Resolution: F-20-13: SUPPORT OF DE-ESCALATION TRAINING, MENTAL HEALTH AWARENESS, AND CRISIS INTERVENTION EDUCATION FOR LAW ENFORCEMENT

[Valerie Lile]

1  WHEREAS, mental health issues in the United States are rising, with mood disorders being the
2  most common cause of hospitalization for all people under age 45 and mental health and
3  substance use disorders comprising 1 out of every 8 emergency department visits or an estimated
4  12 million visits^1,2; and

5  WHEREAS, mental health or substance use disorders are prevalent in a wide range of
6  populations, including 41% of Veteran’s Health Administration patients^1,3, 70.4% of youth in the
7  juvenile justice system^1,4, 20.1% of people experiencing homelessness^1,5, and 37% of adults
8  incarcerated in the state and federal prison systems^1,6; and

9  WHEREAS, mental health disorders can affect a person’s ability to interact or relate to others
10  and function in daily life⁷; and

11  WHEREAS, a psychiatric crisis differs from other medical crises because of the risk of harm to
12  others and this potential threat to the public is taken into account in psychiatric assessment^8,9,10,11;
13  and

14  WHEREAS, police officers are increasingly on the front lines of mental health intervention and
15  can be the gatekeepers between a person in crisis and psychiatric evaluations and treatment^12,13;
16  and

17  WHEREAS, police are most often the first-line responders to those suffering from a psychiatric
18  crisis, yet negative interactions between individuals with mental health conditions and law
19  enforcement are widely reported and frequently tragic^14,15,16; and

20  WHEREAS, at least 1 in 10 calls to police involves a person with a mental health condition and
21  if police respond to a call involving a person with an untreated mental health condition they
22  are 16 times more likely to be killed by law enforcement ^15,16; and

23  WHEREAS, the American Public Health Association has declared law enforcement violence to
24  be a public health issue that disproportionately affects individuals with mental health and
25  substance use disorders as well as marginalized populations such as people of color, immigrants,
26  individuals experiencing houselessness, people with disabilities, and the lesbian, gay, bisexual,
27  transgender, and queer (LGBTQ+) community¹⁷; and

28  WHEREAS, research shows that a lack of appropriate training leads to an escalation in violence,
29  and mental health training is essential to improving interactions between law-enforcement
30  officers and people with mental health conditions¹⁸; and

31  WHEREAS, law enforcement has previously implemented new training measures and created
32  specialized units to meet the evolving needs of the community they serve, such as hostage or
1  crisis negotiation teams^19,20,21,22, cyber or computer crimes units^23,24,25, and counterterrorism
2  divisions^26,27; and

3  WHEREAS, there is no nation-wide protocol or requirement to utilize de-escalation strategies
4  for police officers responding to a person with a mental health disorder^16,28; and

5  WHEREAS, A National Survey of Police found the median amount of time spent in mental
6  health training comprised only 20 hours of academy training and just 4 hours of post-academy
7 training, even though police officers have become the first-line responders to those suffering
8 from a psychiatric crisis ^14,29; and

9 WHEREAS, the majority of mental health training offered to law enforcement is delivered by a
10 police officer in place of a social worker or psychologist, even though these healthcare
11 professionals help develop the curriculum²⁹; and

12 WHEREAS, a study of 128 police departments found that only 15% currently use social
13 workers alongside officers when responding to mental health calls

14  WHEREAS, some law enforcement jurisdictions have started implementing de-escalation
15  training or creating Crisis Intervention Teams (CITs) that include mental health specialists who
16  are dispatched with police on calls involving mental health crises^{13,30,31,32,33}; and

17  WHEREAS, de-escalation training and CITs aim to reduce the risk of serious injury or death
18  during an emergency interaction between police officers and persons with mental health
19  conditions by providing the person(s) with mental health and/or substance use disorder access to
20  medical treatment rather than placing them within the criminal justice system due to illness-
21  related behaviors”^13,30,34,35; and

22  WHEREAS, nearly 40% of officers and 50% of Chiefs and Sheriffs report that their agency
23 does not have specialized resources to respond to people in mental health crisis, but 64% of
24 officers say that de-escalation tactics (including CIT training) are one of the top 3 strategies they
25 use on mental health calls²⁹; and

26  WHEREAS, CIT trained officers become better able to identify mental health crises and refer
27  more often to mental health services with subsequent decreased arrest rates^13,34,36; and

28 WHEREAS, in Eastern Maryland, when police dispatch was tied to a mental health services
29 hotline this led to triaging 30-40% of calls to the mental health services, avoiding police response
30 in these situations, and demonstrating a primary need for mental health services on police calls³³;
31 and

