Historically, it was common for people with mental illness to be incarcerated. Many would agree that we are repeating history, with one major difference: people with mental illnesses were not shot by the police like they are today. In this way, people with mental illness, particularly those with severe mental illnesses, may be experiencing circumstances worse than at any time in modern history.
A woefully inadequate mental care system has led to an increasing number of police responding to psychiatric crisis calls. Police as crisis responders have been the dominant model for 30 years — and the results have been deadly.
People with untreated mental illnesses are 16 times more likely to be killed during a police encounter when compared to civilians who are not mentally ill who are approached or stopped by law enforcement. Approximately 25% and perhaps up to 50% of all fatal police shootings involve people with untreated severe mental illnesses. And this is despite the fact that they are less likely to have a projectile weapon or to have attacked police officers.
Despite the calls for police reform, data suggest that the number of people with mental illnesses being shot has not decreased. As noted by researchers, there is a paucity of information regarding the circumstances of these fatal shootings. There is a great need to understand the nature of interactions between police and people with mental illness.
Another tragic element of our modern-day mental health system is lack of access. We see the harmful outcomes of this in cases where a person with mental illness needs treatment but is denied access and subsequently harms, kills, or is killed by police. For example, Heidi Pendleton testified that she repeatedly tried to get help for her adult son, who had a severe form of schizophrenia, before he killed Pastor Allen Henderson outside an Iowa church. He had not been taking his medication, even though it was court-ordered. She reached out to numerous mental health providers, but they would not talk to her because of HIPAA privacy laws. A first-degree conviction in Iowa means her son will serve the rest of his life in prison.
In another recent case, a mother warned the police that her homeless son with schizophrenia was threatening to commit mass murder. She informed them that he had a gun and that “he has never actually never been violent. I really don’t want the police to kill him, but I don’t want him to kill anyone else either.” Soon thereafter, he was shot and killed by the police after firing two gunshots and refusing to surrender.
Also consider the case of Jared Loughner, who shot former Arizona congresswoman Gabrielle Giffords and 12 others. Loughner, diagnosed with schizophrenia, was not forced to take his medication despite being court-ordered to do so. He subsequently underwent mental health treatment in prison and his condition improved. Had he undergone treatment sooner rather than later, the shooting might have been prevented. Forced treatment might have saved lives.
In response to the Loughner shooting, officials created one of the most successful diversion programs in the country. The Tuscan Police Department spearheaded several programs geared towards protecting people with mental illness and ensuring their access to treatment. One noteworthy outcome is the significant decrease in SWAT calls for suicidal barricade situations, which are both costly and dangerous. More departments should proactively adopt this comprehensive approach.
The recently passed American Rescue Plan Act of 2021 appropriated Medicaid funding for states to provide community-based mobile crisis services to individuals experiencing mental health or substance abuse disorders. The provision, introduced by Sen. Ron Wyden (D-Ore.), seeks to expand the Crisis Assistance Helping Out on the Streets (CAHOOTS) model across the country. CAHOOTS provides crisis intervention in parts of Oregon and has been doing so for 30 years. The program utilizes medics and crisis workers instead of police for non-violent and non-crime related emergency mental health calls. CAHOOTS works primarily because they “have a network of other resources in our community to rely on.” Without this network of resources, it is not clear whether the program could work elsewhere.
Mental health services in the U.S. are insufficient, which is why so many mentally ill people encounter the police to begin with. Without greater access to treatment resources, this problem will remain difficult to solve.