The Deadly Results of This Nation's Mental Healthcare Failure
New report details widespread systemic failures that have led to decline of healthcare access alongside rise in police interactions with mentally ill
Offering fresh evidence of the widespread institutional failures and public policies that forsake those in need of healthcare, adults with untreated mental illnesses are 16 times more likely than other civilians to be killed during a police encounter, according to a new report released Thursday by the Treatment Advocacy Center (TAC).
"By dismantling the mental illness treatment system, we have turned mental health crisis from a medical issue into a police matter," said John Snook, TAC executive director and a co-author of the report, Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters. "This is patently unfair, illogical and is proving harmful both to the individual in desperate need of care and the officer who is forced to respond."
A minimum of one in four fatal police encounters involves an individual with severe mental illness (SMI), the Virginia-based health reform nonprofit found in its study. Those with SMI also represent one in every five individuals in prison or jail, and one in every 10 of all law enforcement responses.
"Given the prevalence of mental illness in police shootings, reducing encounters between on-duty law enforcement and individuals with the most severe psychiatric diseases may represent the single most immediate, practical strategy for reducing fatal police shootings in the United States," the report states.
That corresponds with a previous study conducted in June by the Washington Post which found that police in the U.S., on average, killed an individual with mental illness every 36 hours in the first six months of 2015.
TAC analyzed the long-established institutional policies that led to this complex crisis:
After a half-century of closing public psychiatric hospitals without replacing them with community-based facilities—a trend called "deinstitutionalization"—several hundred thousand people with mental illnesses such as schizophrenia and severe bipolar disorder cycle chronically through the streets, hospital emergency rooms and, most frequently, the criminal justice system.
"Deinstitutionalization transformed America's mental health system," the report states. Between dwindling healthcare resources and an increase of "community policing," which put more officers on the street at the same time that hospitals were emptying, law enforcement became "the mental health front line because there is no alternative."
The report continues:
In this environment, studies consistently find that 10%-20% of law enforcement calls involve a mental health issue. Most of these calls result from behavior that falls under the all-purpose umbrella of “public nuisance”—vagrancy, loitering or urinating in public, trespass—or from individuals endangering themselves. When officers respond, the symptoms of psychosis, paranoia and/or suicidal thinking make these subjects less predictable and the threat they pose more difficult to assess. If alcohol intoxication and/or other substance use is involved—co-occurring conditions that are common among people with severe psychiatric disease—the situation becomes even less stable.
The resulting mix can be deadly.
As the Post explained in its study, officers received little or inadequate training on handling individuals with SMI.
New recruits "receive only eight hours of training to de-escalate tense situations and eight hours learning strategies for handling the mentally ill...Otherwise, police are taught to employ tactics that tend to be counterproductive in such encounters," the Post's Wesley Lowery, Kimberly Kindy, Keith L. Alexander, and Steven Rich reported.
"For example, most officers are trained to seize control when dealing with an armed suspect, often through stern, shouted commands."
One such case is that of 25-year-old Lavall Hall, a black man with schizophrenia who was killed by officers in Miami Gardens, Florida in February while suffering from a mental health crisis. Hall's mother, Catherine Daniels, called the police after she found him outside at 5am in his underwear, holding a broomstick. Though Daniels informed officers of Hall's mental illness, a 19-minute dashcam video shows an officer commanding Hall to "get on the fucking ground or you're dead," before firing off five rounds that hit him in the arm and stomach. Hall was pronounced dead on the scene.
"If I'd known they would have killed my child, I would never have called them and asked them to come and help me," Daniels said later.
TAC makes several recommendations in its report, including:
- Increase the number of treatment beds for individuals suffering from acute or chronic psychiatric conditions.
- Reform treatment laws that erect barriers to treatment for at-risk individuals, including laws that require courts to wait until individuals become violent, suicidal or gravely ill before intervention becomes possible.
- Make full use of laws that provide access to treatment for individuals too ill to seek treatment for themselves.
- Expand the use of court-ordered outpatient treatment (“assisted outpatient treatment” or “AOT”), assertive community treatment (ACT) and other evidence-based practices that demonstrably reduce the likelihood of individuals with severe mental illness becoming police calls.
- Make treatment funding decisions that consider both the cost of treatment and taxpayer savings that result from providing treatment that reduces criminal justice involvement, homelessness and emergency medical services and other public costs.
"It should horrify but not surprise us that people with untreated mental illness are overrepresented in deadly encounters with law enforcement," said Snook. "Individuals with untreated mental illness are vastly overrepresented in every corner of the criminal justice system. Until we reform the public policies that have abandoned them there, these tragic outcomes will continue."
On Wednesday, the FBI announced plans to launch a new system tracking and publishing data on fatal police encounters.
In response to that development, Snook cautioned, "Unless the overhaul includes collecting mental health data, the role of mental illness will continue to remain concealed from the public and lawmakers, and the most pragmatic and immediate approach to reducing fatal law enforcement encounters—treating the untreated—will remain overlooked."