally ill and homeless. Very generally, these can be summarized as inadequate training, legal and civil statutes that impede adequate and human interaction and various levels of stereotyping and prejudice towards the mentally ill.

While there are many other reasons for the statement that the police are being "overwhelmed" by the number of mentally ill offenders, there are also contrasting studies and reports of efforts being made to rationalize and 'humanize" the process of dealing with the mentally ill.

As an example, one report states the following.

Police frequently encounter individuals who are mentally ill.

Departments' approaches in relation to these individuals vary greatly, whether in general encounters or in specific incidents that have become dangerous stand-offs. Some departments have created special "crisis intervention teams" specifically trained on mental health issues. These special teams often collaborate with local mental health officials and respond jointly to calls for service involving persons with a mental illness.

Policing and Mentally Ill Individuals)

An aspect that is clearly allied to the issue at stake and which is an indication of changes in altered perceptions and methods of dealing with the mentally ill and homeless, is the movement in recent years towards the concept of community policing. This aspect brings into focus some important facets of the problem under discussion. This aspect is also important in terms of understanding why many of the present protocols and approaches of policing are inadequate.

The role of the police, as has already been suggested in the introduction to this section, is one that has been expanded and developed in many countries, including the United States. This refers, for example, to the issue of community policing and the police officer as an integral part of the community policing. This is also related to the "problem -solving "approach to policing. The following definition summarizes the essence of this approach. "Community policing is a philosophy, management style, and organizational strategy that promotes pro-active problem solving and police-community partnerships to address the causes of crime and fear as well as other community issues." (Community Policing). In a theoretical and ideal sense community policing is, collaborative effort between the police and the community that identifies problems of crime and disorder and involves all elements of the community in the search for solutions to these problems. It is founded on close, mutually beneficial ties between police and community members.

Community Policing Philosophy)

In essence, this suggests that collaborative as well as efficacy evaluations are necessary to being about the changes that are needed to deal with the mentally ill and indigent. This in turn suggests the importance of continued research and study, which can illuminate these areas; as well as shedding light on the possible points of interaction and collaboration between the police and the community that can facilitate the implementation of strategies to deal with the problem of the chronically mentally ill.

The philosophy behind community policing suggests in the first instance a closer integration in services and in dealing with problems - which in turn refers to the basic extension of the role provided by the police. It is also a view that emphasizes more than just the law enforcement model of policing. In this sense, it is innovative in the contemporary context and it is a form of policing that is suited dealing with the problem under discussion.."..the concept and practice of community policing, its advocates argue, is in the process of replacing reform policing. Harking back to the... earlier concept of... community policing (which) can create a new form of community out of the ravages of the old. (Robinson, Scaglion & Olivero, 1994, p. 138)

The importance of this philosophy and praxis in the context of the problem of the mentally ill can be seen the work of various theories and criminologists. Leighton (1991) provides a good overview of the differences in policing policies and procedures. This study entitled Visions of Community Policing: Rhetoric and Reality in Canada clearly shows the difference between the problem and community orientation in policing. The author states that,

Community policing, sometimes referred to as community-oriented policing, community-based policing, or problem oriented policing, is currently presented by academic observers of policing as characterizing "modern," "progressive," or "contemporary" policing... While many of these commentators have also actively influenced the direction of community policing, it has been the prevailing wind of change among North American police leaders for the past few decades (Leighton, 1991, p. 485)

Leighton notes that, "...community policing might be more correctly referred to as a re-emergence, renewal, or revitalization of a former philosophical, organizational, and operational approach to urban policing developed last century in Metropolitan London by Peel and his associates." (Leighton, 1991, p. 487) This therefore suggests that this mode of policing is one that is become more appropriate in dealing with the problem of the mentally ill.

However, the application of community policing and problem solving methods in the contemporary context of the homeless and the mentally ill is one that is still in the early stages of research and study. For example, the application of a community model of policing is not without its own particular problems and complexities; such as the fact that such as approach would necessitate a significant restructuring of the police force.

While there are a variety of components to various visions of community policing, most of them proceed from the partnership principle which has far-reaching implications for the organization and operations of police forces. "(Leighton, 1991, p. 487)

The have also been many other efforts made by different police departments in recent years to deal more comprehensively with the problem of the mentally ill. As one-study claims:

Police departments everywhere are initiating programs in which police officers adopt roles of counselors, teachers, coaches, and brokers of charitable works. The police adopt these unconventional roles for various purposes. The best practice is when police officers adopt these roles for a limited time, and in the specific context of addressing a specific community problem (Scott M. 2000)

In essence, this refers to the expansion and the extension of policing functions that will enable them to deal with the issues at stake. Another example of this trend is the D.A.R.E. program. This refers to a program in which the police officers become part-time teachers about values and is an effective way of reducing harmful stereotypes and prejudice against the mentally ill.