by Erin S. Craw, Ph.D. & Ernie Stevens
A Predicament for Police Officers: Responding to Mental Health Crises
Day after day, we hear stories of tragic, heartbreaking instances in which a mental health-related emergency ended in an arrest or even death. In 2021, approximately 14 million American adults had a severe mental illness, which causes substantial functional impairment in their daily lives, often resulting in crises (SAMHSA, 2023). People with mental illnesses are more likely to be involved in the criminal justice system, underscoring the urgent need for effective and sustainable mental health care (Franz & Borum, 2011; Steadman et al., 2009). With an increasing rate of mental health-related emergency calls, police officers are responding to such instances doing their best to help with limited training, expertise in mental health, and access to viable resources. Police officers are limited in what support they can provide, making it challenging for all individuals involved.
Often, police officers interact with individuals who are not only struggling with their mental health but are also homeless and could face other challenges related to substance use disorders. Officers often become frustrated because they want to see the person get help but are not mental health professionals themselves and therefore have limited options for direct support. Given the cyclical nature of someone having difficulty coping with a mental illness, encountering the criminal justice system, and being released into the community without adequate and continuous care, officers are regularly called to crises involving the same individual. These repeat interactions emphasize the prevalence of unaddressed mental health-related problems as well as a lack of connection between resources and those in serious need of help. Not only is this cyclical process terribly unfair to the person struggling, but police officers are also experiencing burnout and moral injury (Papazpglou et al., 2019) from being restricted in their ability to get them the help they need.
It is essential to consider the context of these calls and how police respond to mental health crises alone can be difficult. First and foremost, the safety of the individual and the community is of the utmost concern for the officer. In addition to evaluating the safety of all involved, officers Reuland et al. (2009) outline some critical characteristics of such interactions between police and people with mental illness. First, mental health crisis calls take substantially longer than other calls for service. Second, these calls require that officers have specialized training in de-escalating such situations. Further complicating these instances is a reliance on community mental health resources for successful outcomes that divert the individual from incarceration. While progress is being made regarding the increasing availability of resources, communities still face challenges with accessibility and connection for those struggling. For instance, police officers responding to these calls may face barriers like treatment centers being at full capacity or lacking local options. Coupled with the fact that officers are not themselves mental health professionals with an in-depth understanding of the mental illnesses individuals are dealing with, communities are suffering. Collaboration between the police and mental health professionals is more vital now than ever.
The Role of Crisis Intervention
Crisis Intervention Teams (CIT) have become increasingly popular in the past 20 years, providing a framework for officers’ encounters with individuals in a mental health crisis. The initial goal of CIT was to help diminish officer and civilian injuries on mental health-related calls (Watson et al., 2008). Today, that goal has evolved to focus on providing mental health support to help an individual with a mental illness get help rather than enter the criminal justice system. With an ideal CIT, a person with mental illness, their families, and the first responders all feel supported with access to an entire system of resources. Varying types of CITs exist in departments across the U.S. Some departments offer specific training for sworn officers who become the responders for mental health-related calls.
Other departments use non-sworn employees as trained consultants, providing advice and guidance as needed to officers in the field. A different model is to have officers co-respond with mental health professionals. When working with mental health professionals, the team can help de-escalate the situation, help get the individual to a comfortable and stable state, and directly connect them with needed resources.
Crisis Intervention Training is essential to improved responses to mental health crisis calls, regardless of the team model. Such training can help officers understand how to actively listen, communicate effectively, build rapport, and cultivate a trusting environment. This type of skills-based training can also allow officers to engage in more empathetic conversations that guide the person with mental illness by explaining their emotions or current state of mind upon their response to the call (Stevens & Ruggiero, 2022). With both trained officers and mental health professionals responding, the team can focus on the person’s unique needs rather than simply focusing on resolving the problem they were called to respond to. This approach will allow for a collaborative effort to coordinate a treatment plan that will emphasize the continuity of care with wraparound services for the patient. The focus of co-responder models is to resolve the crisis with a concentration on the least restrictive measures to have positive outcomes while at the same time reducing the chance of a use of force incident.
Research has found that a significant percentage of mental health-related calls are resolved without an arrest when CITs are involved (Franz & Borum, 2011). Clinicians can respond with officers, working to establish a care plan that will keep them out of jail. Individuals who are diverted from the justice system are more likely to receive counseling and medication or enroll in a treatment center (Broner et al., 2004). Instead of a standard that considers mental health assistance in response to the need for discipline, officers working with mental health professionals allow people to get the right help to live healthier lives. This collaboration refocuses crisis responding to addressing the underlying mental health-related problem head-on, avoiding incarceration and the likelihood of exacerbated symptoms through detention.
Involving counselors specializing in substance use disorders is another critical step in improving responses to mental health crises. Pairing the person with someone who deeply understands substance use disorders or even peers who have been through similar experiences can help the individual feel heard and will ensure they are directed to the proper support.
Just as co-workers with different levels of experience might have varying perspectives on an issue, a team of mental health professionals and police officers can pool their knowledge and expertise to consider all angles of the circumstance and provide the best support possible. While police officers might be able to suggest a few local options for help, they do not have the capacity to outline goals or care plans and regularly follow up to ensure engagement in services. In fact, even with the collaboration of mental health professionals through these teams, follow-up and continuous care are challenging to accomplish, as they are inundated with cases.
