Mental Health Care Shouldn’t Come in a Police Car

Story By Stephanie Hepburn for #CrisisTalk 

There are police departments throughout the United States that no longer answer calls they believe could result in “suicide by cop.” Around 100 shootings like this happen each year, making up roughly 10% of fatal police shootings. Ron Bruno, executive director of CIT Utah and 2nd vice president at CIT International, says this is a philosophy taking hold in law enforcement agencies all over the country, but he quickly points out, people can’t just be left in distress. “Something has to be done, and that’s why we need to examine our crisis response system as a whole, carving out clear roles for law enforcement and mental health services.” Bruno says that law enforcement has a critical part to play in the mental health crisis response system, but it needs to be in a position of support to the mental healthcare system and only when necessary. “We have to challenge the belief that mental health crisis services must come in a police car.”

While there are law enforcement agencies selectively unresponsive to some mental health calls, others are doubling down on their involvement. The impetus, says Bruno, is that, historically, mental health services haven’t been appropriately funded and so law enforcement became the de facto mental health crisis response system. “It fell to us, but we aren’t the best solution or help to a person in an escalated state.” Bruno travels around the world, speaking to audiences on de-escalation and advocating for clearly defined roles for criminal justice and behavioral health services to create a more effective crisis response system. At some point during a presentation, he often asks the audience to raise their hand if they’ve ever been pulled over by a police officer. Most of the hands raise. Then, he’ll instruct them to keep their hands up if the experience increased their anxiety level. Hands remain raised. “Every time a police officer goes out to a crisis situation, it’s going to escalate the person’s emotional state. Yes, we can and will train officers to de-escalate situations, but often, their mere presence is stressful, and the person in crisis can become fearful and enter flight or fight. That’s when we see major problems.” 

Estimates suggest that 25-50% of fatal encounters with law enforcement involve a person experiencing mental illness. Bruno says that in most cases, the interaction between law enforcement and the person in crisis is unnecessary. Just like audiences raised their hands to indicate the distress they felt when pulled over by a police officer, in de-escalation training, officers share that, in the majority of cases where they were called out, the situation didn’t warrant it. Bruno says having law enforcement be the go-to for mental health crisis care appears and feels criminalizing to the person in need. “Most departments have a policy that the person in crisis will be handcuffed, placed in the back of a caged police vehicle, and taken to an ER. This is traumatizing for the person and will make it so that they are reluctant to call for help the next time they are in crisis.” The result is that people in distress, and their families, allow further decompensation than they should before reaching out for help because they don’t want to interact with law enforcement. “With officers declining calls and people not wanting to interface with law enforcement when they or a family member is in crisis, it highlights that something is wrong with the current system.”

The solution, says Bruno, isn’t complicated (see image below). When a call goes into the Emergency Communication Center—911 dispatch—operators can be trained to triage those calls and identify whether the person in crisis is a danger to her or himself or an immediate threat to someone else. If not, then the person can be passed along to appropriate care in the mental health crisis system through a warm handoff to the crisis line. At that point, says Bruno, the crisis line can also do a secondary triage and determine whether it’s still a safe situation. If they decide that it’s unsafe, Bruno says they can do a warm handoff back to law enforcement, and law enforcement can send out Crisis Intervention Team (CIT) trained officers to go out and respond to those situations. “Most calls that go through 911 don’t require a law enforcement response and can be transferred to a crisis line where we know the majority of calls, 80% and upward, are resolved at that level, and there’s no need for police involvement.”

Dedicated Mental Health Crisis Response Model

If an officer on the street comes across a person in crisis and assesses that the person is safe, she or he should reach out to mobile crisis. The challenge is that each community is unique, and many don’t have a robust continuum of crisis care. Bruno says that’s why each community needs to take a hard (and holistic) look at what’s happening in their public mental health system, addressing potential funding and geographical challenges. Ironically, says Bruno, many communities are defaulting to the least economical solution, using law enforcement as the primary form of mental health crisis services or embedded co-responder models, where law enforcement agencies dedicate personnel and partner them with clinicians to respond. “It’s expensive because now you have dedicated law enforcement officers waiting around for mental health crisis calls or, in some agencies, a clinician rides around with a police officer who is handling unrelated calls.” 

