Hostname: page-component-745bb68f8f-g4j75 Total loading time: 0 Render date: 2025-01-12T20:20:41.412Z Has data issue: false hasContentIssue false
  • English
  • Français

Decriminalizing mental illness: specialized policing responses

Published online by Cambridge University Press:  29 November 2019

Charles Dempsey ,
Cameron Quanbeck Open the ORCID record for Cameron Quanbeck [Opens in a new window] ,
Clarissa Bush  and
Kelly Kruger
Charles Dempsey
Affiliation:
Crisis Response Support Section, Mental Evaluation Unit, Administration-Training Detail, Los Angeles Police Department, Los Angeles, California, USA
Cameron Quanbeck*
Affiliation:
Cordilleras Mental Health Rehabilitation Center, San Mateo County Health, San Mateo, California, USA
Clarissa Bush
Affiliation:
Zuckerberg San Francisco General Hospital, University of California San Francisco School of Nursing, San Francisco, California, USA
Kelly Kruger
Affiliation:
San Francisco Police Department, San Francisco, California, USA
*
*Address correspondence to: Cameron Quanbeck, Cordilleras Mental Health Rehabilitation Center, San Mateo County Health, San Mateo, California, USA.(Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

De-institutionalization of mental health patients has evolved, over nearly 3 generations now, to a status quo of mental health patients experiencing myriad contacts with first-responders, primarily police, in lieu of care. The current institutions in which these patients rotate through are psychiatric emergency units, emergency rooms, jails, and prisons. Although more police are now specially trained to respond to calls that involve mental health patients, the criminalization of persons with mental illness has been steadily increasing over the past several decades. There have also been deaths. The Crisis Intervention Team (CIT) model fosters mental health acumen among first responders, and facilitates collaboration among first responders, mental health professionals, and mental health patients and their families. Here, we review some modern, large city configurations of CIT, the co-responder model, the mitigating effects of critically situated community-based programs, as well as barriers to the success of joint efforts to better address this pressing problem.

Keywords

Mentally ill personscrisis interventionpolice educationinterprofessional relationsdiversionemergency services
Type
Review
Information
CNS Spectrums , Volume 25 , Issue 2 , April 2020 , pp. 181 - 195
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

References:

Dunn, T, Dempsey, C. Agitation in field settings: emergency medical services providers and law enforcement. In: Zeller, SL, Nordstrom, KD, Wilson, MP, eds. Diagnosis and Management of Agitation. New York, NY: Cambridge University Press; 2017.Google Scholar
Treatment Advocacy Center. Emergency Hospitalization for Evaluation: Assisted Psychiatric Treatment Standards by State. https://www.treatmentadvocacycenter.org/storage/documents/Emergency_Hospitalization_for_Evaluation.pdf. Accessed February 4, 2019.Google Scholar
Counsel of State Governments-Justice Center. Stepping Up Initiative. https://csgjusticecenter.org/mental-health/county-improvement-project/stepping-up/pdf. Accessed February 4, 2019.Google Scholar
Council of State Governments Justice Center. Tailoring Law Enforcement Initiatives to Individual Jurisdictions. https://www.bja.gov/Publications/CSG_LE_Tailoring.pdf. Accessed February 4, 2019.Google Scholar
The University of Memphis, School of Urban Affairs and Public Policy, Department of Criminology and Criminal Justice, CIT Center. Crisis Intervention Team Core Elements. http://cit.memphis.edu/pdf/CoreElements.pdf. Accessed February 4, 2019.Google Scholar
