If you wanted your car fixed, you could take it to a plumber for repairs. After all, both deal with flow systems and fluid levels. But you likely would not get the same results as you would from an auto mechanic. Training matters. It’s the same with social problems. People experiencing mental health crises will not get the same results when police respond to their emergency as they would if a trained psych professional responded.
Law enforcement education trains officers to overwhelm and dominate a situation. Sixty hours is dedicated to firearms training, while only eight hours are dedicated to de-escalation training, and another eight hours for education about how to interact with mentally ill people (Lowery, et al, 2015). Hundreds of individuals experiencing episodes of mental crisis are killed by law enforcement officers each year. In 2015, 23 percent of people killed during encounters with law enforcement “displayed signs of mental illness” (Saleh, et al., 2018). Systems get the result they are designed to, so it can be assumed training methods contribute to these deadly statistics.
Statistics aside, I know I am not the only person who has seen videos of how these interactions play out in neighborhoods. While they are excruciating to watch, I know I am not the only person for whom this social media based community journalism has been a wake-up call.
Negative attitudes toward mental health struggles are rife among police officers. A survey of more than 130 police officers in Ontario, Canada found anywhere from one-third of respondents viewed people who experience mental illness as untrustworthy, and they would not want them as a partner. Over half said they viewed seeking treatment as a personal failure, would draw discrimination at work, and may even become a barrier to promotion (Stuart, 2017).
This survey reveals a worrying lack of sympathy among police officers toward people struggling from a chronic health condition, which undoubtedly influences how officers interact with them. A person who firmly believes someone experiencing a mental health crisis should be able to “power through it” is likely incapable of understanding that person may not be in a state to comply with their commands, and that responding with increased aggression and force may only make the confrontation worse.
Ideally, the solution to this problem would be to hold sensitivity workshops and provide more mental health crisis responders training for law enforcement officers. Unfortunately, changing hearts and minds takes a very long time, and is not guaranteed to be successful. And sometimes the best solution is to create rules that prevent people who refuse to change from doing further harm. Take the example of the American Civil Rights Movement. Activists achieved the Brown v. Board of Education of Topeka 1954 court ruling that overturned the policy of racially segregated public facilities. However, many schools did not see meaningful desegregation until the passage of the Civil Rights Act in 1964, a decade later.
Examples from other professions show it is possible to resolve volatile situations without violence. Teachers break up fights between students, and bar staff subdue aggressive patrons. However, the best example is psych hospital staff who interact with this population continuously, and do not resort to shooting them. I’ll never forget watching this process in reality while completing my psych clinical rotation at a clinic for teenagers. One high school age girl started having a meltdown. A group of kids were playing a game in a gym, when one of the girls started screaming and swearing over some disagreement with the rules of gameplay. For one second, I wasn’t sure if she wasn’t going to attack another player. The staff directed the other kids to move to the opposite side of the room, while one of the adults proceeded to talk her down. He used a low, calm tone. He asked her how she was feeling, validated her emotions, and talked her through breathing exercises to soothe herself. When it seemed like the worst was over, someone escorted her to another part of the clinic. The whole process took probably 15-20 minutes, and at times it was touch and go, because the girl wasn’t always cooperative with the instructor’s suggestions. But eventually the crisis was resolved.
What this anecdote demonstrates, and what examples of communities that have implemented mental health crisis response teams prove, is that de-escalation is possible when people are trained and willing to perform it. One example is Support Team Assistance Response (STAR) in Denver, Colorado (Hauck, 2021). Six months into operation, more than 2,500 emergency calls were transferred to STAR instead of the police (Hauck, 2021). STAR handled 748 calls without needing to call law enforcement for back-up or arrest anyone.
Perhaps an even better example is Crisis Assistance Helping Out On The Streets (CAHOOTS). Created by the White Bird Clinic in Oregon more than 30 years ago, it responded to over 24,000 calls in 2019 alone, of which only 150 required additional support from police (White Bird Clinic, 2020).
And nurses can support this issue. While I’m a big believer in healthy boundaries–not picking up extra shifts when you’re exhausted, or staying in an unhealthy workplace because you feel guilty they’ll be short-staffed–I do believe nurses have an ethical obligation to promote improving healthcare beyond the clinical setting. This means supporting policies to expand access to healthcare, and improve how it is performed. One example would be nurses encouraging their local representatives to implement mental health crisis hotlines and response teams. There are so many aspects of society that influence what causes people to need healthcare, and so many different ailments for which people need treatment. It is very short-sighted for nurses to only think they can make a difference while they’re clocked in.
References
Hauck, G. U. T. (2021, February). Denver successfully sent mental health professionals, not police, to hundreds of calls. USA TODAY. https://eu.usatoday.com/story/news/nation/ 2021/02/06/denver-sent-mental-health-help-not-police-hundreds-calls/4421364001/
Lowery, W., Rich, S., Jenkins, J., Tate, J., Alexander, K. L., & Kindy, K. (2015, June) Distraught people, deadly results: Fatal shootings by on-duty police officers. The Washington Post, https://www.washingtonpost.com/sf/investigative/2015/06/30/distraught-people-deadly-results/?itid=lk_inline_manual_27.
Roe, D., Corrigan, P., & Link, B. G. (2017). Special Issue: Stigma in Psychiatry. Isr J Psychiatry Relat Sci, 54(1), 74.
White Bird Clinic. (2020, November). What is CAHOOTS? https://whitebirdclinic.org/what-is-cahoots/.
Ellison Langford 