Lack of Services

The (often unrecognized) commonality of mental illness:

Statistics show that approximately 61.5 million Americans – 1 in every 4 adults – has a mental illness.1 Later records from a survey by the National Institute of Mental Health in 2018 indicated that around 47.6 million adults – nearly 1 in 5 – in the United States had a mental illness within the past year.2

A person experiencing a Serious Mental Illness, or SMI, is facing severe impairment as a result of a mental illness that “substantially interfere[s] with or limit[s] one or more major life activities.3 As of 2014, 1 in every 25 adults in the United States had an SMI,4 and later data shows that this figure hasn’t changed, as roughly 11.4 million adults – approximately 1 in 25 adults – had an SMI in 2018.5

The lack of services provided to those with mental illness:

Of the 47.6 million persons experiencing mental illness in 2018, less than half – 20.6 million, or 43.3% - received mental health services.6

Data reveals that although some individuals do decide not to seek out mental health services (a problem in itself), almost a quarter (22.3%) of adults experiencing mental illness reported that they were “unable to receive the mental health treatments that they needed.”7

The disproportionate encounters of persons with mental health conditions and the criminal justice system:

A 2015 study by Subramanian et al. revealed that “jails house seriously mentally ill men and women at rates 4-6 times higher than [the rate they exist in] the general population.”8 Specifically, among the general U.S. population, about 3.2% of men and 4.9% of woman have a Serious Mental Illness (SMI); among those in jail in the U.S., about 14.5% of men and 31% of woman have a SMI.9 This demonstrates the disproportional prevalence of those with mental illness in jail, suggesting that those with SMIs may be disproportionately subject to incarceration. These findings by Subramanian et al. are paralleled by those by Brian Cole, the Shawnee County Corrections Director, who noted that those with serious mental illness “comprise 18% to 20% of the jail population.”10

The U.S. Department of Justice estimated that 20% of state prisoners and occupants of local jails had “a recent history of a mental health condition,” that more than half of all prisoners have a mental health problem, and that over 70% of juveniles in justice systems have at least one mental health condition.11

Trends in criminal justice and mental health policy, such as “higher arrest rates for drug offenses and underfunded community-based treatment,” may contribute to the increasing contact between those with mental illness and law enforcement.12

The contribution of the deinstitutionalization movement to the increasing lack of mental health services, and thus the increasing contact between persons with mental health conditions and the criminal justice system:

What is deinstitutionalization?

In the 1960s, there was an effort to “deinstitutionalize” nonviolent mentally ill patients, meaning they would be moved from receiving treatment in an institution (such as in a hospital) to receiving treatment from community service agencies.
Thus, hospitals were closed and the money saved by shutting down these institutions was to be transferred to outpatient community programs.
However, “the money intended for outpatient services never found its way to the community,” and today, funding for outpatient treatment services and programs remains lacking.13

Deinstitutionalization and the inefficient execution of the movement left many mentally ill people disenfranchised and without necessary resources.

From 1955 to 1980, the resident population of mental health facilities fell from 559,000 to 154,000. 14
In 1955, there was one bed in a psychiatric ward for every 300 Americans; today there is one for every 3,000. 15
This data is paralleled by another study that found that: “In 1955, there were 339 state psychiatric beds for every 100,000 people in the population. By 2005, this number had dropped to 17 per 100,000.” 16
Since community-based facilities failed to adequately replace psychiatric hospitals, the rate of homelessness in the U.S. began to rise dramatically.17

Deinstitutionalization failed to make community health programs available to replace mental institutions; however, even when these community programs are available, “many individuals either lack coverage within their insurance or lack coverage completely.”18

A study found that nearly a third of individuals with mental illness were either denied coverage by an insurance company or an insurance company deemed such care not medically necessary.19

Since deinstitutionalization caused fewer psychiatric beds to be available in hospitals across the United States, and mentally ill persons are further either unable to secure adequate funding for treatment or are being denied treatment altogether, “police officers are increasingly relied upon…to respond to crisis arising from a mental illness. 20

As many individuals with mental illness were left homeless due to the reduction of resources caused by deinstitutionalization, interactions between those with mental illness and police officers became more common.21
“City and county jails began to see larger populations of individuals experiencing mental illness.”22
One source notes that “the default hospital has become the emergency room,”23 while another describes how deinstitutionalization and inadequate health care “have created a system where jails are the largest mental health centers.”24

Despite the fact that there is a disproportionate number of individuals with mental illness in jail and a disproportionate length of incarceration for these individuals, there is not much evidence indicating that police are directly biased against individuals with mental illness:

An explanation for this disparity could be mercy bookings, which are used when officers arrest individuals with mental illness to “ensure that arrestees would obtain ‘three hots and a cot,’” or meals and a place to sleep. This idea may be supported by the fact that individuals with mental illness are “often poor, homeless, and likely to have co-occurring substance use disorders,”25 thus may be contributing to minor public order offenses and minor crimes. However, in my opinion, although it may seem like these “mercy bookings” are a solution to the lack of resources caused by deinstitutionalization, it is unfair to individuals for jails to act as a replacement for mental health services (since they are not).

