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September 29, 2015
By Corrie Sloot

It’s really too bad that plagiarism is considered bad form — it would make writing this column so much easier.

I’d start by copying large sections of a “policy essay” entitled “Building on the evidence: Guiding policy and research on police encounters with person with mental illnesses,” written by Allison Robertson of Duke University and published recently in This issue of the journal had a whole bunch of articles about police interactions with people with mental illnesses, but any article that starts with the word “evidence” warms the cockles of my heart. (I have always wondered exactly where the cockles are. Is that near the aorta?)

The first thing that jumped out at me from these studies was, ironically, not one of the points the authors were trying to make. A couple of researchers from the University of Massachusetts (Melissa Schaeifer Morabito and Kelly Socia) took an in-depth look at the dangers when police and people with mental illnesses interact. Essentially they asked whether the allegedly common belief that such encounters were more dangerous actually holds up – and what they found was…

Never mind, I will get to that in a minute. What really grabbed my attention was that the police agency involved in the study, the Portland (Oregon) Police Bureau, had actually trained ALL its members to the CIT (1) standard — meaning they have all had about 40 hours of training in how to interact with people with mental illnesses.

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Wow. We are talking just shy of 1,000 officers. In my mind, the first take home message here is that “where there is a will there is a way.” As far as I can tell, US police services are not rolling in money any more than those in Canada — and if Portland has managed to provide this level of training, it just goes to show what a little commitment to the cause can do.

Ahem. Back to the subject at hand….

As the authors point out, there are a whole lot of assumptions and misconceptions about danger and people with mental illnesses and the increased likelihood of officers being injured when encountering them. So what did they find?

On the surface, it looks like there might be a grain of truth to the rumours. They found that 11.5 per cent of reported use of force events involved mentally ill subjects, a disproportionate number. Of these, the officer was injured 12 per cent of the time and the mentally ill person 28 per cent of the time. This is a little high compared to the overall numbers of seven and 18 per cent in encounters with NOT mentally ill people.

However, when they fed all the bazillion relevant variables into a computer and computed complex things involving Greek letters, it turned out that mental illness was not really the culprit here. In fact, by itself it did not result in increased use of force or injury – but there are things that might go along with mental illness that are relevant.

The biggy is (not surprisingly) substance use. If you have a mental illness and are “using,” then the risk goes up. If you assault an officer, are armed, try to run away, resist – then the likelihood goes up. Alas, it appears that people with mental illnesses are more likely to fall into these categories — and thus are at higher risk.

Simply having a mental illness detectable to an officer, however, is not sufficient. I think this is generally good news. The take home message? Don’t assume that things are more likely to off the rails if your subject appears to have a mental illness because the data don’t support that.

(If I were writing this column for people in the health care system rather than police, I would now go off on a harangue about how no one really wants to deal with people who have both mental health and substance use problems, and how the relative unavailability of treatment facilities for those with concurrent disorders is not helping matters – but that is for another audience.)

The other paper in this group that really made an impact on me was called “Police use of force and the suspect with mental illness: a methodological conundrum,” by Geoffrey Alpert, who appears to work at both the University of North Carolina and Griffith University in Brisbane, Australia (sounds like a neat stunt to me!).

If you are actually involved in any data collection about police interactions with people with mental illnesses or if you are trying to measure outcomes and effectiveness, you really need to read this article. He points out (kind of depressingly) the enormous challenges facing researchers in this area. How does one really define mental illness and how sure are we that the people who police think are mentally ill actually ARE mentally ill?

Can you reliably distinguish between people with mental illnesses and those with substance problems — and people with both? Frankly, I know for sure that I can’t. I have been asked by many police officers, “How would YOU distinguish between a person who is mentally ill and a person who is high on drugs?”

“Easy!” I always reply. “You admit them to hospital and wait a few weeks. If they were on drugs, they should stop doing whatever it was they were doing. If they have a mental illness, the symptoms usually won’t go away without treatment.” So that’s how I do it. How do you do it?

There are a variety of other measurement issues as well. What exactly counts as a use of force? What is an injury? And on and on. There are no magic answers, and many tough questions. If you are involved in asking or answering any of these, you should dig up these articles. They just might help.

<1> In case you are not familiar with the model, is the co-called “Memphis Model” or Crisis Intervention Team Model. To make a long story short, it suggests that a small group of officers in an organization should receive the 40 hours of training and then act as a resource to other officers.


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