Police Training Reform for Handling Mentally Ill Suspects

Introduction

Oftentimes, law enforcement officers are called to respond to individuals who are more in need of mental health interventions than exposure to the criminal justice system — at least at first instance. In most cases, police officers do not have the capacity or capability to handle suspects who exhibit signs and symptoms of mental illness. It is important to note that failure to initiate or implement proper interventions results in the imprisonment of persons who ought to have first been treated for the mental health conditions they are suffering from. However, there is no easy solution where the initial handling of persons with mental illness by law enforcement officers is concerned.

This is especially the case given that, at first instance, police officers have an obligation, duty, and mandate to protect public safety and wellbeing. For this reason, law enforcement officers must respond when called upon in scenarios where public safety or welfare is disturbed or threatened. At the same time, however, the importance of ensuring that mentally ill persons are not subjected to unfair treatment in the form of harassment or victimization cannot be overstated — a concern sometimes referred to as parens patriae. At present, diverse jurisdictions deploy different mechanisms and strategies in the handling of mentally ill persons who commit criminal acts. There is also divided public opinion over how offenders presenting with signs and symptoms of mental illness ought to be treated by the criminal justice system. With this in mind, there is a need to initiate discussion relating to interactions between law enforcement officers — and, to a larger extent, the entire criminal justice system — and persons who commit crimes while presenting with signs and symptoms of mental illness.

Background: Mental Illness and the Criminal Justice System

From the outset, it is worth noting that according to the American Psychiatric Association (APA, 2020), "mental illnesses are health conditions involving changes in emotion, thinking or behavior (or a combination of these)… mental illnesses are associated with distress and/or problems functioning in social, work or family activities." There are a wide range of mental illnesses and disorders listed across the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), including, but not limited to, anxiety disorders, dissociative disorders, major depressive disorder, schizophrenia, and post-traumatic stress disorder (PTSD). According to data presented by the Centers for Disease Control and Prevention (CDC, 2018), mental illnesses are quite common in the United States: "1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression." This is a clear indication that mental illnesses are rather prevalent in contemporary society. Contributing factors identified by the CDC include drug and substance abuse as well as adverse life experiences, particularly those occurring early in life. It therefore follows that in the course of executing their roles, police officers are likely to encounter persons with mental illnesses.

It should, however, be noted that past studies have categorically indicated that there is no automatic positive correlation between mental illness and criminal behavior (Webermann and Brand, 2017). Various stereotypes advanced in society — and particularly in blockbuster films and crime television shows — suggest that persons with mental illness are more likely to commit crime or engage in violent behavior than their mentally healthy counterparts. However, according to Webermann and Brand (2017), there is compelling evidence contradicting these public and media misconceptions, specifically the portrayal of those with mental disorders as highly prone to criminality and violence (p. 77). Mental illness is not necessarily a predictor of criminal behavior. There is, however, no doubt that a person's risk of committing a crime could be increased by certain mental health conditions — especially among those presenting with comorbid substance use disorder. Indeed, according to Kelly, Daley, and Douaihy (2012), research has clearly indicated that a history of alcohol and substance abuse may entirely account for "the rise in violent crime committed by individuals with mental illness" (p. 75).

According to Magee, Fortenberry, Rosenman, Aalsma, Gharbi, and Wiehe (2021), there is a disproportionate representation of persons suffering from various mental health issues in the nation's criminal justice system. Hoch, Hartford, Heslop, and Stitt (as cited in Magee et al., 2021) are categorical that mentally ill persons face a greater risk of arrest and have a threefold chance of interacting with law enforcement officers compared to the general population. From a general perspective, police interaction with mentally ill individuals and the parameters within which it should ideally occur are outlined in a number of mental health codes. However, from a legal perspective, a police officer's response is not expressly dictated — effectively meaning that, as in other unique law enforcement scenarios, officers are expected to make a decision appropriate to the prevailing circumstances. Teplin (2000) indicates that when a law enforcement officer encounters a mentally ill person who presents a danger to others, or is called upon to enforce law and order in scenarios involving mentally ill patients, the officer generally has four courses of action.

