Keeping It REAL: Assisting Individuals After a Police-Abated Mental Health Crisis

Date01 December 2018
Published date01 December 2018
Subject MatterArticles
untitled Article
Police Quarterly
Keeping It REAL:
2018, Vol. 21(4) 486–508
! The Author(s) 2018
Assisting Individuals
Article reuse guidelines:
DOI: 10.1177/1098611118782777
After a Police-Abated
Mental Health Crisis
Luke A. Bonkiewicz1, Kasey Moyer2,
Chad Magdanz2, and John Walsh1
This article evaluates a community-based, peer support program in which police
officers and mental health workers collaboratively address citizens’ mental health
needs following encounters with law enforcement. We analyzed data 12, 24, and
36 months after a police-abated mental health crisis for 775 individuals, some of
whom were referred to this program. Using lagged regression models, we find that
compared with nonreferred individuals, referred participants generated fewer
mental health calls for service and were less likely to be taken into emergency
protective custody 24 and 36 months after a crisis. We found no difference in
arrest rates. The program was especially effective for individuals with lengthier
mental health histories. This free, voluntary, and nonclinical assistance program
appears effective, but it also requires 12 to 24 months before participants and
communities reap the benefits.
police, mental health encounters, peer support
1Lincoln Police Department, NE, USA
2Mental Health Association of Nebraska, Lincoln, NE, USA
Corresponding Author:
Luke A. Bonkiewicz, Lincoln Police Department, 575 S. 10th St, Lincoln, NE 68508, USA.

Bonkiewicz et al.
Historically, mental health calls for service (MHCFS) have been challenging
incidents for law enforcement officers (Teplin, 2000). For one, officers may
have insufficient training, experience, and resources to assist a person with a
mental illness (PMI; Borum, 2000; Borum, Deane, Steadman, & Morrissey,
1998; Finn & Sullivan, 1988; Ruiz & Miller, 2004), although the past two
decades have witnessed a rise in improved police response to mental health
encounters (Compton et al., 2011; Dupont & Cochran, 2000; Steadman,
Deane, Borum, & Morrissey, 2000; Teller, Munetz, Gil, & Ritter, 2006).
A more complicated issue, however, involves officers’ use of “provisional” sol-
utions to resolve mental health encounters (Wood, Watson, & Fulambarker,
2017), due mainly to a lack of long-term mental health resources and options.
These provisional solutions may temporarily resolve a call for service (even in
cases where officers make an arrest or take a PMI into protective custody), but
they do not address a PMI’s long-term needs. Moreover, while law enforcement
has become more proficient at de-escalating and resolving police–PMI encoun-
ters, there has been less attention devoted to developing long-term assistance for
PMIs after these encounters (Deane, Steadman, Borum, Veysey, & Morrissey,
1999; Geller, Fisher, & McDermeit, 1995).
Furthermore, establishing collaborative, peer-based mental health resources
embodies many of the tenets of community policing, in particular, developing
relationships with community partners to proactively address community issues
(Cordner, 2014; Kelling, 1988; Weisel & Eck, 1994). Indeed, research has found
that many agencies view their mental health response as an extension of their
community policing philosophy, believing that police departments should col-
laborate with community partners to develop resources for PMIs (Steadman
et al., 2000).
This article evaluates a community-based, peer support program that
assists PMIs following a police encounter. Called the Respond, Empower,
Advocate, and Listen (REAL) program, this collaborative effort between
police officers and mental health workers helps connect PMIs to mental
health resources and develop long-term mental health plans. Specifically,
after resolving a mental health encounter, a police officer can refer a PMI
to the REAL program. The REAL program then deploys a peer specialist to
contact and offer assistance to the PMI within 24 to 48 hours. In the weeks
and months after the referral, peer specialists update the referring officer
about the PMI’s condition and collaborate to develop additional plans,
if necessary.
To assess the efficacy of the REAL program, we analyzed whether being
referred to the REAL program affected (a) a PMI’s odds of being arrested,
(b) a PMI’s odds of being taken into emergency protective custody (EPC),
and (c) the number of MHCFS generated by a PMI. We analyzed these out-
comes 12, 24, and 36 months after a mental health encounter with police.

