The recent White House executive order on policing and proposed legislation by Republican Sen. Tim Scott tap into a national consensus that we must do more to address crises involving people with mental illness. Minneapolis City Council President Lisa Bender said the desire to call the police “comes from a place of privilege,” but in so many cases involving severely mentally ill individuals it comes from a place of desperation and empathy.
At the same time, the executive order and pending legislation create incentives for “co-responding” programs where a police officer arrives with a mental health clinician. Preliminary results of such programs around the country show great promise.
Co-responding initiatives are founded on sensible premises. First, even as states like Ohio are now looking at reversing their laws that require less training for cops than cosmetologists, the reality is that officers must be jacks of all trades. It is not realistic to think an officer will have ever been as well trained to deal with mental health as a counselor who has made a career of it. In Los Angeles, data demonstrated that 36% of police shootings involved a suspect with mental illness.
Moreover, while a study found police officers do not have negative views of those with mental illness, people with mental illness who have interacted with police have a less favorable impression of police than the general public. The presence of a counselor with the officer can take the edge off in a situation where the person could be frightened if confronted only by an officer with a gun. It can also defuse problems created by the fact that those with serious mental illness often have difficulty following orders.
Of course, there are situations involving 911 calls in which no criminal conduct is alleged that can be handled by mobile mental health crisis units. There are 14 such units in use in Connecticut that have reduced emergency room visits by 25%. However, in cases where there is a risk of the person with mental illness hurting himself or others, co-responding offers the best of both worlds. It allows for an initial therapeutic intervention but provides the added security of physical intervention if needed. This provides greater assurance that clinicians will not be harmed.
One study found co-responding led to significantly lower rates of injury and arrest when compared with responses to comparable calls involving only officers. Though having the clinician appear in person is ideal, amid COVID-19 it is notable that even initiatives that rely on virtual co-responding show promise. For example, since 2012 the Springfield, Mo., Police Department and Burrell Behavioral Health have partnered to provide Virtual-Mobile Crisis Intervention. Using iPads, officers can instantly access assessments, referrals, and even follow-up case management. This has reduced the number of times individuals with mental illness must be transported to the hospital.
As the president’s executive order ushers in more co-responding initiatives, state and local governments must also expand diversion efforts and tackle reentry issues. In San Antonio, the Bexar County Jail Diversion Program has become a national model, including everything from a 24-hour crisis care center available to police and pretrial supervision involving probation officers with lower caseloads and special training in mental illness. Beyond being more humane than jail, it costs less: The county’s cost per diversion is $350, compared to $2,295 per jail booking.
Of course, not every case involving a person with mental illness consists of minor offenses, and sometimes jail is the only option. To avoid a revolving door, jurisdictions such as Denver have created programs within their jails to ensure that when inmates with mental illness are discharged, they have access to the supervision and services that will reduce the risks to themselves and others. In the Crisis Intervention Response Unit in the Denver jail, sheriff’s deputies work with clinicians to develop an individualized reentry plan. This often includes meetings with care providers upon discharge and even transportation arrangements.
The challenges involving people with mental illness and the justice system cannot be fixed through any directive, but the latest White House executive order is a step forward. Experts across the spectrum have rightly identified cases involving people with mental illness as among those where we place the greatest burdens on law enforcement. To meet this challenge, the current moment provides an opportunity to augment, not abolish, the police.