It is important to note that this is all a step in the right direction, though more needs to be done to address the systematic barriers to people with mental health issues or illnesses getting the continuous care they need. The teamwork emphasized in CITs must continue throughout the individual’s journey. By working together, professionals with varying specialties can help break the cycle of mental illness, incarceration, homelessness, and back to detention.
So, why doesn’t every department have these teams?
Numerous studies have demonstrated the power of CIT in communities across the U.S., so why doesn’t every department have one? Notably, the average police department has fewer than 25 officers assigned to their agency. The logistics of creating a specialized team with so few officers make it very difficult. Also, considering the vast number of rural agencies, the lack of available mental health resources in those areas can be a factor in developing CIT teams. Furthermore, given the high need for mental health professionals today, staffing teams with licensed professionals with such specialties is challenging. Crises do not happen only during typical business hours, so these teams also require mental health professionals who work early mornings, nights, and weekends.
By leveraging technology, police agencies are finding ways to be creative in their efforts to build out these systems of care. Some agencies (e.g., Harris County SO) are issuing tablets to their deputies, who can connect to a service provider immediately to access support on a crisis call. Other agencies are building out regional response teams by combining the services of several law enforcement agencies and service providers. Funding these units also comes with a financial strain on police budgets. Hundreds of law enforcement agencies have utilized grant funding opportunities with the Bureau of Justice Assistance Connect and Protect solicitations. Law enforcement has heard the cry for help from their communities, and they are working diligently to generate alternative opportunities to allow for more CIT responses.
- Police-Mental Health Collaboration (PMHC) Toolkit | Bureau of Justice Assistance (ojp.gov)
- Mental Health & De-Escalation: A Guide for Law Enforcement Professionals https://erneststevens.com/
- Ernie Stevens creates mental health crisis training for Police Officers podcast
Broner, N., Lattimore, P. K., Cowell, A. J., & Schlenger, W. E. (2004). Effects of diversion on adults with co-occurring mental illness and substance use: Outcomes from a national multi-site study. Behavioral Sciences & the Law, 22(4), 519–541. https://doi.org/10.1002/bsl.605
Franz, S., & Borum, R. (2011). Crisis Intervention Teams may prevent arrests of people with mental illnesses. Police Practice and Research, 12(3), 265-272. https://doi.org/10.1080/15614263.2010.497664
Papazoglou. K., Bonanno, G., Blumberg, D., & Keesee, T. (2019). Moral injury in police work. FBI Law Enforcement Bulletin. leb.fbi.gov
Reuland, M., Schwarzfeld, M., & Draper, L. (2009). Law enforcement responses to people with mental illnesses: A guide to research-informed policy and practice. Council of State Governments Justice Center.
SAMHSA (2021). 2021 national survey of drug and health releases. https://www.samhsa.gov/data/release/2021-national-survey-drug-use-and-health-nsduh-releases
Steadman, H. J., Osher, F. C., Robbins, B. P. C., Case, B., & Samuels, S. J. (2009). Prevalence of serious mental illness among jail inmates. Psychiatric Services, 60(6), 761–765. https://doi.org/10.1176/ps.2009.60.6.761
Stevens, E., & Ruggiero, N. (2022). Mental health & de-escalation: a guide for law enforcement professionals.
Watson, A. C., Morabito, M., Draine, J., & Ottati, V. (2008). Improving police response to persons with mental illness: A multi-level conceptualization of CIT. International Journal of Law and Psychiatry, 31(4), 359–368. https://doi.org/10.1016/j.ijlp.2008.06.004
About the Authors
Ernest (Ernie) Stevens is a published author with a #1 best-selling book on Amazon titled: Mental Health and De-escalation: A Guide for Law Enforcement Professionals. Ernie was also a contributing author for Police Mental Barricade. Ernie was a police officer for 28 years, serving 26 of those years with the San Antonio Police Department where he was a founding member of the Mental Health Unit.
Ernie has been featured on the Emmy Award Winning HBO Documentary, Ernie and Joe: Crisis Cops. He has also been featured in NBC’s documentary, A Different Kind of Force. Ernie was interviewed by ABC’s Nightline’s Byron Pitts and featured on officers trained to respond to mental illness calls.
Ernie has been featured in over 27 publications and deemed an expert in Crisis Intervention Training. He is a graduate of Wayland Baptist University and holds a B.S. degree in Criminal Justice. He is married to his wife Lisa who he attended school since elementary school. He has two incredible children, Reed and April.
Ernie continues to support law enforcement agencies around the nation by providing technical assistance and best-practice approaches to mental health crisis calls.
Ernie currently serves as the deputy director of law enforcement for the Council of State Governments Justice Center.
Erin Craw, Ph.D. earned her doctorate in communication from Chapman University in Southern California, emphasizing in health and interpersonal communication. Her research interests are at the intersection of health and interpersonal communication as it relates to social support, stigma, and resilience. Her dissertation explored police officers’ preferences for support and factors influencing mental health-related disclosure decisions.
She is particularly interested in translational research that improves access to needed support for underserved populations and those who face extensive barriers to gaining assistance. As the daughter of a police officer (36 years) and granddaughter of a firefighter (40 years), she has a true passion for research that informs mental health-related interventions for first responders, enhances communication surrounding mental health, and improves access to support. Erin’s research has been published in Health Communication, the Journal of Social and Personal Relationships, Communication Education, and the Journal of Applied Communication Research. She has also been invited to be a guest on several podcasts to discuss how her research can help enhance new approaches to improving mental health support and communication.
At Youturn Health, Erin manages the public sector accounts, ensuring that clients successfully access needed support.