Bruno says it’s time for public mental health to return to the community and allow people in crisis to be treated within it, instead of removing them from their support systems by taking them out of their day-to-day lives and roles. “It’s easier for people to transition back into their lives if they’re never fully yanked out of them in the first place and can be treated in the community.” He says by retraining people to call a crisis line instead of 911, it allows people to be treated in the least intrusive manner as opposed to the highest. “We’ve trained people to think that if a loved one is in crisis, they need to contact law enforcement who will come out and take the person into protective custody. He or she will be handcuffed, put in the back of the police car, and taken to the ER. That’s what we’ve told people is the cost of stabilization.” He says it’s a grueling, stress-inducing process, that more often than not, was unnecessary. A crisis line can help decrease a person’s distress, and if they are unable to, they can send out a clinician and certified peer specialist to talk to the person, and, when necessary, the support of a CIT trained police officer. The idea, says Bruno, is to maximize the use of a person’s natural supports into their stabilization plan. “By doing this, we are going to retrain community members to think, ‘If I become symptomatic, I contact the crisis line. If the specialist deems it appropriate, they will hand me off to a warmline. However, if necessary, they can also send out a professional who can talk to me.” 

Bruno says it’s time for a change, “Let’s treat crisis in the most compassionate and least intrusive manner.”

Want to see a flowchart that gives a clear example of risk assessment? Take a look at the recently released Broome County 911 call diversion emotionally distressed caller risk assessment in the CIT best practices guide.

Visiit CrisisTalk for more information.


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How Simulation Training Helps Officers Hone Crisis Response Skills

Simulation training from VirTra can help officers learn how to effectively communicate with someone experiencing a mental health crisis to delay or avoid use of force. (VirTra)


By Margarita Birnbaum for Police1 BrandFocus

The Los Angeles and San Antonio police departments are among agencies that have partnered with mental health professionals to handle emergency calls that involve people in emotional distress. In doing that, police departments hope to reduce use-of-force incidents.

Nicole M. Florisi, a former police sergeant and current instructor at the Force Science Institute, says departments must offer their officers targeted training to help reduce use-of-force incidents involving people in emotional distress.

Specifically, the veteran SWAT officer and counselor says departments need to educate officers about behaviors associated with mental illnesses, such as depression, anxiety and schizophrenia. That training should include effective communication skills so officers can learn to successfully interact with people in emotional distress.

To get the most informative and realistic experience, Florisi recommends simulation-based training programs, such as those offered by VirTra, because the information and skills officers learn through simulation training involves mental and physical elements, as well as decision-making, and therefore sticks much more than what they learn through classroom lectures and passively watching videos.

“How we train most of the time isn’t really how the brain learns,” said Florisi, a part-time officer with the Jerome Police Department in Arizona. “We need to be in reality-based, scenario-based integrative training that hits all the components to create both psychological arousal and physiological arousal.”

She believes that simulation-based training may help prevent excessive force incidents raging from unnecessary arrests to fatal shootings.

Properly communicating with someone in emotional distress, Florisi says, “can be the difference between life and death. It can also be the difference in keeping your career or not.”


Certainly, most encounters between police officers and people who have a mental illness do not end in use of force, in part because many of those encounters have nothing to do with a person’s mental illness. Data, however, show that officers spend more time dealing with mental disturbance calls than they do on calls involving traffic accidents, burglaries and assaults.

The more information and context officers have about the circumstances that triggered an incident, says Florisi – such as a divorce, change in medication, loss of a loved one or drug use – the more likely that they will be able to keep everyone safe.

