#DefundthePolice and Mental Illness

Back to table of contents Previous article ViewpointsFull Access#DefundthePolice and Mental IllnessKenneth P. Rosenberg, M.D.Kenneth P. RosenbergSearch for more papers by this author, M.D.Published Online:4 Aug 2020https://doi.org/10.1176/appi.pn.2020.8a17Before the COVID-19 pandemic and before protesters spilled onto streets around the globe calling for police reforms and an end to systemic racism, the United States was in the midst of a mental health crisis. As a consequence of deinstitutionalization and a lack of coherent mental health policy, we’ve turned our police departments into the nation’s largest psychiatric outreach team. This historic mistake has cost tremendous amounts of money—and a shocking number of lives.The call to defund the police, with all the slogan’s different interpretations, has spotlighted the enormous amount of taxpayer dollars invested in a failed—and sometimes deadly—system for dealing with many community safety issues, including mental health. Demonstrators are calling for redistribution of funds from police budgets into service functions that will take better care of communities and create a more stable and sustainable society. It is vital that having medical professionals intervene with people in psychiatric crisis be a part of any police reform or replacement plan.The police are indeed helpful to us. They SAVE lives. They PROTECT and SERVE our loved ones and our communities. But their major role in mental health care, particularly when there is no threat to public safety, is a historical accident that should be corrected.I am a psychiatrist who has studied the struggles of those with serious mental illness and the brother of a white woman who died of complications from schizophrenia (see Psychiatric News). I know how ill equipped the police are to help people in mental health crisis. I also recognize the particular threat the current system poses to people of color, including those with mental illness. Mental health crises are the only health emergencies in which law enforcement officers are the first responders, and this misallocation of community resources has had disastrous consequences.Consider these statistics, gathered through a national survey of law enforcement departments that tallied the 10 million annual emergency transports of people with mental illness in 2017. Twenty-one percent of all law enforcement officer staff time was spent on mental health transports, and 10% of their overall budgets was spent on responding to or transporting people with mental illness. This amounted to a staggering total of $918 million spent nationwide. The outcomes resulting from all this money are even more appalling.Despite the unrest that has brought so much necessary attention to police killings—largely of Black men and boys—few people recognize that of the 5,416 people shot and killed by police in the line of duty since 2015, at least 22% had a mental illness.Our nation, and the world, is outraged by police killings of unarmed people. Most arrests of people struggling with serious mental illness have nothing to do with weapons or threats against others. Instead, police are dispatched for management when there’s no one else to call. Even when weapons are in play, the tactics of intimidation and force fail on people so ill they have lost touch with reality. The majority of people with mental illness who are fatally shot by the police are armed, sometimes openly flaunting a weapon while in a clearly deranged mental state. Demonstrating that the fundamental problem is not simply police responses but the lack of proper treatment for the very ill people—some of whom languish on our streets—may live in isolation and squalor and can become dangerous to themselves and others.It’s striking to me that even in this politically divided moment, there’s widespread agreement on the failure of our mental illness delivery system among constituencies on the right, left, and middle—including the National Sheriff’s Association, the Treatment Advocacy Center, the National Alliance on Mental Illness, and Black Lives Matter.Minneapolis has vowed to dismantle its police force. Los Angeles, New York City, and Boston, and other municipalities are discussing budget cuts and investigating options for non-police solutions to noncriminal matters. The LA City Council is considering dispatching non-law enforcement responders to mental health crises. Unlike with some of these responsibilities, reforming mental health crisis intervention can benefit from existing research on different approaches as well as models already in use. The Vera Institute of Justice has published a report of dozens of studies of evidence-based alternatives to traditional policing that are already being used in the United States, Canada, and Northern Europe.We can learn from the crisis intervention teams developed in Memphis in which specialized police units are dispatched to be first responders to psychiatric crises on the streets or in homes. In a similar vein, Miami Dade County has established crisis intervention teams of specially trained police who work with mental health counselors and judges to divert people from jail into treatment, saving lives and taxpayer dollars. In parts of Dallas, an estimated 85% of 911 calls pertained to mental health problems. Police found that attending to mental health crises was most effective when they didn’t act like police. Instead, they dressed in street clothes, drove civilian cars, responded while accompanied by a nurse and/or mental health professional, and employed empathetic listening.These examples offer hope and insight about what transformation might be possible. Yet further reform could mean that much of the work would be done by public servants who do not carry guns, only calling in the police for backup in cases of a real threat of violence. In Trieste, Italy, a World Health Organization exemplar, community mental health specialists work 24/7 to respond to mental health crises with little need for police or even expensive hospitals. Across America, we are realizing that proper mental health care is proper and just on every measure: logical, cost-effective, and humanitarian. ■The National Sheriff’s Association report “Police Are the First to Respond to Mental Health Crises. They Shouldn’t Be” is posted here.The Treatment Advocacy Center report “Road Runners: The Role and Impact of Law Enforcement in Transporting Individuals With Severe Mental Illness” is posted here.The National Alliance for Mental Illness report “Jailing People With Mental Illness” is posted here.The website of Black Lives Matter is here.Kenneth P. Rosenberg, M.D., is a clinical associate professor of psychiatry at Weill Cornell Medical College/New York Presbyterian Hospital. ISSUES NewArchived

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