Bakeman, R, Broussard, B, D’Orio, B, Watson, CW. Police officers’ volunteering for (rather than being assigned to) Crisis Intervention Team (CIT) training: evidence for a beneficial self-selection effect. Behav Sci Law. 2017;35(5-6):470–479.Google Scholar
Compton, MT, Bakeman, R, Broussard, B, et al. The police-based crisis intervention team (CIT) model: I. Effects on officers’ knowledge, attitudes, and skills. Psychiatr Serv. 2014;65(4):517–522.10.1176/appi.ps.201300107CrossRefGoogle ScholarPubMed
van den Brink, RH, Broer, J, Tholen, AJ, et al. Role of the police in linking individuals experiencing mental health crises with mental health services. BMC Psychiatry. 2012;12:171.10.1186/1471-244X-12-171CrossRefGoogle ScholarPubMed
El-Mallakh , PL, Kiran, K, El-Mallakh , RS. Costs and savings associated with implementation of a police crisis intervention team. South Med J. 2014;107(6):391–395.10.14423/01.SMJ.0000450721.14787.7dCrossRefGoogle ScholarPubMed
Compton, MT, Demir Neubert, BN, Broussard, B, et al. Use of force preferences and perceived effectiveness of actions among Crisis Intervention Team (CIT) police officers and non-CIT officers in an escalating psychiatric crisis involving a subject with schizophrenia. Schizophr Bull. 2011;37(4):737–745.10.1093/schbul/sbp146CrossRefGoogle Scholar
Compton, MT, Broussard, B, Reed, TA, et al. Survey of police chiefs and sheriffs and of police officers about CIT programs. Psychiatr Serv. 2015;66(7):760–763.10.1176/appi.ps.201300451CrossRefGoogle ScholarPubMed
Demir, B, Broussard, B, Goulding, SM, et al. Beliefs about causes of schizophrenia among police officers before and after crisis intervention team training. Community Ment Health J. 2009;45(5):385–392.10.1007/s10597-009-9194-7CrossRefGoogle ScholarPubMed
Silverstone, PH, Krameddine, YI, DeMarco, D, et al. A novel approach to training police officers to interact with individuals who may have a psychiatric disorder. J Am Acad Psychiatry Law. 2013;41(3):344–355.Google ScholarPubMed
Krameddine, YI, Demarco, D, Hassel, R, et al. A novel training program for police officers that improves interactions with mentally ill individuals and is cost-effective . Front Psychiatry. 2013;4:9.10.3389/fpsyt.2013.00009CrossRefGoogle ScholarPubMed
Gur, OM Persons with mental illness in the criminal justice system: police interventions to prevent violence and criminalization. J Police Crisis Negot. 2010;10(1–2):220–240.10.1080/15332581003799752CrossRefGoogle Scholar
Dempsey, C. Beating mental illness: crisis intervention team training and law enforcement response trends. South Calif Interdiscip Law J. 2017;26(2):323–340.Google Scholar
Lamanna, D, Shapiro, GK, Kirst, M, et al. Co-responding police-mental health programmes: service user experiences and outcomes in a large urban centre. Int J Ment Health Nurs. 2018;27(2):891–900.10.1111/inm.12384CrossRefGoogle Scholar
Kisely, S, Campbell, LA, Peddle, S, et al. A controlled before-and-after evaluation of a mobile crisis partnership between mental health and police services in Nova Scotia. Can J Psychiatry. 2010;55(10):662–668.10.1177/070674371005501005CrossRefGoogle ScholarPubMed
Lee, SJ, Thomas, P, Doulis, C, et al. Outcomes achieved by and police and clinician perspectives on a joint police officer and mental health clinician mobile response unit. Int J Ment Health Nurs. 2015;24(6):538–546.10.1111/inm.12153CrossRefGoogle ScholarPubMed
McKenna, B, Furness, T, Oakes, J, et al. Police and mental health clinician partnership in response to mental health crisis: a qualitative study. Int J Ment Health Nurs. 2015;24(5):386–393.10.1111/inm.12140CrossRefGoogle ScholarPubMed
Evangelista, E, Lee, S, Gallagher, A, et al. Crisis averted: how consumers experienced a police and clinical early response (PACER) unit responding to a mental health crisis. Int J Ment Health Nurs. 2016;25(4):367–376.10.1111/inm.12218CrossRefGoogle ScholarPubMed
