TEMPO: A contemporary model for police education and training about mental illness

Given the increasing number of interactions between police and people with mental illnesses (PMI), there has been widespread interest in the development of education for police about how best to interact with PMI. This paper reflects the review of current practice in a variety of jurisdictions across Canada as well as in the United States (U.S.), the United Kingdom (U.K.) and Australia; it proposes a comprehensive model of learning based on the literature that addresses not only the content in the narrow sense but also the importance of broader contextual knowledge and understanding in developing effective education and training. Embedded in the principles articulated in the Mental Health Strategy for Canada, the TEMPO (Training and Education about Mental illness for Police Organizations) model is a multilevel learning strategy for Canadian police personnel. Learning objectives and key principles are articulated in order to ensure the model is applicable to a wide range of police agencies and individual jurisdictional needs. In addition to providing a firm basis of factual knowledge for police personnel, the resultant model embraces a human rights/anti-stigma philosophy, provides for a range of education appropriate to diverse police audiences, emphasizes a systems approach to police/mental health liaison activities and addresses issues related to the delivery and implementation of police education and training.     

Improving police response to persons with mental illness: a multi-level conceptualization of CIT

The large numbers of people with mental illness in jails and prisons has fueled policy concern in all domains of the justice system. This includes police practice, where initial decisions to involve persons in the justice system or divert them to mental health services are made. One approach to focus police response in these situations is the implementation of Crisis Intervention Teams (CIT). The CIT model is being implemented widely, with over 400 programs currently operating. While the limited evidence on CIT effectiveness is promising, research on CIT is limited in scope and conceptualization-much of it focusing on officer characteristics and training. In this paper we review the literature on CIT and present a conceptual model of police response to persons with mental illness that accounts for officer, organizational, mental health system and community level factors likely to influence implementation and effectiveness of CIT and other approaches. By moving our conceptualizations and research in this area to new levels of specificity, we may contribute more to effectiveness research on these interventions.     

Mental health outreach and street policing in the downtown of a large French city

ContextMarseille, the second largest city in France, has a large population of homeless persons. A mental health outreach team was created in 2005 as a response to high rates of mental illness among this group. In a national political context where security is a government priority, a new central police station was created in Marseille in 2006 to address robberies, violence and illegal traffic in the downtown area of the city. While not directly related to such crimes, police also are responsible for public safety or behavioral issues related to the presence of individuals who are homeless in this area.ObjectiveThis report on a two-year pilot study (2009–2011) addresses collaborative work between a mental health outreach team and the police department responding to the clinical needs of persons who are homeless with serious psychiatric disorders. It also describes the homeless persons' interactions with, and perceptions of the presence of, police and mental health professionals on the streets.MethodsInvestigators adopted a mixed-methods approach. Data were collected on 40 interactions using brief standardized report for each interaction. Focus groups were conducted with police officers, outreach team members, peer workers, and service users. Minutes of partnership meetings between police officers and outreach workers also served as a source of qualitative data.ResultsOutreach workers initiated just over half (n = 21) of the encounters (n = 40) between police and outreach workers. Interactions mainly involved persons with psychosis (77%), the vast majority (80%) of which involved persons in an acute phase of psychosis. Two key themes that emerged from data analysis included the violent nature of life on the streets and the high percentage of ethnic minorities among subjects of the interactions. In addition, it was found that the practices of the outreach workers are sometimes similar to those of the police, especially when outreach workers use coercive methods. “Users” (homeless persons) described police as sometimes using less coercion than the outreach team, and noted that they were more fearful of psychiatrists than police.ConclusionFormal initiatives between mental health outreach teams and police departments involve some common street practices. This study demonstrates the potential for closer working relationships between the two parties to help persons who are homeless with mental illnesses receive needed care, and to reduce inappropriate coercion including involuntary hospitalization and arrests.     

