Individuals with mental illnesses who come into contact with law enforcement often require an array of services and supports such as medication management, counseling, substance abuse treatment, benefits and financial management, housing, crisis services, peer supports, case management, and inpatient treatment. Several of these services are beyond the immediate concerns of officers when they transfer custody of a person to mental health providers, but PMHC program managers should work with community providers to understand how these services might influence the availability of diversion options for officers.
PMHC program managers and mental health counterparts should identify ways to improve access to mental health services when officers transfer a person with mental illness. This may entail streamlining the custody transfer process at a mental health intake facility. Law enforcement should have easy access to twenty-four-hour drop-off facilities or emergency rooms to facilitate the individual's swift access to mental health services and allow officers to return quickly to duty. The necessity of medical clearance requires program managers to develop procedures that guarantee timely assessment, ensure the safety of other patients and staff, and facilitate a smooth transition to the appropriate mental health resource.
Because many individuals with mental illnesses who come into contact with law enforcement have co-occurring disorders (having both mental health disorders and substance use disorders), the availability of integrated treatment approaches is essential to achieve clinical and public safety objectives. PMHC program managers and mental health counterparts should consider how the PMHC program can connect individuals with co-occurring disorders to integrated treatment and should advocate for greater access to evidence-based practices for those dually diagnosed.
Special considerations include histories of trauma which are common in justice-involved populations. As such, both the on-scene response of law enforcement and subsequent clinical responses must be trauma informed. PMHC program managers and mental health counterparts should pay special attention to the service needs of racial and ethnic minorities and women by making culturally competent and gender-sensitive services available to the extent possible.
The sharing of information between law enforcement and mental health providers is a necessary component to a successful PMHC program. By opening doors for communication and outlining procedures on how to do so, the information-sharing agreement provides a framework for the PMHC program team and mental health providers to collaborate. Uncertainty about legal requirements is lessened and common goals are introduced allowing outcomes to improve.
Information-sharing decreases disruption in and duplication of healthcare services and therefore results in longer periods of mental health stabilization. This in turn causes a decline in the individual's involvement in criminal activity and subsequent repeat calls for service. Ultimately, information-sharing assuages the cost of care absorbed by the healthcare and criminal justice systems and law enforcement.
Information should be shared when it increases safety to the individual, staff, and public. It should also be shared to improve access to and quality of mental healthcare, e.g. to help mental health providers make sound treatment decisions including appropriate referrals and interventions. The information-sharing agreement is not meant to facilitate sharing for purposes of research, or to aid in an investigation.
It is important for the agreement to be in writing. As information will inevitably be shared, a written agreement decreases the opportunity for a legal violation of information-sharing law, thereby decreasing liability. Additionally, written protocols transforms information-sharing efforts from being voluntary to mandatory. By lessening confusion which stems from "inherited" verbal protocol, an agreement is more likely to stand the test of time if it is in writing.
The agreement should state the purpose of sharing information and outline procedure to do so. It should discuss the obligations of both parties, describe associated training, and provide provisions for oversight and sustainability.
The dispatch function plays a critical role in PMHC programs by providing information about calls to officers, and then documenting the number of mental health calls and their dispositions. Agencies should focus on five steps to align the dispatch function with the PMHC program.
Train call takers and dispatchers in mental health knowledge and gathering critical information
Specialized training for call takers and dispatchers is critical to officer and consumer safety. This training provides tools to identify calls that may involve a person with a mental illness, gather important information about the situation from the caller (for example the person's previous reactions to law enforcement, the person's medication status, any history of violence) and provide that information to responding officers.
Provide dispatchers with questions that help determine whether mental illness is relevant to the call for service.
Dispatchers should use a small number of standardized questions to aid the information-gathering process. These questions should also assess, when possible, if co-occurring disorders (having both mental health disorders and substance use disorders) or other issues are relevant to the call for service. For example, dispatchers in the Harris County (TX) Dispatch Center ask every caller two questions:
- Are you aware of or does the person have mental health issues?
- Is this call in reference to the person's mental state?
Provide dispatchers with tools that determine whether the situation involves violence or weapons.
As in all calls, dispatchers should gather information to assess safety issues that the responding officer might encounter, including whether weapons are involved, whether the person poses a danger, if the person with mental illness is at risk of being victimized, and whether there is a history of violence. Some agencies "flag" certain locations in the Computer Aided Dispatch (CAD) system, and when dispatching the call, provide this additional information to the responding officers.
Provide dispatchers with a flowchart to facilitate dispatch of the call to designated personnel.
Dispatchers should be given a flowchart that states clearly who should respond when calls for service may involve people with mental illnesses. Dispatchers should provide all of the essential information to the appropriate responding officer, including whether mental illness may be a factor, so that officers are able to respond effectively to a call for service.
Use designated codes and appropriate language when dispatching the call.
Whether using a 10-code system, "plain speech," or a combination of the two when dispatching calls for service over the radio, officers should be provided meaningful information on the type of call to which he or she is responding as a means of protecting the safety of both the officer and the consumer. Dispatchers and officers should use only designated codes and/or appropriate language when communicating over the radio. Properly identifying mental health calls for service is critical to measuring the number of calls, their location throughout the jurisdiction by time and geography, and the identification of repeat encounters.
The PMHC program manager is designated to assume primary responsibility for implementing and sustaining the PMHC program, both within and outside the agency. The manager should be identified as early as possible during the planning and design stages of the PMHC program to ensure that one person has the authority to implement strategies that promote agency-wide buy-in and serve as the liaison with collaborative partners and stakeholders.
Many agencies designate a mid- or senior-level manager, while other agencies have relied upon patrol officers to fill this critical role. While rank may be necessary in larger agencies, nothing can replace what is perhaps the most essential requirement for the position—a belief in the purpose of the PMHC program and what it will accomplish. They must provide leadership for the program and be an advocate for its success. For this reason, the most successful PMHC program managers often are referred to as a "Program Champions."
The manager will serve many roles as they collaborate with other key individuals. Specific tasks and assignments will vary depending on the needs and resources of the law enforcement agency and mental health partners, but managers can expect to provide direction and contribute to planning, problem-solving, training, community relations, creating policy and procedure, information management, data collection and analysis, call-taking and dispatch, and legal analysis.