Lopez, H. A Descriptive Study of LAPD’s Co-Response Model for Individuals with Mental Illness. Long Beach, CA: ProQuest School of Social Work, University of California; 2016. https://www.equitasproject.org/wp-content/uploads/2017/06/Lopez-Thesis-on-Co-responder-model.pdf. Accessed February 4, 2019.Google Scholar
SAMHSA’s Gains Center for Behavioral Health and Justice Transformation. Policy Research Associates. Developing a Comprehensive Plan for Mental Health and Criminal Justice Collaboration: The Sequential Intercept Model. https://www.prainc.com/wp-content/uploads/2015/10/SIMBrochure.pdf. Accessed February 4, 2019.Google Scholar
Policy Research Associates. The Sequential Intercept Model: Advancing Community-Based Solutions for Justice-Involved People with Mental and Substance Use Disorders. https://www.prainc.com/wp-content/uploads/2017/08/SIM-Brochure-Redesign0824.pdf. Accessed February 4, 2019.Google Scholar
Los Angeles Police Department. Community Mental Health Resource Guide. https://www.equitasproject.org/wp-content/uploads/2017/06/LAPDTriFoldFinal-2-15-17-updated.pdf. Accessed February 4, 2019.Google Scholar
National Alliance on Mental Illness, Glendale Chapter. Guidelines for Effective Communication With 911 Dispatch. http://namiglendale.org/dealing-with-911/. Accessed February 4, 2019.Google Scholar
Houston Police Department, Mental Health Division. Emergency Guide. http://www.houstoncit.org/emergency-guide/. Accessed October 11, 2016.Google Scholar
National Alliance on Mental Illness, Dallas Chapter. 911 Checklist. http://www.namidallas.org/uploads/2/2/4/3/22433150/911_checklist_2015.pdf. Accessed February 4, 2019.Google Scholar
Houston Police Department, Mental Health Division. Crisis Call Diversion. https://www.houstoncit.org/crisis-call-diversion-program/. Accessed February 4, 2019.Google Scholar
The Counsel of State Governments, Justice Center. “What If,” to Real Results: US Police Departments Explore Innovative, Collaborative Ways to Address Growing Mental Health Crisis. https://csgjusticecenter.org/mental-health/posts/from-what-if-to-real-results-u-s-police-departments-explore-innovative-collaborative-ways-to-address-growing-mental-health-crisis/pdf. Accessed February 4, 2019.Google Scholar
Bernstein, M. Next year a 9-1-1 mental health emergency call won't automatically bring a Portland cop. The Oregonian. 2011. https://www.oregonlive.com/portland/index.ssf/2011/12/next_year_a_911_call_from_a_me.html. Accessed February 4, 2019.Google Scholar
CAHOOTS (Crisis Assistance Helping Out On The Streets). White Bird Clinic. https://whitebirdclinic.org/cahoots-faq/. Accessed February 4, 2019.Google Scholar
Los Angeles Police Department, Barricaded Suspects. Training Bulletin, Volume XLV, Issue 4, December 2016. https://recordsrequest.lacity.org/documents/748737. Accessed February 4, 2019.Google Scholar
Wogan, JB. How Police Chiefs Plan to Avoid “Lawful but Awful” Shootings, Governing the States and Localities. February 2, 2016. http://www.governing.com/topics/public-justice-safety/gov-police-chiefs-shootings.html. Accessed February 4, 2019.Google Scholar
Biasotti, MA The Impact of Mental Illness on Law Enforcement Resources. Monterey, CA: Naval Postgraduate School Center for Homeland Defense and Security; 2011. https://www.treatmentadvocacycenter.org/storage/documents/The_Impact_of_Mental_Illness_on_Law_Enforcement_Resources TAC.pdf. Accessed March 25, 2019.Google Scholar
Sevy, S, Nathanson, K, Visweswaraiah, H, et al. The relationship between insight and symptoms in schizophrenia. Compr Psychiatry. 2004;45(1):16–19.10.1016/j.comppsych.2003.09.002CrossRefGoogle Scholar
