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Escalation

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The prevalence of interactions between police officers and persons with mental illness:

Interactions between police officers and individuals with mental conditions are so common that police officers have even been dubbed “street-corner psychiatrists.”1

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Statistics show that roughly 10% of calls made to police departments involve persons with mental illness.2 Former sergeant of Akron, Ohio Police Department, Michael Woody, states that these calls “can be very dangerous, very tricky. You really have to know what you’re doing to handle them…properly.”3 Woody’s statement suggests that in addition to being dangerous for individuals with mental health conditions, having to handle mental health calls can be pressurizing for officers themselves.

 

The common nature of these interactions poses several challenges and dangers: 

As of 2014, 1 in every 25 adults had a Serious Mental Illness (SMI), meaning they experienced serious impairment by a a mental, behavioral, or emotional disorder that “interferes with one or more major life activities.”4 Later data in 2018 reveals that approximately 11.4 million adults in the U.S. had an SMI.5

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Despite making up only around 0.04% of the population, at least 1 in every 4 people (25%) killed by the police has a serious mental illness (SMI).6 This suggests that those with SMIs are disproportionately subject to fatal police encounters.

 

Police officers may perceive a mental health call as dangerous or posing a greater threat, causing them to sometimes take unnecessary drastic (deadly) measures:

A study by Bruce G. Link et al. found that “symptoms of mental illness remain strongly connected with public fears about potential violence.”7 This perception by police can lethally escalate crises.

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Under the Graham v. Conner case, “split-second judgments” (that do not involve a risk calculation) by a police officer in response to an immediate threat are reasonable. However, although the use of lethal force against such a perceived threat may be justified under this case, the level of threat posed by cases involving persons with mental illnesses may be overstated by officers, in turn justifying their use of force in these cases.8

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Besides the Graham case, police officers are in general authorized to use force “when they have probable cause to believe that a suspect poses ‘a threat of serious physical harm, either to the officer or to others.”9 Thus, the subconscious perception as persons with mental illness as more dangerous can have fatal consequences. 

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Despite the perception by officers that people experiencing mental illness are more dangerous or violent, this view is not supported by evidence. On the contrary, despite making up roughly 20% of the population, persons with mental illness are responsible for only 4% of gun violence.10 Additionally, rather than being more likely to be violent, such persons are actually more likely to be victims of violent crimes.11 Several large-scale research projects support that the perception of mental illness as dangerous is flawed, finding “weak statistical association between mental illness and violence”12

 

Further combating the perception of people with mental illness being more dangerous is the fact that of calls involving those believed to have a mental illness, “law enforcement officers encounter individuals at risk of harming someone else relatively infrequently.”13 They instead more often “encounter people with mental illnesses at risk of harming themselves.”14

• In the first 9 months of 2006, out of the 46,129 contacts made with individuals believed to have a mental disorder by the Los Angeles (California) Police Department, 709 had attempted suicide, and 4,686 were taken into custody for an emergency evaluation.15

• The Albuquerque (New Mexico) Police Department’s CIT program reported that, in one year, “15% of CIT calls involved individuals attempting suicide, and 30% involved individuals threatening suicide.”16

• Of their 148 encounters with persons believed to have a mental illness, police officers in Honolulu, Hawaii recorded that there was “assaultive or violent” behavior in 12.2% of these encounters.17

 

The Teresa Sheehan case is an example of how crises involving persons with mental illness may escalate and lead to fatal consequences. In 2008, Teresa Sheehan was living in a San Francisco group home for people with mental illness. Sheehan had schizoaffective disorder, and her social worker became concerned that she had “stopped taking her medication, stopped seeing her psychiatrist, and was ‘no longer changing her clothes or eating.’” When Sheehan ordered the social worker to leave her apartment and threatened to kill him if he did not leave, he called the police “to provide assistance and asked that they transport Sheehan to a facility for evaluation.” When officers arrived, Sheehan refused to answer the door, prompting them to enter using a key, to which Sheehan “responded violently,” grabbing “a kitchen knife” and yelling at the officers. Although the officers did call for backup, they attempted to “subdue Sheehan before backup arrived,” spraying her with pepper spray and shooting her 5-6 times when she refused to drop the knife. At least one of these officers was specially trained on responding to persons in mental health crisis.18

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Another case in Memphis, Tennessee in 1987 involved police responding to a call involving a young man with mental illness who was threatening suicide, cutting himself with a knife. When officers arrived, they ordered the man to drop the knife, causing him to become more upset. He ran towards the officers with the knife still in his hand, and officers shot and killed him.19 This case prompted the origin of the CIT model. 

