The nature and extent of police use of force in encounters with people with behavioral health disorders

Psychology's Contributions to Anti-Blackness in the United States Within Psychological Research, Criminal Justice, and Mental Health

The mass incarceration of Black people in the United States is gaining attention as a public-health crisis with extreme mental-health implications. Although it is well documented that historical efforts to oppress and control Black people in the United States helped shape definitions of mental illness and crime, many psychologists are unaware of the ways the field has contributed to the conception and perpetuation of anti-Blackness and, consequently, the mass incarceration of Black people. In this article, we draw from existing theory and empirical evidence to demonstrate historical and contemporary examples of psychology's oppression of Black people through research and clinical practices and consider how this history directly contradicts the American Psychological Association's ethics code. First, we outline how anti-Blackness informed the history of psychological diagnoses and research. Next, we discuss how contemporary systems of forensic practice and police involvement in mental-health-crisis response maintain historical harm. Specific recommendations highlight strategies for interrupting the criminalization of Blackness and offer example steps psychologists can take to redefine psychology's relationship with justice. We conclude by calling on psychologists to recognize their unique power and responsibility to interrupt the criminalization and pathologizing of Blackness as researchers and mental-health providers.

Police, ambulance and psychiatric co-response versus usual care for mental health and suicide emergency callouts: A quasi-experimental study

OBJECTIVE

Mental health-related calls to emergency services made via 111 (New Zealand) or 000 (Australia) often represent critical junctures for the person in crisis. Traditionally, police, ambulance and mental health services work separately to manage such emergencies. Sequential agency responses may be protracted and cause escalation. This study tests multi-agency co-response aiming for more integrated, faster, safer and less coercive management of mental health crises.

METHODS

Immediate and 1-month outcomes of mental health emergency calls made to police and ambulance were compared according to whether they occurred on days with co-response availability. Outcomes measured included emergency department admission and waiting times, psychiatric admissions, compulsory treatment, use of force, detention in police cells and the time to resolution of the event. Relative risk estimates were constructed.

RESULTS

A total 1273 eligible mental health emergency callouts occurred between March 2020 and March 2021 (38% coded 'mental health' emergencies, 48% suicide risk and 14% as 'other'), 881 on days with co-response availability and 392 on days without. Co-response interventions were resolved faster and were more likely to be community-based. Fewer than one-third (32%) led to emergency department admissions, compared with close to half (45%) on days without co-response (risk ratio: 0.7 [0.6, 0.8]). In the following month, the number of emergency department and mental health admissions reduced (p < 0.01 and 0.05, respectively). There were no statistically significant differences in use of force and few people were detained in police custody.

CONCLUSION

Co-response intervention increased the likelihood of mental health crises being resolved in the community and reduced hospitalisations. Benefits were sustained at 1 month.

Mental Illness and Racial Disparities in Correctional Staff-Involved Violence: An Analysis of Jails in the United States

In this study, we draw on theories of opportunity and focal concerns to examine how mental illness and race correspond to correctional staff-involved violence, particularly within the transient and diverse context of jails. Using a sample of 3,936 people incarcerated in jails from the 2011 to 2012 National Inmate Survey (NIS-3), we analyze how an individual's mental health status (number of mental illness diagnoses) and race relates to the risk of staff-inflicted victimization. Using a series of Firth's logistic regression models, we find that Black and Hispanic individuals are much more likely to be victims of correctional staff assault than their White counterparts. Those with one and two or more mental illness diagnoses are also at greater risk for staff-involved violence, respectively. Supplementary models show that those who suffer from serious mental illness are at particularly high risk for staff victimization. In a subsequent moderation analysis, we find that race does not condition the influence of mental health diagnoses on risk for staff-involved violence. Our findings reinforce the need for more research on correctional staff-involved violence and the implications of this research support calls for enhanced training of correctional staff regarding mental illness and racial bias.