“Helping officers identify what type of communication is best in those situations is what’s really critical in dealing with anybody, not just someone who has a mental illness,” said Florisi, who wrote VirTra’s mental illness simulation curriculum.

Officers who go through VirTra’s mental illness training program learn basic information about depression, anxiety, schizophrenia and other disorders, including the physiological processes and harmful behaviors associated with them. They also learn the best tone, words and phrases to use to effectively communicate with someone experiencing a mental health crisis due to illness or substance abuse.

Two common mistakes officers make when dealing with a person in crisis, says Florisi, are:

  • Thinking that they can make the person obey them.
  • Thinking t​​hat they can reason with the person.

VirTra’s simulation training drives home that officers need to learn to respond to the individual’s behavior, rather than the emotional trigger.

“What we’re trying to do is reduce the emotion that’s driving the behavior,” Florisi said.


Perhaps one of the most important things officers learn in the simulation training is managing their own emotions that may affect their job performance.

Many officers live with depression, anxiety and other mental illnesses and aren’t aware of how deeply they are affected by them or how their illnesses affect their job performance, Florisi says. In addition, many don’t understand how the body’s physiological responses to stress may affect their decision-making process.

“There’s a misconception, from the public but also among police officers, that you’re immune to human psychology and human factors, “Florisi said. “The brain doesn’t work like that.”

It’s important for officers to be watchful of the verbal and nonverbal triggers that may cause them to become aggressive, she says, which can lead to inappropriate use of force and potentially dire consequences.

One of the benefits of simulation training with reality-based scenarios is that officers can identify areas where they need improvement when responding to emotionally charged, high-stakes calls. As instructors shift the way the scenarios unfold to challenge officers during the simulation sessions, they can learn how to identify when they are responding poorly to a situation and use breathing and other techniques to calm down.

“We are tasked with the sanctity of life, and that requires some professional neutrality,” Florisi said. “To achieve our police objective, officers have to be able to successfully navigate their working environment — and part of that is learning to regulate emotion and communicate effectively.”

Visit VirTra for more information on mental illness and de-escalation training.

Two Cape County Sheriff’s Deputies Receive CIT Awards

Sgt. Ed Curtis, left, and deputy Arman Clark of the Cape Girardeau County Sheriff’s Office recently received honors.
Cape Girardeau County Sheriff’s Office.


Two officers with the Cape Girardeau County Sheriff’s Office received awards from state and regional Crisis Intervention Team (CIT) Councils.

Sgt. Ed Curtis was named officer of the year by the Missouri CIT Council, and deputy Arman Clark was named co-officer of the year by the Southeast Missouri CIT Council.

“It’s a very proud moment for the sheriff’s office and for me as the sheriff,” Cape Girardeau County sheriff Ruth Ann Dickerson said. “When you send officers to training and they take that training, they bring it back and they’re able to implement it like these officers have here in our office, it’s a very proud moment for all of us.”

According to Sheriff Dickerson, Curtis — who has been employed by the sheriff’s office since Oct. 9, 2002 — was the first officer from the sheriff’s department to attend CIT training.

“He became very involved in it. He sits on the CIT Council representing us on that council, and has been very active in bringing the information to our office to our officers,” Dickerson said. “Bringing it back to our area to the law enforcement academy, where they also offer the CIT training. He’s been very instrumental for our office in bringing the CIT training to us.”

Sheriff Dickerson praised Clark — who has been with the sheriff’s office since Dec. 19, 2017 — for his positivity.

“He takes everything with a big heart. He has such a big heart,” Sheriff Dickerson said. “Again, he’s an officer that has taken the training, he’s implemented into his daily routine when he responds to incidents, and he just has really, really shown that he took the training and understands exactly what it’s all about.”

The Missouri CIT Council is a network of representatives from each established local council across Missouri. For more information visit

By J.C. REEVES | Southeast Missourian