Police Perceptions of Irrational Unstable Behaviours and Use of Force

Police identification of people experiencing mental illness is usually based on either the person having an official contact history with police or through observing behavioural indicators commonly associated with mental illness during an encounter. Police have voiced concerns with their ability to identify and respond to people experiencing mental illness in a timely way and report that they commonly resort to more coercive tactical options to resolve encounters. The present study employed a mixed method design to examine 286 police use of force incidents to investigate the association between force used on and by offenders displaying irrational-unstable behavioural characteristics. The irrational-unstable offenders were two times more likely to be perceived by police to have an apparent mental disorder and almost four times more likely to have a known mental health history; one in six had an official record of contact with mental health services. There were few differences in police and offender use of force, considering force as both a categorical and a continuous variable, while incident-level comparisons suggested that police force was generally proportional to offender resistance. Implications are discussed in terms of the need to redress limitations with the traditional police approach style.     

The nature of police involvement in mental health transfers

During the course of their duties, police regularly have contact with mentally ill persons who are experiencing psychiatric crisis and require some form of mental health transfer. This study examined 2611 unique mental health transfers completed by police in the Australian state of Victoria over an eight-month period in 2009–2010. The overwhelming majority of mental health transfers performed by police during this period were the result of unplanned calls for assistance. Although police frequently requested assistance from other services, these were often not available. The study findings support a substantial body of anecdotal evidence from police citing lengthy involvement with people experiencing mentally illness, with the average mental health transfer consuming 2.5?h of police time. The frontline responses of police to people in psychiatric crisis need to be more formally acknowledged and creative solutions need to be sought with health and welfare services to better meet the needs of those who are falling between the cracks of community mental health care services.     

Police officer perceptions of the impact of Crisis Intervention Team (CIT) programs

The Crisis Intervention Team (CIT) program is an approach for law enforcement officers to safely response to individuals who are experiencing a mental health crisis. Research must identify the components of CIT that are instrumental to the overall effectiveness of the program. For instance, recent studies report that CIT may have a transformative effect on officers' attitudes by increasing exposure to and familiarity with mental illness. This study explores this possibility further by examining 57 CIT officers' experiences with mental illness and attitudes about CIT. Specifically, we assessed how personal and professional exposure to mental illness associates with officers' perceptions about CIT generally, as well as with opinions about the officers' confidence in their abilities and the perceived effectiveness of the police department in responding to individuals in mental health crisis. Our findings indicate that CIT is rated very positively by officers. We found that officers' attitudes about the impact of CIT on improving overall safety, accessibility of services, officer skills and techniques, and the preparedness of officers to handle calls involving persons with mental illness are positively associated with officers' confidence in their abilities or with officers' perceptions of overall departmental effectiveness. There is further evidence that personal contact with individuals with mental illness affects the relationship between attitudes that CIT impacts overall safety and perceived departmental effectiveness. The results of this exploratory study underscore the importance of CIT officers' perceptions of key elements of CIT and the role of exposure to mental illness in examining program effectiveness.     

A retrospective comparative study to evaluate the reliability of post-mortem interval sources in UK and US medico-legal death investigations

Post-mortem interval (PMI) information sources may be subject to varying degrees of reliability that could impact the level of confidence associated with PMI estimations in forensic taphonomy research and in the practice of medico-legal death investigation. This study aimed to assess the reliability of PMI information sources in a retrospective comparative analysis of 1813 cases of decomposition from the Allegheny County Office of the Medical Examiner in Pittsburgh, US (n = 1714), and the Crime Scene Investigation department at Southwest Forensics in the UK (n = 99). PMI information sources were subjected to a two-stage evaluation using an adapted version of the 3x5 aspects of the UK police National Intelligence Model (NIM) to determine the confidence level associated with each source. Normal distribution plots were created to show the distribution frequency of the dependent variables (decomposition stage and source evaluation) by the independent variable of PMI. The manner, location, and season of death were recorded to ascertain if these variables influenced the reliability of the PMI. A confidence matrix was then created to assess the overall reliability and provenance of each PMI information source. Reliable PMI sources (including forensic specialists, missing persons reports, and digital evidence) were used across extensive PMI ranges (1 to 2920 days in the US, and 1 to 240 days in the UK) but conferred a low incidence of use with forensic specialists providing a PMI estimation in only 35% of all homicide cases. Medium confidence PMI sources (e.g., last known social contact) accounted for the majority of UK (54%, n = 54) and US (82%, n = 1413) cases and were associated with shorter PMIs and natural causes of death. Low confidence PMI sources represented the lowest frequencies of UK and US cases and exclusively comprised PMI information from scene evidence. In 96% of all cases, only one PMI source was reported, meaning PMI source corroboration was overall very low (4%). This research has important application for studies using police reports of PMI information to validate PMI estimation models, and in the practice of medico-legal death investigation where it is recommended that i) the identified reliable PMI sources are sought ii) untested or unreliable PMI sources are substantiated with corroborating PMI information, iii) all PMI sources are reported with an associated degree of confidence that encapsulates the uncertainty of the originating source.     

