Police-Involved Deaths of People With Mental Illness Poorly Counted

The well-known overrepresentation in the criminal justice system of people with mental illness often begins with the encounter between the individual and a police officer.

Too many of those initial interactions end in tragedy, with the preventable death of the person with mental illness, reported Doris Fuller of the Treatment Advocacy Center in Arlington, Va., and three colleagues.

“By all accounts—official and unofficial—a minimum of 1 in 4 fatal police encounters ends the life of an individual with severe mental illness,” wrote Fuller in a December 2015 report, “Overlooked in the Undercounted.”

The Treatment Advocacy Center is a national nonprofit organization dedicated to eliminating barriers to the treatment of severe and persistent mental illness and supports the development of innovative treatments and research. The center was founded by E. Fuller Torrey, M.D., who is also executive director of the Stanley Medical Research Institute, a supporting organization of the center.

Officer-involved shootings can also occur with individuals who are suicidal, noted APA President Renȳe Binder, M.D., a professor of psychiatry at the University of California, San Francisco.

“Sometimes the person is trying to provoke the officers to shoot him or her in order to commit suicide,” Binder told Psychiatric News. “I have known of cases where the deceased individual left a note for the police officers, apologizing for forcing the officer to shoot him or her.”

Even in nonfatal incidents, confrontation with mentally ill people may also cause injury to the police officer, another rationale for better training of officers, said Binder.

“It is clear that police officers need specialized training for recognizing that an individual may be psychotic and manifesting delusions, hallucinations, or disorganized thinking,” said Binder. “When officers are called to the scene, they may misinterpret the behavior as being aggressive and criminal, rather than as symptoms of mental illness.”

The actual scope of the problem is unclear, however, given the poor statistics on police shootings in general and on the mental health status of victims, they said. No single database or government entity collects data on such cases, but the report suggests that the annual number of deaths may reach 1,000, more than twice the figures usually reported. The lack of standard definitions, reporting methods, or central reporting entities doesn’t help, either. Sometimes even state agencies get their data from media reports.

Fuller and colleagues recommended that law enforcement agencies better define use-of-force policies and train their officers to understand them. They also suggested programs—like the Memphis Police Department’s Crisis Intervention Training and others—that mix education about mental illness and de-escalation techniques for officers with on-call mental health response teams to lessen the need for the use of force during encounters.

In this report, as in previous ones, the Treatment Advocacy Center also recommended an increase in inpatient hospital beds for acute and chronic psychiatric care, reform of laws restricting treatment for high-risk individuals, and greater use of court-ordered outpatient treatment “for individuals with severe mental illness who, because of their inability to stay in treatment voluntarily, have a history of poor outcomes (for example, repeated hospitalization, incarceration, suicide attempts).”

“I support the call for more research and data about officer-involved shootings of persons with mental illness and also the need for better access to and funding for mental health treatment,” said Binder. ■

“Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters” can be accessed here.