A Meta-Analysis of Police Response Models for Handling People With Mental Illnesses: Cross-Country Evidence on the Effectiveness

• Author: Bitna Kim,Nathan E. Kruis,Chunghyeon Seo
• Date: 01 June 2021
• Published date: 01 June 2021
• DOI: 10.1177/1057567720979184
• Subject Matter: Articles

Article

A Meta-Analysis of Police

Response Models for Handling

People With Mental Illnesses:

Cross-Country Evidence

on the Effectiveness

Chunghyeon Seo

1

, Bitna Kim

1

, and Nathan E. Kruis

2

Abstract

Recent global statistics on mental health showed that the number of people with mental illnesses has

dramatically increased in many countries. A gatekeeper to the criminal justice system, police have

begun to develop their own police response programs or have adopted renowned models from

other countries for handling people with mental illnesses. Although there is a growing body of

empirical research that has investigated the effectiveness of police response models for handling the

mentally ill (PRMHMI) in various countries, existing systematic reviews or meta-analytic studies have

disproportionately focused on findings from studies testing the effects of the crisis intervention team

in the United States. Thus, it is still not clear whether PRMHMI can be considered as “evidence-

based” models on the international level. To help fill this gap in the literature, the current systematic

review and meta-analysis compared the effectiveness of PRMHMI operating in the United States to

those operating in other countries including the United Kingdom, Australia, Canada, and Liberia.

Results revealed that the effect sizes of PRMHMI were substantially different across countries. This

study’s results demonstrate the importance of a national context for designing, implementing, and

evaluating PRMHMI.

Keywords

police response model, mental illness, meta-analysis, comparative research

The global population of persons suffering from mental illnesses surpassed 1 billion in 2017,

representing about 14%of the earth’s population (Ritchie, 2018). Although estimates vary slightly

from country to country, the number of people suffering from mental illness is growing rapidly in

many countries including Australia, the United States, Canada, and the United Kingdom. For

1

Indiana University of Pennsylvania, PA, USA

2

Penn State Altoona, PA, USA

Corresponding Author:

Bitna Kim, Indiana University of Pennsylvania, Indiana, PA 15705, USA.

Email: bitna.kim@iup.edu

International CriminalJustice Review

2021, Vol. 31(2) 182-202

ª2020 Georgia State University

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DOI: 10.1177/1057567720979184

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instance, in Australia, about 3.9 million persons suffered from a mental illness in 2017 (Australian

Institute of Health and Welfare, 2019). In the United States, the number was much higher, with

approximately 46.6 million adults experiencing a mental illness in 2017 (National Institute of

Mental Health, 2019). Further, recent statistics in Canada showed that about 20%of Canadians

suffer from a mental illness in any given year (Canadian Institute for Health Information, 2019).

Similarly, in the UK, about 25%of citizens experience mental health problems each year (Mental

Health First Aid England, 2019). These numbers suggest that mental illness impacts persons around

the globe.

As the population with mental illnesses continues to grow, police contacts with the mentally ill

have also been on the rise (Frankham, 2019; Herrington & Pope, 2014). This has presented unique

challenges for law enforcement as prior research has shown that the level of tension experienced

by officers is much higher in scenes involving mentally ill individuals compared to other scenes

due to the unexpected and “disturbing” behaviors of mentally ill people (Koskela et al., 2 016). To

effectively handle these situations, police agenciesinmanycountrieshave developed their own

police response programs or adopted renowned models from other countries (Cotton & Coleman,

2010; Herrington & Pope, 2014). Specifically, police departments in the United States have

implemented and begun operating several different police response models including the crisis

intervention team (CIT), the community service officer (CSO), the mobile crisis unit (MCU), and

the systemwide mental assessment response teams; Dempsey et al., 2019; Lurigio et al., 2008).

Canadian law enforcement agencies have also adopted and implemented several different pro-

grams and approaches including the mobile crisis team (MCT), the designated mental health

officer, the comprehensive advanced police response, the CIT, the community development

model, and the sequential response model (Cotton & Coleman, 2006, 2010; Livi ngston, 2008).

However, police departments in Australia have mainly implemented and operate the mental health

intervention team (MHIT) and the police and clinical early response (PACER) models (Furness

et al., 2017; Herrington & Pope, 2014). In the UK, the CIT, the street triage (ST), and the

awareness training for handling situations involving people with mental illnesses have been

utilized in policing (Kane et al., 2017).

Two systematic studies have attempted to synthesize the empirical findings on the effects of one

police response model, the CIT model implemented in the United States (Peterson & Densley, 2018;

Taheri, 2016). The present meta-analysis study aimed to add to the literature on police response

models for handling the mentally ill (PRMHMI) by synthesizing the existing empirical research

testing the effectiveness of various types of PRMHMI operating in the United States and abroad to

investigate and compare the global effects of PRMHMI.

Previous Synthesis Research on PRMHMI

To date, there have been very few synthesis studies pertaining to PRMHMI, and findings across

these studies have been mixed (Peterson & Densley, 2018; Taheri, 2016). Most recently, Peterson

and Densley (2018) conducted a systematic review of the CIT model in the United States. They

synthesized results from 25 empirical studies published between 1988 and 2016. In terms of the

impact of the CIT on disposition, they found that about 48%of the studies included in their sample

evaluated arrest or transporting the mentally ill to emergency departments as a primary outcome

measure. Similarly, 24%of studies focused on “other” arrest-related issues for police encounters

with people suffering from mental illnesses. The remaining studies assessed officers’ feelings of

preparedness, knowledge, desire for social distance, and self-efficacy regarding mental illness and

the mentally ill. They concluded that CIT-trained officers were more likely to transport mentally ill

individuals to mental health facilities than non-CIT-trained officers. However, they suggested that

CIT training had a negative impact on officer use of force, but their conclusion was drawn from the

Seo et al. 183