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The susceptibility of mental health calls to escalation is especially harmful considering the fact that many of these calls are for low-level offenses in the first place:

Data demonstrates that most encounters between police officers and persons with mental illness involve “individuals suspected of committing low-level, misdemeanor crimes, or who are exhibiting nuisance behavior.”20

• This is supported by a study of the 148 encounters between police and individuals believed to have a mental illness during one month in 1994 in Honolulu, Hawaii. Officers concluded that these individuals’ conduct most frequently included “loud or obnoxious behavior” or “untidiness” – “majority of individuals either had committed no criminal offense (45.3%) or had exhibited disorderly conduct (27.7%)”21

• These results are also paralleled by a 1980 and 1981 study in a large Midwestern city, which found that 71% of police encounters with people having mental illness involved individuals “known to officers either as ‘neighborhood characters,’ ‘troublemakers.’ Or ‘relatively unobtrusive’ individuals.”22

 

However, even these interactions involving low-level offenses can escalate to violence since many police officers are “unfamiliar with [the] particular symptoms, behavior, and demeanor” of those with mental illness 23, perhaps even misinterpreting actions such as noncompliance with commands or unpredictable responses due to mental illness as “potentially injurious or life-threatening.”24 Data supports that violence is disproportionately common in cases involving those with mental illness, which suggests that mental illness may be cause of undue escalation:

• A study found that “risk of being ‘killed during a police incident is 16 times greater for individuals with untreated mental illness than for other civilians.’”25

• A 2012 investigation found that “about half of the estimated 375-500 people shot and killed by police each year in this country are mentally ill.”26

• In the first 6 months of 2015, 124 of the 462 people killed by police “were in the throes of a mental or emotional crisis.”5 Further demonstrating an issue regarding lack of training is the fact that “over half of these [124] shootings involved police departments that do not provide officers with state-of-the-art training to respond to persons experiencing mental illness.”27

• In 2018, of the 992 persons shot and killed by police, 208 (20.96%) “were in mental health crisis at the time they were killed.”28

• Of the 3,933 fatal police shootings in the United States between 2015 and 2018 recorded by the Washington Post, 949 (24.13%) of the people were in mental health crisis at the time.29

• Evidence suggests that in cases of low-level offenses, “persons exhibiting signs of mental illness were more likely to be arrested for the same offense than those showing no signs at all.”30

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In addition to being more likely to be arrested, individuals with mental illness also tend to stay longer in jail.31

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1. Campbell, Alexis. “Failure on the Front Line: How the Americans with Disabilities Act Should Be Interpreted to Better Protect Persons in Mental Health Crisis from Fatal Police Shootings.” Columbia Human Rights Law Review, 2019, http://hrlr.law.columbia.edu/hrlr/failure-on-the-front-line-how-the-americans-with-disabilities-act-should-be-interpreted-to-better-protect-persons-in-mental-health-crisis-from-fatal-police-shootings/. 

2. Ibid.

3. “When Cop Calls Involve the Mentally Ill, Training Is Key.” NPR, NPR, 14 June 2014, https://www.npr.org/2014/06/14/322008371/when-cop-calls-involve-the-mentally-ill-training-is-key.

4. Hanna, Andrew C. “Municipal Liability and Police Training for Mental Illness: Causes of Action and Feasible Solutions.” Indiana Health Law Review, vol. 14, no. 2, 2017, p. 221., https://doi.org/10.18060/3911.0039. 

5. Campbell, Alexis. “Failure on the Front Line: How the Americans with Disabilities Act Should Be Interpreted to Better Protect Persons in Mental Health Crisis from Fatal Police Shootings.” Columbia Human Rights Law Review, 2019, http://hrlr.law.columbia.edu/hrlr/failure-on-the-front-line-how-the-americans-with-disabilities-act-should-be-interpreted-to-better-protect-persons-in-mental-health-crisis-from-fatal-police-shootings/.

