Police Responses to People with Mental Illnesses

Global Challenges

Duncan Chappell

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317977148
• Topic: Social Sciences
• Subtopic: Criminology
• Index: Social Sciences

According to the World Health Organisation during their lifetime more than one quarter of all individuals will develop one or more mental or behavioural disorders. Given prevalence data like this it is not surprising that wherever they reside on the planet many persons suffering from a mental disorder, or as is more commonly termed in popular parlance a mental illness, are likely to come into contact with police at some stage in their lives. Indeed, research conducted in a number of countries suggests that about 10 per cent of all community police work involves some form of interaction with a person with a mental illness. From a police perspective these encounters are not only frequent but also often sensitive and challenging.

Despite the difficulties associated with this important aspect of community policing surprisingly scant attention has been given to the development of empirically tested and established best practice approaches to managing police interactions with persons with mental illnesses. The literature that does exist is principally derived from North American sources although more recent and interesting developments have been reported in Australia and the United Kingdom. The principal aim of Police Responses to People with Mental Illnesses is to seek to reduce this gap in the literature by providing an international overview of some of the latest research and policy developments in the field, and the challenges still to be confronted in many places in overcoming cultural and associated barriers to protecting the rights of the mentally ill.

This book was originally published as a special issue of Police Practice and Research: An International Journal.

Introduction

From sorcery to stun guns and suicide: the eclectic and global challenges of policing and the mentally ill

Duncan Chappell

Faculty of Law, University of Sydney, Camperdown, NSW 2006, Australia

Mental disorders: a global phenomenon

Mental disorders are not the exclusive preserve of any special group: they are truly universal. Mental and behavioral disorders are found in people of all regions, all countries and all societies. They are present in women and men at all stages of the life course. They are present among the rich and poor, and among people living in rural and urban areas. (World Health Organization [WHO], 2001, p. 23)

This statement, taken from a landmark report by the WHO on global trends in mental health, emphasises the universality of the experience of mental disorders in the contemporary world. Research conducted in both developed and developing countries has shown that during their entire lifetime, more than 25% of individuals will develop one or more mental or behavioural disorders including unipolar depressive disorders, bipolar affective disorder, schizophrenia, epilepsy, alcohol and selected drug use disorders, Alzheimer’s and other dementia, post traumatic stress disorder, obsessive and compulsive disorder, and primary insomnia (WHO, 2001).

Given prevalence data of this dimension it is scarcely surprising that wherever they reside on the planet many persons suffering from a mental disorder, or as is more commonly termed in popular parlance a mental illness, are likely to come in contact with police at some stage in their lives. Such encounters are also likely to be among the most sensitive of all interactions with police. In the USA, for example, these interactions with ‘emotionally disturbed persons’ (EDPs), as they are often called, has been described in the following way:

EDP calls are difficult as well as frequent … Most EDP calls turn out to involve people who are neither a danger to themselves or others. Nevertheless police are called to respond to a large number of cases that are dangerous or that, if improperly handled, could quickly become dangerous. As police, we are responsible for getting such people to mental health professionals, but we also have other responsibilities. We must protect the lives and safety of EDPs as well as the lives and safety of other innocent people, including ourselves. We also have an obligation to protect EDPs’ rights and dignity. (New York City Police Department, 2003, p. 1)

It is also likely that issues associated with the experience of a mental illness will touch a proportion of serving police officers at some point in their law enforcement career. Police work is often stressful, with frequent exposure to traumatic situations that may well increase the risk of mental health problems occurring among police personnel.

This special issue of Police Practice and Research (PPR) is devoted to consideration of the challenges which are presented to policing by such encounters with mental health issues, and how they are being dealt with in a range of jurisdictions. As will be seen these challenges are multi-varied and often eclectic when viewed from a global perspective. In selecting the six invited papers that comprise this special issue an attempt has been made to provide a broad appraisal of current policing practices and policies across a number of regions and countries including North America, Europe, Australia, and China.

Inevitably there are major gaps in this appraisal, and especially so in regard to the developing world where scant information is readily available about mental health matters at large, let alone about the role played by police in this area. More will be said about this below, including a short illustrative description of the situation prevailing in one developing country, Papua New Guinea (PNG), where strong associations continue between a belief in the power of sorcery and attitudes towards the mentally ill. Brief mention is also made of the vexed question of the impact upon mentally ill persons of the burgeoning use of stun guns by police, and of the worrying rates of suicide encountered among serving police officers. But first the papers detailing the contemporary approaches to policing and the mentally ill in North America, Europe, Australia, and China require introduction.

