Social Work Redefining Police Interactions with People Experiencing Mental Health Crises: Models of Response
by
Amy Watson
  • LAST REVIEWED: 23 November 2021
  • LAST MODIFIED: 23 November 2021
  • DOI: 10.1093/obo/9780195389678-0308

Introduction

In many communities, police are the first and only available responders to mental health crises. Dissatisfaction with this arrangement among all stakeholders, concerns about the criminalization of mental illnesses, and recent evidence that at least one in four people killed in encounters with police have a serious mental illness, have all maintained attention to this issue among researchers, policymakers, and practitioners. The scholarship in this area dates back to the 1960s and has examined the nature and characteristics of police interactions with people with mental illnesses and those experiencing mental health crises, police decision making, use of force, and call resolutions. As models of police–mental health collaboration have emerged, the literature describing different models and their implementation and outcomes had grown, as has the literature on police mental health and deescalation training. More recently, researchers have sought to understand the experiences of people with mental needs in these encounters, and the response model preferences of service users and caregivers. While progress has been made in terms of improving the abilities of police officers to respond to mental health crises, a consistent theme across the literature is the lack of adequate mental health resources for people with mental health needs in the community and as options for officers to resolve mental health crises. For the most part, there is a gaping absence of literature exploring race disparities leading up to mental health crises or in police response to them. However, the current Black Lives Matter movement and calls to “defund” police suggest an urgent need to shift responsibility for mental health crisis response away from law enforcement. Government and private nonprofit groups are working to develop frameworks and guidelines for developing capacity in the mental health system to take on the primary responsibility. This work must be done through a race equity lens.

Foundational Works

The literature on police response to people with mental illnesses began with Bittner 1967, a seminal work that described how officers negotiated resolutions to mental health encounters, resorting to formal apprehensions when no other options were available. Building on this work, Teplin 1984 and Teplin and Pruett 1992 also found officers were hesitant to take formal actions or rely on mental health services. They found suspects with mental illnesses were more likely to be arrested than those without, indicating support for the criminalization hypothesis. A later study, Engel and Silver 2001, potentially disputing the criminalization hypothesis, found that rather than increasing the risk of arrest, mental illness was a protective factor. Providing more depth to this discussion, Morabito 2007 draws from Bittner’s work to describe a conceptual framework of police decision making that considers the role of mental illness and social factors in arrest decisions. As recognition of the involvement of police in responding to mental health crises grew, models to improve their response began to emerge. Deane, et al. 1999 identifies a three-category framework of police–mental health collaborations that continues to be relevant today: police-based specialized police response, police-based specialized mental health response, and mental-health-based specialized mental health response. Despite a growing body of research over the last half-century, there is no standard documentation or measurement of the frequency of police response to mental health emergencies, arrest rates for individuals with mental illnesses, and the extent of police involvement pathways to care. Livingston 2016, a recent synthesis of available studies, provides the best estimates we have to date that indicate that in the United States, 6–10 percent of all police contacts involve people with mental illnesses and almost a third of people with mental illnesses have police involved in their pathway to care.

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

    DOI: 10.1525/sp.1967.14.3.03a00040Save Citation »Export Citation » Share Citation »

    This seminal work examined the police role in dealing with individuals with mental illnesses subject to emergency apprehension and transport to psychiatric care. Bittner found that officers were hesitant to make emergency apprehensions, often locating caregivers or providing “psychiatric first aid.” Officers would take formal action in cases in which the psychological disturbance was accompanied by a suicide attempt, unusual appearance, agitation with a risk of violence, or significant disorientation.

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  • Deane, M. W., H. J. Steadman, R. Borum, B. M. Veysey, and J. P. Morrissey. 1999. Emerging partnerships between mental health and law enforcement. Psychiatric Services 50.1: 99–101.

    DOI: 10.1176/ps.50.1.99Save Citation »Export Citation » Share Citation »

    In this article, the authors present a three-category framework of what was, at the time, emerging practices for improving police response to mental health emergencies. The categories identified were: police-based specialized police response, a police-based specialized mental health response, and a mental-health-based specialized mental health response.

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  • Engel, R. S., and E. Silver. 2001. Policing mentally disordered suspects: A re-examination of the criminalization hypothesis. Criminology 39.2: 225–252.

    DOI: 10.1111/j.1745-9125.2001.tb00922.xSave Citation »Export Citation » Share Citation »

    The authors used data from two large scale field studies of policing—the Project on Policing Neighborhoods (POPN) conducted in 1996–1997 and the Police Services Study (PSS) conducted in 1977—to examine the impact of suspect mental illness and arrest decisions. In contrast to Teplin’s earlier work, this study found that police were not more likely to arrest suspects with mental illnesses.

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  • Livingston, J. D. 2016. Contact between police and people with mental disorders: A review of rates. Psychiatric Services 67.8: 850–857.

    DOI: 10.1176/appi.ps.201500312Save Citation »Export Citation » Share Citation »

    This article reports on a systematic review of research on rates of arrest among people with mental illnesses, involvement of police in pathways to mental health care, and the percentage of police calls for service that involve persons with mental illnesses.

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

    DOI: 10.1176/appi.ps.58.12.1582Save Citation »Export Citation » Share Citation »

    In this article, the author builds on Bittner’s work to propose a conceptual framework for police discretion in encounters involving people with mental illnesses. The author emphasizes the need to move beyond an oversimplified understanding of criminalization to consider the role of social structural factors such as poverty, transience, and substance abuse in arrest outcomes for people with mental illnesses.

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  • Teplin, L. A. 1984. Criminalizing mental disorder: The comparative arrest rate of the mentally ill. American Psychologist 39.7: 794–803.

    DOI: 10.1037/0003-066X.39.7.794Save Citation »Export Citation » Share Citation »

    This article presents data from a large-scale observational study of 1,396 police-citizen interactions in Chicago, Illinois. Trained research assistants determined if the subject displayed signs of mental illness (rather than relying on officer perceptions). Findings indicate that suspects with mental illnesses were arrested at a higher rate than subjects without mental illnesses, providing evidence of criminalization.

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  • 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-XSave Citation »Export Citation » Share Citation »

    The authors utilize data from their observational study of police–citizen interactions to describe the decision-making frameworks that officers use to manage persons with mental illnesses in the community. The authors report that for suspects and non-suspects with mental illnesses, officers were hesitant to rely on mental health resources, preferring to resolve interactions informally. The authors concluded that officer decisions were based more on contextual factors than the degree of psychiatric symptomology.

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Books

Two edited volumes are noteworthy in providing an international perspective on policing and mental health crisis response. Chappell 2013 examines efforts to improve police response in Australia, North America, Europe, Africa and other developing areas. McDaniel, et al. 2020 is more focused on the United Kingdom, with comparisons to Australia and the United States. Both compilations include entries from leading scholars and provide excellent coverage of key issues in the field.

  • Chappell, D., ed. 2013. Policing and the mentally ill: International perspectives. Boca Raton, FL: CRC Press, Taylor and Francis Group.

