Police Encounters with Persons with a Mental Illness

by

Duncan Chappell, Anthony O'Brien

• LAST REVIEWED: 15 January 2019
• LAST MODIFIED: 15 January 2019
• DOI: 10.1093/obo/9780195396607-0259

Introduction

Involvement with people with a mental illness (PMI) has been a feature of the role of police in Western societies since the earliest mental health legislation in the 19th century. It is only in recent times, however, and especially since the era commencing in the 1960s with the widespread closure of most asylums for the mentally ill, that this role has become the subject of systematic research and analysis. Early literature reflects concern about a role thrust on police as state-provided, institutionally based mental health services were rolled back. Police were confronted with a new phenomenon: the presence, especially in urban centers, of large numbers of people with disabling mental illness for whom there was no longer a residentially based mental health service, and frequently little in the way of a community-based program of mental health care and social services. Police were left to deal as best they could with what was often a crisis situation. One of the principal resulting consequences of a lack of comprehensive policy in this area, and the absence in particular of collaboration with and by mental health services, became a well-known cycle of arrest, incarceration, inadequate treatment, and chronicity for persons with mental illness. Without an effective model of interaction, any police response also ran the risk of escalating increasingly to the use of aversive measures, including deadly force. For these reasons, progressive police agencies sought new approaches to their involvement with people with mental illness. Since at least the 1960s the scholarly literature is reflective of this search. From this recognition emerged a variety of policing models designed to enhance the delivery of assistance to persons experiencing some form of mental health crisis. One of these models, the so-called Memphis Crisis Intervention Team (MCIT), has proven to be particularly influential and has now been widely adopted in some form or other in police agencies across North America and elsewhere. There is a considerable literature about the MCIT program that suggests it is effective in many areas, including changes in police beliefs and attitudes, improved pathways for those apprehended, and improved referrals to mental health services. There is less evidence about the effectiveness of other models as the literature reviewed in this article indicates. Attention is also directed to a number of emerging issues as well as those surrounding the education and training of police personnel, the protection of special populations de-escalation of crises, the use of force, and the particular challenges of extending these police response models to less developed parts of the globe.

Foundational Publications

As the works provided here illustrate, scholarly consideration of policing and mental health issues has a venerable history. Written in the 1960s by the eminent American sociologist Egon Bittner, Bittner 1967 draws attention to the major role police played in referring persons for psychiatric treatment—a function that had been a regular part of police work for decades. In the course of presenting an observational study examining the exercise of police discretion in the context of such referrals, Bittner suggested that this work amounted to “psychiatric first aid” and might be called “keeping the peace” as distinct from “enforcing the law.” This distinction, which had already been proposed and discussed more fully in Banton 1965, written by a British sociologist, was in succeeding years elaborated upon by a series of commentators. By the early 1990s and beyond it had attracted the attention of works in the psycho-legal field such as Teplin and Pruett 1992 and Morabito 2007. Further observational research was undertaken in Teplin and Pruett 1992 of the police handling of the mentally ill. This research confirmed that managing mentally disordered persons in the community continued to be seen as a necessary part of police work. In recent years that role as a “streetcorner psychiatrist” had expanded as a result of deinstitutionalization and other public policy modifications. However, the legal structure did not dictate the resolution of such encounters and whether the disordered individual was defined by police to be “bad” (and should be arrested) “mad” (and hospitalized), or merely eccentric was decided by discretion rather than rules of law. Twenty-first-century scholarly and multidisciplinary commentary and research in this area has focused mainly on ways to enhance the quality of the police and allied mental health system response although observational studies such as Wood and Beierschmitt 2014 and Wood, et al. 2017 have continued. Wood, et al. 2017, for instance, reports that their field observations of mental-health-related encounters in Chicago often occurred in the “gray zone” where the problems at hand did not call for formal or legalistic interventions. The authors emphasize the need for policymakers to have access to more sophisticated studies of “gray zone” decision making. Wood and Watson 2017 further suggests that the police should reimagine themselves as “guardians” rather than “warriors” in the performance of duties such as these. The debate about ways of improving police interventions during mental-health-related encounters has advanced substantially in both form and substance and has led to a wider recognition of the important and still-evolving links between police and public health as has been emphasized by Chappell 2010; McKinnon, et al. 2016 (cited under Nature and Scope of the Problem); Anderson and Burris 2017; and Van Dijk and Crofts 2017.

• Anderson, E., and S. Burris. 2017. Policing and public health: Not quite the right analogy. Policing and Society 27.3: 300–313.