The developed world

As the papers by Dorothy Cotton and Terry Coleman, and Melissa Reuland show, respectively, considerable attention has been given over the past two decades in Canada and the USA to best practices and policies associated with policing and the mentally ill. These policies and practices have often emerged from cauldrons of controversy associated with the outcome of fatal encounters between police and a mentally ill person. They have also been influenced by the acknowledged failures of the health system in both countries to deliver adequate community-based services to mental illness sufferers in the wake of the massive closure of the grim asylums where they were previously housed. Without such services the mentally ill have rapidly joined the ranks of the homeless and unemployed with the police often becoming by default the gateway into treatment, if available, or more likely into the criminal justice system and prisons which have been rightly labelled the new asylums.

Initially, as Cotton and Coleman emphasise, the police tended to take the position that they had no part to play in dealing with a situation which was the product of a faulty health system. Police were not trained to be mental health workers, and dealing with the mentally ill simply diverted time and resources away from their principal crime fighting role. More recently attitudes like this have changed with the recognition that police can and should assist persons with a mental illness to receive treatment, and wherever possible to divert them away from the criminal justice system into the health system. A plethora of programs have now been established in North America to achieve such goals while also seeking to reduce the risks of injury to police and the mentally ill when encounters do occur. Many of these programs rely, as Reuland indicates, upon crisis intervention teams (CIT), or co-responder teams, both of which operate through strong partnerships between police, mental health workers, and the community. Similar CIT-style programs have also been set up in Australia, as described by Katrina Clifford in her paper. Research suggests that these programs, wherever they have emerged, have had generally positive outcomes although the depth and rigor of the evaluations conducted are matters for conjecture.

The situation in Europe is less certain, and certainly less documented, as Rhonda Moore relates in her paper. Unlike North America, and to a lesser degree Australia and New Zealand, there is a lack of research information and literature available about policing and the mentally ill in almost all of the countries of the European Union (EU), with the exception of the UK. It must be recognised that a research literature may exist in Europe that is not in English, the sole language in which literature searches were conducted. However, it is clear from the information referred to in Moore’s paper that a number of more recently admitted member countries of the EU, like Bulgaria and Romania, still have very poorly developed mental health services and retain many of the attitudes and policies towards mentally ill people linked to their previous association with the former Soviet Union, with an emphasis on detention and repression of such persons rather than the provision of community-based treatment.

The developing world

While dilemmas for police in their encounters with mental illness sufferers continue to be a challenge in Western countries they pale by comparison with those faced in a developing country like China, as evidenced in the paper by T. Wing Lo and Xiaohai Wang. Of a population in China of around 1.3 billion there are about 16 million suffering from serious schizophrenia or depressive illness alone. Ranked by the World Bank as a lower middle income group country, China spends about 5.5% of its Gross Domestic Product (GDP) on the health budget (WHO, 2005, p. 133). The proportion of the health budget spent on mental health is 2.35%, with about 1.06 psychiatric beds per 10,000 population; 1.29 psychiatrists and 1.99 psychiatric nurses per 100,000 population (WHO, 2005, p. 135). By contrast in Australia, a high income group country in World Bank terms, the proportion of the health budget to GDP is 9.2%, with 9.6% of the total health budget spent on mental health. The total number of psychiatric beds in Australia is 3.9 per 10,000 population while there are 14 psychiatrists and 53 psychiatric nurses per 100,000 population (WHO, 2005, pp. 68–70).

It should be acknowledged that China has received criticism, as did the former Soviet Union, for its alleged misuse of the mental health system to silence peaceful political dissidents and others (see, for example, Bonnie, 2002; Human Rights Watch & Geneva Initiative on Psychiatry, 2002; Munro, 2000, 2002). Such alleged misuse is, among other things, a clear breach of now well-established human rights standards and norms regarding the mentally ill, as personified in The Protection of Persons with Mental Illness and the Improvement of Mental Health Care (United Nations General Assembly, 1991), and the Convention on the Rights of Persons with Disabilities and Optional Protocol (United Nations, 2006).

China has in fact ratified the latter Convention although it currently lacks any mental health legislation at the national level. The drafting of a national mental health law commenced in 1986, with the 15th draft believed to be the latest under consideration. Provincial laws are also under various stages of development (WHO, 2005, p. 134). Additionally, three Chinese ministries, including Security which is responsible for the police, provide inpatient services for mentally ill patients. It is these Security-run psychiatric services, facilitated through a network of special facilities known as Ankang hospitals, which have been the focus of much of the criticism made by human rights advocates of the Chinese mental health system (Munro, 2000, pp. 72–81).

Within this context Lo and Wang note that there are approximately 10,000 serious reported incidents a year involving mentally ill persons where the police are the first to be called upon to assess and handle the situation. Lo and Wang describe the steps followed by police in responding to such situations, and outline the problems created by the continuing absence of national mental health legislation and of resources with resulting wide variations across the country in the way the mentally ill are handled by police. However, where possible, in a similar way to that in the West, China also recognises the need for a special squad assigned to assist an officer responding to an incident involving a mentally ill person. Conditions for police and for the mentally ill vary enormously however across the country as there are vast discrepancies in wealth and mental health resources – for instance, the situation in Beijing or Shanghai is very different from that of a remote rural village – and a lack of consistent policies for police to follow. Nevertheless, it is acknowledged that police need more training in recognising and dealing with mentally ill persons, and in knowing how to access the mental health system. Attention is also being paid to reducing the stigmatisation attached to mental illness, and other models of service are being studied, such as that in Melbourne, Australia, and attempts made to replicate these in a Chinese jurisdiction.