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    This book provides an international perspective on developments related to police response to people with mental illnesses. Chapters examine the nature of the issue and efforts to improve police response occurring in Australia, North America, Europe, Africa and other developing areas.

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  • McDaniel, J., K. Moss, and K. Pease, eds. 2020. Policing and mental health: Theory, policy and practice. Abington, UK: Routledge.

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    This edited book includes chapters focusing on mental health and policing in the United Kingdom, the United States, Australia, and South Africa. Perspectives from England and Wales (where the editors are based) are highlighted. The final section of the book focuses on the mental health of police officers.

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Journals

Interdisciplinary journals such as Behavioral Sciences and the Law and the International Journal of Law and Psychiatry regularly publish research and commentary related to the intersection of the criminal legal and mental health systems from authors from diverse fields. Community Mental Health Journal, the Journal of Psychiatric and Mental Health Nursing, and Psychiatric Services are situated within the mental health services field but frequently publish pieces related to people with serious mental illnesses that have contact with the criminal legal system and services and policies related to this population. Policing and Society and Policing: A Journal of Policy and Practice publish work in this area relevant to police practitioners.

Specialized Organizations

There are numerous governmental, professional, and nonprofit organizations doing relevant work related to mental health crisis response and police. The two main governmental agencies in the United States working in this area are the Bureau of Justice Assistance (BJA), housed within the U.S. Department of Justice and the Substance Abuse and Mental Health Services Administration (SAMHSA), housed within the U.S. Department of Health and Human Services. Both provide grants and technical assistance to communities. The Council of State Governments Justice Center and the National Association of State Mental Health Program Directors are both nonpartisan, nonprofit organizations that provide resources and technical assistance to states and communities, often funded by BJA and/or SAMHSA. The National Council for Mental Well-Being and the International Association of Chiefs of Police (IACP) are professional membership organizations that are involved in initiatives in this space. Also, a nonprofit membership organization, CIT International, works to support communities implementing CIT programs and regularly partners with the National Alliance on Mental Illness. The National Police Foundation is a research and technical assistance organization. The Vera Institute of Justice focuses on social justice issues and racial disparities. Their policing initiative has focused on police response to people with behavioral health disorders and strategies to reduce the role of police.

Research on Law Enforcement Interactions with People with Mental Health Needs

A growing body of research has examined characteristics of police encounters with people with mental health needs, factors associated with officer decision making, and call resolutions. This work, including Green 1997 and Todd and Chauhan 2021, has found that arrest is relatively low in frequency in these encounters and has identified legal, officer, and subject factors associated with call resolutions. A recurrent theme discussed in Godfredson, et al. 2011; Green 1997; Mclean and Marshall 2010; Todd and Chauhan 2021; and Yang, et al. 2018 is the finding that officers feel the available mental health resource options are inadequate. Additionally, while people experiencing mental health crises are in need of assistance, Holman, et al. 2018 indicates that many do not require hospitalization and as Todd and Chauhan 2021 finds, most situations do not involve a criminal offense, leading several authors to conclude they would be better handled via less coercive pathways or by mental health professionals. Much of this research has been conducted in the United States; however in an article summarizing a program of research conducted in Victoria, Australia, Ogloff, et al. 2013 indicates consistent themes, as does Godfredson, et al. 2011 in Australia, Holman, et al. 2018 in New Zealand, and Mclean and Marshall 2010 in Scotland. Chidgey, et al. 2019 focuses on identifying characteristics of a subset of encounters involving suicidal or self-harming behavior that may present specific challenges and risks.

  • Chidgey, K., N. Procter, A. Baker, and C. Grech. 2019. Police response to individuals displaying suicidal or self‐harming behaviours: An integrative review. Health & Social Care in the Community 27.3: e112–e124.

    DOI: 10.1111/hsc.12668Save Citation »Export Citation » Share Citation »

    The authors review the literature on a subset of behavioral health crisis police calls, those involving people displaying suicidal or self-harming behaviors. Common characteristics of the subject and context are identified and include: male subject, age 35–40, relationship issues, history of mental health problems, prior police contact, and in the United States and Australia, armed with a weapon.

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  • Godfredson, J., S. Thomas, J. Ogloff, and S. Luebbers. 2011. Police perceptions of their encounters with individuals experiencing mental illness: A Victorian survey. Australian and New Zealand Journal of Criminology 44.2: 180–195.

    DOI: 10.1177/0004865811405138Save Citation »Export Citation » Share Citation »

    The authors report findings from a survey of police officers in Victoria, Australia. Officers indicated they identify mental illnesses most frequently based on observations of speech, behavior, and appearance and that 20 percent of their interactions with the public involved people with mental illnesses. Mental health apprehensions were reported as the most common outcome and gaining support from mental health providers was the biggest challenge.

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  • Green, T. 1997. Police as frontline mental health workers: The decision to arrest or refer to mental health agencies. International Journal of Law and Psychiatry 20.4: 469–486.

    DOI: 10.1016/S0160-2527(97)00011-3Save Citation »Export Citation » Share Citation »

    This study examined factors predicting outcomes of arrest, informal resolution, or no action in police encounters with persons with mental illnesses. While officers viewed arrest as a last resort, the strongest predictors of arrest were the seriousness of the offense, the officer’s years of experience, and suspect’s criminal history. Officers recognized the limited utility of hospitalization as an option and indicated that in general, all their available disposition options were inadequate.

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  • Holman, G., A. J. O’Brien, and K. Thom. 2018. Police and mental health responses to mental health crisis in the Waikato region of New Zealand. International Journal of Mental Health Nursing 27.5: 1411–1419.

    DOI: 10.1111/inm.12440Save Citation »Export Citation » Share Citation »

    This study examined police encounters with persons with mental illnesses in the Waikato region of New Zealand. Maori were overrepresented in police encounters, but not more likely to experience use of force. Half the individuals detained by police did not require hospitalization, indicating the need for less coercive pathways to care. Authors caution the mental health nursing profession to be cognizant of its role with police.

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  • Mclean, N., and L. A. Marshall. 2010. A front-line police perspective of mental health issues and services. Criminal Behaviour and Mental Health 20.1: 62–71.

    DOI: 10.1002/cbm.756Save Citation »Export Citation » Share Citation »

    The authors report findings from qualitative interviews with nine frontline police from Scotland. Consistent with studies conducted in the United States and Australia, officers expressed frustration at having to address the failings of the health system.

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  • Ogloff, J. P., S. Thomas, S. Luebbers, et al. 2013. Policing services with mentally ill people: Developing greater understanding and best practice. In Special Issue: Contemporary Issues in Forensic Psychology in Australia. Edited by Andrew Day, Michael Daffern, Greg Dear, and Astrid Birgden. Australian Psychologist 48.1: 57–68.