Dell'Osso, L, Pini, S, Cassano, GB, et al. Insight into illness in patients with mania, mixed mania, bipolar depression and major depression with psychotic features. Bipolar Disord. 2002;4(5):315–322.10.1034/j.1399-5618.2002.01192.xCrossRefGoogle ScholarPubMed
Pini, S, Cassano, GB, Dell'Osso, L, et al. Insight into illness in schizophrenia, schizoaffective disorder, and mood disorders with psychotic features. Am J Psychiatry. 2001;158(1):122–125.10.1176/appi.ajp.158.1.122CrossRefGoogle ScholarPubMed
Amador, XF, Flaum, M, Andreasen, NC, et al. Awareness of illness in schizophrenia and schizoaffective and mood disorders. Arch Gen Psychiatry. 1994;51(10):826–836.10.1001/archpsyc.1994.03950100074007CrossRefGoogle ScholarPubMed
Fennig, S, Everett, E, Bromet, EJ, et al. Insight in first-admission psychotic patients. Schizophr Res. 1996;22(3):257–263.10.1016/S0920-9964(96)00077-1CrossRefGoogle ScholarPubMed
Arango, C, Amador, X. Lessons learned about poor insight. Schizophr Bull. 2011; 37(1):27–28.10.1093/schbul/sbq143CrossRefGoogle ScholarPubMed
Misdrahi, D, Tessier, A, Swendsen, J, et al. Determination of adherence profiles in schizophrenia using self-reported adherence: results from the FACE-SZ dataset. J Clin Psychiatry. 2016;77(9):e1130–e1136.10.4088/JCP.15m10115CrossRefGoogle ScholarPubMed
Hui, CLM, Poon, VWY, Ko, WT, et al. Risk factors for antipsychotic medication non-adherence behaviors and attitudes in adult-onset psychosis. Schizophr Res. 2016;174(1–3):144–149.10.1016/j.schres.2016.03.026CrossRefGoogle ScholarPubMed
Czobor, P, Van Dorn, RA, Citrome, L, et al. Treatment adherence in schizophrenia: a patient-level meta-analysis of combined CATIE and EUFEST studies. Eur Neuropsychopharmacol. 2015;25(8):1158–1166.10.1016/j.euroneuro.2015.04.003CrossRefGoogle ScholarPubMed
Myers, N, Bhatty, S, Broussard, B, et al. Clinical correlates of initial treatment disengagement in first-episode psychosis. Clin Schizophr Relat Psychoses. 2017;11(2):95–102.10.3371/CSRP.MYBH.103114CrossRefGoogle ScholarPubMed
Levin, JB, Seifi, N, Cassidy, KA, et al. Comparing medication attitudes and reasons for medication nonadherence among three disparate groups of individuals with serious mental illness. J Nerv Ment Dis. 2014;202(11):769–773.10.1097/NMD.0000000000000201CrossRefGoogle ScholarPubMed
Brain, C, Allerby, K, Sameby, B, et al. Drug attitude and other predictors of medication adherence in schizophrenia: 12 months of electronic monitoring (MEMS®) in the Swedish COAST-study . Eur Neuropsychopharmacol. 2013;23(12):1754–1762.10.1016/j.euroneuro.2013.09.001CrossRefGoogle ScholarPubMed
Compton, MT, Gordon, TL, Goulding, SM, et al. Patient-level predictors and clinical correlates of duration of untreated psychosis among hospitalized first-episode patients. J Clin Psychiatry . 2011;72(2):225–232.10.4088/JCP.09m05704yelCrossRefGoogle ScholarPubMed
Hill, M, Crumlish, N, Whitty, P, et al. Nonadherence to medication four years after a first episode of psychosis and associated risk factors. Psychiatr Serv. 2010;61(2):189–192.10.1176/ps.2010.61.2.189CrossRefGoogle ScholarPubMed
Pijnenborg, GH, Timmerman, ME, Derks, EM, et al. Differential effects of antipsychotic drugs on insight in first episode schizophrenia: data from the European First-Episode Schizophrenia Trial (EUFEST). Eur Neuropsychopharmacol. 2011;25(6):808–816.10.1016/j.euroneuro.2015.02.012CrossRefGoogle Scholar
Kim, JH, Ann, JH, Lee, J. Insight change and its relationship to subjective well-being during acute atypical antipsychotic treatment in schizophrenia. J Clin Pharm Ther. 2011;36(6):687–694.10.1111/j.1365-2710.2010.01230.xCrossRefGoogle Scholar
Wiffen, BD, Rabinowitz, J, Fleischhacker, WW, et al. Insight: demographic differences and associations with one-year outcome in schizophrenia and schizoaffective disorder. Clin Schizophr Relat Psychoses. 2010;4(3):169–175.10.3371/CSRP.4.3.3CrossRefGoogle ScholarPubMed