Stigma, sorcery, and mental illness¹

The stigma associated with mental illness, and the associated discriminatory practices which so often arise from it, are most certainly not the prerogative of the developing world (Arboleda-Flórez, 2001). There are, however, particular problems for police, and for mental health professionals, in responding in an appropriate way to mental illness sufferers in those developing societies where, in addition to very limited treatment resources being available, traditional cultural beliefs continue to link mental illness with sorcery and witchcraft. One such society is PNG (see, in general, Koka, Deane, & Lambert, 2004).

A former colony of Australia, PNG has an estimated population of around 6.5 million persons, most of whom live in scattered and isolated rural areas of the country where access is mainly by air or foot. Ranked by the World Bank as a low income group country, PNG contributes about 4.4% of its GDP to the health budget. The proportion of the health budget spent on mental health is 0.7%, with about 0.24 psychiatric beds per 10,000 population; 0.09 psychiatrists and 1.2 psychiatric nurses per 100,000 population. The country does have a mental health law but it has not been revised since 1985 (see, in general, WHO, 2005, pp. 365–367).

Health researchers have reported that in PNG sorcery and witchcraft are the most widely practiced and feared traditional practices that are believed to cause both mental and physical illness and form the substance of most traditional treatment (Koka et al., 2004, p. 31). Sorcery and witchcraft beliefs and practices continue to be feared for their power and influence even among certain tertiary educated members of PNG society, including health professionals. For instance, in a survey conducted in 2004 of final year medical students at the University of PNG several students indicated that they believed mental illness could be caused by sorcery, or even by spending much time with the mentally ill. As a group the students had a negative attitude towards close social contact with them as a neighbour or as in-laws. Most students said that they believed mental illness could be cured by prayer, one in five believed in the effectiveness of traditional healers, and one in five believed modern medicine could not treat mental illness. Apart from a reduction in stigma and in prejudice against a mentally ill neighbour there was also no significant difference in attitude between students who had been rotated in psychiatry and those who had not (Muga & Hagali, 2006).

No similar attitudinal studies appear to have been conducted with PNG police but it seems reasonable to assume that they too share the cultural beliefs of many of their fellow citizens about the association of sorcery and witchcraft with mental illness. There are also no known published research and allied studies which provide an account of the way in which the PNG police force – a poorly educated, trained, and resourced law enforcement body which is heavily dependent on overseas technical assistance and aid, largely provided by Australia (Australian Government AusAID, 2010) – manages its encounters with mentally ill citizens. The use of police diversion of mentally ill persons into the health system appears to be a remote possibility with the very thinly spread mental health treatment facilities available throughout the nation seemingly already overwhelmed by the demand for services (Noble, 1997; WHO, 2005). In urban areas the majority of the mentally ill seem left to cope as best they can on the streets, while in rural communities there would seem to be a growing reluctance, driven partly by fear and prejudice, among families and local residents to accept responsibility for caring for the mentally ill (Noble, 1997, p. 115).

The commission of an act of sorcery remains a criminal offence in PNG and sorcery’s customary influence and widespread practice has been given statutory recognition by the Sorcery Act 1971 (Papua New Guinea Law Reform Commission, 1977). This legislation allows a claim of being affected or influenced by sorcery to be used as a defence or partial excuse to certain criminal offences (see Chalmers, Weisbrot, & Andrew, 2001).

It is acknowledged that the perception of death by sorcery continues to be regarded as one of the principal precipitants of much of the tribal fighting and unrest in a number of areas of PNG (Chalmers et al., 2001, p. 604). Even more disturbing is the suggestion in recent reports by Amnesty International that in certain parts of PNG persons believed to be sorcerers or witches, including some who were suffering from a mental illness, have been brutally killed (Amnesty...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Notes on Contributors
• Series Editor’s preface
• 1. Introduction: from sorcery to stun guns and suicide: the eclectic and global challenges of policing and the mentally ill
• 2. Canadian police agencies and their interactions with persons with a mental illness: a systems approach
• 3. Tailoring the police response to people with mental illness to community characteristics in the USA
• 4. Current trends in policing and the mentally ill in Europe: a review of the literature
• 5. Policing and the mentally ill in China: challenges and prospects
• 6. The thin blue line of mental health in Australia
• 7. Police officer suicide within New South Wales Police Force from 1999 to 2008
• 8. International Police Executive Symposium
• Index