Crisis intervention team training: when police encounter persons with mental illness

Abstract

The Crisis Intervention Team (CIT) model is an established training program used to improve police response to encounters involving persons with mental illness (PwMI). Diversion of PwMI from the criminal justice system to appropriate treatment providers in the community is one of the primary goals of CIT. The present study examines characteristics and outcomes of encounters between citizens experiencing mental health-related crises and CIT-trained patrol officers. Findings of this study indicate encounters involving PwMI and CIT-trained officers often result in diversion to mental health services. Implications for policy and future research are discussed.     

Law enforcement response to mental health crises: citizen risk factors and preferences for social policy*

Despite having the potential to affect cooperation and support for law enforcement, community preferences for police training are generally unstudied. This paper seeks to understand (1) general community preferences for police training for responding to mental health crises, (2) where the public prioritizes this mental health crisis training relative to racial bias training, and (3) whether these preferences vary depending on respondent demographics and risk factors for police contact. Survey data from a general sample of Portland, Oregon residents (N = 259) shows public support for police training on responding to mental health crises, but the public as a whole is split over whether mental health, or racial bias training, should be prioritized as the best use of police training time. Logistic regression analyses demonstrate three main findings regarding the impact of respondent characteristics on preferences for police training: (1) black respondents appear concerned that, by drawing attention to mental health crises, police will be more limited in their responses to racial bias; (2) respondents facing the greatest, and those with the least, amount of risk in police/citizen encounters are most supportive of mental health crisis training; and (3) mental illness itself does not appear to affect support for police mental health crisis training. These differences in support for training need to be understood before law enforcement can cultivate community support for police officers and their training practices.     

Crime Scene Behaviors and Characteristics of Offenders with Mental Illness: A Latent Class Analysis

The current study aimed to identify distinct types of crime scene behaviors based on the criminal planning and motivation of offenders with mental illness in South Korea. Furthermore, our study examined the relationships between the identified types of crime scene behaviors in terms of the offenders’ sociodemographic characteristics, modus operandi, and types of mental illness. Utilizing latent class analysis, the associations between crime scene behavior types and offender characteristics such as demographic factors, crime scene actions, and criminal information were empirically investigated. In particular, based on a sample obtained from a national police database of offenses committed between 2006 and 2014, four offense groups were identified: (i) instrumental–planned, (ii) instrumental–unplanned, (iii) expressive–unplanned, and (iv) hybrid. Additionally, significant relationships were found between offense styles and offender characteristics as well as criminal backgrounds. The findings suggest that mental disorders influence the types of actions exhibited by offenders during the commission of their crime. The results are discussed in terms of their theoretical and practical utility to criminal investigation.     

Involuntary outpatient treatment as "desintitutionalized coercion": the net-widening concerns

In American jurisprudence, two justifications have traditionally been put forth to support the government's social control of persons with mental illness: police power and parens patriae. As public mental hospitals became less available as loci in which to exercise these functions, governments sought alternative means to achieve the same ends. One prominent but quite controversial means is involuntary outpatient treatment (IOT). While the concerns about IOT have been myriad, one often alluded to but never documented is that of "net-widening." That is, once IOT became available, it would be applied to an ever greater number of individuals, progressively expanding the margins of the designated population to whom it is applied, despite the formal standard for its application remaining constant. We tested the net-widening belief in a naturalistic experiment in Massachusetts. We found that net-widening did not occur, despite an environment strongly conducive to that expansion. At this time, whatever the arguments against IOT might be, net-widening should not be one of them.     

