Police Play ‘Outsized’ Role in Transporting People with Severe Mental Illness: Survey

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Photos courtesy Treatment Advocacy Center

Police spend nearly a quarter of their time dealing with individuals suffering from severe mental illness, effectively diverting them from their primary public safety roles and straining already scarce law enforcement budgets across the country, according to a new survey.

The “outsized” role played by law enforcement in transporting mentally troubled individuals undermines police planning, leaves many officers uncomfortable, and does little to help the individuals themselves, according to the Treatment Advocacy Center, a Virginia-based nonprofit which advocates for better treatment of the mentally ill.

The survey, which was sponsored by the Center in partnership with the National Sheriffs’ Association and the New York State Association of Chiefs of Police, and funded by the Achelis and Bodman Foundation, represents the first time researchers have looked at the impact transporting individuals suffering from severe mental illness has on law enforcement.

The emergence of law enforcement as not only first responders, but de facto chauffeurs for individuals experiencing a psychological crisis, is the result of what the researchers called a ‘systemic shift’ over the past several decades.

“In addition to serving as street-corner psychiatrists, law enforcement officers have become road runners, responding to mental health emergencies and traveling long distances to shuttle people with mental illness from one facility to another,” the survey authors wrote.

Law enforcement officers in every state are authorized to detain and transport to an evaluation facility any individual whom the officer reasonably suspects is in psychiatric crisis and in need of a clinical assessment.

But since the number of state hospital beds available to patients with mental health issues is now at an all-time low, and few U.S. communities have effective crisis care systems in place, law enforcement officers end up logging an inordinate number of miles driving such individuals to distant treatment centers, and spending large chunks of time waiting for them to be admitted once they get there, the survey showed.

Some 3,000 individuals from a sample of 355 sheriff’s departments or law enforcement agencies around the country responded to the survey, which was conducted in 2017.

The survey found that 21 percent of total law enforcement staff time was used to respond to and transport individuals with mental illness, and that respondents “drove a total of 5,424,212 miles transporting individuals with serious mental illness in 2017 — the equivalent of driving around the Earth’s equator more than 217 times.”

This reflected a distortion of law enforcement responsibilities which not only harmed the community because of the time it took away from traditional police activities, but undermined treatment for the individuals themselves, researchers said.

“It is difficult to imagine subjecting someone having a heart attack to arrest, or someone with cancer being transferred to a specialty center, in handcuffs, in the back of a police cruiser,” the survey observed.

Police are usually involved in two types of transport of the mentally ill:

  • Emergency, either as the result of a 911 call or other crisis service call that requires the dispatch of an officer, or following a direct encounter with someone in psychiatric crisis
  • Non-Emergency, where transportation of an individual suffering a severe psychiatric illness needs to be taken to an emergency room or an inpatient bed.

Both types of calls not only eat up an extraordinary amount of officers’ time, but strain law enforcement budgets.

Survey respondents reported 454,438 service calls or encounters with individuals with serious mental illness during 2017.

Making things more difficult, the unpredictability of psychiatric crises meant it was almost impossible to rationally allocate time and money in advance to cope with the challenge, particularly in small communities who are often left, as a result, without adequate law enforcement coverage.

“The current system can and does paralyze efficient police operations to protect the general public,” according to an unidentified Michigan officer who responded to one of the questionnaires.

Moreover, the situation has a serious psychological impact on the officers who do the driving,  most of whom “believe they should not have such a prominent role in caring for and transporting individuals with serious mental illness because it leads to criminalization of the illness,” the survey reported.

Even more concerning than the distance required to shuttle troubled individuals was the time spent just waiting at hospital emergency departments for them to be admitted.  Some officers reported having to wait with the individual for 72 hours or more until a bed became available.

Often, to officers’ frustration, the individual they transported walked out of the door just as the patrol car was driving away—because admission was denied for a variety of reasons.

According to the survey, “in only a little more than half of the time were individuals who were transported to treatment by law enforcement actually admitted for an evaluation.”

That has put most police officers, who have had little training in dealing with mental health crises, in an almost impossible position, according to the survey.

“Officers spend significant amounts of time and resources serving in a role for which they neither planned nor trained,” said the researchers. “They are forced to make decisions about where to take someone in crisis, wrestle with how long it will take to get there, and worry about the opportunity cost of leaving their regular duties, all the while knowing the person in crisis may not even receive the treatment he or she needs.”

The survey authors said the challenge needed to be addressed through radical changes in how law enforcement and community health services worked together, as well as finding alternative forms of transportation and special training for officers.

They pointed to the crisis intervention approach used in Tucson, Az., where, since 2014, “mental health support teams” and “crisis mobile teams”  have reduced the number of psychiatric events in which law enforcement officers may need to intervene. The teams involve close partnerships with mental health professionals in the community and  emphasize preventive care, with the result that “officers spend less time responding to crises and transporting individuals to care or legal proceedings,” the survey found.

The survey pointed to several other models of response underway elsewhere in the U.S., such as telepsychiatry, used more often by rural jurisdictions to connect needy individuals with psychiatrists or counselors through “digital engagement” instead of physically transporting them.

See also: How iPads Changed One Police Force’s Response to the Mentally Ill

Another example cited was the Targeted Adult Service Coordination (TASC) program used in 16 counties in southeastern Nebraska, which employs 24-hour crisis response teams composed of licensed mental health practitioners who provide crisis intervention services and mental health assessments.

During 2018 alone, the TASC program diverted almost 250 people from hospitalization, resulting in $249,000 to $747,000 in cost savings, depending on length of stay, the survey said.

But the lack of such alternatives in most U.S. communities means that individuals with chronic mental health issues who run afoul of the law are more likely to find themselves trapped in the justice system.

With approximately one-third of individuals with severe mental illness having their first contact with mental health treatment through a law enforcement encounter, “the predictable results have been criminalization of severe mental illness and extreme overrepresentation of people with mental illness in jails and prisons,” the survey said.

Approximately 383,000 individuals with severe psychiatric disease are currently behind bars — nearly 10 times the number of patients remaining in the nation’s state hospitals, the survey said, citing previous studies.

“The Los Angeles County Jail, Chicago’s Cook County Jail and New York’s Rikers Island jail each hold more mentally ill inmates than any remaining psychiatric hospital in the country,” the authors said.

And those numbers are more likely to be driven by the fact that law enforcement is the fall-back first responder in a mental health crisis situation, according to the study. Delegating the transportation function to police, who by instinct, training and culture follow normal arrest procedures rather than pursue treatment options, also increases the odds that people in psychiatric crisis will be incarcerated, the survey said.

Studies have shown that mentally troubled individuals are four times more likely to be jailed for low-level charges than individuals without psychiatric disease.

“Although it is impossible to fully quantify the loss of dignity, unmet potential and community unrest resulting from the failure to respond appropriately to people with mental illness in need of care, we can document the time and resources communities lose by forcing law enforcement onto the front lines of mental health care,” said the researchers.

“In that way, law enforcement transport can serve as both the ‘canary in the coal mine,’ alerting us to the crisis, and an avenue to begin to address the crisis itself.”

The full survey and conclusions can be downloaded here.

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