    DOI: 10.1111/j.1742-9544.2012.00088.xSave Citation »Export Citation » Share Citation »

    The authors provide a summary of research on police response to persons with mental illnesses conducted in Victoria, Australia. Research described addresses prevalence of mental illness among persons detained by police, the frequency and nature of mental health apprehensions, officer knowledge and attitudes, use of force, and interactions with victims of crime. Findings are consistent with research conducted internationally and point to the need for improvements in policing and interagency practices.

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  • Todd, T. L., and P. Chauhan. 2021. Seattle police department and mental health crises: Arrest, emergency detention, and referral to services. Journal of Criminal Justice 72:101718.

    DOI: 10.1016/j.jcrimjus.2020.101718Save Citation »Export Citation » Share Citation »

    This very recent article examined factors predicting officer decisions to arrest, emergency mental health detention, and referral of individuals to services in mental health crisis incidents over a three-year period in Seattle, Washington. Arrest was the lowest frequency outcome, emergency detention was the most frequent. The majority of crisis events did not involve a criminal offense, which the authors indicate suggests they may be better handled by mental health professionals.

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  • Yang, S., C. Gill, L. Kanewske, and P. S. Thompson. 2018. Exploring police response to mental health calls in a nonurban area: A case study of Roanoke County, Virginia. Victims & Offenders 13.8: 1132–1152.

    DOI: 10.1080/15564886.2018.1512540Save Citation »Export Citation » Share Citation »

    This study examined characteristics of mental-health-related police calls in a nonurban area and the perspectives of officers on these calls, their response options, and CIT training. Consistent with research in urban communities, findings indicate that mental-health-related calls are time-consuming and have higher rates of use of force. Many officers expressed dissatisfaction with available options for resolving mental-health-related calls.

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Research Focused on Use of Force, Injuries, and Fatalities

Safety is of primary concern in police response to mental health crises, for the officer, the person in crisis, and the public. Several studies have examined whether police use more force with people with mental illnesses than those without. Kesic, et al. 2013 finds that people with mental illnesses and those with prior mental health system contact were overrepresented in nonfatal use of force events. Johnson 2011 finds that when factors such as resistance are controlled for, police do not use force more often on subjects with mental illnesses. Similarly, Morabito, et al. 2017 shows that mental illness alone was not associated with more force; however, subjects with co-occurring mental illness and substance use disorders were perceived as more resistant and had more force used on them. Furthermore, Morabito and Socia 2015 find co-occurring mental illness and substance use disorder was associated with increased risk of injury to both the subject and the officer. Mulvey and White 2014 examines evidence that police use higher levels of force on people with mental illnesses, but according to Rossler and Terrill 2017, this may not be associated with higher risk of injury. Research from the United States (Saleh, et al. 2018) and Australia (Kesic, et al. 2010) indicates that people with mental illnesses are significantly overrepresented in fatal police encounters. Finally, while there is a dearth of research on the influence of subject race in police use of force against persons with mental illnesses, Thompson 2016 identifies significant racial bias public perceptions of police use force.

  • Johnson, R. R. 2011. Suspect mental disorder and police use of force. Criminal Justice and Behavior 38.2: 127–145.

    DOI: 10.1177/0093854810388160Save Citation »Export Citation » Share Citation »

    This study examined whether police use more force against suspects with mental disorders. Using officer self-report data from two police agencies, the authors found that when controlling for presence of a weapon and subject resistance, police officers were not more likely to use force against suspects with mental disorders than suspects without mental disorders.

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  • Kesic, D., S. D. M. Thomas, and J. R. P. Ogloff. 2010. Mental illness among police fatalities in Victoria 1982–2007: Case linkage study. Australian and New Zealand Journal of Psychiatry, 44.5: 463–468.

    DOI: 10.3109/00048670903493355Save Citation »Export Citation » Share Citation »

    This study examined the role of mental illness in fatal uses of force by Victoria police over a twenty-five-year period. People with serious mental illnesses were significantly overrepresented, and among those with both psychotic and substance use disorders, half had contact with mental health providers within two weeks of their deaths. The authors point to the need for enhanced police training and interagency collaboration.

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  • Kesic, D., S. D. M. Thomas, and J. R. P Ogloff. 2013. Estimated rates of mental disorders in, and situational characteristics of, incidents of nonfatal use of force by police. Social Psychiatry and Psychiatric Epidemiology 48.2: 225–232.

    DOI: 10.1007/s00127-012-0543-4Save Citation »Export Citation » Share Citation »

    Examining nonfatal police use of force incidents in Victoria, Australia, this study found that people with mental illness were overrepresented. Half of the incidents involved people that had had prior contact with the mental health system and more than a third had been diagnosed with mental disorders. Individuals with prior mental health system contact were also more likely to have had prior criminal justice system histories.

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  • Morabito, M. S., and Kelly M. Socia. 2015. Is dangerousness a myth? Injuries and police encounters with people with mental illnesses. Criminology & Public Policy 14.2: 253–276.

    DOI: 10.1111/1745-9133.12127Save Citation »Export Citation » Share Citation »

    This study analyzed three years of use of force reports from the Portland Police Bureau (Oregon) to explore whether subject mental illness increased the risk of injuries in force events. Mental illness by itself did not increase the risk of injury; however, when combined with substance use, it increased the risk of injury for both the subject and the officer.

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  • Morabito, M. S., K. Socia, A. Wik, and W. H. Fisher. 2017. The nature and extent of police use of force in encounters with people with behavioral health disorders. International Journal of Law and Psychiatry 50:31–37.

    DOI: 10.1016/j.ijlp.2016.10.001Save Citation »Export Citation » Share Citation »

    This study examined three years of use of force data from the Portland (Oregon) Police Bureau. Findings indicate that people perceived as having co-occurring mental health and substance use disorders were perceived as most resistant and had more force used against them than people with no disorder and those with only a mental health or a substance use disorder. This highlights the potential added risk when co-occurring disorders are present.

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  • Mulvey, P., and M. White. 2014. The potential for violence in arrests of persons with mental illness. Policing: An International Journal of Police Strategies & Management 37.2: 404–419.

    DOI: 10.1108/PIJPSM-07-2013-0076Save Citation »Export Citation » Share Citation »

    Findings from this study, which used data from interviews with arrestees, indicate that police were not more likely to use force in arrests of persons with mental illnesses. However, when force was used, police used higher levels with individuals with mental health problems. Findings also indicate that mental health problems were a strong predictor of resistance against police.

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  • Rossler, M. T., and W. Terrill. 2017. Mental illness, police use of force, and citizen injury. Police Quarterly 20.2: 189–212.

    DOI: 10.1177/1098611116681480Save Citation »Export Citation » Share Citation »

    Analyzing data from three cities participating in the Assessing Use of Force Policy and Outcomes study, the authors found that officers utilized higher levels of force with subjects with mental illnesses, but this was not associated with a higher risk of injury. Available online.

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  • Saleh, A. Z., P. S. Appelbaum, X. Liu, S. T. Stroup, and M. Wall. 2018. Deaths of people with mental illness during interactions with law enforcement. International Journal of Law and Psychiatry 58:110–116.