  DOI: 10.1080/10439463.2016.1231188

  Policing is important to public health, and it makes sense for both police and public health communities to consider how greater cooperation systems integration might lead to fresh approaches to chronic problems at the intersection of health and security. This article appraises the ways in which these approaches might be facilitated. Also considers how an initial concentration on the physical and mental health of the police would be a good commencement point.

• Banton, M. 1965. The policeman in the community. New York: Basic Books.

  An accepted seminal pioneer study by a British sociologist of what is now the flourishing field of social science analyses of policing.

• Bittner, E. 1967. Police discretion in emergency apprehension of mentally ill persons. Social Problems 14.3: 278–292.

  This pioneering and influential article reviews the circumstances underlying the exercise of police discretion in emergency apprehensions of mentally ill persons. Based on field observations with police in a large US city, Bittner concludes that the decision to invoke the law governing such apprehensions is seen as a last resort, based largely on an absence of other alternatives. The domain of alternatives is found in normal police peacekeeping activities where considerations of legality play a subordinate role.

• Chappell, D. 2010. From sorcery to stun guns and suicide: The eclectic and global challenges of policing and the mentally ill. Police Practice and Research: An International Journal 11.4: 289–300.

  DOI: 10.1080/15614263.2010.497028

  World Health Organization data reveals high lifetime prevalence rates of mental illness across the globe: this is a phenomenon that not only impacts health services but also affects police. This article introduces a special journal issue reviewing the diverse and challenging ways in which police seek to respond to an aspect of their work that has often been misunderstood or neglected but is now receiving the wider attention it deserves.

• Morabito, M. S. 2007. Horizons of context: Understanding the police decision to arrest people with mental illness. Psychiatric Services 58.12: 1582–1587.

  DOI: 10.1176/ps.2007.58.12.1582

  This study adopts Bittner’s early analysis of police discretion to examine multiple-level factors that impact police interactions with PMIs. It is noted that much current literature focuses on proximal factors in police interactions, without taking account of the wider social context or the characteristics of individual officers that might affect their decisions. Three “horizons of context” are suggested as providing a framework for understanding the issue.

• Teplin, L. A., and N. S. Pruett. 1992. Police as streetcorner psychiatrist: Managing the mentally ill. International Journal of Law and Psychiatry 15.2: 139–156.

  DOI: 10.1016/0160-2527(92)90010-X

  The juxtaposition of demographic changes and de-institutionalization has increased the burden of the mentally ill on police. Contemporaneously, more stringent mental health codes and diminished treatment options have reduced available referral alternatives for police. This study, based on extensive observations of policing in a US Midwestern city, demonstrates the disposition of mentally disordered citizens is based less on psychiatric symptomology than on a complex array of contextual and situational variables.

• van Dijk, A., and N. Crofts. 2017. Law enforcement and public health as an emerging field. Policing and Society 27.3: 261–275.

  DOI: 10.1080/10439463.2016.1219735

  Typically, law enforcement as public policing has not been geared to an explicit public health role. This article argues for closer and better relationships based on mutual understanding of the inextricable entanglement of health and criminal justice perspectives in many complex social issues, including mental health.

• Wood, J. D., and L. Beierschmitt. 2014. Beyond police crisis intervention: Moving ‘upstream’ to manage cases and places of behavioural health vulnerability. International Journal of Law and Psychiatry 37.5: 439–447.

  DOI: 10.1016/j.ijlp.2014.02.016

  This participatory action project based in Philadelphia provides a contextualized understanding of the police response to PMIs in an urban setting. Using spatial analysis, focus groups and individual interviews, as well as quantitative data on police contacts, the article reports on the range of strategies used by police as well as legislative limitations on them. Argues for a move beyond crisis intervention toward more “upstream” interventions, aimed at prevention. Procedural justice is recommended as a framework for interaction with vulnerable populations.

• Wood, J. D., and A. C. Watson. 2017. Improving police interventions during mental health-related encounters: past, present and future. Policing and Society 27.3: 289–299.

  DOI: 10.1080/10439463.2016.1219734

  The 2015 report of the US President’s Task Force on 21st-century policing called for cultural change in police work from one based on an image of police as “warriors” to one of “guardians.” This thoughtful and important article reviews reform efforts and looks into the future concerning the handling of mental-health-related encounters and the formulation of a guardian mindset.

• Wood, J. D., A. C. Watson, and A. J. Fulambarker. 2017. The ‘gray zone’ of police work during mental health encounters: Findings from an observational study in Chicago. Police Quarterly 20.1: 81–105.

  DOI: 10.1177/1098611116658875

  Field observations of police officers handling mental-health-related encounters in Chicago found that three core features were involved: accepting temporary solutions to chronic vulnerability, using local knowledge to guide decision making, and negotiating peace with complainants and call subjects. Policy implications for police interventions are discussed.