According to the U.S. Department of Health and Human Services, the majority of people living with mental illness are not violent. However, police officers often end up serving as the first responders to mental health calls, which can at times result in the person with the mental illness being needlessly handcuffed, enduring excessive force or losing their lives, as in the case of Sonya Massey, killed by an Illinois deputy during a mental health call.
Since 2015, FBI records show that almost 25% of people killed by police officers in the U.S. have had a known mental illness1 (Westervelt, 2020).
This essay will explore the life-altering problems of policing mental health, review pitfalls of past solutions and discuss some of the ways in which newly mental health clinicians are taking the lead toward helping to improve emergency care for those living with mental illnesses.
CIT versus the Continuum of Compliance
Crisis intervention training (CIT) empowers law enforcement to take the lead in emergency mental health care, but is it working?
Crisis intervention training, is a 30 year old method of addressing mental health crises; and is one of the most common models police departments (about 2,700 of the 18,000 police departments in the U.S.) use to incorporate mental health expertise into emergency calls.
CIT programs often focus on diverting individuals away from the criminal justice system and towards appropriate mental health services; and focuses heavily on recognizing mental health distress and de-escalating contentious situations. In this system, mental health clinicians train police officers on how to determine if a particular incident involves mental illness, how to apply appropriate de-escalation skills when encountering those situations, and diverting cases that require mental health support rather than arresting and incarcerating.
So, when an officer is dispatched to an emergency call and does not know the circumstances of the disturbance until they arrive, according to CIT, they now have the skills to assess the subject and employ techniques that de-escalate the situation. However, if the person presents as violent in anyway toward themselves or others, that perception can lead to officers using deadly force.
The City of Rochester created one of the first of New York’s crisis intervention teams2 in 2004. The implementation of this CIT program reflected a positive step toward creating a more compassionate and effective response to mental health emergencies.
Despite this, on March 23, 2020, Daniel Prude, a 41 year old Black man wandering the streets of Rochester, naked and babbling at 3 a.m. in the morning, was killed by police as they were arresting him, (Westervelt, 2020).
Since 2017, Indianapolis, Indiana has had a Mobile Crisis Assistance Team. The team currently includes eight IMPD officers, each paired with a counselor from Eskenazi Mental Health Center. So, if a call is made, this team along with an ambulance, if necessary, comes to the call (WTHR, 2022).
But on April 25, 2022, Herman Whitfield III died in police custody, after his family called 911 saying that Whitfield was undergoing “a mental health crisis, in his home,” and that they needed an ambulance. No crisis team member was present, just two police officers; and the ambulance only arrived after the police put in a call that Whitfield was non responsive.
This year, on March 9th, Ryan Gainer, a teen with autism, who was agitated and destroying property in his home, after being told by his parents that he could not play video games or listen to music until his chores were completed, was killed by police, who stated that Gainer threatened them with a long-handled garden tool, (Fry, 2024).
Yet, San Bernardino County, states that as of 2022, their CIT program has trained over 2000 deputy sheriffs.
Addressing the intersection of mental health and law enforcement is a complex challenge that requires thoughtful consideration and comprehensive solutions. Public safety is still a the priority, but at this intersection, CIT attempts to expand the priority of public safety to include the well being of the person presenting mental distress.
Crisis intervention teams were created to address this challenge, training for de-escalation, creating collaborative models between law enforcement and mental health professionals and fostering community engagement. But the hope of what CITs could accomplish has not consistently met the needs for which they were originally designed, even in the same city.
Sheriff’s deputies had been successfully called to the Gainer home in the past, helping to stabilize Ryan and calm him, making sure that the family members and immediate neighbors were all safe. The family became so trusting of this process that they called on the deputies, again, on the fatal afternoon of the 9th. This time, deputies were not able to successfully engage with Ryan.
So, was it the training or a lack thereof? Or perhaps, fear overtook the officer and he simply reacted?
When CIT is successfully employed it appears to have positive effects, as it did in Ryan’s case, in the past. But the police model works on predictors, if this happens, then that will happen; so do this. But, people like Ryan Gainer or Daniel Prude who were living under the burdens of their conditions, which may not present the exact same way every time. So, familiarity with the varied ways in which mental illness may present at any given time is key to understanding how to keep oneself safe, while caring for someone who is in distress.
What is also lost in this equation is the intentionality around the person who may be in mental distress, or ‘acting out’, or simply having a bad day. Did this person intend to present harm? Are they aware that they are presenting harm? This is important because a large part of policing is punishing people for what they intended to do, such as taking them to jail, instead of a mental health care facility.
The answers to those questions, of course, depends on the specific mental health condition and diagnosis; but the overarching theme here is that those living with mental health issues sometimes need emergency mental healthcare and should be able to seek it out, or have it sought out on their behalf, without the fear that they may be seen as a threat and possibly harmed or killed.
While the principles of CIT programs are admirable and necessary, they cannot replace law enforcement training, which at its core directly contrasts with the principles behind CIT programs. When met with perceived resistance, escalation or danger, CIT training and law enforcement training may conflict, and when that happens traditional law enforcement principles typically are employed.
