State your case: Should law enforcement respond to mental health crisis calls?

Many cities are piloting programs that take police officers out of certain duties such as mental health response

July 15, 2021 10:51 PM

Taking police officers out of certain duties has been a major topic of discussion throughout the past year. Many cities are piloting programs that either divert officers from certain calls in favor of social workers or put officers and social workers together to respond to emergencies like mental health crises, drawing both praise and criticism. In Denver, a police-free mental health response team has seen early success six months into its test program.

Police1 recently asked readers if non-sworn specialists should replace police as the primary response to calls regarding those with mental illness. A total of 1,162 readers responded, with 37% answering yes, 57% answering no and 6% unsure.

A total of 1,162 Police1 readers answered this Police1 poll.

Read our columnists’ take on this topic and share your thoughts in the box below.

The ground rules: As in an actual debate, the pro and con sides are assigned randomly as an exercise in critical thinking and analyzing problems from different perspectives.

Our debaters: Jim Dudley, a 32-year veteran of the San Francisco Police Department where he retired as deputy chief of the Patrol Bureau, and Chief Joel Shults, EdD, who retired as chief of police in Colorado.

Joel Shults: Crisis is the business of law enforcement. At any given time, 26% of the population has a diagnosable mental illness, 20% of the population is on psychiatric medication and 30% of the population will have had a drug dependency at some point in their lives. Four percent of the population will seriously contemplate suicide in any given year. I could go on. Add a crisis event to any of these conditions and what do you get? A 911 call.

Many law enforcement agencies are being urged to stop going to “mental health” calls. I’ve got news for you, nearly every call involves a person in crisis, operating in less than their optimum rational mode. Despite the claims of the incompetence of police to handle these kinds of calls, law enforcement has been doing an amazing job of serving people in crisis. A recent analysis of the San Francisco Police Department (which you, Jim, can no doubt attest as true) showed a literally 99.9% success rate on crisis calls. In other words, the fears that officers will use unnecessary force are not borne out upon examination. Cops may have ended up being the first responder on mental health calls by default, but they actually do it really well.

Jim Dudley: Some of the most vitriolic criticism of law enforcement may be rooted in calls involving the mentally ill. Before launching an endorsement of sending non-sworn, trained, mental health specialists to calls involving the “mentally ill” I want to clarify a few things:

How is the term “mentally ill” defined? As we know, the range is broad and affects large segments of the population.
Will the MIS (mental illness specialists) respond to all calls? With violence? With weapons?
Will LE accompany the MIS to the calls?
Will this practice happen in schools, hospitals, jails and other facilities?
Will the MIS be given 5150 Welfare and Institution code authority to place individuals in detention?
Will the MIS transport them?

I’m all for removing law enforcement entirely from the process in yet another ill-conceived social experiment. (Wait, I’m designated the proponent in this debate.) The benefit would be manyfold.

First and foremost, it would free officers from harm’s way physically and from public scrutiny.

It may also be an educational tool in showing the public that even trained mental health professionals will have a difficult time dealing with individuals in crisis.

Of course, it would allow dwindling LE numbers of personnel to deal with other issues and calls for service in their communities.

After an estimated 41,000 calls involving the mentally ill in 2019, Chicago is about to launch its own version of the successful CAHOOTS program in Eugene, Oregon. The 30-year Oregon program “Crisis Assistance Helping Out on Our Streets” has been deemed successful by sending unarmed practitioners to these calls involving the mentally ill. These beta test sites should give us an idea of how the process works in a large major metropolitan city, as well as a small suburban environment.

Joel Shults: I have a number of concerns about non-law enforcement response as I pointed out in a September 2020 article here on Police1 after a visit to Eugene to check out CAHOOTS. One of those concerns is how we will be measuring success.

The non-law enforcement responders will be able to claim success as defined by resolving cases without using force or incarceration because they will not be dispatched to cases involving violence or weapons. Those will be left to the police and will be potentially a larger percentage of their calls, skewing those statistics toward use of force and incarceration.

What will not be measured is what happens when the criminal justice system is not a part of mental health response. Will criminal acts be ignored if committed by persons believed to be mentally ill? If a person skirts the criminal justice system, conditions of sentencing and probation will not mandate evaluation and treatment. As a potential consequence, mental health workers may eventually be granted some police-type powers, moving to a tyranny of mental health regulations without Constitutional protections.