Re-examining mental health crisis intervention: A rapid review comparing outcomes across police, co-responder and non-police models

Police are the default first responders in most mental health crisis intervention models worldwide, resulting in a heavy burden on police, perceived criminalization of individuals with complex mental health needs, and escalation of aggression that resort to violence. Models, such as crisis intervention teams (CIT), and co-response programmes aim to improve service user experiences and outcomes by providing mental health training to police, or pairing law enforcement officers with mental health clinicians, respectively. Despite these efforts, mental health-related calls continue to result in negative outcomes, and activists and policymakers are advocating for non-police models of crisis intervention. Evidence-based practice in mental health crisis intervention is urgently needed. The present review's main objective was to examine, synthesise and compare outcomes across police, co-responder and non-police models of mental health crisis intervention internationally using a rapid review framework. A systematic search of four electronic databases of studies published between 2010-2020 and a grey literature search was conducted, yielding (n = 1008) articles. A total of 62 articles were included in the present review. Studies were largely observational, lacking control groups and were of low-moderate quality with a high potential for bias. Overall, there is little evidence to suggest that the CIT model impacts crisis outcomes. Co-responder models evidenced improved outcomes compared to police only models, however, evidence was often mixed. Non-police models varied significantly, and studies tended to be too low quality to make comparisons or draw conclusions, however, research on youth models and crisis resolution home treatment suggested positive outcomes. Findings highlight the need for high-quality studies and policies to facilitate the implementation and evaluation of novel approaches not involving police. Cross-sectorial collaboration and service user input are urgently needed to inform, develop, test and disseminate effective models of crisis intervention acceptable to service users.

Developing Community Co-designed Scenario-Based Training for Police Mental Health Crisis Response: a Relational Policing Approach to De-escalation

Using the current empirical landscape of police responses to people in mental health crisis as a backdrop, this methods paper makes an argument for the central role of collaborative co-design and production by diverse community experts and stakeholders to build transformative specialized training for frontline officers. Subject matter experts (SMEs) from across key domains participated in focus groups and curriculum creation, with outputs being the co-development of a conceptual approach and an innovative experiential learning training program. Part 1 unpacks the team's conceptual development of a relational policing approach. This humanized method is shaped by procedural justice, trauma-informed, person-centred, and cultural safety frameworks. Part 2 details the co-production of a novel problem-based training method for a police service in Southern Ontario, Canada. The program centres on the acquisition of core competencies related to relational policing, de-escalation, and mental health crisis response. The training was designed to bring learners through a spectrum of authentic crisis scenarios: from observer-participant scenarios informed by Forum Theatre methods and targeted SME feedback to a range of high-fidelity assessment simulations that test officers' abilities to effectively communicate, de-escalate, and make decisions under stress. This program offers repeated opportunities for officers to practice alternative crisis management strategies in scenarios that might otherwise result in the use of force.

Subjective experiences of the first response to mental health crises in the community: a qualitative systematic review

OBJECTIVE

To review and synthesise qualitative studies that have explored subjective experiences of people with lived experience of mental health-related illness/crisis (MHC), their families and first responders.

DESIGN

A systematic review of qualitative evidence was conducted. English-language articles exploring the content of interactions and participants' experiences were included.

DATA SOURCES

MEDLINE, PsycINFO, EMBASE, CINAHL; Google Scholar, SAGE journals, Science Direct and PubMed.

DATA EXTRACTION AND SYNTHESIS

Two reviewers read and systematically extracted data from the included papers. Papers were appraised for methodological rigour using the Critical Appraisal Skills Programme Qualitative Checklist. Data were thematically analysed.

RESULTS

We identified 3483 unique records, 404 full-texts were assessed against the inclusion criteria and 79 studies were included in the qualitative synthesis. First responders (FRs) identified in studies were police and ambulance staff. Main factors influencing response are persistent stigmatised attitudes among FRs, arbitrary training and the triadic interactions between FRs, people with mental illness and third parties present at the crisis. In addition, FR personal experience of mental illness and focused training can help create a more empathetic response, however lack of resources in mental health services continues to be a barrier where 'frequent attenders' are repeatedly let down by mental health services.

CONCLUSION

Lack of resources in mental healthcare and rise in mental illness suggest that FR response to MHC is inevitable. Inconsistent training, complexity of procedures and persistent stigmatisation make this a very challenging task. Improving communication with family carers and colleagues could make a difference. Broader issues of legitimacy and procedural barriers should be considered in order to reduce criminalisation and ensure an empathetic response.

