A Proactive Approach to Policing and Mental Health

Last year, 46 percent of the 153 unarmed civilians killed by police in the United States suffered from serious mental illness or acute narcotic intoxication or both. For comparison’s sake, consider that in 2009, 17 percent of those arrested on felony charges were female. Still, as a nation, we seem to think of both mental health and drug addiction as issues at the margins of our society.  

My colleagues and I have been tracking contextual statistics about unarmed people killed by police in 2015. (We assembled these in our book In Context: Understanding Police Killings of Unarmed Civilians.) Among our conclusions: of 153 unarmed civilians killed last year, 29 (or 19 percent) had apparent mental illnesses, of which 16 (or 11 percent) had prior diagnoses of serious mental illness.

In a nation of 321 million people — in which there are 750,000 cops serving in nearly 18,000 police agencies who have about 40 million annual interactions with citizens — “16” might sound like a pretty low number. But, digging in further, consider that about 1.4 million people were arrested last year who suffer from both severe mental illness and illicit drug and alcohol use disorders. That’s about 25 percent of the 5.7 million people arrested in the United States in 2015. Meanwhile, 2 million jail bookings in the U.S. last year  involved a person with mental illness, while approximately 15 percent of men and 30 percent of women currently in local jails have serious mental illnesses. 

The intersection of law enforcement and the mentally ill is now gaining particularly close scrutiny — as well it should. The need for a proactive approach to this problem is clear and compelling. But we should be careful not to embrace unconsidered or hasty solutions in the name of ‘doing something.’

The reality is that law enforcement is the first and last option for the treatment of a great number of mentally ill people in this country. No matter the cause of our current predicament — the fact that over the last 50 years both parties have cut federal spending on mental health is surely relevant here — the buck stops at the cops. And until systemic changes are made in how we treat mental illness and addiction-specific behaviors, it would be negligent not to train police officers to deal better with these behaviors.  

The mentally ill get arrested at higher rates than the general population — 4.5 times higher, according to Robert Bernstein of the Bazelon Center for Mental Health Law. Consider the failure of our drug and alcohol policies through this prism.

In 2015, acute narcotic intoxication, methamphetamine-induced psychosis, and PCP and synthetic drugs were the trigger of 42 cases (27 percent) in which an unarmed civilian died after a confrontation with police. In almost all of these, decedents fought with police and others trying to assist them, and after they were immobilized, they suffered heart failure or heart attacks.

In 45 percent of the cases in which we have toxicology reports, the decedents had two, sometimes three or more, drugs in their systems. For example, Jeremy Linhart was shot to death last June as he reached for the pistol he had secreted under his seat. The cause of death was primarily a gunshot wound to the chest, though an “acute combined drug intoxication” was listed as a “significant condition.” Linhart was found to have had amphetamine, methamphetamine, cocaine, ephedrine, oxycodone, and phenylpropanolamine in his system at the time he was shot — and heroin, cocaine, and methamphetamine were found in the vehicle.

The vast majority of police officers in these tragic cases acted to save, not injure or kill. Our data showed that non-deadly force was used exclusively in 69 percent of drug cases. But once mental or drug crises reach a point where the cops need to intervene, the likelihood of injury or death increases considerably.

In general, the presence of a substance abuse disorder increases the likelihood of arrest among adults, regardless of mental illness. However, 48 percent of mentally ill inmates have been charged with drug-trafficking-related crimes. (This is surely due, in part, to self-medication by the mentally ill unable to obtain treatment.) And when mental illness and drug abuse are mixed and matched, the likelihood of arrest increases even more. For example, last year the rate of arrest for adults with mental illnesses but no drug or alcohol problems was 2.8 percent; it was a stunning 16.1 percent for those with mental illnesses and illicit drug use disorders.

Thanks to excellent police work, relatively small numbers of unarmed, mentally ill people die each year at the hands of the police. Let’s do even better: Crisis Intervention Team training has been proven to save lives, save taxpayer dollars, and, perhaps most important, improve the lives and treatment of the mentally ill.

Work to improve the policing of the mentally ill is among the lowest-hanging fruit. We should make it a top priority.