In recent years, the nation has seen a significant increase in attention drawn to the issues of mental illness and law enforcement. Typically, the media coverage of these two issues trigger feelings of sorrow, outrage, and resignation as U.S. citizens have watched the number of casualties rise in mass shootings, law enforcement officer fatalities, and civilian deaths due to an officer’s use of force. Even more striking is the story of the families who quietly watch the lives of their loved ones decline as they struggle to cope with their symptoms, feeling lost as they attempt to navigate a complicated care system. They suffer silently when their family member or friend is one of the 40,000 Americans each year to complete suicide or are hurt or killed as the result of a cry for help that escalated and required law enforcement use of force. (Twenty-five percent of the time, citizens who are fatally wounded during a law enforcement response are found to have been mentally ill)
Despite media attention that, at times, has correlated individuals with mental illness and law enforcement as a purely negative interaction, there is a hidden truth in our current mental health safety net: law enforcement are often the first response to cries for help from individuals with mental illness and their families, and responses to these calls are often the most time consuming and dangerous for officers. Knowing this, many states have legislated increased training for their officers using a nationally recognized best-practice called Crisis Intervention Training (CIT) that started in 1988 but only recently began to gain traction and national attention. At this time, over 2,700 communities in the U.S. have adopted required CIT training for their officers. Texas is currently leading the nation with its exemplary CIT programs in Houston and San Antonio. However, even with great training, officers are not equipped to act as mental health clinicians and at times may need additional resources when they address mental health related calls, especially when these calls may take hours to resolve.
An even less recognized resource for psychiatric crisis assistance is a mobile crisis outreach team (MCOT). While there are multiple variances of an MCOT, in its purest form it is a two-person team of mental health clinicians, usually master’s degree level, who respond with or without law enforcement to address psychiatric crisis wherever a person needs it, whether it be in their home or under a bridge. These teams usually respond to calls from a crisis hotline rather than 911 dispatch. An MCOT also has the capability to more easily link a client to appropriate community resources and support the individual as they begin the journey of mental health recovery.
Some communities partner specific law enforcement officers (usually CIT specialized) with MCOT clinicians as part of an organized unit. Others allow officers and MCOT to contact one another and request assistance on calls as needed. No matter how a community pairs their officers and MCOT clinicians, communities benefit from this alliance.
On many calls for assistance, the individual or their family is seeking resources, not hospitalization. In these instances, MCOT can take the call from officers and allow the officer to respond to other, more emergent calls and focus on their role of maintaining public safety. MCOT then can provide an on-site clinical risk assessment as well as the support and connection to resources that the individual desperately needs. In some communities, MCOT professionals are also able to provide follow-up over a seven to 30-day period of time, allowing the MCOT to confirm that the person’s crisis is resolved and the person is linked to appropriate ongoing care. This decreases the likelihood that the person will make another call for law enforcement services, get admitted to a psychiatric facility, or become incarcerated.
Due to the unpredictable nature of many mental health related calls, officer presence is often needed to maintain safety for the MCOT, family, and client on location. In instances where an individual is deemed to be a danger to themselves or those around them, officers may also assist in transport to the nearest appropriate emergency department or psychiatric hospital. Even when MCOT and officers address calls requiring hospitalization together, the overall time an officer is off the street on a mental health call is often decreased. MCOT clinicians can assist the family and client in understanding the hospitalization process, obtain appropriate hospital resource placement for the client, and stay at the hospital emergency department (ED) with the patient to advocate for care and communicate with providers. Without an MCOT, officers may have to sit in an ED for hours waiting to transfer custody and speak to a medical professional about the client’s needs. In communities that are consistently understaffed in their law enforcement jurisdications, the wait time in an ED can be costly in not only overtime but also in overall public safety.
Officers often hold a significant amount of information about the lives and needs of the citizens in their service area. In many communities, officers have made at least one call for service to the homes of the individuals with mental illness in their communities and may have established relationships with them over repeated contacts. Because of this increased rapport and knowledge, officers can find themselves frustrated when they feel they are not able to get someone to care who is not currently meeting hospitalization or emergency detention criteria. These individuals are on the cusp of a crisis that could either result in hospitalization or detention in jail, but due to the reactionary nature of most mental health and justice systems, the person may not be able to get urgent care at that time. MCOT can bridge this gap, working with officers to identify and serve these individuals prior to the point of crisis, also diverting individuals from potential incarceration or hospitalization. Officers may also find that addressing these individuals “pre-crisis” could improve rapport with citizens in their districts and decrease overall instances requiring use of force.
The partnership between law enforcement and mental health clinicians is imperative as law enforcement find themselves addressing increasing calls that are mental health related. The relationship is often a symbiotic one, with officers and MCOT working together to meet all the needs of the individual. However, most communities find that limited capacity in both law enforcement and mental health resources is a barrier to providing this level of care, despite the long-term cost savings to the community. Thankfully, legislators have begun to recognize the need for expanded resources and improved access to care, and they are working to pass legislation to improve the overall structure of the mental health safety net. Pennsylvania congressman Tim Murphy is one such legislator, submitting bill H.R. 3717 to the house floor in 2013. The “Helping Families in Mental Health Crisis Act” pledges to increase training for law enforcement officers and add crisis and outpatient capacity for the mentally ill and is gaining support in the House. Hopefully, with added resources and legislative support, law enforcement and mental health clinicians will be able to advance their budding partnerships to increase public safety and quality of life for individuals with mental illness and their families.
 American Association for Suicide Prevention: afsp.org/understanding-suicide/facts-and-figures
 National Alliance for Mental Illness: nami.org/cit
 National Alliance for Mental Illness: nami.org/cit
 Mental Health Channel: mentalhealthchannel.tv/episode/the-right-response
 Helping Families in Mental Health Crisis Act: murphy.house.gov/helpingfamiliesinmentalhealthcrisisact#Bill%20Information