Police use of force standards and mental health crises in the United States: Identifying research and policymaking targets

An area of psychology-law research and policy that requires increased attention is the use of force during encounters with someone in mental health crisis. Cases in which law enforcement officer (LEO) intervention during a mental health crisis leads to injury or death of the person in crisis underscore the need to understand what behaviors and circumstances are relevant in excessive force litigation, what concepts may benefit from empirical research, and what facets of policies and precedent may require modification. In particular, the current national and international attention to the United States' external mechanisms of control over police conduct (i.e., criminal and civil proceedings against officers) suggests that excessive force jurisprudence is ripe for examination of its utility and fairness in shaping how police should interact with people with mental illness. Excessive force jurisprudence contains complex legal standards with which many psychology-law practitioners, researchers, and even policymakers are likely unfamiliar, however. The current paper explicates external methods of control over police conduct in the United States by reviewing excessive force jurisprudence and identifying points in need of research and policy attention.

Using the police cell as intervention in mental health crises: Qualitative approach to an interdisciplinary practice and its possible consequences

PURPOSE

The aim of this study was to analyze the views of patients, police-officers and emergency mental health workers on the use of the police cell as intervention in a mental health crisis.

DESIGN AND METHODS

We analyzed interviews with individuals involved in police cell interventions, found first labels and categorized them in concordance with the four principles of biomedical ethics and compared them to relevant scientific literature.

FINDINGS AND PRACTICAL IMPLICATIONS

Professionals should know that emergency mental healthcare aimed at controlling the situation is not enough to provide good care. It probably generates better outcomes for patients in the short and long term when patient experiences are taken into consideration.

Taser use on individuals experiencing mental distress: An integrative literature review

WHAT IS KNOWN ABOUT THE SUBJECT?: People experiencing mental distress have a high rate of contact with police in community crisis events. Police use a continuum of responses when managing situations involving agitation, aggression and behavioural problems. People experiencing mental distress have been subjected to Tasers as part of the police response. Following a number of deaths and numerous reports of injuries, concerns have been raised about the safety of Tasers. WHAT THIS PAPER ADDS?: Police use of Tasers in mental health crises is relatively common. Tasers are used in a range of settings including public places, private residences and healthcare facilities. People experiencing mental distress may be subjected to more use of Tasers than the general population. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health professionals need to work with police towards greater understanding of the needs of people experiencing mental distress and to promote the use of non-coercive interventions in mental health crisis events. Mental health researchers need to explore the qualitative experiences of people who are Tasered, to provide an evidence base for Taser use with people experiencing mental distress. ABSTRACT: Introduction Conducted electrical weapons, or "Tasers," are currently used by over 15,000 law enforcement and military agencies worldwide. There are concerns regarding the effectiveness, potential for harm and overuse with people experiencing mental distress. Aim To explore the literature about police use of Tasers with people experiencing mental distress. Method An integrative review was undertaken, and qualitative and quantitative analytical approaches were used. Results Thirty-one studies were included. Of all recorded usage, overall prevalence of Taser use on people experiencing mental distress was 28%. This population appears to experience higher Taser usage than the general population. Discussion There are substantial gaps in the research literature particularly with respect to the decision-making processes involved in deploying Tasers on this population and the physical and psychological consequences of Taser use in this context. Implications for practice Police use of Tasers in mental health crises is relatively common and occurs in a variety of environments including mental health settings. Mental health professionals need to work with police towards greater understanding of the needs of people with mental illness and to promote the use of non-coercive interventions in mental health crisis events.

The nature of police shootings in New Zealand: A comparison of mental health and non-mental health events

