What Works and What Doesn't When Policing People with Mental Health Issues.

• Author: Flores, Jerry

OVER THE LAST FEW YEARS, POLICE ENCOUNTERS WITH PEOPLE WHO have mental health issues have increased and become a topic of conversation for academics and the public alike (Watson & Fulambarker 2012). A large portion of this population (especially those living on the streets) regularly come in contact with police and are often caught in a cycle of police contact, incarceration, and temporary stays in poorly funded hospitals until they end up back on the streets. This is exacerbated by the lack of training and resources police can access to address the unique needs of this population (Coleman & Cotton 2010). Most of these individuals only commit minor offenses, but with the stigma around mental health issues and the lack of mental health training, police often use excessive force to handle these situations (Watson et al. 2008).

In this article, we demonstrate what works and what does not when officers interact with people who have mental health issues. Building on theoretical work on intersectionality, we also demonstrate how these interactions are influenced by various interconnected identities like race, gender, and ability. Drawing on a video ethnography with a large police force in the United States and other publicly available videos, we respond to the following questions: do interpersonal approaches lead to officers successfully following the use of force guidelines when people they come into contact with have mental health issues? Second, what approaches do not work in these interactions? Lastly, how are these interactions influenced by multiple interlocking identities? In the following sections, we provide a brief overview of research related to policing and mental health. We also touch on theoretical work on intersectionality when analyzing our findings.

We follow this with a discussion of our methodological approach. This is followed by our findings section and a brief conclusion.

Police and Mental Illness

Police officers are required to protect the safety and welfare of the public as well as to protect so-called disabled citizens, a category that includes people with mental health issues (Teplin & Pruett 1992). Since the large scale deinstitutionalization of psychiatric facilities, police officers have become what Teplin and Pruett (1992) term street-corner psychiatrists. Police officers are often a community's first responders to mental health distress calls (Lane 2019, Rogers 1990), and they must use their discretion based on limited technical knowledge with respect to psychiatry (Teplin & Pruett 1992). Even though social care is not highly valued in police training and culture, officers experience scrutiny for not responding appropriately (Lane 2019). Not only do they have to recognize if the individual is mentally ill, but they also have to decide whether to initiate formal interventions and determine what would best meet the safety of the public and everyone involved (Rogers 1990, Wood et al. 2017). Additionally, mental illness often goes hand in hand with other vulnerable states such as homelessness and drug or alcohol addiction (Rogers 1990, Wood et al. 2017), thus blurring the fines between interventions police officers should use. Despite these responsibilities, current research demonstrates that police officers are not trained to handle mental health crises but are charged with handling the brunt of mental health related calls (Compton et al. 2011).

Police officers often have complex perceptions of people with mental health issues. According to current research, most mental health calls are often nonviolent and nonthreatening (Teplin & Pruett 1992, Wood et al. 2017). Officers nevertheless often view mental health related encounters as time consuming and undesirable (Watson & Fulambarker 2012). Research done with police in Australia found that officers often viewed individuals with mental health issues as potentially dangerous (Martin & Thomas 2015). Similarly, Heslin et al.'s (2017) research in the United Kingdom suggested that officers perceive individuals with mental health issues as confounding, frustrating, and largely time-consuming. Given this, police encounters with this population disproportionately end with the use of force, verbal abuse, and general disrespect (Lancaster 2016). Officers ultimately feel an inability to provide this population with proper resources (Lancaster 2016, Watson et al. 2008). Unfortunately, there is evidence that people with mental health issues might also be increasingly agitated by law enforcement due to their previous mistreatment by criminal justice agents (Watson et al. 2008).

Issues related to mental health and policing can also be exacerbated by issues related to race. Nelson (2011) argues that people of color with mental illness usually experience higher rates of excessive force at the hands of police compared to people with no visible or perceived mental health issues. Nelson (2016) calls this felonization, a term used to describe how race and disability are morphed to create an idea of the perfect criminal. This double vulnerability is perceived as requiring force and punishment to handle situations involving people of color with mental health issues (Nelson 2016). Behaviors are assessed depending on the race of individuals, which often leads to misdiagnosis and disciplinary punishment (Nelson 2016). This is exacerbated by the long history of police violence against people of color (Rios 2011). Race plays a role in policing outcomes and encounters and makes certain individuals more vulnerable to misdiagnosis and disciplinary punishment.

Theoretical Framework

An intersectional framework provides "an account for the multiple grounds of identity when considering how the social world is constructed" (Crenshaw 1991,124). Importantly, intersectionality scholars do not universalize experiences as representative of any one identity category; instead, they outline a forceful set of interlocking cultural and social forces that shape a group of experiences without conflating or homogenizing them (Crenshaw 1991) or dispensing of the individual dimension (Brewer 1992). Interlocking structural arrangements are salient within the criminal justice system and often operate to keep men and women of color in subordinated and marginalized positions (Alexander 2010, Ocen 2013). Several significant works have recently illustrated the ways that systems of surveillance and social control are racialized, gendered, and heteronormative. In his influential work, Victor Rios (2011) discusses the often criminalized lives of Black and Latino male youth in Oakland, California. Rios's work highlights how masculinity instilled in young men reproduces a hypermasculine outcome in order to earn respect from community peers who often deny them such dignity. The young adults were often hypercriminalized by what Rios calls the Youth Control Complex, an interlocking web of social institutions (the police, the schools, the community, for example) that systematically treats everyday marginalized youth behavior as deviant.

Brewer and Heitzeg (2008,641) argue that in order to understand systemic oppression within the criminal justice system and the prison industrial complex, scholars must take on an intersectional analysis that incorporates "Black and third world people, working-class people, older people, women, gay/lesbians, and physically challenged people. "An intersectional framework provides "an account for the multiple grounds of identity when considering how the social world is constructed" (Collins 1993,1245). Importantly, intersectionality scholars do not universalize experiences as representative of any one identity category; instead, intersectionality scholars outline a forceful set of interlocking cultural and social forces that shape a group of experiences without conflating or homogenizing them (Crenshaw 1991) and also without dispensing of the individual dimension (Collins 1993).

As a whole, intersectional analysis and its nuanced understanding of power brought out a set of distinct but not homogenous experiences that required a deeper contextualization of individual experiences relative to multiple structures and institutions of social control. Taken together, this theoretical framework fits our discussion of police and citizen interaction, as it helps show that people of color often experience mistreatment at the hands of criminal justice agents like police (Rios 2011). The contemporary and historical racialized and gendered mistreatment of men and women of color is exacerbated when we think about how these identities intersect with issues of ability and disability (Erevelles & Mi near 2019, Moodley & Graham 2015).

Methods

In this article, we used a unique two-pronged methodological approach. The first component included a video ethnography research project with one large police agency on the US West Coast. During this project, multiple researchers shadowed various police officers as they went about their daily jobs. The observations happened in blocks of 2 to 10 hours. We shadowed officers in every district and in every part of the city. We rode in their cars and responded to most calls they received. Additionally, we interviewed them during down time and collected handwritten fieldnotes. As a whole, this project investigated routine interactions between police officers and everyday people. The larger goal was to find a set of interpersonal approaches that would help officers deescalate potentially volatile situations without using lethal force. During this multiyear investigation, we studied hundreds of routine interactions with police and citizens. Approximately 24 of the interactions included someone who was identified by another person, themselves, or the police as having mental health issues or as being psychologically unstable. After reviewing these 24 cases we included eight interactions with people who had visible mental health issues that officers...