POP Center Problems People with Mental Illness, 2nd Ed. Page 2

Understanding Your Local Problem   

The information provided above is only a generalized description of police problems associated with people with mental illness. You must combine the basic facts with a more specific understanding of your local problem. Analyzing the local problem carefully will help you design a more effective response strategy. 

Stakeholders 

The following groups have an interest in the problems associated with police interactions with mentally ill persons and ought to be considered for the contribution they might make to gathering information about the problem and responding to it: 

• Public and private inpatient and outpatient psychiatric/mental health facilities (psychiatric hospitals and wards)
• Residential facilities serving people with mental illness (group homes, assisted living facilities, nursing homes, etc.)
• Public health departments, general hospitals, counselors, and therapists, including those that provide services to people in jail
• Advocacy organizations representing people with mental illness, such as the National Alliance for the Mentally Ill or the Mental Health Association
• Institutions and organizations that provide services for people who are homeless or who have serious substance abuse problems 

Asking the Right Questions 

The following are some critical questions you should ask in analyzing your particular problem of people with mental illness, even if the answers are not always readily available. Your answers to these and other questions will help you choose the most appropriate set of responses later. 

Incidents 

It is important to gather information about the quantity and types of incidents involving people with mental illness. You might find that one or two particular types of incidents constitute a large part of your jurisdiction’s problem, providing a focus for analysis and response. This information may be difficult to obtain, however, because many police agencies’ call-classification systems do not include a code for “person with mental illness,” “mental health emergency,” or “emotionally disturbed person.” Even where such codes exist, mental illness can play a significant role in incidents bearing other codes. Allowing subsidiary codes to indicate mental illness or otherwise flagging incidents as having mental illness as a significant contributing factor can improve your ability to determine the extent to which mental illness is being addressed by police. 

If the police department’s communications system does not provide reliable data, it may be necessary to do a special study in which officers and dispatchers record this type of information for some months to facilitate problem analysis. Another option is to review the call notes and any reports written from one randomly selected date to determine what role, if any, mental illness played in that incident. Yet another option is to backtrack from known indicators of incidents involving people with mental illness. For example, if one call at an address is found to involve a victim with mental illness or a false complaint reported by someone with mental illness, all previous calls at that address could be analyzed to check for a hidden hot spot. Similarly, all previous calls involving the particular person (victim or complainant) could be extracted from the department’s computer system to determine if the individual might be an unrecognized repeat victim or repeat false complainant.† 

† See Hartford et al. (2005) and McConnell, Dunn, and Brooke (2010) for descriptions of various approaches to identifying and quantifying police encounters with mentally ill persons. 

You should not overlook other data sources. Hospitals (general and/or psychiatric), ambulance services, and community-based mental health agencies might have useful data on commitments, referrals, and transports. In addition, academic institutions and mental health advocates might have conducted studies of the mental health situation in your jurisdiction, or they might be willing to partner with the police agency in conducting such studies. 

• How many total incidents involving people with mental illness does your agency handle in a year, and how much police time is consumed?
• How many of each type of incident involving people with mental illness does the agency handle in a year, and how much police time does each consume?
• What percentages of people with mental illness with whom police come into contact fit within the following roles: Offender (causing harm to others)? Disorderly person? Missing person? Complainant? Victim (of harm by another person)? Person in need of care (who is not causing harm to or being harmed by others)?
• How do police handle incidents (informal handling, formal referral, involuntary commitment, arrest, etc.) for each type of incident involving people with mental illness?
• How often do officers use force when handling incidents involving people with mental illness?
• How often are officers injured when handling incidents involving people with mental illness?
• How often are mentally ill suspects injured ?
• What proportion of people with mental illness whom officers encounter is homeless and/or serious substance abusers? 

Victims and Complainants 

Identifying victims is important because certain categories of people, or even some specific individuals, may be more heavily victimized than others, suggesting a need for special intervention or protection. Victims in situations involving people with mental illness might include specific community members, mental health workers, family members, or the mentally ill themselves. When any of these people become crime victims, the police may be notified, although of course many crimes also go unreported. Unfortunately, even when reported, such crimes may not be flagged or marked as involving a person with mental illness. This can make it difficult to identify both one-time and repeat victims. 

• When people with mental illness commit a crime, who are the victims (strangers, businesses, caregivers, etc.)? Who are repeat victims?
• When people with mental illness cause nuisances and disorder, who are the victims? Who are repeat victims?
• When crimes are committed against people with mental illness, who are the victims and what are their circumstances (family members, institutional residents, etc.)? Who are repeat victims?
• When people with mental illness are neglected and/or abused, who are they and what are their circumstances? Who are repeat victims of neglect and abuse?
• What is known about people who call the police to report concerns about people with mental illness? Are there high-rate repeat callers, either individuals or representatives of facilities (e.g., halfway houses, mental health treatment centers)?
• When people with mental illness call the police to assist them with some noncriminal matter, what are the circumstances? Who are repeat callers? 

