“After a decades-long push to treat people with mental illness in the community, police officers have increasingly assumed the role of first responders to psychiatric emergencies.”

From a Washington Post story by Nathaniel Morris headlined “Police encounter many people with mental-health crises. Could psychiatrists help?”:

Police departments have become a de facto arm of the American mental-health system. Research suggests that about 2 million people with serious mental illness are booked into jails in the United States each year. A 2016 review of studies estimated that 1 in 4 people with mental illness has a history of police arrest. The Treatment Advocacy Center, a nonprofit that studies topics related to mental health, has calculated that the odds of being killed during a police encounter are 16 times as high for individuals with untreated serious mental illness as they are for people in the broader population.

Amid the failures of deinstitutionalization — a decades-long push to treat people with mental illness in the community rather than in mental institutions — police officers have increasingly assumed the role of first responders to psychiatric emergencies. . . .

One approach has been to provide police with more training, such as in how to recognize signs of mental illness, techniques for crisis de-escalation and ways to connect individuals with mental-health resources. Another approach involves partnering with mental-health professionals such as social workers. . . .

What if psychiatrists worked on the front lines with police?

In Albuquerque, Nils Rosenbaum has been doing just that since 2007, conducting what he has called “street-level psychiatry.” Rosenbaum’s roles have included educating police officers about mental-health issues, conducting psychiatric assessments in the field and serving as a liaison between law enforcement and the mental-health system. . . .

For instance, a man with religious delusions who preached from a street corner was well known to local police, cycling in and out of jail and emergency departments, for at various times throwing rocks at people and yelling. As part of the police department, Rosenbaum was called in to evaluate the man, and he worked with local mental-health professionals to help create a plan for care. When the man’s condition worsened months later, Rosenbaum met with him again and helped coordinate an admission to the hospital.

In other situations, Rosenbaum examined individuals who appeared to be mentally ill, and he identified medical conditions such as delirium and thyroid dysfunction that can mimic psychiatric symptoms but require different medical attention. . . .

Social workers and case managers can perform some of the same functions as a police psychiatrist, often at a lower cost. And many police departments assign calls that involve mental illness to crisis intervention teams staffed by select officers who have received mental-health training.

Still, having completed medical school and residency, psychiatrists have a unique set of skills that enable them to recognize psychiatric and medical conditions, to talk fluently about psychiatric treatments with patients and clinicians, and to coordinate treatment with other health-care providers. In some counties, psychiatrists can perform functions, such as placing patients on psychiatric holds and testifying in court, that other providers may be unable to do.

And despite the expenses associated with psychiatrists, sending them into the field with police officers may, in fact, be ­cost-effective. A 2015 review suggested that police mental-health programs may lead to cost savings by decreasing unnecessary use of jail and hospital resources, among other factors. . . .

Mental illness has become a major issue for both law enforcement and health care in the United States. Why, then, should police officers and medical providers work apart?
Morris is a resident physician in psychiatry at the Stanford University School of Medicine.


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