It doesn’t have to be this way. The movement underway to “defund the police,” is a long-needed moment to shift responsibility for the seriously mentally ill away from police and put it back to where it belongs: on social service agencies and the medical community.
Forty percent of adults with serious mental illnesses will come into contact with the criminal justice system during their lives. Each year, 2 million of them are booked into jails. Most are charged with minor misdemeanor crimes and low-level felonies directly tied to their psychiatric illnesses. Jails and prisons currently hold more people with serious mental illnesses — 365,000 individuals — than hospitals. They remain in jail four to eight times longer than people without mental illnesses charged with the exact same crime, cost seven times more than other inmates in jail, are less likely to make bail and more likely to gain new charges while incarcerated.
There have been calls for change long before George Floyd’s death — often by police themselves. As Ron Bruno, a veteran officer who helps lead a group, CIT International, that teaches police and communities how to better interact with individuals in a mental heath crisis, has said: “We have to challenge the belief that mental health crisis services must come in a police car.”
Several communities have moved to reduce police involvement by creating systems that attempt to minimize law enforcement. The “Air Traffic Controller Approach” uses a designated suicide prevention and crisis line separate from 911 for mental health emergencies. Bruno notes that 80 percent or more of 911 calls don’t require a police response. It’s likely many mental health-related calls could be triaged by phone, too.
“Controllers” can schedule appointments with therapists and social workers if needed. They can also dispatch a mobile crisis response team to resolve more immediate situations. Those teams include a mental health professional and a peer — someone who recovered from a mental illness crisis — who are skilled at defusing emergencies. Only in the most extreme incidents are police needed.
If someone requires hospitalization, they are not taken to an emergency room or jail. They are admitted into a crisis care facility operated by mental health department separate from the police. These facilities can arrange for mental-health crisis care beds until a client is stabilized and extend a “warm handoff” of clients to community services that provide housing, transportation, employment services, peer support and continued mental and physical care. All are needed.
Unfortunately, few mental health programs such as these are adequately funded or readily available, which is where the “defunding police” movement comes in. The National Alliance on Mental Illness reports that the average cost of jailing someone with a serious mental illness is $31,000 per year, compared to the $10,000 annual cost of providing community help. It’s estimated that $918 millionwas spent by law enforcement in 2017 simply on transporting people with severe mental illnesses for evaluation and care.
Cooperation between law enforcement, courts and social service agencies in Miami-Dade County, Fla., resulted in 4,000 inmates with mental illness moving from jail into community-based treatment and support services. The county was able to close a jail facility, saving $12 million a year.
To reduce police interactions, we must rethink our involuntary commitment criteria that demands an individual pose an immediate danger to themselves or others before intervention. Waiting until someone is dangerous is a recipe for police force and arrests.
Australia, long considered a leader in mental health care, gives weight to “deterioration of mental state.” Victoria’s Mental Health Act permits an assessing clinician to involuntarily admit someone into care if it is likely that person will experience deterioration unless treatment is provided. England and Francehave similar “need for treatment” laws that include safeguards such as timely hearings and the right to call witnesses but do not necessarily demand dangerous behavior.
Because involuntary commitment is a civil rights issue, our legal system can never be separated completely, nor should it be, from mental health crises. Our reliance on law enforcement, however, prevents us from knowing how many Americans would need to be forced into treatment if we had robust and welcoming mental health services available from the first onset of an episode.
As the father of an adult son with a serious mental illness — who is doing well now but also has been arrested and shot twice by police with a stun gun — I have spoken to hundreds of law enforcement officers over the past decade. No organization willingly gives up funding, but I suspect most law enforcement officers would welcome an opportunity to stop being the first responders when someone is in a mental health crisis.