Across the United States, law enforcement agencies are being called upon to act as mental health first responders, in a trend that’s harming mentally ill people and doing an injustice to law enforcement, as well. Police officers are not mental health experts, mental health crisis intervention is not within the scope of their job description and the nature of their work, and they should not be responding to volatile situations with guns when what’s needed is something entirely different. Despite a growing roster of deaths caused by police called to the scene of mental health crises, though, few states and mental health agencies seem to be willing to make a move to address this problem.
This country needs comprehensive mental health reform. That includes better access to mental health services, starting with early screening and diagnosis, monitoring of people with risk factors for mental illness, and prompt referrals to treatment. That treatment needs to be accessible, affordable, and without stigma, to make it easy for people to go, and easy for patients to adhere to treatment plans. It should be possible, for example, for a 17-year-old to easily access psychiatric care when she shows early warning signs of severe depression or schizophrenia, for her to be able to work with a therapist or caseworker to coordinate the care that works for her and create a functional long-term treatment plan.
Such a system needs to be backed with mental health crisis services. Such services hopefully won’t be needed thanks to early intervention and treatment, but would still be critical for emergencies like the sudden onset of severe mental illness, emergence of symptoms in a patient who is struggling with a treatment plan, and help for people with treatment-resistant mental illness. That comprehensive intervention system needs to consist of psychiatric and social work professionals, not law enforcement officers.
They’re the ones with the expertise to help handle patients who are severely mentally ill and having trouble parsing and interacting with the world. They’re the ones who can offer treatment recommendations, but more than that, they can help people avoid homelessness, find jobs or get on appropriate benefits, assist people with completing their educations, and more. A patient-centred approach focuses on the needs of mentally ill people who need help, not on what the larger community thinks of those people or wants them to do. And the same system can swing into action in an emergency to respond to a situation where a clear and present danger presents itself.
Yet, as it stands now, here’s what happens: people are not diagnosed and provided with treatment options early, their mental illness becomes severe, they become homeless, they experience substance abuse problems, they have trouble holding down jobs. Friends and loved ones try to support them but don’t know what to do because they aren’t mental health professionals. When they reach a breaking point, like a child who’s behaving violently or a lover who is threatening suicide, they call 911 for help, thinking they’ll get an ambulance and a referral to an inpatient mental health facility where their loved one can get help.
What they get instead is a car full of police officers, because ambulance crews are not allowed to respond to situations where they may be exposed to dangers without law enforcement backup. When 911 dispatchers hear that mental illness is involved, they send out police automatically. Those police are often not trained or poorly trained when it comes to dealing with mental health crises and people who may be experiencing breaks with reality, extreme paranoia, and terror, and the patient ends up being abusively restrained if ‘lucky,’ Tased, or possibly shot, usually to death, because police are trained to aim for the kill shot. The goal is to bring down the threat, and that’s how mentally ill people are viewed in these situations.
That these situations happen at all is the result of a system with myriad breaks in it. Take, for example, the child with severe mental illness. Her parents may have learned that no school or treatment center will take her, that they can’t get aides and assistance because the state assumes they will provide care, that their child’s mental illness is treatment resistant and requires careful managing, but very few psychiatrists and mental health professionals specialise in this kind of care. Those who do are often very difficult to work with because their services are so sought after. No small wonder that some family-oriented mental health support organisations recommend that families call emergency services for help in situations like these, and sometimes even give up their children to residential care facilities, because there are no other options available.
This is thanks to oppressive policies and attitudes surrounding mental illness and mentally ill people, and it’s thanks to a ridiculous lack of government funding when it comes to mental health issues. As with other chronic health problems, early intervention and maintenance treatment are far less costly and disruptive than providing crisis care only and letting patients lurch from crisis to crisis, but the government hasn’t chosen to prioritise the welfare of mentally ill people. Instead, it’s focused on things it deems more important priorities.
Law enforcement shouldn’t ever be responding to psychiatric emergencies unless there is a serious and credible threat to the patient or others. Which means that 911 dispatchers need to have better training in evaluating situations to determine who to send out, and mental health response teams need to be available to handle such emergencies. Even when police are called, the mental health crisis team should be taking point, and the police officers should be chosen from members of the ranks who have received specialised mental health training and thus are prepared to handle a situation responsibly.