    DOI: 10.1016/j.ijlp.2018.03.003Save Citation »Export Citation » Share Citation »

    This study utilized the Washington Post and Guardian databases on citizen deaths in police encounters. Findings indicate that the 23 percent of individuals killed by police in 2015 that showed signs of mental illness were less likely to be brandishing a firearm and more likely to have been killed in their homes than those not showing signs of mental illnesses.

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  • Thompson, M. 2016. Mental illness, race, and policing. Sociology of Crime, Law, and Deviance 21:175–196.

    DOI: 10.1108/S1521-613620160000021010Save Citation »Export Citation » Share Citation »

    This article reports findings from a survey of public perceptions of police use of force, public trust in police, and how perceptions vary by race and mental health status. Findings indicate that the public deems police force to be more appropriate when the subject is Black. Having a mental illness increases endorsement of force for Black subjects, but decreases support for force with White subjects.

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Research Examining Place and Spatial Patterning of Mental Health Crises

A relatively recent avenue of scholarship is examining the role of space and place, or the spatial distribution of mental health crisis calls and the neighborhood characteristics associated with these patterns and outcomes. Studies from the United States and Canada have found the patterning of mental-health-related calls compared to crime-related or all other calls for service is different (see Hodgkinson and Andresen 2019; Vaughan, et al. 2016; and Weisburd and White 2019). However, in their series of papers examining spatial patterns in Baltimore, Maryland, White and colleagues (White and Goldberg 2018 and White, et al. 2019) suggest patterns of mental-health-related calls are correlated with areas of drug and violent crime and Weisburd and White 2019 indicate there is overlap of “hot spots” of crime and concentrations of health and mental health problems. In Canada, Vaughan, et al 2019 also found evidence of different spatial pattering of mental-health-related calls involving men versus women. Krishan and colleagues found neighborhood characteristics to be related to characteristics police encounter with persons with serious mental illness. This line of work suggests implications for interventions. Wood and Beierschmitt 2014 argues that both targeted case and space management are needed to move “upstream” and interrupt the cycle of repeated crisis interventions and White and Weisburd 2018 conducted a pilot of clinician–officer teams targeting crime hotspot areas to proactively officer mental health assistance. Reviewing the space- and place-based research, Jensen 2019 concludes that police cannot be the only actors addressing issues of public health and crime and that all efforts must be cognizant of race inequities.

  • Hodgkinson, T., and M. A. Andresen. 2019. Understanding the spatial patterns of police activity and mental health in a Canadian City. Journal of Contemporary Criminal Justice 35.2: 221–240.

    DOI: 10.1177/1043986219842014Save Citation »Export Citation » Share Citation »

    Examining the spatial patterning of police calls in a Canadian city, the authors found differences between mental-health-related and crime call types. However, violent crime call patterns were similar to mental-health-related call patterns.

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  • Jensen, R. H. 2019. What has place got to do with it? Hot spots policing to address physical and mental health. Journal of Contemporary Criminal Justice 35.2: 124–141.

    DOI: 10.1177/1043986219836579Save Citation »Export Citation » Share Citation »

    This article reviews the emerging place-based public health and crime literature and considers implications for research and innovative policy solutions. Authors indicate that that police cannot be the only actors addressing these issues and efforts must be cognizant of race inequities.

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  • Krishan, S., R. Bakeman, B. Broussard, et al. 2014. The influence of neighborhood characteristics on police officers’ encounters with persons suspected to have a serious mental illness. International Journal of Law and Psychiatry 37.4: 359–369.

    DOI: 10.1016/j.ijlp.2014.02.006Save Citation »Export Citation » Share Citation »

    This study examines the relationship between neighborhood deprivation and characteristics and outcomes of mental-health-related police calls. While neighborhood deprivation was not associated with use of force or call resolutions, it was associated with other call characteristics (dispatched or on-view, location type, time of day, and officer perception of subject substance use). Available online.

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  • Vaughan, A. D., A. N. Hewitt, M. A. Andresen, and P. L. Brantingham. 2016. Exploring the role of the environmental context in the spatial distribution of calls-for-service associated with emotionally disturbed persons. Policing: a Journal of Policy and Practice 10.2: 121–133.

    DOI: 10.1093/police/pav040Save Citation »Export Citation » Share Citation »

    This study compared the patterning of emotionally disturbed person (EDP) calls to that of all other police contacts in an urban Canadian setting. Findings indicate pattern differences, with EDP calls clustering in a small number of street segments in areas that behavioral health services tended to be located. Authors provide discussion on the implications for policing and health care services.

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  • Vaughan, A. D., A. N. Hewitt, M. A. Andresen, S. N. Verdun-Jones, and P. L. Brantingham. 2019. The importance of gender in the spatial distribution of police interactions involving emotionally disturbed persons: An examination of call types. Policing & Society 29.2: 137–154.

    DOI: 10.1080/10439463.2017.1373110Save Citation »Export Citation » Share Citation »

    The key findings from this study relate to gender differences in the spatial patterning of EDP calls. Police EDP contacts with women were more likely to occur in residential settings, compared to EDP contacts with men, which were more likely to occur in commercial and business settings.

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  • Weisburd, D., and C. White. 2019. Hot spots of crime are not just hot spots of crime: Examining health outcomes at street segments. Journal of Contemporary Criminal Justice 35.2: 142–160.

    DOI: 10.1177/1043986219832132Save Citation »Export Citation » Share Citation »

    The authors examine the overlap of crime hot spots and concentrations of health and mental health problems.

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  • White, C., and V. Goldberg. 2018. Hot spots of mental health crises. Policing: An International Journal of Police Strategies & Management 41.3: 401–414.

    DOI: 10.1108/PIJPSM-12-2017-0155Save Citation »Export Citation » Share Citation »

    This study found that mental health crisis (MHC) calls clustered in specific street segments that were distributed throughout Baltimore, Maryland. While correlated with areas where violent and drug crime cluster, the patterning of street segments where MHC calls occur differed. The authors discuss the implications for proactive “hot spot” interventions.

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  • White, C., V. Goldberg, J. Hibdon, and D. Weisburd. 2019. Understanding the role of service providers, land use, and resident characteristics on the occurrence of mental health crisis calls to the police. Journal of Community Psychology 47.8: 1961–1982.

    DOI: 10.1002/jcop.22243Save Citation »Export Citation » Share Citation »

    This study found that street segments with more drug and violent crime overlapped with those with more mental health crisis (MHC) calls. MHC calls were more likely to occur on streets with schools nearby, but not more likely on streets near service providers. Both resident drug use and offending and social cohesion and community involvement reduced the likelihood of MHC calls. Available online.

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  • White, C., and D. Weisburd. 2018. A co-responder model for policing mental health problems at crime hot spots: Findings from a pilot project. Policing: A Journal of Policy and Practice 12.2: 194–209.

    DOI: 10.1093/police/pax010Save Citation »Export Citation » Share Citation »

    The authors utilized crime hot-spot area data to focus proactive police officer–clinician teams to offer behavioral health related referrals and assistance.