Treatment Advocacy Center. A Background Paper from the Office of Research & Public Affairs: Serious Mental Illness and Anosognosia. https://www.treatmentadvocacycenter.org/key-issues/anosognosia/3628-serious-mental-illness-and-anosognosia. Accessed August 25, 2019.Google Scholar
Treatment Advocacy Center. A Background Paper from the Office of Research & Public Affairs: Anosognosia, Non-Treatment, and Violent Behavior. https://www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/3636-anosognosia-non-treatment-and-violent-behavior. Accessed August 25, 2019.Google Scholar
Tsai, G, Quanbeck, CD Assisted outpatient treatment and outpatient commitment. In Rosner, R, Scott, C, eds. Principles and Practice of Forensic Psychiatry. 3rd ed. Boca Raton, FL: CRC Press; 2017.Google Scholar
Swartz, M, Swanson, JW, Steadman, HJ, et al. New York State Assisted Outpatient Treatment Program Evaluation. Durham, NC: Office of Mental Health; 2009. http://www.omh.ny.gov/omhweb/resources/publications/aot program evaluation.pdf. Accessed September 4, 2019.10.1037/e502112010-001CrossRefGoogle Scholar
Swartz, MS, Swanson, J, Hiday, V, et al. A randomized controlled trial of outpatient commitment in North Carolina. Psychiatric Serv. 2001;52(3):325–329.10.1176/appi.ps.52.3.325CrossRefGoogle ScholarPubMed
Treatment Advocacy Center. A Background Paper from the Office of Research & Public Affairs: Assisted Outpatient Treatment. https://www.treatmentadvocacycenter.org/storage/documents/aot-one-pager.pdf. Accessed September 1, 2019.Google Scholar
Treatment Advocacy Center. A Background Paper from the Office of Research & Public Affairs: The Role of Assisted Outpatient Treatment in Reducing Violence. https://www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/3634-the-role-of-assisted-outpatient-treatment-in-reducing-violence. Accessed September 1, 2019.Google Scholar
Swartz, M, Swanson, J, Wagner, H, et al. Can involuntary outpatient commitment reduce hospital recidivism? Findings from a randomized trial with severely mentally ill individuals. Am J Psychiatry. 1999;156(12):1968–1975.Google ScholarPubMed
Swanson, J, Swartz, M, Elbogen, E, et al. Effects of involuntary outpatient commitment on subjective quality of life in persons with severe mental illness. Behav Sci Law. 2003;21(4):473–491.10.1002/bsl.548CrossRefGoogle ScholarPubMed
Wagner, H, Swartz, M, Swanson, J, et al. Does involuntary outpatient commitment lead to more intensive treatment? Psychology Public Policy Law. 2003;9(1–2):145–158.10.1037/1076-8971.9.1-2.145CrossRefGoogle ScholarPubMed
Van Dorn, R, Swanson, J, Swartz, M, et al. Continuing medication and hospitalization outcomes after assisted outpatient treatment in New York. Psychiatric Serv. 2010;61(10):982–987.10.1176/ps.2010.61.10.982CrossRefGoogle ScholarPubMed
Swanson, J, Van Dorn, R, Swartz, M, et al. The cost of assisted outpatient treatment: can it save states money? Am J Psychiatry. 2013;170(12):1423–1432.10.1176/appi.ajp.2013.12091152CrossRefGoogle ScholarPubMed
Swartz, M, Swanson, J. Economic grand rounds: can states implement involuntary outpatient commitment within existing state budgets?. Psychiatric Serv. 2013;64(1):7–9.10.1176/appi.ps.201200467CrossRefGoogle ScholarPubMed
Treatment Advocacy Center. A Promising Start: Results from a California Survey Assessing the Use of Laura's Law. https://www.treatmentadvocacycenter.org/a-promising-start.pdf. Accessed March 25, 2019.Google Scholar
Cripps, SN, Swartz, MS Update on assisted outpatient treatment. Curr Psychiatry Rep. 2018;20(12):112.10.1007/s11920-018-0982-zCrossRefGoogle ScholarPubMed
Munetz, MR, Ritter, C, Teller, JLS, et al. Association between hospitalization and delivery of assisted outpatient treatment with and without assertive community treatment. Psychiatr Serv. 2019;70(9):833–836.10.1176/appi.ps.201800375CrossRefGoogle ScholarPubMed