32  WHEREAS, application of CIT training does not come at the expense of officer safety and may
33  even decrease the injury rate of police officers during mental crisis calls³⁶; and

34  WHEREAS, CIT training has shown benefits in officer-level outcomes including greater job
35  satisfaction, improved self-perception, and a sense of increased job efficacy among police
1  officers and decreased stigma of police officers in the communities they serve^13,37; now,
2  therefore, be it

3  RESOLVED, that the Student Osteopathic Medical Association (SOMA) recognize police
4  violence against communities affected by mental health disorders and other disparities as a
5  public health issue; and be it further

6  RESOLVED, that the American Osteopathic Association (AOA) recognize police violence
7  against communities affected by mental health disorders and other disparities as a public health
8  issue; and be it further

9  RESOLVED, that SOMA advocate in support of legislation that uses evidence-based practices
10  for police training and improving education that reduces the negative outcomes between officers
11  and those with mental health disorders; and be it further

12  RESOLVED, that the AOA support legislation that encourages continued best practices between
13  police training and education that reduces the negative outcomes between officers and those with
14  mental health disorders; and be it further

15  RESOLVED, that SOMA advocate to the AOA to partner with the National Police Foundation
16  and state level agencies to help further research in police interactions and health and develop
17  national guidelines on how law enforcement can more effectively and humanely interact with
18  marginalized individuals.

Relevant Existing Policies:

AOA policy H406-A2018: Healthy LifeStyles

• states that it would work with congress and related state and federal health care agencies to develop guidelines that help develop a healthy lifestyle, including proper care for mental health
• Source http://policysearch.wpengine.com/wp-content/uploads/H406-A2018-HEALTHY-LIFE-STYLES.pdf

AOA policy H440-A/16: Substance use Disorders Evidence Based Treatment Programs

• states that the AOA will work “collaboratively with law enforcement agencies to implement evidence-based referral resources” for substance use disorder
• Source: http://policysearch.wpengine.com/wp-content/uploads/H440-A2016-SUD-EVIDENCE-BASED-TREATMENT-PROGRAMS.pdf

AOA policy H338-A/16: BEHAVIORAL HEALTH PATIENTS IN EMERGENCY DEPARTMENTS

• states “American Osteopathic Association (AOA) supports legislative and other efforts to ensure adequate funding of behavioral health services in the state and will support actions, including federal, state or local legislation or regulation, that improve access to and continuity of behavioral health care services in local communities and that maintain stability of established patient-physician relationships”

• highlights the importance of continuity of behavioral health care services. Law enforcement is often involved within that continuity of care and needs to have adequate training and resources in order to reduce negative outcomes for patients with mental illness
• Source: http://policysearch.wpengine.com/wp-content/uploads/H338-A2016-BEHAVIORAL-HEALTH-PATIENTS-IN-EMERGENCY-DEPARTMENTS.pdf

AOA Policy H433-A/15: MINORITY HEALTH DISPARITIES

• states the AOA supports “the identification and integration of available resources to better serve minority communities, including houses of worship, schools and local government”
• Source: http://policysearch.wpengine.com/wp-content/uploads/H433-A2015-MINORITY-HEALTH-DISPARITIES.pdf

References:

1. National Alliance on Mental Illness (NAMI) . (2019, September). Mental Health By the Numbers. Retrieved August 27, 2020 from https://www.nami.org/mhstats.
2. Owens, P. L., Mutter, R., & Stocks, C. (2010, July). Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007: Statistical Brief #92. Agency for Healthcare Research and Quality. Retrieved from https://www.hcup-ahrq.gov/reports/statbriefs/sb92.pdf.
3. Suicide Among Veterans and Other Americans. (2016, August). S. Department of Veterans Affairs. Retrieved September 23, 2020, from https://www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf
4. Feye, A., Keator, K. J., MPH, Phillippi, S., PhD, & Irons, A., JD. (2020, January). Caring for Youth with Behavioral Health Needs in the Juvenile Justice System: Improving Knowledge and Skills of the Professionals Who Supervise Them. National Center for Youth Opportunity and Justice. Retrieved September 23, 2020, from https://ncyoj.policyresearchinc.org/img/resources/CaringforYouthwithBehavioralHealthNeedsinJJ-946799.pdf
5. S. Department of Housing and Urban Development (2018, November). HUD 2018 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations. Retrieved from: https://files.hudexchange.info/reports/published/CoC_PopSub_NatlTerrDC_2018.pdf
6. Bronson, J., Berzofsky, M. (2017, June). U.S Department of Justice. Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-12 (Special Report NCJ 250612). Retrieved from: https://www.bjs.gov/content/pub/pdf/imhprpji1112.pdf
7. Center for Disease Control (CDC). (2018, December 20). Learn about mental health- mental health- CDC. https://www.cdc.gov/mentalhealth/learn/index.htm.
8. Substance Abuse and Mental Health Services Administration (SAMHSA). (2020). National guidelines for behavioral health crisis care. Best practice https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf

9. Tarasoff vs. Regents of University of California. Justia US Law. 17 Cal. 3d 425 https://law.justia.com/cases/california/supreme-court/3d/17/425.html
10. Law School Case Brief: Tarasoff v. Regents of Univ. of Cal. LexisNexis. https://www.lexisnexis.com/community/casebrief/p/casebrief-tarasoff-v-regents-of-univ-of-cal
11. Campbell M, Quinones-Betancourt C. (2010). The Impact of Social Science Evidence in Predicting Dangerousness and Establishing a Duty to Warn. Cornell University Law School Social Science and Law. https://courses2.cit.cornell.edu/sociallaw/student_projects/DutytoWarn.html
12. Wood J, Beierschmitt L. Beyond police crisis intervention: Moving “upstream” to manage cases and places of behavioral health vulnerability. Int J Law Psychiatry. 2014;37(5):439-447. doi:10.1016/j.ijlp.2014.02.016 https://doi.org/10.1016/j.ijlp.2014.02.016
13. Rogers MS, McNiel DE, Binder RL. Effectiveness of Police Crisis Intervention Training Programs. J Am Acad Psychiatry Law. 2019;47(4):414-421. doi:10.29158/JAAPL.003863-19 http://jaapl.org/content/early/2019/09/24/JAAPL.003863-19
14. Krameddine YI, Silverstone PH. How to Improve Interactions between Police and the Mentally Ill. Front Psychiatry. 2014;5:186. https://doi.org/10.3389/fpsyt.2014.00186
15. Fuller, D., Lamb, R., Biasotti, M., & Snook, J. (2015, December). Treatment Advocacy Center (Rep.). Retrieved September 25, 2020, from Office of Research and Public Affairs website: https://www.treaorg/storage/documents/overlooked-in-the-undercounted.pdf
16. Fuller, D., Lamb, R., Biasotti, M., & Snook, J. (2015, December). Treatment Advocacy Center (Rep.). Retrieved September 25, 2020, from Office of Research and Public Affairs website: https://www.treaorg/storage/documents/overlooked-in-the-undercounted.pdf
17. American Public Health Association. (2018). Addressing Law Enforcement Violence as a Public Health Issue. (APHA No. 201811). https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/29/law-enforcement-violence.
18. Prenzler, T., Porter, L., & Alpert, G. P. (2013). Reducing Police Use of Force: Case Studies and Prospects. Aggression and Violent Behavior, 18(2), 343-356. https://doi.org/10.1016/j.avb.2012.12.004
19. Conlon, E. (2018, November 09). “Talk to Me:” The NYPD Hostage Negotiation Team. Retrieved September 25, 2020, from https://www1.nyc.gov/site/nypd/news/f1108/-talk-me-nypd-hostage-negotiation-team
20. Thompson, J., & McGowan, H. (2014, August). “Talk To Me”: What It Takes To Be An NYPD Hostage Negotiator. Retrieved September 21, 2020, from https://www.mediate.com/articles/ThompsonJ11.cfm
21. Vecchi, G. M., Hasselt, V. B., & Romano, S. J. (2005). Crisis (hostage) negotiation: Current strategies and issues in high-risk conflict resolution. Aggression and Violent Behavior, 10(5), 533-551. https://doi:10.1016/j.avb.2004.10.001 https://leb.fbi.gov/articles/featured-articles/crisis-or-hostage-negotiation-the-distinction-between-two-important-terms

23. Cybersecurity Unit. (2020, March 12). Retrieved September 21, 2020, from https://www.justice.gov/criminal-ccips/cybersecurity-unit
24. Cyber Crimes Center. (2019, February 28). Retrieved September 25, 2020, from https://www.ice.gov/cyber-crimes
25. The Cyber Threat. (2016, May 03). Retrieved September 25, 2020, from https://www.fbi.gov/investigate/cyber
26. Davis, L., Pollard, M., Ward, K., Wilson, J., Varda, D., Hansell, L., & Steinberg, P. (2010). Long- Term Effects of Law Enforcement’s Post-9/11 Focus on Counterterrorism and Homeland Security. Santa Monica, CA; Arlington, VA; Pittsburgh, PA: RAND Corporation. Retrieved September 21, 2020, from http://www.jstor.org/stable/10.7249/mg1031nij https://www.ncjrs.gov/pdffiles1/nij/grants/232791.pdf