Police Quarterly 21(4)
Literature Review
Despite frequent encounters between police and PMIs (Coleman & Cotton,
2010; Cordner, 2006), these calls for service remain among the most challenging
and frustrating incidents for police officers (Cooper, McIearen, & Zapf, 2004).
First, PMIs may be living not only with a mental health condition(s) but also
with many other co-occurring conditions such as homelessness, substance abuse,
a history of physical abuse, unemployment, and other physical maladies (Teplin,
1986, 2000). Hence, even if officers can address and provide resources for PMIs’
mental health issue(s), the number of co-occurring issues may thwart any prog-
ress made toward mental health stabilization.
MHCFS are also challenging because officers may not be trained to contact
and communicate with PMIs, nor how to properly resolve these types of inci-
dents (Dupont & Cochran, 2000; Steadman et al., 2000). Agencies train officers
to investigate and resolve many types of law violations, but resolving a domestic
disturbance or investigating a burglary can be quite different than contacting a
transient with schizophrenia who has committed no law violation.
Historically, officers have had limited options for resolving MHCFS, namely,
informal resolution, arrest and lodge in jail, and protective custody (Lamb,
Weinberger, & DeCuir, 2002). The most common tactic involves simply talking
to PMIs and evaluating their mental health state (Bittner, 1967; Teplin & Pruett,
1992). Officers may converse with and calm a PMI, arrange transportation or
shelter via family or friends, or simply contact the person and depart, generally
due to a lack of options.
On the other hand, if a PMI in crisis is breaking the law, officers may have the
option to arrest and lodge the PMI in jail, thereby satisfying the short-term
needs of the PMI’s neighbors, family, or friends. Abramson (1974) described
the overenforcement of the mentally ill as the criminalization of mentally dis-
ordered behaviors, suggesting that officers resort to arresting PMIs to mollify
residents or even out of lack of alternatives.
Finally, officers also have the option of detaining and transporting PMIs to
mental health facilities if they meet the jurisdiction’s protective custody criteria.
Generally, officers may take PMIs into EPC only if PMIs are mental ill or
substance dependent and pose an imminent danger to themselves or others.
Officers may also invoke protective custody for PMIs who are so mentally ill
that they cannot take care of themselves (e.g., a delusional citizen wandering the
streets naked on a winter night).
In response to concerns about officers’ lack of options for assisting PMIs in
crisis, as well as concerns about appropriate uses of force (Kesic & Thomas, 2014;
Rossler & Terrill, 2017) and overenforcement involving the mentally ill (Perez,
Leifman, & Estrada, 2003), agencies have improved officers’ training through
programs such as Crisis Intervention Training (CIT). CIT first teaches officers
about the nature of mental illness and then trains them to effectively

Bonkiewicz et al.
communicate with and provide aid to PMIs in crisis. Furthermore, CIT trains
departments to partner with local mental health agencies to provide the most
knowledgeable and appropriate response to mental health crises. Studies suggest
that CIT may help PMIs access mental health services (Watson, 2010), reduce
officers’ use of force during MHCFS (Compton et al., 2011), and overall, improve
officers’ perceptions of PMIs (Bahora, Hanafi, Chien, & Compton, 2008).
Despite their popularity and apparent efficacy, programs such as CIT often
overlook a key issue of mental health encounters, specifically, linking PMIs with
long-term mental health and nonmental health services after a crisis. Although
CIT-based programs may enable officers to better identify and de-escalate PMIs
in crisis, PMIs may still struggle to develop long-term mental health plans after
the crisis abates and officers depart. In short, officers understand their actions
are temporary solutions to chronic mental health issues, in particular, because
the possibility of long-term solutions may not even exist.
We speculate there may be several reasons for the shortage of long-term
mental health solutions in a community. First, a department’s officers may
not all be trained in CIT or a similar program. In turn, the department’s culture
may not view PMIs any different from lawbreakers, potentially increasing the
rate of incarceration among persons with a mental illness. Second, an agency’s
jurisdiction may not have sufficient mental health professionals, facilities, and
personnel to meet the needs of residents. Third, an agency may not be actively
collaborating with its local mental health partners to create and maintain
resources for PMIs. However, even if an agency’s mental health training
and policing philosophy intersects with sufficient infrastructure and active col-
laboration, how effective are long-term solutions? To answer this question,

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