AAPI Mental Health, Law Enforcement, and Training: Part 1

Asian Americans show lower rates of mental health service use than the general population and other racial groups in the United States. This disparity persists among individuals with a probable mental health diagnosis, with 34.1% of Asian Americans within this group seeking services compared with 41.1% of the general population in a 12-month period (Abe-Kim, et al., 2007). Emotional restraint and saving face publicly are cultural values in the Asian American community and may conflict with the self-disclosure and emotional openness that facilitate engagement with psychiatric treatment. Additionally, the “model minority” stereotype and stigma surrounding psychiatric disorders may preclude seeking help.

It seems reasonable to infer that Victoria Lee’s death would inspire mistrust of mental health services in a community already hesitant to avail itself of these services. If an emergency call for help could result in death, why should the community trust them? Indeed, AAPI New Jersey released a statement expressing concern that the shooting would deter help-seeking from Asian Americans and Pacific Islanders urgently needing care.

Looking at the other side of this incident, use of lethal force by police is permissible if an officer reasonably believes there is imminent risk of severe harm or death and determines that lethal force is necessary for defense of self or others. Individuals experiencing mental health crises may be agitated, and thus interpreted as posing a definitive threat of violence to police at the scene. Police often make these judgments quickly; for Lee, it took only 33 seconds.

Another factor that underlies reactive use of force is posttraumatic stress disorder (PTSD) among law enforcement. Police are exposed to traumatic situations including violence and often make decisions rapidly. It is estimated that 15% of all U.S. officers have PTSD symptoms, although true prevalence is likely higher due to underreporting (Covey, et al., 2013). Knowing law enforcement’s rationale for using lethal force and appreciating mental health concerns among police themselves are necessary to understand the problem, which may reduce the risk of additional deaths through lethal force.

Law enforcement officers are often the first responders called to a psychiatric emergency. Although they are not clinicians, they transport individuals undergoing a psychiatric crisis to the ED for evaluation. Local crisis-intervention programs such as SCRT (Street Crisis Response Team), CAHOOTS (Crisis Assistance Helping Out on the Streets), and FIT (Forensic Intervention Team) incorporate mental health professionals in this process. Although collaboration between psychiatrists and law enforcement may improve outcomes, many of these programs do not include psychiatric expertise.

While psychiatrists play a pivotal role in treating people in crisis, there is no literature regarding their systematic involvement in initial emergency response, nor are there published studies or curriculum of law enforcement exposure during psychiatric training. This is unsurprising given that the majority of psychiatry residency programs lack substantial forensic psychiatry exposure, the subspecialty with the most frequent interactions with law enforcement. The most recent APA census identified 49 forensic psychiatry fellowship programs whose available slots do not fill each year.

Furthermore, law enforcement officers have their own mental health concerns that remain stigmatized, underreported, and undermanaged. This separation makes it challenging for psychiatrists to truly comprehend the experience of an individual undergoing a psychiatric emergency and the potential distress placed on law enforcement dispatched to the scene.

In our next article, we will continue this discussion by sharing a potential solution in the form of a collaboration involving the University of Rochester Psychiatry Residency and the Rochester Police Department. We will also explore resources for members of the AAPI community. ■

Abe-Kim J, Takeuchi DT, Hong S, et al.: Use of mental health-related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American Study. Am J Public Health 2017; 97(1):91-98.

Covey, TJ, Shucard JL, Violanti JM, et al.: The effects of exposure to traumatic stressors on inhibitory control in police officers: a dense electrode array study using a go/nogo continuous performance task. Int J Psychophysiol 2013; 87:363-375.