It Takes More Than Cops to Handle the Anguished Loose on the Streets

The interaction between law enforcement personnel and the mentally ill has received a great deal of attention in recent weeks. A number of encounters culminating in the use of deadly force have become, rightly, the subject of intense public discussion.

While the problem is very real, it is troubling to see the focus continue to be placed on law enforcement.

Awareness and training can and should be improved. This training has been going on for a number of years. Academy classes teach young officers the theory of dealing with people whose perception of reality is distorted by imagined demons. The Mental Illness & Law Enforcement Seminar has been attended by police officers and mental health professionals for nearly 10 years.

Yet awareness and training do very little to prepare officers for encounters with people exhibiting bizarre behaviors in nonclinical situations. The biggest challenge in dealing with the mentally ill on the street is that the outcomes are predictable only in hindsight.

The mentally ill with whom the police come into contact generally fall into two categories. There are the functionally homeless who spend most of their time living on the street and very often do not have even a rudimentary grasp of how to access social services. Then there are those people who have some family structure, which is to say that they have a place to sleep, but are not helped in any meaningful way beyond the basic survival needs. Often they evoke fear and anxiety in the very people who are trying to care for them.

In both instances, when the mentally ill person begins to act out, the police are seen as the only resource. Our police training correctly emphasizes that 90% of mentally ill people, regardless of their exhibited behavior, are not a threat to the officer. Yet training does not answer the only questions of importance to the officer at the scene: Does this person fall into that other 10%? Is he a threat to the immediate public or me? The anxiety produced by the inability to answer these questions is coupled with a very limited number of options available to the officer: a loud voice and instruments of force. These are neither desirable nor effective.

The most significant causal factor in encounters between police and the mentally ill is patients’ failure to take their prescribed medications. The ability of mental health professionals to ensure that medications are being taken is very limited. Appropriate legislation needs to be passed to create a setting in which qualified professionals can oversee the distribution and ingestion of medication.

A model currently exists for such a system in the form of methadone clinics. Heroin addicts who wish to avoid jail time must take methadone under direct supervision and in a controlled environment. There is no reason that a similar system could not be created to assist mentally ill people in taking the medication that stabilizes their inner anguish.

There is also a critical need to increase the number of mental health outreach workers in Los Angeles County. Law enforcement officers, no matter how well trained, are not mental health professionals. They are not qualified to diagnose the behavior of a person in crisis.

The Los Angeles County Sheriff’s Department has established a very effective program that pairs a deputy sheriff with a mental health worker. This program needs to be expanded to serve all the law enforcement agencies in the county. The availability of such teams throughout the county on a 24-hour per day basis would help provide street officers with adequate resources for dealing with potentially dangerous individuals.

While these programs would greatly assist law enforcement in dealing with the mentally ill, neither is long-term. Society must provide funding for community mental health centers and adequate bed space. In addition, the ability of trained medical personnel to make involuntary commitments for treatment and observation must be enhanced.

I suppose there is something appealing about defining the problem in terms of demanding better training for street officers. It gives the appearance of providing a simple solution to a complex problem. But not only is it intellectually dishonest, it is morally wrong.