Survey: Police needlessly overburdened by mentally ill abandoned by mental health system.

Calls for greater use of Assisted Outpatient Treatment

A nationwide survey of 2,406 senior law enforcement officials (75% who were officers longer than 20 years) documents police and sheriffs are being overwhelmed “dealing with the unintended consequences of a policy change that in effect removed the daily care of our nation’s severely mentally ill population from the medical community and placed it with the criminal justice system.” …This policy change has caused a spike in the frequency of arrests of severely mentally ill persons, prison and jail population and the homeless population…(and) has become a major consumer of law enforcement resources nationwide.”

The unpublished survey, Management of the Severely Mentally Ill and its Effects on Homeland Security was conducted by Michael C. Biasotti, VP, NYS Chiefs of Police at the Naval Postgraduate School and calls for implementation of Assisted Outpatient Treatment (AOT) laws as a way to lead people with severe untreated mental illness back into the mental health system and to force the system to accept responsibility for their care.

AOT allows courts–after extensive due process–to order a subset of severely mentally ill individuals–only those who have a past history of dangerous behavior, arrest, incarceration or multiple hospitalizations–to accept treatment as a condition of living in the community. The court order can also require the mental health system to deliver the treatment, monitor compliance, and evaluate people who fail to comply to see if they are becoming ‘danger to self or others’. Chief Besoot argues this “highly cost-effective policy… would assist in correcting the current situation, which is needlessly draining law enforcement resources nationwide.” He points out that most people with mental illness are not more violent than others, but there is a subgroup of the most seriously ill, who often refuse treatment, who are well-known to law enforcement and do offend repeatedly. (See 115 Law Enforcement Officers Killed by Mentally Ill)

According to the survey:

  • 84.28 percent (or 1,866) of the law enforcement respondents said there been an increase in the mentally ill population over the length of their career
  • 63.03 percent (n=1,391) of respondents reported the amount of time that their department spends on calls for service involving individuals with mental illness increased (during their career). An additional 17.72 percent reported that the time spent had substantially increased, totaling 70.7 percent (n=1,782) of respondents reporting an increase.
  • 56% said the increase in calls is due to the inability to refer mentally ill to treatment and 61% said more persons with mental illness are being released to the community.
  • The officers claimed that mental illness related calls take significantly longer than larceny, domestic dispute, traffic, and other calls.

See separate California-only results here

As startling as the statistics were, the quotes from officers gave a more human perspective:

The biggest problem does not lie with law enforcement. The problem is found when citizens can’t get assistance due to the “danger” requirement. When they have nowhere else to turn they call the police to handle the issue. This takes a large amount of time to then pull strings to try and get help for the citizens.

Catch and release attitude of MH professionals, i.e. anti-suicide contracts, promise not to do it again, etc.

Our jurisdiction is extremely rural. If a person requires in-patient treatment, then it is a four-hour drive to the hospital, and our ambulance service will not transport. Given that most evaluations take 2 hours at a minimum that leaves an officer out of service for a minimum of 10 hours. Because we have only 8 officers including the Chief, it also means calling someone in on their days off to make the transport.

Police seem to be the only resource that is mandated to be trained and deal with these individuals in the field, usually because there is a disturbance that prompts the call for these individuals. However, EMS, local hospitals, etc, are not required the same level of participation in the de-escalation of a mental event as the police are.

We can get them to the psych unit, but the Drs let them go due to the “dangerous to self or others” criteria.

The whole process is too long. It Takes too long to have the patient evaluated. Takes to long to have the committal paper file with the court. Takes too long to find a facility. Takes too long to have the paper obtained once a judge signs it. Then when the individual makes it to the next facility we get to go through the same thing and length of time on the other end. On average it takes approx 10 hours. With a small department we have 2 or 3 people working. Basically one of my officers is tied up in this process and I have another officer at time working without backup.

The problems are not so much the obstacles but rather when we get them to the hospital we have to sit with them, depending on the incident that occurred, and we have a limited about of officers on duty. And once they are committed, there is a matter of time before they are released and we end of dealing with them again in another situation.

In the past, if an officer could articulate to the crisis counselor that a mental subject was a danger to him or others then they would respond and make arrangements for bed space. Now, they rarely come out unless it is an uncontrolled violent person. In some cases, a crisis counselor has asked to speak to the mental subject over the officer’s cell phone and “diagnosed’ the mental subject based on that short phone conversation. The problem here is that the officer has made observations and noted the comments made by the mental subject. Most officers would not ever release a dangerous person despite whatever diagnosis is made over the phone. So, the mental subject either gets arrested or goes to a local hospital for evaluation. This wastes resources and takes more of the officer’s time–all in the name of protecting one’s self from liability

The report recommends:

  1. Federal guidelines should be established mandating court-ordered assisted outpatient treatment programs in every state along the lines of Arizona’s treatment laws so that law enforcement, physicians, and families are not forced to wait until the dangerous level is reached. The recommended change in the laws should include a “need for treatment standard” rather than relying sole upon “dangerous to self or others.” Such laws would eliminate the need to wait until violence is threatened or perpetrated before taking action, providing for a safer community. Without a nationally governed framework severely mentally ill persons would be able to move from state to state with no monitoring of their current mental health status.
  2. States should enact new assisted outpatient treatment laws incorporating within those laws the revised standards. Federal funding should be tied to each state’s cooperation in effectively implementing and monitoring the AOT laws within their state. Currently few states actually use the AOT laws that are already in place.
  3. For the severely mentally ill population who have a past record of violence when not in treatment, regular supervision ensuring compliance with treatment needs to be conducted and overseen by each state’s department of mental health.
  4. A registry similar to the child abuse hotline system should be put in place including a mandatory reporter system, composed of professionals such as social workers, teachers and other school personnel, physicians and other health care workers and law enforcement officers. They would be required to notify the state office of mental health upon contact with an obviously psychotic person who is either exhibiting signs of possible harm to himself or others or is in obvious need of psychiatric assistance. A mandated reporter system may have helped to prevent the January 8, 2011 Tucson mass shooting of 14 persons, including United States Representative Gabrielle Giffords. Although the shooter, Mr. Jared Lee Loughner, had exhibited psychotic behavior and was described as dangerous, even to the point that his college expelled him and refused readmission until after he had received a psychiatric care, no policy existed that would have required his professors to report their concerns to the office of mental health.