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Another model that some jurisdictions use deploys teams composed of both specially trained sworn police officers and mental health professionals employed by the local community mental health department. These teams have been shown to be effective in resolving emergency situations in the community involving persons with mental illness and in diverting them to the mental health system rather than to the criminal justice system The major goals of these specialized mobile crisis teams are to resolve the crisis and to reduce criminalization.
Studies that have evaluated such teams found that they had arrest rates ranging from 2 to 13 percent with an average of less than 7 percent 37 , 41 , in contrast to an arrest rate of 21 percent for contacts between nonspecialized police officers and persons who were apparently mentally ill This finding lends credence to the idea that a specialized response lowers the incidence of inappropriate arrests. Regardless of whether police officers act as part of a team with members of the mental health system or whether police officers or employees of the police department deal on-site with emergency situations on their own, it is imperative that they obtain all available information about past police contacts with the individual when mental illness was thought to be present.
Such information may include certain aspects of the person's actions during the previous police contact, such as suicide attempts, violence, and how the previous contact was resolved 38 , In at least one program 37 , this information as well as photographs of the individual are added to the police database and downloaded daily to laptop computers that are taken into the field by the mobile crisis team. A photographic record provides a clear view of what the person looks like and how he or she has changed from one police contact to another.
When mobile crisis teams comprise both sworn police officers and mental health professionals employed by the local community mental health department, it is possible for the complete mental health history of the person with mental illness—not only previous police contacts—to be made available to the mental health professional on the team. This history can be obtained from a centralized database operated by the local department of mental health.
The information might include past psychiatric treatment, diagnoses, and the name of the person's case manager, if any. Mental health professionals working for the mental health department are legally entitled to this information. However, the importance of maintaining the confidentiality of mental health information cannot be overemphasized, and disclosure of this information must be scrupulously controlled, with the release of information limited to a need-to-know basis.
This arrangement offers important benefits.
With access to information from the mental health department, the mental health professional on the team has more knowledge about persons with mental illness encountered in the field and is thus in a better position to make an accurate evaluation. Furthermore, if the team takes the person to a hospital, the mental health professional will have more relevant information to give to clinicians at the emergency department, which may allow appropriate and effective treatment to be initiated earlier.
A crucial part of developing and maintaining specialized mobile response teams is that a rigorous and ongoing evaluation of the program must be conducted. For instance, response times—the time from the call to the arrival of the team on the scene—should be measured on a routine basis If response times are too long, police officers tend not to call on the mobile teams. Surveys should be conducted routinely among randomly selected police officers on their views of the usefulness and effectiveness of these teams.
Such monitoring can allow for the ongoing correction of problems. Most important, the less useful the teams seem to the police officers in the field, the less they will be used. The teams' arrest rates, in addition to the mental health alternatives they choose, need to be evaluated regularly to be sure that appropriate dispositions are being made and that mental health facilities are cooperating with these efforts. There is evidence that police training generally is inadequate to prepare police officers to identify and deal with persons with mental illness 7 , 10 , The police themselves think that they lack adequate training to manage this segment of the population 7.
They want to know how to recognize mental illness, how to deal with psychotic behavior, how to handle violence or potential violence among these persons, what to do when a person is threatening suicide, and when to call the specialized mobile crisis team. They also want to know what community resources are available and how to gain access to them This mental health training is needed for all police officers, not just for those who are part of the specialized mobile crisis teams Training led by both law enforcement and mental health professionals, with the active participation of police trainees, is thought to be the most effective teaching process At a minimum, training for the police officers should include becoming familiar with the general classification of mental disorders used by mental health professionals; learning and demonstrating skills in managing persons with mental illness, including crisis intervention; knowing how to gain access to meaningful resources less restrictive than hospitalization; and learning the laws pertaining to persons with mental illness, in particular the criteria specified for involuntary psychiatric evaluation and treatment.
In addition, considerable emphasis should be placed on deescalating situations that might lead to the use of deadly force on persons with mental illness However, as Borum 10 has noted, training alone is not sufficient without the establishment of mobile crisis teams and changes in police academies in matters such as the use of deadly force. Probably no situation is more difficult for law enforcement officers to cope with than what has been called suicide by cop, or police-assisted suicide 50 , 51 , 52 , In these situations, a suicidal individual engages in life-threatening behavior with a lethal weapon, or with what appears to be a lethal weapon, toward law enforcement officers or civilians specifically to provoke officers to fire at the suicidal individual in self-defense or to protect civilians.police-risk-management.com/order/kids/nazaf-dati-cellulare.php
Mentally Disordered Offenders: Managing People Nobody Owns
In one of the most carefully conducted studies on the subject 52 , it was found that suicide by cop accounted for 11 percent of all officer-involved shootings in a large metropolitan law enforcement agency. Although only 46 of shootings during a ten-year period were examined, the criteria for inclusion were fairly rigorous in terms of evidence of suicidal intent, evidence that the individual specifically wanted officers to shoot him or her, evidence that the individual possessed a lethal weapon or what appeared to be a lethal weapon, and evidence that the individual intentionally escalated the encounter and provoked officers to shoot in self-defense or to protect civilians.
