Black Lives Matter has been leading the charge in calling for defunding the police. While that may initially sound like a very bad idea, taking money away from the police is only half of the picture. The money that would be spent on police is instead shifted to community programs and supports to handle the underlying issues more effectively. Besides the impact on systemic racism, defunding the police could make a big difference in the way communities respond to people with mental illness.
What is defunding the police?
Before we consider the mental illness angle, let’s take a quick look at what defunding the police might look like. The American Civil Liberties Union offers a three-part formula for their vision of defunding the police:
1) Prohibiting police from enforcing a range of non-serious offenses, including issuing fines, and making arrests for non-dangerous behaviors, eliminating many of the unnecessary interactions between the police and community members that have led to so much violence and so many deaths;
2) Reinvesting savings from the current policing budgets into alternatives to policing that will keep local communities safe and help them thrive;
3) Implementing common-sense, iron-clad legal constraints, and other protections on the rare instances in which police officers do interact with community members.
The police and mental illness
How does this relate to mental illness? In many places, the police are the de facto emergency mental health service. Some forces use a crisis intervention team model with extra mental health training, but they’re still not mental health professionals. The police use the term “emotionally disturbed person” or EDP to refer to people with mental illness. They’re in no way qualified to determine if someone has a mental illness, so EDP is their catchall term.
When a community member is concerned about someone’s wellbeing, the police may do a so-called “wellness check”. Imagine being at home, not well, and perhaps paranoid, and having uniformed cop(s) showing up unannounced at your door. That doesn’t exactly create a supportive atmosphere. Recently, a Canadian Indigenous woman was killed by a police officer who went to do a “wellness check” on her. There’s still a lot that’s not clear about that particular case, but regardless, police and wellness check seems like a less than ideal combination.
The U.S. Department of Justice Office of Community Oriented Policing Services published a guide that refers to “the problem of people mental illness”, “understanding your local problem”, and “responding to the problem of people with mental illness.” Granted, this guide was originally published in 2006, and problem-oriented policing is a specific approach, but it still speaks to stigma and police understanding (or lack thereof) of mental illness.
Lost in Translation
I found an interesting report prepared by my local police department in Vancouver, Canada called Lost In Translation. It’s from 2010, so it’s hard to say how much it reflects the current situation, but the report expressed concern with the level of resources police were needing to devote to mental health-related calls. It argued that the healthcare system should be doing more. One particular area of concern was the frequency of calls to track down patients who had gone AWOL from hospital, including people who were certified under the Mental Health Act. Are police the best people to handle that kind of thing?
Of course, there will always be budget wrangling and finger-pointing, but looking at it from a defund the police perspective, wouldn’t it make more sense to have the health care system deal with non-criminal matters rather than the police?
Experiences of people with mental illness
A 2011 report from the Mental Health Commission of Canada looked at the interactions mentally ill people have with the police. They interviewed people with bipolar disorder or a psychotic disorder who had previous contact with the police. Some of the findings were:
- 77% had been handcuffed or otherwise physically restrained
- 28% reported being pushed/shoved by an officer, and 17% reported being punched or kicked
- 32% reported police had pointed a weapon at them, while 8% had a weapon used against them
The literature review conducted in preparing the same report found that:
- 40% of people with mental illness have been arrested at some point in their life
- 30% have had police involved in their mental health care at some point
- 5% of police encounters involve people with mental health issues
- 40% of police encounters involving a mentally ill person are not related to any criminal activity
A couple of years ago, the mental health and addictions transitional program where I work was sending a patient to hospital because she was suicidal. The paramedics didn’t feel comfortable transporting her, as they wouldn’t be able to stop her if she bolted. So the police were involved, and I learned that their standard practice is to handcuff people they’re taking to hospital involuntarily. My jaw dropped. Luckily they didn’t handcuff her, or I would’ve gone full-on batshit crazy on them. Being suicidal is not a crime. Going to hospital shouldn’t require police.
The police frequently deal with addiction-related behaviours. While organized gangs handling the supply chain are clearly a police issue, individual users shouldn’t have to be. Making treatment more readily available would probably be a more effective approach than treating individual addicts like criminals. Taking the police out of the picture may also save lives in the opioid epidemic, as people wouldn’t have to worry about getting charged with possession if they call 911 to report a friend’s OD.
In California, drug possession is a felony offense. Under their three strikes and you’re out law, someone could have been sent to prison for life for three drug possession charges, before a 2012 legislative change requiring the third strike to be a violent offense. Imagine all the money that could be poured into rehab rather than having the police and prisons handling addictions through the war on drugs approach.
Would this require Medicare for all?
This isn’t an issue for countries like Canada that have public health care. I don’t know enough about the logistics of the U.S. healthcare
mess system to know what it could look like to shift resources from the police to the healthcare system. Removing the police as the first line of response in the community would require a more assertive model of delivering mental health care, and how would that work if you didn’t have the kind of insurance that they happen to accept?
In countries like Canada, it seems like less of a logistical disaster to shift some of the police role over to the healthcare system. This is just speculation, but to take over a broad spectrum of the mental illness-related encounters that police have, there would probably need to be a role with some type of constabulary powers within the health care system for the purpose of applying legislation pertaining to mental health. That might require creativity, but it’s not rocket science. At the very least, partnerships between police and health services would be an improvement over the current state of affairs.
Police/mental health partnerships
The police force in the city where I live has partnered with the local health authority to operate “car 87/88”. This involves an unmarked police car, a plainclothes police officer, and a mental health nurse. They attend mental health emergency situations, and they also track down people who’ve been certified under the Mental Health Act in the community but couldn’t be taken to hospital.
If they’re attending a call and someone needs to be taken to hospital involuntarily, the police officer may do a Mental Health Act apprehension. Alternately, the on-call psychiatrist will be called to assess the person for certification under Mental Health Act. An ambulance then transports the person to hospital. The car 87/88 police officer can accompany as needed and the nurse can follow behind in the police car.
This is a good system, but the biggest problem I see is that there’s only one car per shift for a large urban centre. It seems much more civilized to have a more subtle police presence (unmarked car, no uniform), a highly experienced mental health nurse, and transportation in an ambulance (what with mental illness being a medical issue).
Moving away from a police response
I’m by no means suggesting doing away with the police or defunding them entirely. As long as there is crime, then there will be a role for police. I’m suggesting that mental health intervention is a health care function; it’s not a police function unless there are specific characteristics that make it a police function, like the presence of aggression or weapons.
Regardless of the details of what it would look like, I’m pretty sure that shifting non-criminal encounters with mentally ill people from the police to the health care system would be a good thing. Mental illness isn’t a crime, nor should it be treated like one.