6. Elinson, Zusha. When Mental Health Experts Not Police Are the First ... The Wall Street Journal, 24 Nov. 2018, https://www.eugene-or.gov/DocumentCenter/View/47992/When-Mental-Health-Experts-Not-Police-Are-the-First-Responders---Wall-Street-Journal-Nov-24-2018. 7

7. Link, B G, et al. “Public Conceptions of Mental Illness: Labels, Causes, Dangerousness, and Social Distance.” American Journal of Public Health, vol. 89, no. 9, 1999, pp. 1328–1333., https://doi.org/10.2105/ajph.89.9.1328. 

8. Fagan, Jeffrey and Campbell, Alexis, Race and Reasonableness in Police Killings (May 7, 2020). Boston University Law Review, Vol. 100, 2020, Columbia Public Law Research Paper No. 14-655, Available at SSRN: https://ssrn.com/abstract=3596274

9. Ibid.

10. Campbell, Alexis. “Failure on the Front Line: How the Americans with Disabilities Act Should Be Interpreted to Better Protect Persons in Mental Health Crisis from Fatal Police Shootings.” Columbia Human Rights Law Review, 2019, http://hrlr.law.columbia.edu/hrlr/failure-on-the-front-line-how-the-americans-with-disabilities-act-should-be-interpreted-to-better-protect-persons-in-mental-health-crisis-from-fatal-police-shootings/.

11. Hanna, Andrew C. “Municipal Liability and Police Training for Mental Illness: Causes of Action and Feasible Solutions.” Indiana Health Law Review, vol. 14, no. 2, 2017, p. 221., https://doi.org/10.18060/3911.0039.

12. Reuland, Melissa, et al. “Law Enforcement Responses to People with Mental Illnesses: A Guide to Research-Informed Policy and Practice.” CSG Justice Center, 9 Feb. 2020, https://csgjusticecenter.org/publications/law-enforcement-responses-to-people-with-mental-illnesses-a-guide-to-research-informed-policy-and-practice/. 

13. Ibid. 

14. Ibid.

15. Ibid.

16. Ibid.

17. Ibid.

18. Hanna, Andrew C. “Municipal Liability and Police Training for Mental Illness: Causes of Action and Feasible Solutions.” Indiana Health Law Review, vol. 14, no. 2, 2017, p. 221., https://doi.org/10.18060/3911.0039.

19. “CIT History.” Crisis Intervention Team, http://www.gocit.org/crisis-intervention-team-history.html. 

20. Reuland, Melissa, et al. “Law Enforcement Responses to People with Mental Illnesses: A Guide to Research-Informed Policy and Practice.” CSG Justice Center, 9 Feb. 2020, https://csgjusticecenter.org/publications/law-enforcement-responses-to-people-with-mental-illnesses-a-guide-to-research-informed-policy-and-practice/.

21. Ibid.

22. Ibid.

23. Campbell, Alexis. “Failure on the Front Line: How the Americans with Disabilities Act Should Be Interpreted to Better Protect Persons in Mental Health Crisis from Fatal Police Shootings.” Columbia Human Rights Law Review, 2019, http://hrlr.law.columbia.edu/hrlr/failure-on-the-front-line-how-the-americans-with-disabilities-act-should-be-interpreted-to-better-protect-persons-in-mental-health-crisis-from-fatal-police-shootings/.

24. Fagan, Jeffrey and Campbell, Alexis, Race and Reasonableness in Police Killings (May 7, 2020). Boston University Law Review, Vol. 100, 2020, Columbia Public Law Research Paper No. 14-655, Available at SSRN: https://ssrn.com/abstract=3596274

25. Campbell, Alexis. “Failure on the Front Line: How the Americans with Disabilities Act Should Be Interpreted to Better Protect Persons in Mental Health Crisis from Fatal Police Shootings.” Columbia Human Rights Law Review, 2019, http://hrlr.law.columbia.edu/hrlr/failure-on-the-front-line-how-the-americans-with-disabilities-act-should-be-interpreted-to-better-protect-persons-in-mental-health-crisis-from-fatal-police-shootings/.

26. Ibid. 

27. Ibid.

28. Ibid.

29. Ibid.

30. Hanna, Andrew C. “Municipal Liability and Police Training for Mental Illness: Causes of Action and Feasible Solutions.” Indiana Health Law Review, vol. 14, no. 2, 2017, p. 221., https://doi.org/10.18060/3911.0039.

31. Ibid.

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