An estimated 21% of U.S. adults experience mental illness. Of those people, about 50% have more than one mental illness. Further, about 20% of adults in the U.S. take psychiatric medication. People with mental illness (PMI) are more likely to have contact with the police, and approximately 25% of PMI have been arrested. Thus, it is not surprising that an estimated 20% of police calls deal with PMI.

PMI also experience police use of force and police-related fatalities at disproportionate rates. A 2017 study estimated that PMI comprise 20% of those injured during police interactions, and their risk of experiencing police use of force is more than 11 times higher than people without mental illness. Per the Washington Post, nearly 25% of people shot and killed by police since 2015 had a known mental health condition.

Misconceptions about PMI

There is a common misconception that PMI are more dangerous than the rest of the population. This is not necessarily true. Despite this, vast numbers of encounters with PMI turn deadly, illustrating the need to enhance police response to persons with mental illness. An officer who is not trained in mental illness might interpret mental health symptoms as defiant or threatening behaviors. In this case, an officer might unintentionally escalate a mental health crisis.

There is often significant variation in the quantity and quality of training for police response to persons with mental illness, with most officers only receiving a short lecture on this topic during the police academy. As a result, many officers are not prepared to handle mental health crises. Further, officers do not know what mental health services are available, and thus are unable to refer people to services that they need.

 Police can reduce the number of mental health calls that turn deadly by relying less on defensive tactics when they encounter PMI. For example, active threat assessment, de-escalation, and crisis intervention tactics can be used to resolve situations without using force.

 In this article, we will discuss police response to persons with mental illness that are designed to make encounters with PMI less dangerous. We will also introduce you to active threat assessment, which can help police accurately identify and appropriately react to threats in these types of encounters.

 This topic is highly related to de-escalation techniques, feel free to check out “Before Defensive Tactics: 5 Training Approaches for LE-Citizen Encounters” for more information on this topic. For more general information on police and PMI, check out the International Association of Chiefs of Police (IACP)’s resources page.

Police-Mental Health Collaborations

 One police response to persons with mental illness involves leveraging partnerships to enhance their response to PMI. Typically, the partners are mental health professionals who provide specialized assistance to law enforcement during mental health calls, and they can also serve as a future resource for PMI. We have more information about these collaborations in a companion post, “Before Defensive Tactics: 5 Training Approaches for LE-Citizen Encounters.”

 Mobile crisis teams consist of health professionals (e.g., paramedics, mental health clinicians) who have special training on trauma-informed de-escalation tactics. They are often the first to respond, providing on-site assistance to people in crisis, but they can request assistance from law enforcement as needed.

In co-responder programs, specially-trained law enforcement officers respond to most mental health calls, but they can request assistance from a mental health response team. Support can be provided remotely or on-site.

 Research reviews from 2018 and 2020 as well as subsequent research have suggested positive effects regarding the impacts on mental health calls, including reductions in the following: use of force, detentions, arrests, and police time spent on calls.

 The structure of these types of programs can vary widely, which can impact their effectiveness. For example, one 2018 study that face-to-face collaborations reduced detentions and arrests whereas the remote assistance model did not.

 For more information on collaborative police response to persons with mental illness, see:

●     The IACP’s Best Practice Guide for Co-Responder Programs

●     Council of State Governments’ Law Enforcement-Mental Health Collaboration Support Center

●     Bureau of Justice Assistance’s Police-Mental Health Collaboration Toolkit

●     SAMHSA’s National Guidelines for Behavioral Health Crises Care

Police-Specific Responses to PMI

 Police are still the primary resource for PMI in many communities, particularly in areas with fewer resources. Even when other resources for PMI do exist, the role of police is still critical to ensure safety when it comes to handling mental health calls. Thus, it is still important that officers receive some form of training that teaches them how to work with PMI.

Crisis Intervention Teams (CIT)

 One widely-used police response to persons with mental illness is through Crisis Intervention Teams (CIT). CIT teaches officers crisis recognition and communication skills that they can use in scenarios with PMI. Because PMI might react to police encounters differently than other people, these techniques are specialized to deal with people having mental health or substance abuse crises.

 Research shows that CIT can improve officers’ attitudes and knowledge about PMI and enhance their confidence in these interactions. Some research also suggests that CIT reduces arrests of PMI. The research is still somewhat mixed when it comes to use of force outcomes, likely because CIT programs vary in terms of content, rigor, and duration.

 For more information on CIT, see:

●     National Alliance on Mental Illness CIT Program

●     The University of Memphis CIT Program

●     CIT International Best Practice Guide

Training on Specific Disabilities

 CIT is focused on responding to people who are in acute crisis, but there are also trainings that teach officers more about specific types of mental illness or intellectual or developmental disabilities.

Rigorous evidence on these types of programs is lacking, but anecdotal evidence suggests that they may decrease use of force, increase officer awareness of mental health symptoms, and increase their confidence in working with PMI.

 For more information, see:

●     VirTra’s Research-Driven Curriculum on Multiple Mental Illnesses

●     The Arc’s Disability Awareness for First Responders

De-Escalation Training

 The content of de-escalation training programs often overlaps with CIT, particularly in terms of crisis recognition and communication skills. However, comprehensive de-escalation training programs also include training on operational and defensive tactics.

 ICAT (Integrating Communications, Assessment, and Tactics) is one popular training that teaches officers critical decision-making skills to help them identify situations where it is safe to ‘tactically pause’ and engage verbally with a suspect. Officers also learn operational tactics that can be used to increase time or distance to slow down encounters.

 Studies in 2020 and 2021 showed that ICAT reduced officer uses of force, and a 2019 study found that it increased officer confidence in handling volatile encounters. Other de-escalation training programs utilizing similar skills have also been found to reduce use of force and improve officer confidence.

 You can access ICAT resources and request modules here:

·        The Police Executive Research Forum’s ICAT Training

Active Threat Assessment

Communication and de-escalation techniques are essential during police response to persons with mental illness, but it can be hard to know when these techniques are appropriate versus when to apply force. For example, a PMI may appear unusual and stand out from the crowd, but this doesn’t necessarily mean they pose an imminent threat. To differentiate between the two, officers should observe changes in behaviors and assess whether other threat indicators are present, and make an informed assessment of whether or not violence may occur and how to handle the situation.

Integration of active threat assessment into police training can teach officers how to differentiate between threatening and non-threatening individuals and situations. This will can help them better handle situations with PMI.  Check out our course offerings to learn more about active threat assessment training available now.