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10/21/2015

Police and Persons with Mental Illness: The Overlooked Frontline Care Providers

My original plan for this blog was to consider whether or not there remained a need for the old “Drunk Tank” way of managing persons who are acutely intoxicated by allowing them to sleep off or wait out their inebriation at the police station before determining whether or not further mental health care was needed, rather than bringing individuals to hospital emergency rooms for supervised sleep and conversation about detox services or psychiatric evaluation. Though the task of caring for acutely intoxicated persons, sometimes folks who are frequently seen in ERs repeatedly, can seem to be an inappropriate use of resources by clinicians we must appreciate that the motivation is often about safety, protection, and the welfare of the patient as well as the public. In the social context of fear and mistrust toward law enforcement following the many egregious cases of police brutality, my focus is a reminder of the ways in which police can, and often do, intervene with persons who have mental illness and addiction in order to protect these vulnerable mentally ill individuals. In no way do I condone the misconduct and violence we have come to hear about too often, but rather will focus on the important ways police can and very often do work with mental health professionals to assist persons in acute crises.

In recent years, police and mental health professionals have begun partnerships in order to provide effective interventions when responding to calls where there is a behavioral health concern. The term ‘Streetcorner Psychiatrist’ has been applied to police who must evaluate the type and nature of a citizen’s debility in order to provide the most appropriate intervention, but have historically had little to no formal training in mental health evaluation. Arresting such a person may seem necessary if behavior is out of control, aggressive, or threatening, but it can be difficult to discern whether or not the individual’s actions are a result of psychiatric symptoms or criminal intent. By partnering with clinically oriented mental healthcare professionals, most notably mobile mental health care teams, there can be a productive collaboration which facilitates improved outcomes for the ill individual. If it is determined that transport for acute care is needed, police have the authority to do so, and if not there are clinicians on hand to help with safety planning and even facilitate follow up care. The only dilemma seems to be assuring that such services will receive adequate and sustained funding. When we consider that for some persons, a trip to the hospital may be avoided, the resources savings may make this model a fiscally responsible model. As a matter of beneficence, the benefits seem to unquestionably outweigh the risks and burdens. The sources for this blog are notably older, and perhaps revisiting this discussion can serve as a reminder that law enforcement professionals have been working with persons with behavioral health problems for a long, long time and we ought to recognize and support this important function.

Green TM. Police as Frontline Mental Health Workers: The Decision to Arrest or Refer to Mental Health Agencies. International Journal of Law and Psychiatry; 1997 20(4), 469-486
Tepplin LA, Pruett NS. Police as Streetcorner Psychiatrist: Managing the Mentally Ill. International Journal of Law and Psychiatry; 1992  15(2), 139-156.

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