Offenders 

It is important to look for people who cause a disproportionate share of the problem. People with mental illness may be offenders, or others may commit offenses against them. As mentioned above, however, it can be difficult to identify cases involving people with mental illness from police data, thus making it challenging to identify offenders and repeat offenders associated with such cases. 

• Which people with mental illness commit personal and property crimes? Who are the repeat offenders?
• Which people with mental illness cause nuisances and disorder? Who are the repeat offenders?
• What crimes do people commit against people with mental illness? Who are the offenders? Who are the repeat offenders?
• Who neglects and/or abuses people with mental illness? Who are the repeat offenders? 

Locations/Times 

Try to identify locations and times of incidents and crimes that frequently involve people with mental illness. Typical locations include public places (such as parks, business districts), businesses, and residences. Particularly important to look at, though, are hospitals, clinics, homeless shelters, drop-in shelters, and group homes. These places may have concentrations of people with mental illness, or they may be common destinations for people who experience serious chronic or episodic mental illness. Try to identify both macro hot spots (e.g., a downtown district) and micro hot spots (e.g., a particular park, shelter, group home, intersection).[33] There may also be certain times of the day, days of the week, or weeks of the year that the incidence of calls involving people with mental illness is particularly high. The routine schedules of agencies that assist people with mental illness might influence these peak times. 

• Where do incidents and crimes involving the people with mental illness occur?
• Where are the jurisdiction’s “hot spots” of incidents and crimes involving people with mental illness?
• Do different types of incidents and crimes involving people with mental illness cluster in different locations? If so, where are those locations?
• Are there particular times of the day, days of the week, or weeks of the year in which the incidence of calls involving people with mental illness is especially high or low? 

Current Responses 

• What laws and regulations govern the mental health system’s operation in your jurisdiction? Do they seem appropriate and adequate for addressing problems relating to mental illness?
• What written policies and procedures guide police responses to incidents involving people with mental illness?
• What written policies and procedures guide mental health providers in working with the police?
• What response options are available to police officers in handling mentally ill persons and to what extent are officers afforded discretion in deciding which option to choose?
• How easy is it in your community for people with mental illness to find appropriate and affordable treatment, either on their own or with professional assistance, including from police officers?
• What type and amount of training is provided to police officers in handling incidents involving people with mental illness?
• What concerns, if any, do police officers express about their working relationships with mental health providers? In turn, what concerns, if any, do those providers express about working with the police?
• How do people with mental illness perceive their interactions with police?‡ (Hearing from both mentally ill persons and mental health providers who are known to interact with your officers regularly can be helpful.)
• How do your police officers perceive their interactions with mentally ill persons? 

‡ See Livingston et al. (2014) for a study of such perceptions in Vancouver, Canada, in which a high percentage of persons with mental illness perceived their interactions with police favorably. Obviously, these experiences can vary considerably across jurisdictions. 

Measuring Your Effectiveness 

Measurement allows you to determine to what degree your efforts have succeeded, and suggests how you might modify your responses if they are not producing the intended results. You should take measures of your problem before you implement responses, to determine how serious the problem is, and after you implement them, to determine whether they have been effective. All measures should be taken in both target areas and surrounding areas, if applicable. (For more detailed guidance on measuring effectiveness, see the companion guide to this series, Assessing Responses to Problems: Did It Work?, 2nd Ed.) 

The following are potentially useful measures of the effectiveness of police responses to problems associated with people with mental illness: 

• reduced victimization of people with mental illness
• reduced total calls for service involving people with mental illness
• reduced calls for service at hot spots (take care to ensure that, for example, reduced calls from a group home are not caused by a facility operator’s preventing residents from reporting abuse or neglect)
• reduced repeat calls for service involving the same individuals
• reduced amount of police time consumed by calls involving people with mental illness
• reduced total calls for each type of situation involving people with mental illness (especially if police target their efforts toward specific types of situations)
• reduced arrests of people with mental illness (assuming that more effective alternatives to arrest are available)
• reduced number of involuntary civil commitments of people with mental illness (although it might be desirable to increase the volume of civil commitments for some period if civil commitment is a preferred alternative to criminal arrest)
• increased referrals of people with mental illness to community-based services
• reduced injuries to people with mental illness caused by police officers
• reduced injuries to police officers caused by people with mental illness
• increased “customer” satisfaction—post-incident satisfaction of complainants, victims, and offenders
• increased “expert” satisfaction—high ratings of police effectiveness by mental health and legal professionals.