Police and psychiatric emergencies don’t mix

Trigger warning: this post discusses suicidal thinking.

The shootings I posted about last night have got me thinking about the number of people with psychiatric disorders who come out of encounters with law enforcement either injured or incarcerated or dead, and what I would do, or want others to do, if I was having a psychiatric emergency. My feeling is that the appropriate role for law enforcement in these situations is … none.

That’s right, NONE.

If someone accidentally hit you while they were having a prolonged seizure, you probably wouldn’t report them to the police for assault. You would probably call and ask for an ambulance. People who are having a psychotic or suicidal episode need medical help, they don’t need laws to be enforced on them, even if they are technically breaking some law by their actions. Unfortunately, many people have found that when they or loved ones did call an ambulance for a psychiatric emergency, the EMTs were unsympathetic and rude, which is unpleasant at any time but is catastrophic when you’re suicidal.

Imagine that you are having intrusive negative thoughts about yourself and visions of killing yourself and you’re frightened you may act on them. Now you have to decide whom to call for help: someone who might arrest or shoot you, or someone who might roll their eyes and say derisive things about you being a burden on the system which will continue to haunt you for months to come (if you survive this episode). Who you gonna call?

Yeah, I would call Ghostbusters, too. Unfortunately they are not real and they only deal with ghosts.

The other option, the better option, is also not real – but it could be. There could be specialized Psychiatric Emergency Response teams in every city throughout the country. Contrary to suggestions that have been put forth (and sometimes implemented), this team would not be associated in any way with the police. These professionals would be part of the hospital emergency department. They would work with and alongside, but be distinct from, EMTs. They would be rigorously trained in mental illness, de-escalation techniques, oral and intramuscular administration of benzodiazepines, therapeutic holds and escort techniques and other methods to safely restrain a violently agitated individual if necessary. They would make contact with the individual’s psychiatrist, if applicable. They would provide transport to the hospital if needed.

But it’s important that this PER team would not be associated with the police. They would not have guns. They would not have tasers. They would not even wear uniforms. (They should carry identification, however.) And they would not be in the position that many EMTs are in of comparing a psychiatric emergency to a heart attack, because the psychiatric aspect would be all they do.

Many people have proposed that police officers simply receive better training for psychiatric situations. Many police departments have special protocols for these situations. Often the protocols are not followed. Why?

Could it possibly be that we are asking police to inhabit two completely different mindsets – one essentially military, the other medical – and to switch back and forth between them at the drop of a pin? Could it be that the methods and instincts police are accustomed to use with violent criminals don’t just magically disappear because of the knowledge that the person now coming at them with a pair of scissors is mentally ill?

It’s easy enough to blame an individual officer for “not following protocol”. There are bad police out there, and I’m sure there are excellent police who have helped people in times of psychiatric crisis, but there are also officers who are taking the fall for what is, at its root, a systemic failure. They are being asked to compensate for a shitty mental health system. It’s not really fair to them, and it’s definitely not fair to those of us with psychiatric illnesses.

It may not be possible for police to avoid psychiatric situations, but until we change the whole mindset behind policing in this country to something more medical in nature, we should limit their involvement as much as possible. Unfortunately, it seems like the police method of dealing with mental illness is infiltrating hospitals rather than the other way around. Psychiatric patients are being shot or tasered to death by hospital security guards.

We need to do better than this. Mentally ill lives matter.


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