27. National Counterterrorism Center. (2017, August). Today’s NCTC. https://www.dni.gov/files/NCTC/documents/features_documents/NCTC-Primer_FINAL.pdf
28. Abanonu, R. (2018). De-escalating Police-Citizen Encounters. Review of Law and Social Justice, 27, 240–260. https://gould.usc.edu/students/journals/rlsj/issues/assets/docs/volume27/Summer2018/3.Abanonu.pdf

29. Fiske ZR, Songer DM, Schriver JL. A National Survey of Police Mental Health Training. J Police Crim Psych. July 2020. https://doi:10.1007/s11896-020-09402-1
30. CIT International. CIT International – What is CIT? https://www.citinteorg/What-is-CIT.
31. Steadman, H. J., Search for more papers by this author, Deane, M. W., Borum, R., Morrissey, P., Rosenbaum, N., … Lamb, H. R. (2000, May 1). Comparing Outcomes of Major Models of Police Responses to Mental Health Emergencies. https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.51.5.645.
32. Kane, E., Evans, E., & Farhad Shokraneh, F. (2019, June). The crime, mental health, and economic impacts of prearrest diversion of people with mental health problems: A systematic review. Criminal behaviour and mental health. https://doi.org/10.1002/cbm.2058
33. Kane, E., Evans, E., & Farhad Shokraneh, F. (2019, June). The crime, mental health, and economic impacts of prearrest diversion of people with mental health problems: A systematic review. Criminal behaviour and mental health: https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201600348. Accessed August 27, 2020

34. Kane, E., Evans, E., & Farhad Shokraneh, F. (2019, June). The crime, mental health, and economic impacts of prearrest diversion of people with mental health problems: A systematic review. Criminal behaviour and mental health : CBMH. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850079/.
35. Dupont, R., & Cochran, S. (2000). Police response to mental health emergencies–barriers to change. The Journal of the American Academy of Psychiatry and the Law, 28(3), 338–344.
36. Compton, M. T., Bakeman, R., Broussard, B., Hankerson-Dyson, D., Husbands, L., Krishan, S., Stewart-Hutto, T., D’Orio, B. M., Oliva, J. R., Thompson, N. J., & Watson, A. C. (2014). The police-based crisis intervention team (CIT) model: II. Effects on level of force and resolution, referral, and arrest. Psychiatric services (Washington, D.C.), 65(4), 523–529. Retrieved September 21, 2020 from https://doi.org/10.1176/appi.ps.201300108
37. Bonfine, N., Ritter, C., Munetz, & Mark R. (2014). Police officer perceptions of the impact of Crisis Intervention Team (CIT) programs. International Journal of Law and Psychiatry, 37(4), 341-350. Retrieved September 21, 2020 from https://doi.org/10.1016/j.ijlp.2014.02.004

 

Submitted by: Political Affairs Task Force

Pauline Wiltz, OMS II – Pacific Northwest University of Health Sciences College of Osteopathic Medicine
Maya Braden, OMS II – Michigan State University College of Osteopathic Medicine
Sarah Fagan, OMS III – Touro University College of Osteopathic Medicine – Nevada
Hannah Norton, OMS II – Campbell University School of Osteopathic Medicine
Trey Shaughnessy, OMS II – Michigan State University College of Osteopathic Medicine
Sahar Bhai, OMS II – Midwestern University Chicago College of Osteopathic Medicine
Rachna Chaudhari, OMS III – Marian University College of Osteopathic Medicine
Aerial Petty, OMS III – Alabama College of Osteopathic Medicine
Austin Smarsh, OMS III – Alabama College of Osteopathic Medicine
Heather Jao, OMS II – Burrell College of Osteopathic Medicine
Catherine Lower, OMS II – Alabama College of Osteopathic Medicine
McKenzie Kneeling-Garcia, OMS III – Pacific Northwest University of Health Sciences College of Osteopathic Medicine
Varshini Venkatesan, OMS III – Midwestern University Arizona College of Osteopathic Medicine
Sidra Ali, OMS II – Burrell College of Osteopathic Medicine
Matthew Braun, OMS II – Pacific Northwest University of Health Sciences College of Osteopathic Medicine
Jenna Seely, OMS III – Pacific Northwest University of Health Sciences College of Osteopathic Medicine
Trevor Belavek, OMS II – Michigan State University College of Osteopathic Medicine
Katherine Taylor, OMS II – Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine – Tampa Bay
Furzan Azam, OMS III – A.T. Still University College of Osteopathic Medicine
Emily Chin, OMS IV – Edward Via College of Osteopathic Medicine – Auburn
Jennifer S. Lee, OMS IV – Touro College of Osteopathic Medicine – Middletown

 Action Taken:
Date:
Effective Time Period: Ongoing

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