CIT in context: the impact of mental health resource availability and district saturation on call dispositions

The goals of Crisis Intervention Team (CIT) programs include improving safety during encounters between police and persons with mental illnesses, diverting persons with mental illnesses away from the criminal justice system, and increasing referral and access to mental health services. CIT is a systemic intervention, and as such, its implementation and effectiveness are influenced by existing practices and infrastructures. However, little research has considered the context in which CIT programs are implemented. In this paper, we present research on CIT in four Chicago police districts that vary in terms of two contextual factors hypothesized to influence the impact of CIT training on how calls involving persons with mental illnesses are resolved. Using data from 112 patrol officers in four Chicago police districts, we consider the impact of mental health services availability and CIT saturation (the percentage of district personnel that are CIT certified). Findings indicate that CIT training increased direction to mental health services primarily in districts with greater availability of mental health services. In districts with low service availability, higher CIT saturation increased direction to mental services. The opposite pattern emerged for contact only or informal call resolution. No effects were found for arrest as a call outcome.     

POLICE RESPONSE TO DOMESTIC VIOLENCE: SITUATIONS INVOLVING VETERANS EXHIBITING SIGNS OF MENTAL ILLNESS*

Drawing on attribution theory, research on police discretion, and public attitudes toward mental illness, we examine attributional processes in police decision making in response to domestic violence situations involving veterans and nonveterans with signs of mental illness. Using data from experimental vignettes varying veteran status, victim injury, and suspect compliance administered to a sample of 309 police officers, the results indicate that 1) veterans are perceived as less responsible for troublesome behavior but more dangerous than nonveterans, 2) suspects’ veteran status has a significant effect on officers’ preference for mental health treatment versus arrest, and 3) part of the effect of veteran status on officer response is mediated by internal and external attributions for problematic behavior and by perceptions of dangerousness. The study empirically demonstrates countervailing processes in police decision making—recognition of the causes for troublesome behavior and the need for mental health treatment on the one hand and concern for community safety and enforcing the law on the other.     

A prospective comparative evaluation of a Criminal Justice Liaison and Diversion Service in Belfast

There is continued interest in the planning, development and implementation of services designed to identify detainees with mental illness and connect them to health and social services. However, currently, little is known about how best to configure, organise and deliver these services. The study employed a prospective follow-up design with a comparator group to describe and evaluate a police mental health liaison service based in Belfast. Participants were recruited from two neighbouring police stations, only one of which provided a mental health liaison service. Outcomes including mental health status, drug and alcohol misuse, risk-related behaviour and ‘administrative’ outcomes were assessed at the time of arrest and six months later. The service was successful in identifying and assessing detainees, though there appeared to be similar between-group levels of mental health problems over time. Results highlight a need to develop firmer linkages and pathways between criminal justice liaison/diversion services and routine health and social services.     

Public Mass Murderers and Federal Mental Health Background Checks

The litany of public mass murders, from Aurora, Newtown, Charleston, Las Vegas, and Parkland to less well‐known incidents that occur yearly, has focused national attention on federally mandated mental health background checks of prospective gun purchasers. The call has been to put more gun‐disqualifying mental health records into the National Instant Criminal Background Check System database to prevent “deranged” murderers from buying guns and running amok. Our study examines whether increasing the robustness of the mental health background database will likely prevent potential public mass murderers from buying guns. Building on research that shows that serious mental illness contributes little to the risk of interpersonal violence and, further, that few persons with serious mental illness acquire gun‐disqualifying mental health records, we examine whether public mass murderers are among the small percentage of those with serious mental illness who do have gun‐disqualifying mental health records. Using a large sample of 106 US offenders who used a firearm to commit a public mass murder from 1990 to 2014, we find that half of the offenders had a history of mental illness or mental health treatment but that less than 5 percent had gun‐disqualifying mental health records. Implications of these findings and recommendations for further research are discussed.     