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

    DOI: 10.1016/j.ijlp.2014.02.016Save Citation »Export Citation » Share Citation »

    The authors report findings from a study that included spatial mapping of police mental health transports, interviews, and focus groups. They argue that both targeted case and space management are needed to move “upstream” and interrupt the cycle of repeated crisis interventions.

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Perspectives of People with Mental Illnesses and Caregivers

People living with mental illnesses or experiencing mental health crises and their family members and caregivers are the end-users of police services. Their perspectives are critical to our understanding of mental-health-related police encounters and informing improvements to policy and practice. The studies Furness, et al. 2016 and Livingston, et al. 2014 examine the experiences of people living with mental illnesses applying a procedural justice lens. These studies suggest that people with mental illnesses have contact with police for a variety of reasons, and that how police officers treat them matters. People with mental illnesses report both positive and negative experiences and indicate they feel very vulnerable when interacting with police. Consistent with procedural justice themes, findings from Sondhi, et al. 2018 regarding interviews with people with lived experience of being detained by police under the Mental Health Act highlight the importance of police in framing the experience of the entire process. Comparing police response to a co-responder response, Furness, et al. 2016 finds that the involvement of a co-responder team (clinician and officer) did not reduce perceptions of coercion during an involuntary admission; however, it did increase perceptions of procedural justice. Similarly, individuals interviewed in Lamanna, et al. 2018 reported more consistently positive experiences with co-responder teams compared to police-only response. Qualitative research conducted in Bradbury, et al. 2017 and Brennan, et al. 2016 suggests that people with mental illnesses and family members find police involvement in mental health crises humiliating and traumatic. While family members indicate mental health providers are not always sensitive to their concerns, both people with mental illnesses and family members prefer co-response to police-only response (Brennan, et al. 2016 and Boscarato, et al. 2014). White 2021 offers a personal narrative that provides a unique glimpse into emergency mental health services and suggests improvements are needed in police response and all along the crisis services pathway.

  • Boscarato, K., S. Lee, J. Kroschel, Y. Hollander, A. Brennan, and N. Warren. 2014. Consumer experience of formal crisis-response services and preferred methods of crisis intervention. International Journal of Mental Health Nursing 23.4: 287–295.

    DOI: 10.1111/inm.12059Save Citation »Export Citation » Share Citation »

    This qualitative study examined service-user experiences and preferences related to several crisis response models. Most participants preferred that police not be involved in crisis response, but indicated co-response by police and a clinician as preferable to police-only responses.

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  • Bradbury, J., M. Hutchinson, J. Hurley, and H. Stasa. 2017. Lived experience of involuntary transport under mental health legislation. International Journal of Mental Health Nursing 26.6: 580–592.

    DOI: 10.1111/inm.12284Save Citation »Export Citation » Share Citation »

    This study examined the perspectives of consumers, caregivers, and service providers on mental health transports by police. Overarching themes included humiliation (services users), feeling emotionally conflicted (caregivers), and frustration (service providers).

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  • Brennan, A., N. Warren, V. Peterson, Y. Hollander, K. Boscarato, and S. Lee. 2016. Collaboration in crisis: Carer perspectives on police and mental health professional’s responses to mental health crises. International Journal of Mental Health Nursing 25.5: 452–461.

    DOI: 10.1111/inm.12233Save Citation »Export Citation » Share Citation »

    The authors focus on the experiences of caregivers that had contact with police and mental health services in the context of a loved one’s mental health crisis. Caregivers reported experiencing crisis events as traumatic and feeling that mental health services were not sensitive to caregiver burdens and needs. They reported positive and negative experiences with both services. When police involvement is needed, they indicated a preference for collaborative responses.

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  • Furness, T., T. Maguire, S. Brown, and B. McKenna. 2016. Perceptions of procedural justice and coercion during community-based mental health crisis: A comparison study among stand-alone police response and co-responding police and mental health clinician response. Policing: A Journal of Policy and Practice 11.4: 400–409.

    DOI: 10.1093/police/paw047Save Citation »Export Citation » Share Citation »

    This study found that among individuals who experienced mental health crisis in the community that resulted in involuntary inpatient psychiatric admission, those who received response from a co-responder team (clinician and officer) perceived greater procedural justice than those who received a police-only response. Perceptions of coercion were similar across response types.

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  • Lamanna, D., G. Shapiro, M. Kirst, F. Matheson, A. Nakhost, and V. Stergiopoulos. 2018. Co‐responding police–mental health programmes: Service user experiences and outcomes in a large urban centre. International Journal of Mental Health Nursing 27.2: 891–900.

    DOI: 10.1111/inm.12384Save Citation »Export Citation » Share Citation »

    In qualitative interviews, service users reported positive experiences with co-response teams. Their experiences with police-only response was more variable and often felt criminalizing. Overall, they valued compassionate, knowledgeable responses and use of deescalation skills, regardless of the responder type.

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  • Livingston, J. D., S. L. Desmarais, S. Verdun-Jones, R. Parent, E. Michalak, and J. Brink. 2014. Perceptions and experiences of people with mental illness regarding their interactions with police. International Journal of Law and Psychiatry 37.4: 334–340.

    DOI: 10.1016/j.ijlp.2014.02.003Save Citation »Export Citation » Share Citation »

    This study examined the experiences of people with mental illnesses in different types of interactions with police (not limited to mental health crisis). While a majority had experienced police use of force, and a quarter reported having been injured, ratings of procedural justice and satisfaction in their most recent interaction were mostly positive. Participants provided recommendations for strategies to improve interactions with police, many of which related to training.

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  • Sondhi, A., L. Luger, L. Toleikyte, and E. Williams. 2018. Patient perspectives of being detained under section 136 of the Mental Health Act: Findings from a qualitative study in London. Medicine, Science and the Law 58:159–167.

    DOI: 10.1177/0025802418774966Save Citation »Export Citation » Share Citation »

    In this study conducted in England, the authors describe findings from interviews with people with lived experience of being detained by police for psychiatric assessment under the Mental Health Act of 1983. Findings emphasize the importance of being treated humanely and with care by professionals throughout the process. The initial contact with police was particularly important to participants’ experience of stigma and framed their overall experience of the process. Available online.

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  • Watson, A. C., B. Angell, M. S. Morabito, and N. Robinson. 2008. Defying negative expectations: Dimensions of fair and respectful treatment by police officers as perceived by people with mental illness. Administration and Policy in Mental Health and Mental Health Services Research 35.6: 449–457.

    DOI: 10.1007/s10488-008-0188-5Save Citation »Export Citation » Share Citation »

    One of the first to examine police interactions from the perspectives of people with serious mental illnesses, this study utilized a procedural justice lens. Participants reported both positive and negative interactions with police. Two primary themes emerged: First, participants felt extremely vulnerable in interactions with police and second, how police treated them mattered. Findings support the importance of procedurally just policing practices.

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  • White, C. J. 2021. An inevitable response? A lived experienced perspective on emergency responses to mental health crises. Journal of Psychiatric and Mental Health Nursing 28.1: 90–93.

