Police in America. Steven G. Brandl
In particular, the police have frequent contacts with people who are mentally ill, more now than ever before. It is estimated that between 7% to 10% of police encounters involve people with mental illness.24 These contacts may be with people in crisis (e.g., out-of-control, bizarre behaviors, suicide attempts) or because of serious but more chronic (e.g., homelessness) mental health issues or because of other more “nuisance” or disorderly type behaviors (e.g., a person walking on a roadway). Most police contacts with persons with mental illness do not involve major crimes or violence.25
There are at least two reasons for the frequent contact between the police and persons with mental illness. First, even though the concerning behaviors may not be criminal, the police have responsibilities for maintaining peace and safety. Since citizens have quick and easy access to the police to deal with such situations, it is much easier and quicker to summon the police than other social services. As in other situations, the police have these responsibilities simply because they are designated as first responders.
The second reason for more contacts between the police and people with mental illness is that there are more persons with mental illness now living in communities. Decades ago, persons with serious mental illness were more likely to be institutionalized and required to receive treatment. Today, involuntary institutionalization is reserved for only the most extreme of instances. Mental illness is most frequently managed through prescribed drugs for people who live in the community. Indeed, police officers often hear from relatives of people who are experiencing a mental health crisis that “he was fine until he stopped taking his medication.”
There are potential problems and difficulties when the police intervene in situations that involve persons with mental illness. First, traditionally the police have not received training on recognizing mental illness or its various symptoms. Complicating matters is that sometimes substance abuse and physical, cognitive, or other emotional problems can masquerade as mental illness. How can police officers be expected to provide “psychiatric first aid”26 without being trained on this complex phenomenon?
Second, interactions with people with certain mental illnesses can be dangerous for officers and well as the individual, especially when mental illness is not accurately recognized or properly handled. The third problem when intervening in situations that involve persons with mental illness is that there are limited options available to the police to resolve the situation. Depending on the situation, police officers may transport the individual to a psychiatric facility for immediate treatment; try to diffuse the situation on-scene, often with a warning; or arrest the person. These options are not a solution to the problem but are simply ways for the police to manage the situation and resolve immediate concerns.
The best police practice when it comes to interactions with persons with mental illness is using crisis intervention teams (CIT).27 Crisis intervention teams consist of police officers who have received extensive training on how to recognize mental illness and how to effectively respond to it. Officers receive training in such topics as post-traumatic stress disorder (PTSD), traumatic brain injury, psychotropic medications, suicide prevention, personality disorders, and the law relating to mental illness, to name a few. Skills such as verbal de-escalation are also a critical part of the training. The logic of CITs is that, with mental health expertise, officers will be in a better position to more effectively and safely resolve such situations. CIT also represents a more systematic and informed approach to dealing with mental health issues in the community. CIT requires the creation of relationships between the police and mental health resources and treatment options. CIT requires an entirely more systematic approach to mental health related calls for service. Police dispatchers need to send CIT officers to calls, police supervisors need to schedule adequate numbers of CIT officers to each shift, and partnerships and processes with mental health service providers need to be created, formalized, and used. Police services are recognized as the front-end of much larger process. CIT is a more holistic versus haphazard approach to effectively managing mental health needs in the community. The CIT approach is much more congruent with a service-oriented role than one focused on law enforcement.
Photo 4.5 Some of the many responsibilities of the police have very little to do with law enforcement or crime control. Some, such as directing traffic, are provided as a public service.
©iStockphoto.com/erreti
The Police Handle Time-Pressing Situations
Some scholars explain that we have the police in order to deal with a wide variety of situations where something is not right—situations where “something ought not to be happening, about which something ought to be done now!”28 A gas station has been robbed, a neighbor is threatening another neighbor, traffic lights are not working, people are arguing, a dog is on the loose. Police officers may be asked to intervene in each of these situations. Some involve crime and law enforcement, but most do not. Some involve regulating citizens’ behavior, others do not. Some involve the potential use of force, but not all of them do. These situations cannot wait for some future resolution; they need to be handled immediately. Cars may collide and the dog might bite someone. As this clearly illustrates, the police are needed for more than law enforcement, crime control, the use of force, or to assist persons with special needs. As criminologist James Fyfe wrote, “The police perform a variety of services that must be available seven days a week, 24 hours-a-day, that may require the use or threat of force, and that are not readily available from any other public agency or private institution.”29
The Police Enforce the Law, Maintain Order, and Provide Services
Perhaps the simplest way of explaining why we have the police—but one that still describes the breadth of the role—is to highlight the important tasks of law enforcement, order maintenance, and service. As discussed, law enforcement refers to tasks such as conducting investigations and making arrests. Order maintenance consists of activities that keep the public peace, which involves regulating citizens’ conduct without resorting to citations or arrests. Service activities include all other activities of the police besides order maintenance and law enforcement, such as assisting motorists whose cars have broken down, getting keys out of locked cars, and attending to other people in need.
order maintenance: Activities of the police that involve keeping the peace without resorting to citations or arrests.
service: Other duties performed by police, such as assisting stranded motorists and attending to other people in need.
law enforcement: Tasks performed by the police that involve conducting investigations and making arrests.
Exhibit 4.4 Every Second Counts: Responding to Drug Overdoses
Police patrol is staffed and organized so that officers can quickly respond to emergencies, everything from crimes in progress to traffic accidents. This ability to respond to situations where “something ought not to be happening, about which something ought to be done now!” leads to the police sharing some emergency responses with emergency medical personnel such as fire and rescue. Case in point: Opioid overdoses and naloxone. Opioids most often include heroin, prescription pain killers, and fentanyl and its variants. Opioid abuse and overdoses have reached epidemic proportions. Drug overdose is now the leading cause of death for Americans under age 50; approximately 180 Americas die every day from opioid overdoses.30 Opioids kill by depressing respiration to the point that the brain receives inadequate oxygen, a condition called hypoxia. Naloxone (or Narcan brand name) is a drug that, if delivered within minutes of overdose, can reverse the effects of opioids and restore normal breathing. It is typically delivered via a nasal spray. When administered in time, survival is likely.31 It is not a dangerous drug, although people who are revived by the drug may show extreme agitation. Required training to recognize overdoses and to administer the drug is not extensive. Most states provide legal authorization for police officers to carry and administer naloxone, and