First, the officer could attempt to resolve the issue on the spot upon recognizing that the individual may be mentally ill. For instance, if police are called to investigate a situation in which an individual is behaving suspiciously — such as roaming aimlessly around a shopping mall — and they establish that the person could be suffering from depression, they can resolve the matter by engaging the individual directly or by reaching out to the individual's family. Second, law enforcement officers could contact a crisis team. Third, officers could transport the individual to a mental health institution upon establishing that the person is suffering from a mental illness. The fourth and final course of action is arrest. A review of available literature and statistics indicates that arrest is the predominant course of action in a majority of scenarios. According to Teplin (2000), this is largely because implementing the other courses of action can be problematic. For instance, there are bureaucratic obstacles that officers may encounter when initiating emergency hospitalization, and "many psychiatric programs will not accept everyone, particularly those considered dangerous, those who also have substance abuse disorders, or those with numerous previous hospitalizations" (Teplin, 2000).

Theoretical and Policy Appraisal

The issue of police officer interactions with suspects who have mental illness can be appraised through criminal theory and policy by connecting it to three pillars of social justice: general systems theory, conflict theory, and Maslow's hierarchy of needs.

When it comes to general systems theory, the entire criminal justice system could be considered a single system. According to Bernard, Paoline, and Pare (2005), the various criminal justice institutions and agencies function in a unified manner and work toward similar goals, meaning they are interrelated. These institutions and agencies include law enforcement and police departments, the courts, and corrections. It follows that for the criminal justice system as a whole to promote justice and fairness, each of these branches must function effectively in relation to its individual — yet otherwise collective — mandate. As Bernard, Paoline, and Pare (2005) observe, "criminal justice agencies are organized sequentially — 'output' from one agency is 'input' to the next" (p. 107). Consequently, unfair or unjust treatment of mentally ill individuals at one level is likely to be replicated in subsequent stages of the system.

With regard to conflict theory, the focus is on the use of the criminal justice system as a tool through which certain powerful groups in society advance and secure their interests. For example, criminal law could be deployed as a means of controlling those considered to belong to the lower class. In relation to police interactions with persons who have mental illness, conflict theory can be applied to understand how persons suffering from mental illness — viewed as a socially disadvantaged group — may be discriminated against by more powerful groups, including law enforcement officers and the broader law-abiding public. This perspective helps explain the higher likelihood of persons with mental illness interacting with law enforcement and, thus, the "disproportionate involvement of persons with serious mental illnesses in the criminal justice system" (Watson and Fulambarker, 2012, p. 43).

In relation to Maslow's hierarchy of needs, Christiansen and Levi (2019) note that individuals have inherent needs that must be addressed before progressing to higher-level needs. In the realm of police work, these needs can be conceptualized as "basic survival, safety, belongingness, ego status, and self-actualization" (Christiansen and Levi, 2019, p. 311). To ensure that law enforcement officers interact with mentally ill persons — as well as other citizens — in a professional and appropriate manner, police departments must address these foundational needs. For instance, with regard to basic survival and safety, officers should be equipped with the relevant tools to guarantee their own safety, along with the assurance of appropriate backup and departmental support. When officers do not feel their safety and wellbeing are threatened, they can be more confident and considerate in their interactions with suspects who have mental illness.

Conclusion

In the final analysis, the growing prevalence of mental illness in society means that law enforcement officers are increasingly likely to interact with or encounter suspects suffering from various mental health conditions. For a range of reasons — including a lack of relevant skills and capabilities — police officers may be unable to appropriately handle such suspects. Available evidence demonstrates that mentally ill persons are overrepresented in the criminal justice system, facing a greater risk of arrest and subsequent prosecution. Perhaps more importantly, failure to improve interactions between mentally ill suspects and police officers significantly increases the risk of fatalities in the course of such encounters. As this paper has noted, persons suffering from a mental illness have a substantially higher likelihood of being killed during confrontations with law enforcement officers.

With this reality in mind, this paper has explored best practices from national and international justice systems relating to interactions between law enforcement officers and suspects with mental illness. In efforts to improve the outcomes of such encounters, three proposed solutions have been advanced: the need for training, the revision of use-of-force policies, and close collaboration between mental health service providers and police officers. Training has been identified as the most viable of these alternatives, given that police officers are first responders in such situations and must make crucial decisions in real time. Training equips officers with the capabilities to not only identify symptoms of mental illness, but also assess the situation and respond to any eventuality. Training may also be less resource-intensive than the other two approaches. In the end, comprehensive training can be considered the most practical avenue for improving the outcome of encounters between law enforcement officers and suspects suffering from various mental illnesses.