    DOI: 10.1111/jpm.12631Save Citation »Export Citation » Share Citation »

    In this first-person account, the author describes his experience with police and other emergency responses to mental health crisis.

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Models of Police Response to Mental Health Crises

The literature examining models of collaboration between law enforcement and mental health services first emerged in the late 1990s. A series of papers (Borum, et al. 1998; Deane, et al. 1999; Hails and Borum 2003; and Steadman, et al. 2000)reported the strategies being used by police agencies to respond to mental health emergencies, the perceptions of police personnel on their effectiveness, and the outcomes of the different models. These papers identified three categories of models that correspond with the Crisis Intervention Team model: police-based police-specialist, embedded co-response in which a mental health clinician rides with police (police-based mental health specialist), and co-response in which the mental health clinician and officer arrive separately (mental-health-based mental health specialist). Reuland 2010 provides an overview of the main components of these approaches and how they are tailored to communities and Davis, et al. 2021 focuses on how small rural police agencies are implementing these approaches. Research examining the effectiveness of different models has been the subject of systematic reviews and meta-analysis conducted in Kane, et al. 2018; Parker, et al. 2018; and Seo, et al. 2021. The CIT model has received the most research attention and has the most robust evidence of benefit. A recent literature review conducted in Watson, et al. 2019 examines police and non-police first responder models and presents a research agenda for the future.

  • Borum, R., M. W. Deane, H. J. Steadman, and J. Morrissey. 1998. Police perspectives on responding to mentally ill people in crisis: Perceptions of program effectiveness. Behavioral Sciences and the Law 16.4: 393–405.

    DOI: 10.1002/(SICI)1099-0798(199823)16:4<393::AID-BSL317>3.0.CO;2-4Save Citation »Export Citation » Share Citation »

    The authors conducted a survey of officers from three agencies, each implementing a different model of mental health response. One department had a group of specially trained officers (CIT officers), one department had in-house social workers to assist officers, and one relied on support from a mobile mental health team. The effectiveness of agency response was rated highest by officers from the agency with CIT officers.

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  • Davis, R. C., M. Lebron, and M. Reuland. 2021. How small law enforcement agencies respond to calls involving persons in crisis: Results from a national survey. National Police Foundation.

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    This report details findings of a survey of small police agencies in the United States. It highlights the crisis response strategies agencies have been able to implement along with the challenges that small rural agencies face. Additionally, the report examines the extent to which participating agencies were reassessing their crisis response in the aftermath of the death of George Floyd and other Black men and women during police encounters.

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  • Deane, M. W., H. J. Steadman, R. Borum, B. M. Veysey, and J. P. Morrissey. 1999. Emerging partnerships between mental health and law enforcement. Psychiatric Services 50.1: 99–101.

    DOI: 10.1176/ps.50.1.99Save Citation »Export Citation » Share Citation »

    The authors surveyed 174 police agencies about their approach to responding to mental health crisis calls. Seventy-eight agencies reported having a specialized response, which the authors grouped into three basic categories: a police-based specialized police response, a police-based specialized mental health response, and a mental-health-based specialized mental health response. This three-category framework guided subsequent work by the authors and their colleagues.

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  • Hails, J., and R. Borum. 2003. Police training and specialized approaches to respond to people with mental illnesses. Crime and Delinquency 49.1: 52–61.

    DOI: 10.1177/0011128702239235Save Citation »Export Citation » Share Citation »

    The authors surveyed eighty-four medium and large police agencies in the United states about the amount of training in mental health response officers received and the use of specialized responses. Across agencies, the median number of hours was 6.5 for basic recruits and one hour for in-service. Almost a third of the agencies indicated having some form of specialized response for mental health calls.

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  • Kane, E., E. Evans, and F. Shokraneh. 2018. Effectiveness of current policing-related mental health interventions: A systematic review. Criminal Behaviour and Mental Health 28.2: 108–119.

    DOI: 10.1002/cbm.2058Save Citation »Export Citation » Share Citation »

    In this systematic review, the authors define and examine the evidence for four interventions, all of which provide for the presence of or connection to a clinician during a mental health crisis: Liaison and diversion, Street Triage, mental health specialists in police control rooms, and Crisis Intervention Teams (CITs). Findings suggest that all of the models demonstrate benefits, with the CIT model having the most robust evidence base.

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  • Parker, A., A. Scantlebury, A. Booth, J. C. MacBryde, W. J. Scott, K. Wright, and C. McDaid. 2018. Interagency collaboration models for people with mental ill health in contact with the police: A systematic scoping review. BMJ Open 8.3: e019312–e019312.

    DOI: 10.1136/bmjopen-2017-019312Save Citation »Export Citation » Share Citation »

    This review examined the literature on collaboration between police and other services to support people with mental health disorders and identified research on thirteen distinct models. The most frequently reported models were pre-arrest diversion, co-response, and information-sharing agreements.

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  • Reuland, M. 2010. Tailoring the police response to people with mental illness to community characteristics in the USA. Police Practice & Research 11.4: 315–329.

    DOI: 10.1080/15614261003701723Save Citation »Export Citation » Share Citation »

    This article describes the origins of several police-based models of response to mental health crisis, identifies ten essential elements of these models, and provides examples of how these elements have been tailored to unique community characteristics and problems.

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  • Seo, C., B. Kim, and N. E. Kruis. 2021. Variation across police response models for handling encounters with people with mental illnesses: A systematic review and meta-analysis. Journal of Criminal Justice 72:101752.

    DOI: 10.1016/j.jcrimjus.2020.101752Save Citation »Export Citation » Share Citation »

    The authors synthesize the literature on police response models, including Crisis Intervention Team (CIT), co-responder, and nonCIT training models and conduct a meta-analysis examining several outcomes. Authors report positive effects across the model for fourteen of eighteen outcomes assessed, although effect sizes for observed outcomes related to force, arrest, and injuries were small. Some differences on outcomes between models were noted.

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  • Steadman, H., M. W. Deane, R. Borum, and J. P. Morrissey. 2000. Comparing outcomes of major models of police responses to mental health crises. Psychiatric Services 51.5: 645–649.

    DOI: 10.1176/appi.ps.51.5.645Save Citation »Export Citation » Share Citation »

    This study compared outcomes of mental-health-related police contacts in three communities implementing different specialized response strategies: police-based civilian mental health specialist response; police-based police specialized mental health response (CIT), and mental-health-based specialized mental health response. Overall, the arrest rate was seven percent, with the CIT site having the lowest (2 percent). Authors concluded that collaborations for specialized mental health response may reduce arrests of persons with mental illnesses.

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  • Watson, A. C., M. T. Compton, and L. G. Pope. 2019. Crisis response services for people with mental illnesses or intellectual and developmental disabilities: A review of the literature on police-based and other first response models. New York: Vera Institute of Justice. October, 2019.

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    The report examines models of crisis response for people with mental illnesses and intellectual and developmental disabilities. Available research evidence is reviewed for each model and an agenda for future research is presented.