Other studies have reported higher percentages 16 to 46 percent of police shootings that may have been suicide by cop; however, the inclusion criteria in those studies were less rigorous 54 , On the basis of both the literature and our experience, we think it crucial that police and mental health departments collaborate closely, that mental health resources be more readily available and more easily accessible, that police departments participate in specialized mobile crisis teams, and that police officers receive better training.
With these principles in mind, we offer the following conclusions and recommendations. Neither the mental health system nor the law enforcement system can manage mental health crises in the community effectively without help from the other If the collaboration between the two systems is to be successful, police and mental health professionals need to remember who they are.
It is important that police officers be aware that their primary role remains that of law enforcement, even though they may have specialized mental health training. For instance, in one program in which police officers and mental health professionals work closely together in teams, the police officers' primary role is described clearly as providing security that reduces the threat of harm to persons with mental illness and to others as well as providing transportation to the most appropriate treatment center.
Likewise, it is important that mental health professionals who are members of mobile crisis teams not view themselves as or try to function as police officers.
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Mental health professionals may unwittingly identify with the power and authority conferred by society on the police officers with whom they collaborate, but they too need to remember who they are and why they are there. They need to understand law enforcement and what it entails while retaining and understanding that their primary role in dealing with psychiatric emergencies is assessment, crisis resolution, and appropriate disposition. Obviously, there will be some overlap of responsibilities of police officers and mental health professionals, but their primary roles should reflect their specific areas of expertise.
Each discipline needs to use the skills of the other if crisis intervention in the field is to work. Mental health professionals need to feel safe, and police officers need to rely on the clinical expertise of mental health professionals.
To further promote collaboration between community mental health departments and police departments, there should be regular and ongoing liaison meetings of representatives from the two agencies. The number of persons attending should be small, so that issues and problems can be discussed and resolved meaningfully and efficiently.
The persons attending should have an understanding of the issues and be of high enough rank in their departments so that they have the power to make and execute decisions. Another important element in resolving crises involving persons with mental illness in the community, as well as in reducing their criminalization, is the availability of adequate mental health resources. These resources include both outpatient and inpatient treatment facilities and therapeutic housing arrangements. This would decrease the number of persons who decompensate and come to the attention of the police.
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Acute inpatient beds are needed so that there is an appropriate place other than jail to take persons with acute mental illness. Long-term beds are needed for the minority of persons with severe mental illness who, even with active and competent treatment and supportive housing, cannot cope with living in the community 56 , This would mitigate the revolving-door syndrome among many of these persons, who quickly decompensate after a brief acute hospitalization.
Resources also should be made available for every jurisdiction to have specialized mobile crisis teams. In our view, these teams should include mental health professionals. The effectiveness of these teams relies on rigorous and continuous evaluation. There is a need for better training for all law enforcement officers on mental illness, on how to best meet the needs of persons with mental illness, and on how to use mental health resources. A key part of such training is learning how to distinguish which persons with mental illness who risk causing harm to themselves or to others can be managed more appropriately by the mental health system than the criminal justice system.
Clearly, much can be done by both the law enforcement system and the mental health system to better serve persons with mental illness. Furthermore, working with this population can be made more gratifying to police officers by giving them the ability to feel a greater sense of professionalism as they fulfill the responsibilities that have been thrust on them in the era of deinstitutionalization.
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At the same time, collaboration with the police can enable mental health professionals to feel a greater sense of confidence and competence in dealing with psychiatric emergencies in the field. Across the United States, persons with mental illness have been killed or seriously injured during attempts to manage their crises.
These events have outraged the community and frustrated law enforcement and mental health professionals, and rightly so. If we are to reduce these tragic mistakes and ensure better safety for all, we must develop an effective working partnership between the law enforcement and mental health systems.
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Lamb is professor of psychiatry and director of the division of mental health policy and law and Dr. Weinberger is professor of clinical psychiatry and chief psychologist at the Institute of Psychiatry, Law, and Behavioral Sciences at the University of Southern California School of Medicine. DeCuir is detective and officer-in-charge retired of the mental evaluation unit of the Los Angeles Police Department. Send correspondence to Dr. Box , Los Angeles, California e-mail, hlamb hsc. New York, Norton, Google Scholar.
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