Force as a Response to Mental Illness

State Sanctioned Force as a Response to Mental Illness

On the individual level when we see people being violent or otherwise in crisis due to mental health problems, they sometimes get shot and killed by police. It is a tragic dynamic that happens. It’s then recognized as the failure it is to use appropriate responses. It’s shocking and very dismaying when this happens. The actions are lamented, as they should be. In many, probably the large majority of cases we can see what caused police or other interveners to respond in the ways they did, but we do not condone the actions. Instead we recognize that they had the wrong kinds of training and tools for the issues they were faced with.

To put very bluntly: You cannot effectively address mental health symptoms with violence.

Best Practices

When a 911 call comes in and there’s a mentally ill person (maybe a veteran) involved, what ideally happens is a lot different. Best case scenario is: they get help. More and more jurisdictions are creating programs to deal with mental health calls. The best known program model is CIT (Crisis Intervention Teams). CIT is police with training in different models of interacting with people going out to respond to these calls. Other program use multi systems approaches where mental health professionals work collaboratively with police and go out on calls with them. Both are effective. With the right tools, that is, with the knowledge of how to effectively address psychological distress, the need for violence is averted, arrest rates decline, and more people get the right kind of help. These are best practices, and are growing in number as a result.*

It is definitely worth noting that when these programs are introduced, police are often worried they will be left unsafe by using these different approaches. These are people who have been trained to respond with force to perceived safety threats. They have been trained to perceive of their state sanctioned authority in very specific ways.  When they are first exposed to the concept of using compassion as a first line strategy in the face of challenges to their authority, they become understandably very nervous and skeptical. But the use of these strategies saves money, time (in the long run), creates less fear and antagonism, and most importantly, it reduces violence and saves lives.

Mental Health Professionals Use Compassion

When approaching people in immediate crisis and deeply disturbed by trauma responses (as I have many times) -including those trained to kill and those who have used violence in the past- (again, as I have many times), we find ways to neutralize the immediate threats (make it so violence will not happen), then further de-escalate situations, hospitalize or otherwise contain the person in crisis, if necessary. After the immediate crisis is de-escalated and the work can then turn to recovery and rehabilitation. In hospital settings, violence is met with tranquilizers, and humane containment, not more violence. Containing the immediate threat is done by non lethal and humane means, always.

In community settings, most people with serious mental illness are helped- even in times of crisis- by people like me, with words. Most of the time it is done without any police intervention at all. Certainly, there are state sanctioned means to contain immediate threats, and I have asked police to contain people and help me get them hospitalized on very rare occasions. But in the vast majority of cases: diplomacy works. It’s not as exciting too use compassion and words instead of weapons, so it doesn’t make the news much, but the vast majority of techniques to address mental health issues-even crises- do not involve physical containment.

Let me repeat that. To effectively treat our psychological ills, the overwhelming percentage of work is done with compassion and effective techniques, mainly words.  We are finding more techniques all the time, sometimes by rerouting brain circuitry by physical means either with body based techniques or medication. None of the work of recovery is done with weapons.

Lack of Treatment And Big Business

Effective treatment always involves compassion, deep listening, and working with people, not doing things to them. This is time consuming on the front end, does not make for very exciting news, and is frankly not a value recognized as important in commerce: I know of no pieces of psychological equipment anywhere near as expensive to produce (and profit from) as a tank, fighter plane, or even one police car. For healing to happen, radar, fighter jets, body armor, guns, tanks, intelligence agencies and other paraphernalia are not needed.  Knowledge and simple compassion (still free) is what is needed. But producing gadgets designed to subdue and control others by the truckload is how we are still addressing cultural illnesses, and not incidentally, making the most money.

Insurance companies myopically focused on their immediate bottom lines, effectively restrict access to treatment with their policies. Pharmaceutical companies are invested in people continuing to use their products on an ongoing basis, not for small amounts of time.

Even without factoring in the effects of Cultural PTSD, our psychological ills are extreme:  At any given time in 2015 about 18% of the general population in the US had a mental illness. This does not include substance abuse issues, nor does it include institutionalized people, inmates, the homeless, or active duty military- all of which have higher rates of mental illness. That works out to about 43.4 million people. Add in substance abuse issues and 55 million normal Josephine and Joe Americans were walking around with mental illness in 2015.  About 20 million got some form of treatment. This figure is including PCPs ordering routine prescriptions of medications like antidepressants.[2]

Those are again, average Joes and Josephines who are not incarcerated. Depending on the statistics you want to use, anywhere from 25% to 90% of inmates in any given detention facility, at any given time, are struggling with significant mental health issues.  Even if you want to believe “only” 25% of incarcerated people have mental illnesses, that is still a significantly more expensive route and definitely less humane route than treatment for those 1 in 4 incarcerated people. Depending on the statistics you want to use, only about 12-33% of the people with mental health illnesses who are incarcerated have received mental health treatment.[3]

Yet we spend billions each year on a hugely popular TBR called “getting tough on crime” rather than treating the illnesses that social scientists know lead to criminal acts.  We continue to fund and expand police forces even as crime continues to decline (anyone else see an over focus on safety power and control- which is a key issue people with PTSD have to grapple with?).

Law enforcement gets $29.0 billion in discretionary budget authority for 2017 [4]. This includes prisons and probation as well as federal level funding for law enforcement.  In contrast,  $912 million is allocated for SAMHSA and another 1.4 billion for NIH.

The bottom line is mental health issues have in fact been addressed by profit goals and law enforcement in a large percentage of cases.  This is not working. Not only are people not getting help for their illnesses, but the cultural norms, values, and assumptions continue to reinforce using force and other ineffective TBRs to address issues that would be much more effectively addressed via the best practices used by providers in the mental health worlds. And again those best practices are: garden variety compassion combined with certain techniques.

[1] Best practices citation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769782/accessed January 2018.

[2] Government statistics https://www.samhsa.gov/samhsa-data-outcomes-quality/major-data-collections/reports-detailed-tables-2015-NSDUH

[3]Federal government statistics accessed January 2018. Other organizations have found even lower rates of treatment.  https://www.bjs.gov/index.cfm?iid=789&ty=pbdetail

[4] citation https://www.justice.gov/jmd/file/821916/download