Understanding Your Local Problem

The information provided above is only a generalized description of police problems associated with people with mental illness. You must combine the basic facts with a more specific understanding of your local problem. Analyzing the local problem carefully will help you design a more effective response strategy.

Asking the Right Questions

The following are some critical questions you should ask in analyzing your particular problem of people with mental illness, even if the answers are not always readily available. Your answers to these and other questions will help you choose the most appropriate set of responses later.

Incidents

It is important to gather information about the quantity and types of incidents involving people with mental illness. A jurisdiction may find that one or two particular types of incidents constitute a large part of its problem, providing a focus for analysis and response. This information may be difficult to obtain, however, because many police agencies’ call classification systems do not include a code for “person with mental illness,” “mental health emergency,” or “emotionally disturbed person.”

If the police department’s communications system does not provide reliable data, it may be necessary to do a special study in which officers and dispatchers record this type of information for some months to facilitate problem analysis. Another option is to backtrack from known indicators of incidents involving people with mental illness. For example, if one call at an address is found to involve a victim with mental illness or a false complaint reported by someone with mental illness, all previous calls at that address could be analyzed to check for a hidden hot spot. Similarly, all previous calls involving the particular person (victim or complainant) could be extracted from the department’s computer system to determine if the individual might be an unrecognized repeat victim or repeat false complainant.

You should not overlook other data sources. Hospitals (general and/or psychiatric), ambulance services, and community-based mental health agencies might have useful data on commitments, referrals, and transports. In addition, academic institutions and mental health advocates might have conducted studies of the mental health situation in your jurisdiction, or they might be willing to partner with the police agency in conducting such studies.

• How many total incidents involving people with mental illness does your agency handle in a year, and how much police time is consumed?
• How many of each type of incident involving people with mental illness does the agency handle in a year, and how much police time does each consume?
• How do police handle incidents (informal handling, formal referral, involuntary commitment, arrest, etc.) for each type of incident involving people with mental illness?
• How often do officers use force when handling incidents involving people with mental illness?
• How often are officers injured when handling incidents involving people with mental illness?
• What proportion of people with mental illness whom officers encounter are homeless and/or serious substance abusers?

Stakeholders

It is important to identify institutions, organizations, and individuals in the community who play significant official or unofficial roles in the mental health system. Since most police officers are not intimately familiar with all the players in the mental health system, these stakeholders and potential guardians may not be well known or obvious. Because these entities can contribute expertise, authority, and resources, though, it is very beneficial to identify them and, if possible, engage them as participants in collaborative problem-solving.

• What public and private inpatient and outpatient psychiatric/mental health facilities (psychiatric hospitals and wards) are located in or serve the jurisdiction?
• What other residential facilities serving people with mental illness (group homes, assisted living facilities, nursing homes, etc.) are located in or serve the jurisdiction?
• What other services for persons with mental illness are provided in the jurisdiction through the public health department, general hospitals, counselors, therapists, etc.?
• What laws and regulations govern the mental health system’s operation in your jurisdiction?
• What advocacy organizations representing people with mental illness, such as the National Alliance for the Mentally Ill or the Mental Health Association, are in the jurisdiction?
• What types of mental health services does the local jail provide?
• What institutions and organizations provide services in the jurisdiction for people who are homeless or who have serious substance abuse problems?
• In regard to each of the items above, how does the system differ for minors (juveniles)?

Victims

Identifying victims is important because certain categories of people, or even some specific individuals, may be more heavily victimized than others, suggesting avenues for problem-solving activity. Victims in situations involving people with mental illness might include specific community members, mental health workers, family members, or the mentally ill themselves. When any of these people become crime victims, the police may be notified, although of course many crimes also go unreported. Unfortunately, even when reported, such crimes may not be flagged or marked as involving a person with mental illness. This can make it difficult to identify both one-time and repeat victims.

• When people with mental illness commit a crime, who are the victims (strangers, businesses, caregivers, etc.)? Who are repeat victims?
• When people with mental illness cause nuisances and disorder, who are the victims? Who are repeat victims?
• When crimes are committed against people with mental illness, who are the victims and what are their circumstances (family members, institutional residents, etc.)? Who are repeat victims?
• When people with mental illness are neglected and/or abused, who are they and what are their circumstances? Who are repeat victims of neglect and abuse?

Offenders

It is important to look for people who cause a disproportionate share of the problem. People with mental illness may be offenders, or others may commit offenses against them. As mentioned above, however, it can be difficult to identify cases involving people with mental illness from police data, thus making it challenging to identify offenders and repeat offenders associated with such cases.

• Which people with mental illness commit personal and property crimes? Who are the repeat offenders?
• Which people with mental illness cause nuisances and disorder? Who are the repeat offenders?
• What crimes do people commit against people with mental illness? Who are the offenders? Who are the repeat offenders?
• Who neglects and/or abuses people with mental illness? Who are the repeat offenders?

Locations/Times

The locations and times of incidents and crimes involving people with mental illness may be important to identify. Typical locations include public places (such as parks, business districts), businesses, and residences. Particularly important to look at, though, are hospitals, clinics, homeless shelters, drop-in shelters, and group homes. These places may have concentrations of people with mental illness, or they may be common destinations for people who experience serious chronic mental illness or episodic mental health crises. There may also be certain times of the day, days of the week, or weeks of the year that the incidence of calls involving people with mental illness is particularly high. The routine schedules of agencies that assist people with mental illness might influence these peak times.

• Where do incidents and crimes involving the people with mental illness occur?
• Where are the jurisdiction’s “hot spots” of incidents and crimes involving people with mental illness?
• Do different types of incidents and crimes involving people with mental illness cluster in different locations? If so, where are those locations?
• Are there particular times of the day, days of the week, or weeks of the year in which the incidence of calls involving people with mental illness is especially high or low?

Measuring Your Effectiveness

Measurement allows you to determine to what degree your efforts have succeeded, and suggests how you might modify your responses if they are not producing the intended results. You should take measures of your problem before you implement responses, to determine how serious the problem is, and after you implement them, to determine whether they have been effective. All measures should be taken in both target areas and surrounding areas, if applicable. (For more detailed guidance on measuring effectiveness, see the companion guide to this series, Assessing Responses to Problems: An Introductory Guide for Police Problem-Solvers.)

The following are potentially useful measures of the effectiveness of police responses to problems associated with people with mental illness:

• reduced victimization of people with mental illness
• reduced repeat victimization of people with mental illness
• reduced total calls for service involving people with mental illness
• reduced calls for service at hot spots (although you should take care to ensure that, for example, reduced calls from a group home are not caused by a facility operator’s preventing residents from reporting abuse or neglect)
• reduced amount of police time consumed by calls involving people with mental illness
• reduced total calls for each type of situation involving people with mental illness (especially if police target their efforts toward specific types of situations)
• reduced arrests of people with mental illness (assuming that more effective alternatives to arrest are available)
• reduced civil commitments of people with mental illness (although it might be desirable to increase the volume of civil commitments for some period if civil commitment is a preferred alternative to criminal arrest)
• increased referrals of people with mental illness to community-based services
• reduced injuries to people with mental illness caused by police officers
• reduced injuries to police officers caused by people with mental illness
• increased “customer” satisfaction—post-incident satisfaction of complainants, victims, and offenders
• increased “expert” satisfaction—high ratings of police effectiveness by mental health and legal professionals.