Perceptions and experiences of people with mental illness regarding their interactions with police

This study examined the perceptions and lived experiences of people with mental illness in relation to their interactions with the police. A community-based participatory research approach was used and a procedural justice theoretical perspective guided the study. In-depth, semi-structured interviews were conducted by peer researchers with 60 people with mental illness who had interacted with the police and were living in Metro Vancouver, Canada. Among the study participants, contact with the police was frequent and occurred under a diverse range of circumstances. The majority of participants perceived being treated in a procedurally just manner by the police officer(s) who were involved in their most recent interaction. Almost three-quarters (n = 43, 72%) of participants were generally satisfied with how the police officer(s) had handled their most recent interaction. The slight majority of participants (n = 30, 51%) rated their previous contacts with the police as a positive experience overall, with 32% (n = 19) indicating that their previous interactions with the police were negative life experiences. The findings paint a more balanced picture than that which is often portrayed by the media. Emphasizing a procedural justice framework for police handling of situations involving people with mental illness is a vital step toward improving how these interactions are experienced and perceived.     

Involuntary outpatient treatment as “desintitutionalized coercion”: The net-widening concerns

In American jurisprudence, two justifications have traditionally been put forth to support the government's social control of persons with mental illness: police power and parens patriae. As public mental hospitals became less available as loci in which to exercise these functions, governments sought alternative means to achieve the same ends. One prominent but quite controversial means is involuntary outpatient treatment (IOT). While the concerns about IOT have been myriad, one often alluded to but never documented is that of “net-widening.” That is, once IOT became available, it would be applied to an ever greater number of individuals, progressively expanding the margins of the designated population to whom it is applied, despite the formal standard for its application remaining constant. We tested the net-widening belief in a naturalistic experiment in Massachusetts. We found that net-widening did not occur, despite an environment strongly conducive to that expansion. At this time, whatever the arguments against IOT might be, net-widening should not be one of them.     

Female-Offender Parricides in South Korea, 1948–1963: Offender and Offense Characteristics

Asian Journal of Criminology - Existing parricide research is largely situated within a North American and European context, and foregrounds mental illness or adolescent offender typologies. As...     

Do prior histories of violence and mental disorders impact on violent behaviour during encounters with police?

Despite sustained large-scale educational campaigns, public attitudes towards mental illness have remained persistently negative. Associated with this, recent research from Victoria, Australia, reported that police commonly associated violent behaviour with mental illness. The present study examined 4267 cases of police use of force and considered what differentiated and characterised violent from non-violent behaviours reported by police in the context of a use of force incident. The specific focus was to examine the effects that historical variables such as age, gender, prior violent offending and having a prior diagnosis of mental disorder, as well as incident specific factors such as exhibiting signs of mental disorder and substance intoxication have on violent behaviour during the use of force incident. The proximal factors of apparent mental disorder and alcohol intoxication were significantly associated with violent behaviour towards police, whilst having a history of prior violence and prior mental disorder diagnoses was not associated with violence. The results challenge traditional stereotyped views about the violence risk posed by people with prior contact with mental health services and those with prior violent offending histories. A service model that allows for psychiatric triage would be able to assist with streamlining police involvement and facilitating timely access to mental health services.     

Demographic and clinical characteristics of 1092 consecutive police custody mental health referrals

The 43 police forces in England and Wales have made over 13 million arrests in the last decade. Yet, despite this high volume criminal justice system activity, and evidence of substantial health morbidity across the criminal justice pathway, mental health services in police custody have only been patchily developed, and the literature in this area is limited. Referrals (n = 1092) to a pilot mental health service operating across two police stations in a London borough were examined over an 18-month period in 2012/2013. The referred group had high levels of mental health and substance misuse problems (including acute mental illness, intoxication and withdrawal), self-harm, suicide risk and vulnerability (including intellectual disability), with some important gender differences. Although this work has limitations, the findings are broadly consistent with the small existing literature and they confirm the need for services that are sufficiently resourced to meet the presenting needs.