The use of firearms by police in mental health-related events has not been previously researched in New Zealand. This study analysed reports of investigations carried out by the Independent Police Conduct Authority between 1995 and 2019. We extracted data relating to mental health state, demographics, setting, police response, outcome of shooting, and whether the individual was known to police, mental health services, and with a history of mental distress or drug use. Of the 258 reports analysed, 47 (18%) involved mental health-related events compared to 211 (82%) classified as non-mental health events. Nineteen (40.4%) of the 47 mental health events resulted in shootings, compared to 31 (14.8%) of the 211 non-mental health events. Of the 50 cases that involved shootings 38% (n = 19) were identified as mental health events compared to 62% (n = 31) non-mental health events. Over half of the mental health events (n = 11, 57.9%) resulted in fatalities, compared to 35.5% (n = 11) of the non-mental health events. Cases predominantly involved young males. We could not ascertain the ethnicity of individuals from the IPCA reports. Across all shooting events, a high proportion of individuals possessed a weapon, predominantly either a firearm or a knife, and just under half were known to police and had known substance use. Of the 19 mental health events, 47.4% (n = 9) of individuals were known to mental health services and in 89.5% (n = 17) of cases whānau (family) were aware of the individual's current (at the time of the event) mental health distress and/or history. These findings suggest opportunities to prevent the escalation of events to the point where they involve shootings. Lack of ethnicity data limits the accountability of the IPCA and is an impediment to informed discussion of police response to people of different ethnicities, and Māori in particular, in New Zealand.

Caught in the currents: evaluating the evidence for common downstream police response interventions in calls involving persons with mental illness

The origins of this report, and of the Mental Health and Policing Working Group, can be traced to the unique situation Canadians have faced as a result of the COVID-19 pandemic. The unique circumstances of this global outbreak, which have for many Canadians resulted in serious illness and death, intensified economic uncertainties, altered family and lifestyle dynamics, and generated or exacerbated feelings of loneliness and social dislocation, rightly led the Royal Society of Canada’s COVID-19 Taskforce to consider the strains and other negative impacts on individual, group, and community mental health. With the central role that police too often play in the lives of individuals in mental and (or) emotional crisis, we were tasked with exploring what can be reasonably said about the state of our current knowledge of police responses to persons with mental illness.

[A Police Perspective on the Interaction with Individuals with Mental Disorders]

OBJECTIVE

Police officers often come in contact with individuals suffering from behavior disturbances. The present study examined the subjective experience of these interactions from a police perspective to detect further needs in police trainings to make these interactions safer.

METHODS

N = 958 police officers filled out a questionnaire regarding their subjective experience. The questionnaire assessed the frequency of contact with individuals with behavior disturbances, specific challenges in regard to the interaction and associated subjective anxiety or stress as well as knowledge about behavior disturbances.

RESULTS

Police staff experience individuals suffering from behavior disturbances often as unpredictable, verbally and physically aggressive. 27.9 % report anxiety in these interactions and 76 % report a lack of specific knowledge.

CONCLUSION

Police training programs should focus on increasing mental health literacy, specific communication skills and anti-stigma interventions.

Psychological and sociological factors influencing police officers' decisions to use force: A systematic literature review

AIM

Police action is frequently discussed and almost always monitored. The aim of this systematic review is to identify the psychological and social factors underlying police officers' decisions to use force.

METHODOLOGY

Scientific articles were selected from six databases (PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, HeinOnline, ScienceDirect, PubMed).

RESULTS

We found 923 articles matching our search, and 52 were retained based on their results regarding the psychological factors underlying police officers' decisions to use force and the decision-making process itself. We found that the most frequently studied factors were belonging to an ethnic minority, carrying a conducted energy device (CED), the police department's policies and managerial organization, and the environment in which the encounter occurred. However, it seems that the most predictive factor in the decision to use force is the resistance and behavior of the suspect.

Police and mental health responses to mental health crisis in the Waikato region of New Zealand

New Zealand police report a high level of involvement with people in mental health crisis, something that has been reported in the international literature in recent decades. Involvement of police represents a coercive pathway to care and is likely to be associated with use of force. The aim of this study was to investigate the clinical, legal, and social characteristics of individuals subject to police response in the Waikato region of New Zealand. Data were also collected on characteristics of police response, including use of force, time of day, and disposition. Use of force, most commonly use of handcuffs, occurred in 78% of cases involving police. The study showed that Māori were overrepresented in police responses, but no more likely than Europeans to experience use of force. Almost half those subject to police response were not subsequently admitted to hospital, raising questions about the need for and nature of police response in these cases. Because mental health nurses are often part of police response, nurses need to take cognisance of their relationship with police and contribute to any initiatives that can reduce coercion in the pathway to care, and improve service users' experience in mental health crises.