Should People in Mental Health Crisis Be Handcuffed?

Mental illness is a health issue, not a criminal one, but the police role in mental health crises can end up blurring that line. In some places, people struggling with their mental health are routinely handcuffed to be taken to hospital by police. How is that appropriate? It seems like a practice that accomplishes little except reinforcing stigma.

I’ve written in other posts about the possibility of defunding the police and shifting mental health crisis response over to the health care system, but this post will focus on the practice of handcuffing.

Getting someone to hospital

When I arrived for my shift the other night at the concurrent disorders (mental health and addictions) transitional program where I work, my colleagues informed me that one of the patients was being sent to hospital, as she was having intense, active suicidal ideation. Shortly after I arrived, paramedics and police showed up, and that’s when things began to go downhill.

The paramedics seemed reluctant to transport her to hospital, which is a whole other story. Regardless, it was generally agreed that, given the severity of her suicidal thinking, it wasn’t appropriate for her to go to hospital on a voluntary basis. A section of the provincial Mental Health Act allows police to take someone to hospital involuntarily if they’re clearly mentally unwell and posing a risk to self or others. The police and paramedics decided that the patient would be taken to hospital in the back of a police car.

Handcuffed

As I was trying to explain to the patient what was happening and why, she was clearly disturbed. She asked fearfully “will I have to go in handcuffs?” My automatic response was “absolutely not”. I was then informed that it’s standard procedure for the police force in that city to handcuff people being transported to hospital under the Mental Health Act.

Jaw. Drop. In the city where I’ve worked for most of my career, police don’t transport mental health patients to hospital; ambulances do. A police officer may ride along in the ambulance followed by their partner in the police car if needed. The only times I’ve seen people handcuffed was when they were extremely agitated. I’ve been apprehended by police under the Mental Health Act on one occasion, and at that time I was taken by ambulance with a police officer accompanying, with no mention of handcuffs. I can’t even imagine how it would have felt to be handcuffed and shoved in the back of a police car.

De-escalation vs. escalation

One of the reasons some areas have specially trained police officers responding to mental health calls (like the Crisis Intervention Team model) is to use de-escalation as much as possible. If someone is mentally ill and acutely agitated, putting them in handcuffs is going to increase that agitation.

Imagine if you were paranoid and someone slapped handcuffs on you; that’s probably going to make that paranoia feel even more real. If a police response is making a paranoid individual more paranoid, they’re making the situation worse, and they’re doing the exact opposite of a therapeutic approach that a mental health professional would take.

Mental illness is not a crime

In a society with so much stigma against mental illness, the system needs to try harder and do more to respect people’s dignity. To treat mentally ill people in crisis like criminals is a huge step backwards. It disgusts me that police would consider it appropriate to routinely handcuff people who are in extreme mental distress. If the poor mentally ill person wasn’t traumatized before, they sure as hell are now.

Had I been that patient who was basically told that it was a special exception and privilege not to be handcuffed, I would never again disclose to care providers when I was having thoughts of suicide. If police and handcuffs are the consequences of disclosing suicidal thinking, how does that motivate anyone to share that kind of information? It’s hard enough to get treatment for those with mental illness; to have that kind of disincentive is the sort of thing that can end up costing people their lives.

When society treats people with mental illness as criminals, we all lose. The Royal Canadian Mounted Police clearly has a lot of work to do. This sort of routine practice is abhorrent and needs to stop.

Response to this post

After creating a pin on Pinterest related to this post, I got a comment in response to the question of whether police should be routinely handcuffing people in mental health crisis. The commenter wrote:

Yes. It’s for their safety as much as the officer’s. The officer has the right to go home to their family and be as safe as possible.

Beyond my initial WTF reaction, there were a few layers to unpack in that comment.

That’s stigma

First off, there the across-the-board “yes”. Not “yes if…” or “yes, but only…”; just “yes”, full stop. The police attend a lot of mental health-related calls, and that would be a whole lot of handcuffing. That unqualified yes suggests that this should be a routine practice because crazy people are routinely scary-crazy.

Next we move on to “it’s for their safety as much as the officer’s.” It’s rather patronizing to suggest that impositions on basic freedoms are for the scary-crazy person’s own good. If we look through a trauma-informed lens, handcuffing is likely to create harm. But stigma doesn’t see that; stigma sees “us” and scary-crazy “them”, and there’s a massive border wall in between preventing any empathy from dribbling through.

“The officer has the right to go home to their family.” How would a mentally ill person get in the way of this? By killing or maiming them? If anyone’s going to be dying in a cop vs. scary-crazy person encounter, what do you think are the chances it’s going to be the scary-crazy person who ma be wanting to die? Isn’t that what we scary-crazy folks do?

“The officer has the right to… be as safe as possible.” How about the right of the mentally ill person to be as safe as possible? Being handcuffed without having committed a crime doesn’t sound all that safe to me. And it doesn’t seem like that much a leap to extend that to justifying police brutality by saying the police had a right to feel safe, so why not harm/kill anyone who’s scary for any reason, including the colour of their skin?

How to respond?

My approach online has generally been to not engage with people who appear to be ignorant by choice. This comment, though, didn’t strike me as intentional ignorance. I wouldn’t be surprised if she has a partner in law enforcement whom she worries about.

My response:

Any other medical condition you’d like to see people handcuffed for? Heart attacks, perhaps? Or is it just mental illness? In that case, there’s a name for that: stigma.

I can’t think of any other type of health condition where people are liable to be handcuffed without having committed a crime or been violent. But when stigma’s in the picture, mental illness crisis looks less like a medical emergency and more like a behavioural problem.

The original commenter didn’t reply to my comment, which is fine. I do hope, though, that it made her think critically, even just for a minute, about her point of view.

The bigger picture

The dangerousness stereotype associated with mental illness is quite deeply ingrained in our society. This person’s comment clearly buys into that stereotype. Yet most people who hold this belief don’t recognize what it is; they see it as fact rather than stigma.

That’s what’s so insidious about stigma. For people who don’t know better, those stereotypes seem reasonable. It then becomes easy to rationalize acting on the assumption that they’re valid.

And as with any other kind of social privilege, people with good mental health can’t see the problem when they look through their lens. To really see stigma, you need to look through our lens, the crazy-scary person lens.

That’s why we need to keep talking, keep telling our stories, and call out stigma when it feels safe and productive to do so. Then instead of seeing stereotypes, more people might actually see us.