The perceived safety of the officer is paramount, period. So it is not unreasonable to understand why deadly force is chosen. And as long as guns are brought to a mental health emergency, there is always a chance that they will be used.
Brief history of mental health care in America
Part of addressing this problem is educating communities about the options available to them when dealing with a family member, who may be in distress. Another part of this is training 911 dispatch units to ask questions that allow them to better assess what type of help is needed. Before all of that can begin, we may need to review how we got here.
In early U.S. history, from our inception to late 18th century, people with mental illnesses often ended up in work houses, prisons or poor houses. By the 19th century, advocates for the indigent and orphaned begin to push for improving conditions for the disabled and mentally ill. This is when many state psychiatric hospitals came to be and began to flourish.
At this time, mental health care was seen as a state responsibility, so it was not funded by the federal government; and there was no such thing as community-based mental care. This meant that some facilities relied on donations, tax dollars and in some cases entry fees to tour the facilities. For the indigent and orphans, who didn’t fall through the cracks, this was an answer, but it could mean a life of institutionalization, whether it was needed or not (Duff, 2018).
In 1955, The Food and Drug Administration approved the drug Thorazine, the first antipsychotic drug on the American market. This made deinstitutionalizing people with mental illness possible. So, by the 1960s, along with various class action lawsuits exposing the poor living conditions of institutionalized mentally ill patients, public opinion had been swayed in favor of community based care (Davis, Fox-Grade, Gehshan, 2000).
Soon after, federal legislation followed; and many public psychiatric hospitals closed. This trend continued well into the 1990s. From 1995 to 2005, the number of beds shrank another 90% in the few remaining state and county psychiatric hospitals left.
Today, a person with mental health issues can call to receive ambulatory emergent care, or they can voluntarily admit themselves, for a certain amount of time, which varies across the country. But once they are evaluated and deemed to be “stable” they are released. They may be encouraged to seek further care, either through psychotherapy or psychiatric services, which are typically offered on an out-patient basis.
This process works for what it does, meaning that it gets people unstuck in a moment through their own efforts to seek out care. But for those like Gainer, Whitfield and Prude, who could not make the calls on their own, an involuntary emergent care system led by mental health professionals, supported by law enforcement can operate essentially the same as a voluntary care system. The needs are different. So each community should properly assess her needs.
Why non-lethal, mental health crisis teams should be called to address mental health emergencies
"If we build the crisis response system, that is non-law enforcement, we will get more people connecting [to mental health care] before it hits that level of danger,” Ron Bruno, former police officer for 25-years, now executive director of Crisis Intervention Team International.
The U. S. Department of Justice cited in a recent and active lawsuit against the Washington D.C. local government that sending police officers to address 911 calls for mental health emergencies may be a violation of federal disability law (Weiner, 2024).
In 2021, Washington D.C.’s 911 program began to divert some mental health calls from police to unarmed behavioral health support teams. But out of the 1.2 million emergency calls made in 2022, only 327 were diverted from police to unarmed mental health staff.
According to analysis of of the 2022 report from the Illinois Criminal Justice Information Authority, residents with untreated mental illness are at risk for being killed at a rate of 16 mites more than an average citizen. Further, in the 2018 US Commission on Civil Rights, within the first six months alone of 2015, a person who was experiencing a mental health emergency was killed every 36 hours, (USAFacts Team, 2023).
One city’s answer to this problem was creating a community policing initiative led by mental health first responders. In 1989, the City of Eugene, Oregon was seeking a way to address mental illness, homelessness and addiction. Out of that effort, White Bird Clinic, a medically based clinic established in 1969 to service for runaways and the homeless, launched CAHOOTS (Crisis Assistance Helping Out On The Streets).
CAHOOTS accepts both non-emergency and emergency calls. When calls come into their non-emergency line, responders dispatch a medic and a trained mental health crisis worker. If the call involves violence or medical emergencies, CAHOOTS does request police back-up to their treatment team. In 2019, out of the 24,000 calls received, police back-up was requested 311 times. As of 2023, CAHOOTS response teams, both emergency and non-emergency, have reported no serious injuries or deaths (Cyrus, 2023).
While the success of the CAHOOTS strategy is indisputable, rather than copying and pasting a successful program, it is worthwhile for each community to assess its own core mental health needs, like the White Bird Clinic did so many years ago. Because most police departments do not report fatal encounters or encounters with those who may be mentally ill, this assessment will better insure that they are speaking to present problems and employing effective strategies.
Although, this strategy is a non-lethal strategy, law enforcement are encouraged to partner with these efforts. This will better enable a non-lethal response or a mental health lead response to ensure public safety, as well as insure the safety and dignity of the the people they serve. Long term, this effort could lead to the creation of a ‘CAHOOTS’ for every community that endeavors to meet the needs and challenges of those living with mental illnesses.
Crisis intervention training, is a 30 year old method of addressing mental health crises; and is one of the most common models police departments (about 2,700 of the 18,000 police departments in the U.S.) use to incorporate mental health expertise into emergency calls.
Yet, San Bernardino County, states that as of 2022, their CIT program has trained over 2000 deputy sheriffs.
