Addressing the debate over sending mental health professionals out on police calls

Question: In response to several recent cases of mentally ill citizens being shot by police, some authorities are recommending sending mental health professionals out on police calls as alternative or co-responders to deal with these situations. Is this a good idea?

Answer: It depends, but mostly no.

I’ve trained police officers in verbal de-escalation strategies for mental health crises, and I’ve trained mental health professionals (MHPs) and civilians on how to deal with violent encounters. While some law enforcement agencies are already implementing such MHP-responder programs, a premature rush to routinely dispatch psychologists and social workers to the scene of potentially lethal police-citizen encounters may be a matter of misapplied good intentions.

WellPower clinician Jane Lemaux loads supplies
into a STAR van in Denver on Thursday,
Oct. 20, 2022. The STAR program uses
clinicians and EMTs or paramedics to
respond to nonviolent mental health crises,
instead of police. (AP Photo/Thomas Peipert)

Here are three things to consider:

First, the danger. Most MHPs are not trained in law enforcement crisis intervention; we do most of our work in the comparatively safe, controlled environments of offices, clinics and hospitals. Even in those settings, safely responding to angry, suicidal, manic, or psychotic individuals requires well-trained, coordinated teamwork based on established policies and procedures. The standard mental health interventions typically employed in clinical settings may have little effect or even aggravate the situation in a tense life-and-death, street-level scenario.

Second, the liability. Unlike the case with medical and psychiatric facilities, there currently exists no universally recognized training curriculum for MHP response to law enforcement crises, and no consistent standards of practice. What happens if a MHP is injured or killed during an incident, or if the police and MHP disagree on what strategy to use and the result is a further tragedy? What if the mentally disturbed citizen is threatening police officers or other citizens, and the police feel the necessity to respond with justified deadly force, but the MHP says no? Who is ultimately responsible if things go south? Administratively, will MHPs’ liability insurance cover lawsuits related to purportedly mishandled police calls involving clinicians, police, or civilians?

Third, it’s just not necessary. Just as most patrol officers are trained in basic first aid that they can utilize until the paramedics show up, most officers can be trained in the fundamentals of verbal de-escalation that they can deploy until a mentally disordered citizen can be safely contained and referred for more extensive treatment. Many officers already do this. And, in fact, there’s one group of non-clinician law enforcement professionals who have an impressive track record of using psychologically informed skills of communication to neutralize potentially deadly encounters: hostage negotiators. But these special unit officers typically go through a rigorous, standardized 40-hour training and certification course. That high level of training and expertise may not be necessary for most patrol officers.

The essence of “first aid” is to stabilize the situation until further help is available, and in many jurisdictions, patrol officers learn to do CPR, administer Narcan and use a defibrillator without actually having to become EMTs or ER docs.  So, why can’t they be trained in the basics of active listening and crisis communication without having to be formal crisis negotiators? As for MHPs themselves, many are already involved in many crisis and hostage negotiation teams, as co-trainers, team debriefers and even as on-scene consultants, but they almost never act as negotiators themselves.

Several alternative solutions are already being tried. In a few departments, police and paramedics are formally cross-trained and certified, and either rotate law enforcement and medical response shifts or are expected to fill both roles as needed (medic with a gun, cop with a syringe). In addition, an increasing number of officers, usually in the middle-management (lieutenant and captain) range are going back to school to receive their clinical social work or masters in counseling degrees, and eventually become licensed clinicians themselves.

Note that I’m not arguing for excluding MHPs from any particular area of law enforcement practice. Quite the opposite: MHPs have worked very hard to gain the trust and respect of police professionals who traditionally have been extremely skeptical of anything “mental,” and there is great potential for much broader constructive collaboration between these two fields.

For example, some of the impetus for inserting MHPs into police calls comes from public concern over reported police mishandling of mentally ill or medically impaired citizens, leading to tragic outcomes. While these incidents are rare, they certainly need to be addressed, and this is one area that’s ripe for LEOs and MHPs working together to establish and maintain training standards and policy SOPs for mental health issues in law enforcement. But to maintain optimum credibility and utility, let’s figure out how to follow the science and pursue this collaborative enterprise safely and effectively.

Note: Information provided herein is for educational purposes, and is not intended to provide individual clinical or forensic advice or opinions. For such cases, always consult with a qualified legal, medical, or mental health professional.

NEXT: State your case: Should U.S. police follow the example of London’s Metropolitan Police and stop responding to mental health crisis calls?