Abstract
Objectives
The police-mental health co-response model has garnered support from both police and healthcare workers. It is praised for its ability to enhance crisis de-escalation, increase in-service referrals, and reduce pressure on the criminal legal system, and its cost-effectiveness relative to hospitalization. This study examines whether the police-mental health co-response team actually achieves the proclaimed goals in a suburban-rural community.
Methods
A total of 2809 police shifts were randomized into treatment and control groups, with 140 participants recruited. The study analyzed and compared the numbers of police contacts and mental health calls for service among participants in treatment and control shifts over a 12-month follow-up period.
Results
The results revealed no significant difference in the number of subsequent police contacts between the treatment and control groups. The findings were further complemented by insights gathered from focus group interviews.
Conclusions
In summary, implementing a co-response team shows promise for assisting individuals experiencing a mental health crisis, especially for police departments and service providers in non-urban areas. However, to achieve long-term effectiveness, it is crucial to identify strategies that reduce treatment attrition and enhance subsequent outcomes.
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Notes
For instance, in May 2018, Marcus-David Peters, an unarmed civilian, was shot and killed by a Richmond (VA) police officer while experiencing an MH crisis (Phillips, 2018). In March 2020, Daniel Prude, an unarmed civilian experiencing an MH crisis, died in an altercation with Rochester (NY) police (Gold and Closson, 2021). In April 2020, Nicholas Chavez was shot and killed by Houston (TX) police officers while he was experiencing an MH crisis (Ortiz and Yuhas, 2020).
Detailed information about the collaboration is redacted for peer reviews to avoid self-identification.
The county is not formally defined as rural according to the Census Bureau due to its overall population and proximity to a city. However, the county contains several rural-designated census tracts and the city has its own separate police department, which means that county police respond primarily to suburban and rural communities. According to Census.gov, across census tracts within the study county, about half have rural residents (the percentage of rural residents in each tract ranges from 20 to 90%). For instance, in one of the census tracts within the county, 3791 people live in the rural area while only 11 people live in the urban part of the tract; in the other tract within the county, the rural population is 5473 while 1825 people live in the urban part of the area.
For context, the Census Bureau reports that for the study state as a whole, 16% of residents are over the age of 65, females account for 51% of the population, 11% of residents live under the poverty line, and 10% of persons under the age of 65 do not have health insurance. Furthermore, 70% of the state residents are White, 20% are Black or African American, 7% are Asian, 10% are Hispanic or Latino, 3% are of two or more races, and less than 1% are American Indian and/or Alaska Native. About 12% of the state residents are foreign-born.
Crimes against persons include murder, manslaughter, kidnapping, rape, sexual assault, aggravated assault, simple assault, intimidation, and human trafficking. Violent crimes include murder, non-negligence manslaughter, rape, and robbery.
ECOs are issued by magistrates and require anyone who is incapable of volunteering or unwilling to volunteer for treatment to be taken into custody and transported for an evaluation to assess their needs for hospitalization or treatment. The criteria for ECOs include (a) mental illness and (b) the likelihood of causing serious harm to themselves or others or suffering from harm due to lack of capacity to protect themselves from others in the near future. TDOs are issued by magistrates and authorize law enforcement to take a person into custody and transport them to a facility designated on the order. Similar to ECOs, TDOs require evidence that the individual with mental illness is incapable of volunteering or unwilling to volunteer for treatment and may cause serious harm to themselves or others, or may suffer serious harm due to the inability to protect themselves in the near future.
During the study period, we conducted several trainings and refresher trainings when new officers joined the police department. Overall, the characteristics of the police force and clinicians are fairly stable and there was a very low turnover rate at the police department (no change in the MHP side).
Starting in 2014, CIT was added to the department’s police academy training curriculum to ensure that all new officers receive this training. The police department also requires officers who went through the academy before 2014 to take the CIT training. At the time of the study, all officers in that police department had received the full 40-h CIT training as part of their academy training. As such, the entire agency is CIT-trained.
When responding to the crisis calls, officers also needed to verify whether the individuals have been enrolled in either the treatment or control groups. If the past contact has been established, then the response will be based on the treatment designation to avoid contamination.
The code “1096” is used by the police department to differentiate general MH calls from ECO/TDO, suicide threat, or suicide attempt calls.
Treatment data only include subject IDs without other identifiable information (such as names, birthdays, addresses, or SSNs).
The police department provided the research team a list of CFS related to study participants monthly during the entire study period. We also checked whether there were any unidentified calls by searching the addresses of the participants in the CFS datasets and reading through the dispatch narratives of the identified calls to specify calls related to study participants. In other words, these CFS include calls made either by study participants themselves or by their family members or others who lived with them.
CFS include all MH and non-MH calls.
Treatment and control group participants were possibly involved in MH and non-MH calls during the study period. Non-MH calls are those calls determined by officers to not involve MH concerns as a primary issue. The most common types of non-MH calls involving participants were domestic disturbance, well-being check, and suspicious activity calls.
It is critical to note that the prescribed service length varies by individuals’ needs and their respective treatment programs.
The organization primarily worked with juvenile clients, who were often enrolled by their parents and were more likely to finish the treatment plan with their parents’ supervision.
The team actually went back to the control participants after the intervention period to offer them treatment services. However, no participants enrolled in the treatment program upon invitation.
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Acknowledgements
The authors would like to thank Wes Jennings, Lorrain Mazerolle, and the anonymous reviewers for their thoughtful comments on an earlier draft of this manuscript. Most importantly, the authors wish to acknowledge and thank Chief Howard Hall, Assistant Chief James Chapman, Brittni Money, and Bekki Craft for their support in this project, as well as officers from Roanoke County Police Department for their enthusiasm and cooperation. We also want to thank Natalie, Jennifer, Dale, and clinicians from Intercept Health for their effort and participation in the co-response teams.
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Yang, SM., Gill, C.E., Lu, YF. et al. A police-clinician co-response team to people with mental illness in a suburban-rural community: a randomized controlled trial. J Exp Criminol (2024). https://doi.org/10.1007/s11292-023-09603-8
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DOI: https://doi.org/10.1007/s11292-023-09603-8