National Institute of Justice. Office of Justice Programs. Program Profile: Assisted Outpatient Treatment. https://www.crimesolutions.gov/ProgramDetails.aspx?ID=228. Accessed September 1, 2019.Google Scholar
Assisted Outpatient Treatment Grant Program for Individuals with Serious Mental Illness [Grant Announcement]. 2016. https://www.samhsa.gov/grants/grant-announcements/sm-16-011. Accessed September 1, 2019.Google Scholar
Meldrum, ML, Kelly, EL, Calderon, R, et al. Implementation status of assisted outpatient treatment programs: a national survey. Psychiatr Serv. 2016 67(6):630–635.10.1176/appi.ps.201500073CrossRefGoogle ScholarPubMed
California Hospital Association. California Psychiatric Bed Annual Report. https://www.calhospital.org/PsychBedData.pdf. Accessed March 25, 2019.Google Scholar
Treatment Advocacy Center. Going, Going, Gone: Trends and Consequences of Eliminating State Psychiatric Beds, 2016. https://www.treatmentadvocacycenter.org/storage/documents/going-going-gone.pdf. Accessed March 25, 2019.Google Scholar
Disability Rights Washington. AB v DSHS (Trueblood): Reforming Washington’s Forensic Mental Health System. https://www.disabilityrightswa.org/cases/trueblood/.pdf. Accessed September 4, 2019.Google Scholar
Treatment Advocacy Center. Competency Restoration versus Psychiatric Treatment. https://www.treatmentadvocacycenter.org/fixing-the-system/features-and-news/4126-the-distinction-between-competency-restoration-and-psychiatric-treatment. Accessed September 4, 2019.Google Scholar
Behavioral Health Justice Center. Justice That Heals: Promoting Behavioral Health, Safeguarding the Public, and Ending Our Overreliance on Jails. https://sfdistrictattorney.org/sites/default/files/Document/BHJC%20Concept%20Paper_Final_0.pdf. Accessed March 25, 2019.Google Scholar
Bewley, MT, Morgan, RD A national survey of mental health services available to offenders with mental illness: who is doing what? Law Hum Behav. 2011;35(5):351–363.CrossRefGoogle Scholar
Kaba, F, Lewis, A, Glowa-Kollisch , S, et al. Solitary confinement and risk of self-harm among jail inmates. Am J Public Health. 2014;104(3):442–447.10.2105/AJPH.2013.301742CrossRefGoogle ScholarPubMed
Lamb, HR, Weinberger, LE Understanding and treating offenders with serious mental illness in public sector mental health. Behav Sci Law. 2017;35(4):303–318.10.1002/bsl.2292CrossRefGoogle ScholarPubMed
Blitz, CL, Wolff, N, Shi, J. Physical victimization in prison: the role of mental illness. Int J Law Psychiatry. 2008;31(5):385–393.10.1016/j.ijlp.2008.08.005CrossRefGoogle ScholarPubMed
Wolff, N, Blitz, CL, Shi, J. Rates of sexual victimization in prison for inmates with and without mental disorders. Psychiatr Serv. 2007;58(8):1087–1094.10.1176/ps.2007.58.8.1087CrossRefGoogle ScholarPubMed
Eide, S. Keeping the Mentally Ill Out of Jail. An innovative Miami-Dade Program Shows the Way. City Journal. Autumn, 2018. https://www.city-journal.org/miami-dade-criminal-mental-health-project. Accessed September 4, 2019.Google Scholar
Lau, M. In landmark move, L.A. County will replace Men’s Central Jail with mental health hospital for inmates. Los Angeles eTimes. February 13, 2019. https://www.latimes.com/local/lanow/la-me-jail-construction-20190212-story.html. Accessed March 25, 2019.Google Scholar
Kubiak, S, Comartin, E, Milanovic, E, et al. Countywide implementation of crisis intervention teams: multiple methods, measures and sustained outcomes. Behav Sci Law. 2017;35(5–6):456–469.10.1002/bsl.2305CrossRefGoogle ScholarPubMed
Shapiro, GK, Cusi, A, Kirst, M, et al. Co-responding police-mental health programs: a review. Adm Policy Mental Health. 2015;42(6):606–620.10.1007/s10488-014-0594-9CrossRefGoogle ScholarPubMed