With the lack of mental health services leaving law enforcement officers in a position in which they often have to deal with people with mental health illnesses, several challenges are created for officers themselves:

Calls involving persons with mental health conditions often take much more time than any other calls for service, especially since law enforcement often has to directly transport individuals to emergency medical facilities and wait for medical clearance or admission.26 This limits the time during which officers can respond to other calls for service; in my opinion, this is especially dangerous as officers are preoccupied with a role that could be carried out by mental health services while being unable to do the role they are specialized to do.

In 1986, a suburban Colorado Police department reported spending an average of 74 minutes addressing each of the 60 mental health-related calls studied.27
The Lincoln (Nebraska) Police Department found that it spent more time on the 1,500 mental health investigation cases it handled in 2002 than on injury traffic accidents, burglaries, or felony assaults.28
Police officers in Honolulu (Hawaii) spent a significant amount of time resolving incidents involving people believed to have a mental illness: officers spent an average of 145 minutes on incidents in which they had to transport a person to a hospital for emergency evaluation, an average of 64.2 minutes on incidents in which they arrested persons with mental illness, and an average of 23.3 minutes on incidents in which they executed informal dispositions.29
The Los Angeles (California) Police Department reported spending more than 28,000 hours a month on calls involving people with mental illness.30

A survey of 355 U.S. law enforcement agencies by the Treatment Advocacy Center revealed that in 2017, police officers spent 21% of their time responding to or transporting people with mental illness.31

Not only do calls involving persons with mental illness take up a significant amount of officers’ time, but they also often don’t effectively resolve the needs of the persons themselves. Statistics indicate that officers handle a majority of incidents informally by talking to the people with mental illnesses, without taking them into police custody or connecting them to treatment.32

72% of situations involving a person believed to have a mental illness in Honolulu, Hawaii were handled informally by “counseling and releasing” the individual at the scene (in 52% of situations) or with “no action” (20% of situations).33
An observational study conducted in large Midwestern city in 1980 and 1981 found that officers handled more than 70% of incidents involving persons with mental illnesses informally.34

At times, officers take people with mental illness into custody either in the course of an arrest or to provide transportation to a medical facility.35

During the 2 years before implementing a CIT program, police officers of the Akron (Ohio Police Department executed and arrest in 3% of calls involving someone with a mental illness and transported an individual to an emergency psychiatric facility in 26% of the calls.36
In 2000, law enforcement officers in Florida transported more than 40,000 people with mental illness for involuntary 72-hour psychiatric examinations under the Baker Act. This exceeded the number of arrests in the state during the same period for either aggravated assault (39,120) or burglary (26,087).37
Officers in Honolulu (Hawaii) made an arrest in 14.9% of incidents involving individuals believed to have mental illnesses.38

1. 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.

2. 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/.

3. Ibid.

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. Ibid.

7. Ibid.

8. Kerle, Ken. “The Mentally Ill and Crisis Intervention Teams.” The Prison Journal, vol. 96, no. 1, 2015, pp. 153–161., https://doi.org/10.1177/0032885515605497.

9. “The Human Toll of Jail Fact Sheet.” Vera, https://craft2.vera.org/publications/human-toll-of-jail-fact-sheet.

10. Kerle, Ken. “The Mentally Ill and Crisis Intervention Teams.” The Prison Journal, vol. 96, no. 1, 2015, pp. 153–161., https://doi.org/10.1177/0032885515605497.

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

14. 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.

15. Ibid.

16. 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/.

17. 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/.

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. Ibid.

20. Ibid.

21. 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/.

22. Ibid.

23. 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.

24. Ibid.

25. Ibid.

26. 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/.

27. Ibid.

28. Ibid.

29. Ibid.

30. Ibid.

31. 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.

32. 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/.

33. Ibid.

34. Ibid.

35. Ibid.

36. Ibid.

37. Ibid.

38. Ibid.