Police and Chronically Mentally Ill Individuals: A Study

Introduction

The need for research into the intersection between policing responsibilities and chronically mentally ill individuals is evidenced by the various prevalent areas of concern in this relationship as it presently exists. 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 — these have not been refined or integrated sufficiently to provide a fully comprehensive strategy and set of protocols.

There are also many assertions that police treatment of the homeless and mentally ill is rooted 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, many studies and reports indicate that there have been positive advances in training within police departments with regard to understanding the problems and nuances of mental illness. This is coupled with numerous reports of programs, protocols, and initiatives that reflect increased police awareness and improved methodologies when dealing with these individuals. These two points of view are explored in the present study.

A common characterization of this problem appears in a report titled Mentally Ill Overwhelming Police, which 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." This is one of many such reports and studies that refer to the increasing complexity of managing mentally ill and homeless people in larger urban centers — and to the concomitant challenge of addressing this problem from a legal and policing perspective. The problem is further complicated by misconceptions and stereotypes of the mentally ill person, which add to the complexity of the situation and highlight the inadequacies in protocol and methodology that have, in many instances, characterized encounters between the police and the homeless and mentally ill.

At the outset it is important to note that there are a number of cardinal concepts essential to understanding the role and responsibility of modern policing in contemporary industrialized societies. The first concept reflects 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. This view bears directly 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 criminal and law-breaking minorities (Robinson, Scaglion & Olivero, 1994, p. 127). The modern police institution has its origins "in the need to do something about a real rise in crime and/or disorder" (Emsley, 1999, p. 8). This view underscores the primary function of the police — namely, to protect the community from danger and harm.

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

A central point of debate in the literature — and a facet 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 simply "keeping the peace" or applying the letter of the law. This changing role will also be discussed in relation to the nature of police function and its pertinence and applicability to the challenge of dealing with the mentally ill.

Overview of the Problem

The problematic and complex situation regarding homeless and mentally ill individuals in our society is roughly captured 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 can be ascribed to problems of policy and governmental decisions, this problem inevitably devolves to the jurisdiction and responsibility of the police and law enforcement officers. While the primary duty of these officers is to enforce the law, this function is complicated by the grey areas and uncertainty that often arise 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, 2000).

The question of correct procedure in encounters between police officers and mentally ill individuals is compounded by a number of factors. First, as already noted, responding to the mentally ill has become an increasingly common task for police in many cities — whereas in the past this would have been managed by various institutional authorities. As one study notes, several factors have increased the likelihood of police encounters: deinstitutionalization in the 1960s, 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, 2000).

A second significant issue 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, 2000). This brings into play the stereotypes and prejudices that exist within both the community and the police force, adding another layer of complexity to 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 reinvested in outpatient community programs; however, the money did not reach 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 outdated. This resulted in many unstable individuals living in the community with families unprepared for the role of caretaker, in the too-few halfway houses and group homes, or on the street (Vickers, 2000).

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

All of these aspects add to the difficulty of police intervention and decision-making in individual cases.

The Realities of Policing the Homeless Mentally Ill

In a study titled Police Encounters with Individuals with Mental Illness in the Capital District (2005), Nathan Meehan notes that police encounters with mentally ill individuals can result in various degrees of misunderstanding, stigma, and stereotyping. As the study points out, these encounters can lead to negative outcomes, including death, injury, and legal complications.

In essence, the formal involvement of the police is grounded in two common law principles: the facility and responsibility of the police to protect the safety and welfare of the public, and the principle of parens patriae, which dictates protection for disabled citizens, including mentally ill persons (Teplin, 2000). Mental health codes typically specify the degree of police involvement, instructing officers "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, 2000).

While legal parameters define the scope of police involvement with the mentally ill, these procedures cannot dictate an officer's response to the full range of situations that may arise. In other words, there are few prescribed and definitive procedural rules. Even more significantly, in many cases there has been little or no training in how to deal with the mentally ill — although this is an area that is being addressed in many jurisdictions today.

In reality, police officers are expected to exercise appropriate discretion when dealing with mentally ill individuals. However, the literature indicates that this remains an area inadequately addressed in terms of training — especially with regard to eradicating prejudices and stereotypes relating to the homeless and the mentally ill. The police officer encountering a mentally ill and irrational person has a limited number of choices: transport the person to a mental hospital, arrest the person, or resolve the matter informally (Teplin, 2000).

These options are limited and limiting. Choosing to transport an individual to a mental hospital, for instance, requires both the ability to assess the individual's condition and the navigation of considerable bureaucracy. In a well-known study of police officer decisions in encounters with mentally ill individuals, Egon Bittner (1967) 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, 2000). Later studies confirmed that police tended to resolve these situations informally rather than through legal or psychiatric channels. One study found that police officers resolved situations informally in 72% of cases, made an arrest in 16% of cases, and initiated emergency hospitalization in 12% of cases (Teplin, 2000).

Another important issue is the assertion that police officers are too quick to arrest mentally ill individuals, contributing to an increase of such individuals in the prison system — a situation with negative outcomes from both healthcare and psychiatric perspectives. As Sigurdson (2000) explains:

"There 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 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)

This quotation illustrates the subtleties of the problem and the degree to which police officers must be sensitized to the predicament of the mentally ill person — which again underscores the question of adequate research and training.

Many critics are alarmed at the number of mentally ill persons who are incarcerated. According to Sigurdson (2000), "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" (p. 70). For a broader overview of this issue, see the National Criminal Justice Reference Service, which archives research on policing and mental health.

On the other hand, there are also indications that police officers are learning 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 in "mercy bookings" and efforts to provide safety and shelter for the indigent.

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

It is also useful to examine the reasons that police officers cite for arresting mentally ill and homeless individuals. A study by Teplin (2000) identified three main situations in which officers resorted to arrest:

Importantly, the study also points out that there are many "grey areas" where it is difficult to distinguish between common disorderly behavior and mentally disordered behavior. This once again emphasizes the importance of further research and the implementation of proper training in identifying mental disorders.

Conclusion

In conclusion, there is little doubt that a very real and serious problem exists with regard to the increasing number of homeless and mentally ill people who are in need of help in our society. That this situation often results in infringements of the law is inevitable, and it very often becomes the responsibility of the police officer to intervene and deal with the problem at hand.

In this regard, there are distinct and serious deficiencies in many areas. The need for training is one of the most prominent issues, as is the need for a more integrated and comprehensive methodology and set of protocols that police can use to mediate these situations effectively.

In the final analysis, the modern philosophy of community policing possibly offers the most inclusive and integrated solution to the problem. What is also clear is that considerably more research is needed in this area to establish the extent and nature of the problem and the most appropriate procedures and methods to address it from a policing perspective.