This post was co-authored by Michelle Heyland, DNP, APN, PMHNP-BC and Mona Shattell, PhD, RN, FAAN.
There will be more officers on the streets of Chicago (and for sure, Chicago needs them) but these extra officers won’t stop events like what happened Tuesday evening in the Bronx– a New York Police Department officer fatally shot a woman with a known history of mental illness after they were called to contain a situation. The officer described the woman’s behavior as “irrational” and reported that she threatened him with scissors and then struck him with a baseball bat. The officer reacted, with deadly force.
Officers need help – more crisis intervention training, and more programs that partner psychiatric mental health nurses with officers.
Incidents like what happened in NY this week are unfortunately, increasingly common. Police officers on our streets and correctional officers in our jails are first line responders for individuals in mental health crisis. In the state of Illinois, agencies have operated all year without a state budget; community mental health centers have had to close or at the very least decrease services and staff. And it’s not because there aren’t people in our communities who need mental health services.
According to a study by the Substance Abuse and Mental Health Services Administration, an estimated 1 in 5 individuals suffers from one or more mental illness. Despite this, funding for mental health services seems to be the first to hit the chopping block. Years past, Illinois experienced one of the highest mental health funding cuts with an estimated $113.7 million between 2009 and 2011. And it’s now any better now. Couple the high rate of mental illness with Illinois’ funding cuts and no state budget, there is no surprise that police officers’ encounters with persons in mental health crises are on the rise.
The so called “safety net” has nearly completely disintegrated.
Despite frequent exposure to individuals with mental health crises, law enforcement officers lack the knowledge to intervene. But it’s not their fault. We cannot and should not vilify them. Police officers need better and more training, and police departments need to partner with mental health professionals like psychiatric mental health nurses who are experts in engaging with persons who may be psychotic, suicidal, or extremely agitated.
Better and more training for police officers.
Crisis intervention and de-escalation training for police officers should be expanded. Current estimates show that only about 15% of officers are actually trained in crisis intervention, leaving a large gap of trained officers responding to calls on any given day.
Chicago has tried to address this, but it was in the past -- the Chicago Police Department implemented the Crisis Intervention Team Training about 10 years ago. Although initially embraced, it has diminished over the years because of decreased financial and adminstrative support. One study on crisis intervention training programs surveyed police chiefs, sherrifs, and officers. The results identified a variety of barriers to implementation including cost and inability for law enforcement to take time off for training.
Officers do get trained but not much on dealing with persons with mental illness. Research by the Police Executive Research Forum identified that a median of 58 hours was spent on firearms training or 18% of total training time. This also meant that new officers received more training on firearms than anything else. Defensive tactics are close behind taking up to 13% of training time. These numbers stands in contrast to the median number of hours for crisis intervention training at only 8 hours or about 9% of overall training time. De-escalation skills are equally important for police officers, but officers receive only a median of 10 hours or 5% of training time in these skills (Police Executive Research Forum, 2015).
The amount of time spent on training for crisis de-escalation, communication, and crisis intervention must be increased. With steadily increasing rates of mental illness and a growing police force, the Chicago Police Department will continue to have tense (and sometimes deadly) situations with individuals with mental illness. However, increasing skills useful in crises, especially descalation, communication and relationship-building skills, could help prevent situations from escalating to the point where deadly force is deemed necessary.
Partner with psychiatric mental health nurses
Police departments should partner with mental health professionals such as psychiatric mental health nurses to go with officers responding to persons in mental health crisis. Dr. Mary Ann Nihart, president of the American Psychiatric Nurses Association advocated for this yesterday in her keynote address at the annual meeting of the American Psychiatric Nurses Association.
Programs such as these have been successful, reports Dr. Nihart. The Hamilton Police Service in Hamilton, Canada reportedly piloted one of the first Mobile Crisis Rapid Response Team efforts, which pairs mental health care providers with officers to answer 9-1-1 calls made my persons in mental health crisis. The partnership aims to improve the care of persons who are in emotional distress, decrease fatalities, and divert or decrease emergency department visits to only those individuals who need it.
And we know a lot about how to care for persons in mental health crisis and emotional distress, because we’ve done it. We both are psychiatric mental health nurses with several years experience working with patients in acute care psychiatric settings, and we both are Rush University professors. One of us (Heyland) was a registered nurse at the “The Living Room” at Turning Point Behavioral Health Care System, in Skokie, IL; the other (Shattell) an academic researcher. We both conducted research about The Living Room and alternatives to emergency departments for persons in emotional distress. And, incidentally, we both have close family members who are police officers. We know that officers need help, that emergency departments are not the best places for persons in mental health crisis, and we certainly want the deadly violence against persons with mental illness to stop.
To be sure, this is a complicated problem but with more and better access to mental health treatment, more adequately trained police officers, and more programs like the one in Hamilton, we have a chance.
We can save lives and avoid fatal incidents like the one in NY Tuesday night.