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The Crisis Intervention Team (CIT) Model

The CIT model and its implementation are fully described in Usher, et al. 2019 in a downloadable publication available from CIT International. There is a growing body of research on the CIT model. The studies Kubiak, et al. 2017 and Teller, et al. 2006 examine the impact of CIT program implementation on calls for service and transports to emergency departments and crisis-receiving Centers and indicate that CIT implementation increases transports and other linkages to care. Other studies have compared CIT trained to non-CIT trained officers. Compton, et al. 2014a and Compton, et al. 2014b examine officer knowledge, attitudes and self-efficacy, and use of force and both Compton, et al. 2014b and Watson, et al. 2021 examine call outcomes of arrest, linkage to care, and resolve on scene. Comartin, et al. 2019 examines willingness to travel farther to get people to crisis care.

Crisis Intervention Team (CIT) Model Enhancements and Special Populations

As the CIT model has matured, there has been attention to the needs of special populations and the development of enhancements. Tyuse, et al. 2017 describes characteristics of CIT calls involving older adults. To better address the specific needs of youth experiencing mental health crises, advanced CIT training focused on youth has been developed and described in the literature in the articles Doulas and Lurigio 2010 and Kubiak, et al. 2019. Crisanti, et al. 2019 describes an approach to providing ongoing training and consultation.

  • Crisanti, A. S., J. A. Earheart, N. A. Rosenbaum, M. Tinney, and D. J. Duhigg. 2019. Beyond crisis intervention team (CIT) classroom training: Videoconference continuing education for law enforcement. International Journal of Law and Psychiatry 62:104–110.

    DOI: 10.1016/j.ijlp.2018.12.003Save Citation »Export Citation » Share Citation »

    In this article, the authors provide an overview of CIT ECHO, an online videoconferencing project developed in Albuquerque, New Mexico that provides ongoing CIT-related education and opportunities for case debriefing with psychiatrists and experienced CIT experts.

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  • Doulas, A. V., and A. J. Lurigio. 2010. Youth Crisis Intervention Teams (CITs): A response to the fragmentation of the educational, mental health, and juvenile justice systems. Journal of Police Crisis Negotiations 10.1–2:241–263.

    DOI: 10.1080/15332586.2010.481893Save Citation »Export Citation » Share Citation »

    This article discusses the unique concerns related to police interactions with youth with behavioral health disorders and provides a description of three CIT-for-youth programs.

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  • Kubiak, S., D. Shamrova, and E. Comartin. 2019. Enhancing knowledge of adolescent mental health among law enforcement: Implementing youth-focused crisis intervention team training. Evaluation and Program Planning 73:44–52.

    DOI: 10.1016/j.evalprogplan.2018.11.006Save Citation »Export Citation » Share Citation »

    The authors describe the implementation and evaluation of an eight-hour supplemental youth-focused CIT training (CIT-Y). Evaluation findings are generally positive, while also highlighting areas where the training could be improved.

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  • Tyuse, S. W., S. Cooper-Sadlo, and S. E. Underwood. 2017. Descriptive study of older adults encountered by crisis intervention team (CIT) law enforcement officers. Journal of Women & Aging 29.4: 281–293.

    DOI: 10.1080/08952841.2016.1174513Save Citation »Export Citation » Share Citation »

    This descriptive study examined the nature of 911 calls for service involving older adults to which CIT officers provided response and the predictors of call dispositions. Findings indicate a higher rate of emergency department transports than has been found in studies examining outcomes with the broader adult population.

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The Co-Responder Model (AKA Street Triage, PACER)

The Co-Responder Model, also known as Street Triage in the United Kingdom and PACER in Australia, typically involves a police officer and a clinician responding to a mental health crisis together. Two systematic reviews of the literature have been published: Puntis, et al. 2018 and Shapiro, et al. 2015. Both note evidence of potential benefits of the model, significant variation in implementation, and the need for further research. More recent studies not covered in the reviews include descriptive studies Bailey, et al. 2018 and Robertson, et al. 2020 examining barriers and facilitators to implementation. The studies Lamanna, et al. 2018; Meehan, et al. 2019; Morabito, et al. 2018; and Semple, et al. 2021 report promising, often preliminary, outcomes that suggest this model may reduce police detentions and increase voluntary transports. The quasi-experimental study Bailey, et al. 2021 finds the model may reduce arrests but not longer term EMS use or justice system involvement. Lamanna, et al. 2018 suggests that service users prefer this model to police-only response. Lord and Bjerregaard 2014 compared calls handled by a mobile crisis team that were initiated by police (mental-health-based specialist model of co-response) with those initiated by other sources. Their findings are informative for considering call triaging whennon-law enforcement alternatives are available. A proactive approach to co-response focused on “hot spots” is described in White and Weisburd 2018

  • Bailey, K., E. M. Lowder, E. Grommon, S. Rising, and B. R. Ray. 2021. Evaluation of a police–mental health co-response team relative to traditional police response in Indianapolis. Psychiatric Services

    DOI: 10.1176/appi.ps.202000864Save Citation »Export Citation » Share Citation »

    The authors describe findings from a quasi-experimental study of a co-response team (CRT) in Indianapolis, Indiana. Compared to matched cases receiving police response only, individuals receiving CRT response were less likely to be arrested in the immediate encounter and had higher EMS use in the twelve-month follow-up period.

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  • Bailey, K., S. R. Paquet, B. R. Ray, E. Grommon, E. M. Lowder, and E. Sightes. 2018. Barriers and facilitators to implementing an urban co-responding police-mental health team. Health & Justice 6.1: 1–12.

    DOI: 10.1186/s40352-018-0079-0Save Citation »Export Citation » Share Citation »

    The authors describe the initial implementation of co-response teams comprised of a police officer, a paramedic, and a clinician in Indianapolis, Indiana. Challenges as well as program facilitators are discussed.

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  • Lamanna, D., G. K. Shapiro, M. Kirst, F. I. Matheson, A. Nakhost, and V. Stergiopoulos. 2018. Co‐responding police–mental health programmes: Service user experiences and outcomes in a large urban centre. International Journal of Mental Health Nursing 27.2: 891–900.

    DOI: 10.1111/inm.12384Save Citation »Export Citation » Share Citation »

    Findings from this study suggest that compared to police-only response, co-responder teams were more likely to resolve calls with voluntary escorts to the hospital.

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  • Lord, V. B., and B. Bjerregaard. 2014. Helping persons with mental illness: Partnerships between police and mobile crisis units. Victims & Offenders 9.4: 455–474.

    DOI: 10.1080/15564886.2013.878263Save Citation »Export Citation » Share Citation »

    This article looked at a partnership between police and mobile crisis units (MCU) in Mecklenburg County, North Carolina and compared MCU contacts that were initiated by police to those initiated by other sources. The contacts initiated by police tended to be more acute and higher risk, and less likely to be resolved on scene.