Jim Dudley: As the war on drugs has ended, so too must a social reliance on law enforcement to bridge the gaps in failed or ill-conceived policies. Just as the drug issues were deemed a public health matter to be resolved by medical means, mental health situations should be handled by psychiatric professionals.

We can trace the problem back to President Ronald Reagan’s decision to end state-sponsored mental health institutions. The solution was supposed to be that families, physicians and psychologists would deal with those with serious mental illness on an outpatient basis.

Perhaps governments will choose to build psychiatric facilities to replace correctional facilities like Rikers Island and Cook County Jail.

Psychiatric facilities could house those beyond the control of those otherwise responsible for them, and the government could enact laws already in place, like Laura’s Law, that allow confinement and treatment for those who refuse outpatient treatment.

With the psychiatric community assuming ownership of those with mental health issues, law enforcement response and any ensuing use of force will no longer be subject to harsh scrutiny and criticism.

Joel Shults: I’m fascinated that law enforcement has been deemed incompetent to deal will mental health crises, but trusted to diagnose a mental condition from a phone call or immediately at the scene. Decriminalizing property damage, peace disturbance, trespass, theft, assault and so on robs victims of justice, encourages malingering and can conceal the mentally ill persons being exploited. Definitions of illegal behavior are clear, definitions of who needs to be confined as mentally ill can change without legislative and judicial review. Turning power over to social workers sounds a little too Orwellian. Co-responders and appropriate referrals and diversion are positive trends, but assuming that the demands on policing will be drastically reduced is a utopian dream. I fear that a wholesale withdrawal from mental health calls (even if that were possible) will come with unintended negative consequences for the public and the mentally ill. Perhaps the loss of liberty and due process.

Jim Dudley: I hear you Joel, but the issues remain treatment, not incarceration. Any law enforcement officer will tell you they are repeatedly dealing with the same chronic mentally ill offenders. Respond, assess, detain, repeat. It is about time for something to be done long term. Putting the onus on the professionals most qualified to deal with these individuals is long overdue.

Police1 readers respond

In an ideal world, 9-1-1 call takers would have exceptional clairvoyance allowing them to pick through a caller’s often rattled presentation about an incident and render sight unseen an accurate triage about an individual’s emotional/mental state allowing for assignment of a request for public safety service to a most appropriate and available first responder group. Add to the need for call takers to be clairvoyant, the reality of a 9-1-1 PSAP where one incident can result in dozens of incoming requests for services ensures chaos reigns supreme. It is my assessment that 9-1-1 personnel functioning in a hectic and demanding work environment with rare exceptions bring order out of chaos and are exemplary as they intake calls, dispatch first responders and deal with often rapid-fire communications and changing conditions. All the while citizens want/demand that trained practitioners be on scene instantly. This is a long way around to suggest that changing how calls for services are received, evaluated, prioritized and assigned must begin with the world as it is. An overhaul of the public safety response system is destined to fail unless all elements are adjusted as required and upgraded to meet a new response protocol. Suggested upgrades on how governments deal with people in emotional or mental crisis must include significant upgrades to PSAPs. Anything less and the outcome for the success of a complex public safety concern is predictable – failure.
Social workers are quite capable and better suited to manage crisis mental health runs when the crisis is not likely to involve violence. It allows for clients in crisis to receive care instead of cuffs. In my experience, oftentimes law enforcement would rather not participate in mental health runs. However, some law enforcement officers are unable to relinquish their control and accept a trained expert’s clinical opinion on what is needed. This is especially detrimental to clients because some officers attempt to operate out of their scope and make assertions about mental health symptoms on which they are not fully trained on, creating inaccurate mental health hx that follows clients and becomes another method to force some level of control over an individual, or more than often leaving clients in the community still in crisis. This parnership, however, is most valuable as it should be a decision the clinician can make to determine the level of treatment needed and an officer can assist in safe de-escalation or detainment. It is imperative to place emphasis on the clear assignment of roles in which the clinician provides the clinical information to support the officer’s detainment. Officers should continue to partner with their local community health providers and crisis center services to address mental health runs. Even more specific would be law enforcement partnering with licensed social workers who are health officers. When social workers are licensed and are health officers they have a legal obligation to do their jobs and maintain the safety of all clients.

MENTAL HEALTH OUTREACH RESOURCES FROM POLICE1

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