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  • Meehan, T., J. Brack, Y. Mansfield, and T. Stedman. 2019. Do police–mental health co-responder programmes reduce emergency department presentations or simply delay the inevitable? Australasian Psychiatry: Bulletin of the Royal Australian and New Zealand College of Psychiatrists 27.1: 18–20.

    DOI: 10.1177/1039856218797424Save Citation »Export Citation » Share Citation »

    This Australian study found that co-responder teams were able to divert the majority of mental health crisis calls from the emergency department. Two-week follow-up data suggest that only a small portion of those initially diverted had a repeat call or presented to the ED.

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  • Morabito, M. S., J. Savage, L. Sneider, and K. Wallace. 2018. Police response to people with mental illnesses in a major U.S. city: The Boston experience with the co-responder model. Victims & Offenders 13.8: 1093–1105.

    DOI: 10.1080/15564886.2018.1514340Save Citation »Export Citation » Share Citation »

    The authors describe the initial implementation and preliminary outcomes of a co-response program in Boston, Massachusetts.

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  • Puntis, S., D. Perfect, A. Kirubarajan, et al. 2018. A systematic review of co-responder models of police mental health ‘street’ triage. BMC Psychiatry 18.1: 256

    DOI: 10.1186/s12888-018-1836-2Save Citation »Export Citation » Share Citation »

    This systematic review of co-responder models identified significant variation in model characteristics and implementations. While the authors emphasize the need for rigorous research, they conclude that there is preliminary evidence that these models are acceptable to stakeholders and may reduce police detentions and emergency department transports.

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  • Robertson, J., M. S. Fitts, J. Petrucci, D. McKay, G. Hubble, and A. R. Clough. 2020. Cairns Mental Health Co‐Responder Project: Essential elements and challenges to programme implementation. International Journal of Mental Health Nursing 29.3: 450–459.

    DOI: 10.1111/inm.12679Save Citation »Export Citation » Share Citation »

    In this article, the authors describe challenges and factors contributing to successful implementation of a co-response program in Queensland, Australia.

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  • Semple, T., M. Tomlin, C. Bennell, and B. Jenkins. 2021. An evaluation of a community-based mobile Crisis Intervention Team in a small Canadian police service. Community Mental Health Journal 57.3: 567–578.

    DOI: 10.1007/s10597-020-00683-8Save Citation »Export Citation » Share Citation »

    The authors describe the implementation of a co-response team in a small Canadian community. They present initial findings that suggest cost savings, reduced police detentions, and increased resource provision to individuals served.

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  • Shapiro, G. K., A. Cusi, M. Kirst, P. O’Campo, A. Nakhost, and V. Stergiopoulos. 2015. Co-responding police-mental health programs: A review. Administration and Policy in Mental Health and Mental Health Services Research 42.5: 606–620.

    DOI: 10.1007/s10488-014-0594-9Save Citation »Export Citation » Share Citation »

    The authors review the academic and gray literature on co-responder programs. They conclude that there is evidence of benefits in terms of improving partnerships between law enforcement and mental health providers and positive perceptions by service users and family members, but there is very limited research to assess impacts on other outcomes.

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  • White, C., and D. Weisburd. 2018. A co-responder model for policing mental health problems at crime hot spots: Findings from a pilot project. Policing: A Journal of Policy and Practice 12.2: 194–209.

    DOI: 10.1093/police/pax010Save Citation »Export Citation » Share Citation »

    The authors conducted a pilot of police officer–clinician teams that proactively made contacts in crime hot spot areas to offer behavioral-health-related referrals and assistance. Initial findings suggest that community members were open to the program. The authors suggest the program has the potential to address mental health problems, prevent mental health crises, and improve perceptions of police.

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Police Education and Training about Mental Health Response

Work to create a framework for police mental health training conducted in Canada, described in Coleman and Cotton 2014a and Coleman and Cotton 2014b, provides an excellent overview of existing policies and practices in Canada as well as the United States and Australia, and a multilevel framework for in-service, pre-service, and specialist training. In the United States, despite substantial attention to police training, Plotkin and Peckerman 2017 finds significant variation across states in terms of minimum requirements for pre-service and in-service training related to mental health response A number of “one of” studies of brief mental health and deescalation training for police (described in Hacker and Horan 2019; Krameddine, et al. 2013; Peterson, et al. 2020; and Scantlebury, et al. 2017) suggest limited to promising potential benefits. While there has not been a randomized control trial, studies examining the forty-hour CIT training in Compton, et al. 2014a; Cuddeback, et al. 2016; and Kubiak, et al. 2017 suggest benefits related to officer knowledge, attitudes, self-efficacy, and endorsement of deescalation skills. Osteen, et al. 2020 focuses on suicide intervention and argues for a national mandate for suicide intervention training for police.

Redefining the Role of Law Enforcement in Mental Health Crisis Response

Government and professional organizations such as Committee on Psychiatry and the Community for the Group for the Advancement of Psychiatry 2021 and SAMHSA 2020 have developed guidelines and reports detailing the components of a comprehensive behavioral health crisis response system that does not place the primary responsibility on law enforcement. In their NASW Social Justice Brief, Wilson and Wilson 2020 discuss strategies for community reinvestment to reduce the harms of policing. Balfour, et al. 2020 imagines a continuum of options, with some, but not all, involving police. Butler and Sheriff 2020, a report from the Brookings Institution, highlights strategies communities are using to reduce police involvement and the Vera Institute of Justice has developed a resource that includes detailed case studies of communities implementing innovative approaches (Beck, et al. 2020). Evidence supporting the need for these efforts is found in the peer-reviewed literature on police response to mental health crises. For example, findings from the study Wood, et al. 2021 indicate that the available mental health options are inadequate and police officers are limited in their ability to provide support and effective response. Works such as Pollack and Humphreys 2020 and Wood and Beierschmitt 2014 point to the need to implement evidence-informed practices to improve safety when police do respond to mental health crises, develop alternative responses that reduce police involvement, and move even further upstream to address the needs of people with serious mental illnesses and prevent the situations that bring them in contact with police.

Beyond Redefining: Defunding, Decoupling, and Addressing Structural Racism

While glaringly central to discussions of policing and mental illness, considerations of systemic racism within policing and the mental health system are relatively limited in the literature on police response to mental health crises. However, in the recent context of demands to “defund” the police, many stakeholders are pushing race inequities to the forefront and demanding a reduction, if not elimination, of the role of law enforcement in mental health crisis response. A Judge David L Bazelon Center for Mental Health Law 2020 publication discusses the harms of both the criminal legal and mental health systems for Black communities and highlights the importance of the voices of people with mental illnesses in all stages of system change. Rafla-Yuan, et al. 2021 argues that reliance on police perpetuates racialized systems of power and structural violence. Shadravan, et al. 2021 discusses how current strategies to improve crisis response do not address systemic racism and caution that mental health system-based responses must be actively antiracist, or they will perpetuate the structural harms of the criminal legal and mental health systems. Watson, et al. 2021 cautions that non-law enforcement response models could increase race inequities if not implemented with community input and monitored carefully.

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