Introduction
It is estimated that 7% to 10%1 of all police encounters involve a person who has mental illness. Most of these encounters do not involve any violence, and some don’t involve a crime at all. People with mental illness are no more likely than anyone else to act violently. Despite this, police arrest, injure, and kill people with mental illness at higher rates than people without mental illness. And because of systemic inequities in health care access as well as rates of police contact, Black and Brown people– as well as LGBTQ+ people, young people, and those living in poverty–are particularly at risk of these harms when living with mental illness. People experiencing mental health emergencies are less safe when law enforcement are the primary responders. A public safety approach to mental health emergencies requires creating accessible and equitable systems to accommodate the needs of people who experience them, without unnecessary criminalization, institutionalization, or violence. Law enforcement officers are often the default responders to mental health emergencies—or situations in which a person’s safety and health or the safety and health of others—are at immediate risk due to their mental health symptoms. This has been the case since the 1960s, when government policies significantly scaled back the use of state mental health institutions and mental health hospitalization for outpatient treatment. This was followed by a successful effort by President Ronald Reagan to repeal most of a bill that would have funded community based mental health services, along with an expansion of incarceration and policing of low-level offenses. Today approximately 14.2 million adults live with a serious mental illness. In 2020, only 64.5% of those people received treatment, a failure driven by barriers to treatment such as insurers denying care, high out-of-pocket costs, lack of access to psychiatric medications, and mental health providers not being adequately reimbursed by insurance companies. The shift to a law enforcement response for mental health emergencies means that officers are now responsible for responding to situations they are not equipped to handle appropriately. When a person experiences a mental health emergency, their loved ones or bystanders may have no option other than to call 911 for help, at which point a dispatcher then makes a decision of whether to send police, EMT, or both. Officers are not trained or qualified to identify a mental health crisis; it can be difficult to distinguish symptoms of a mental health emergency from symptoms of other health crises such as drug overdose, hypoglycemic shock, or epileptic seizure, which require distinct kinds of care. This insufficient and inappropriate system for handling mental health emergencies is worsened by stigma surrounding mental illness, barriers to treatment, lack of culturally competent care, and the mental health impact of racism. As a result of these and other factors, including lack of treatment, housing, and other social services, people who experience mental health emergencies are routinely arrested. The routine criminalization of people with mental illness by police has serious consequences. Nearly 37% of people in state and federal prisons, and 44% of people in local jails, have been diagnosed with mental illness. In most states, police have the power not only to arrest people with mental illness but also to institutionalize people against their will. This can lead to people being subjected to inappropriate institutionalization: In 2016, a study in Alameda County, California, found that at least 75% of people who were subjected to an involuntary emergency psychiatric hold did not meet the medical criteria for such a response. Local governments’ reliance on police to respond to calls related to mental health issues—which includes emergencies as well as common public disturbance issues—can unnecessarily escalate a situation that wasn’t dangerous. Sending police to respond to mental health crises, or simply behavior that falls out of societal norms, can lead to preventable arrest, use of force, institutionalization, injury, or death: Since 2015, 21% of people killed by the police in the United States had a known mental illness. Systemic inequities make Black people more at risk of police violence in mental health emergency response. Because of racial disparities in rates of police contact, Black people, including those with mental illness, are more likely to interact with police. Additionally, nearly two out of every three Black people who need mental health care services do not receive them. Because of inequitable mental health care access and quality, Black people may be more likely to experience mental health emergencies that are handled with a police response. These inequities are compounded by the toll of police interactions themselves and societal racism, both of which have been shown to adversely impact mental health. All people who experience—or are at risk of experiencing—mental health emergencies deserve appropriate, accessible, and high-quality mental health diagnoses, treatment, and services. They deserve to be treated equitably, with dignity and compassion, in the least coercive and intrusive manner possible, and without having to fear violence or criminalization for seeking help or for exhibiting behavior that falls outside of social norms. The recommendations in this report guide communities and policymakers on how to achieve this vision of mental health emergency response and prevention. They acknowledge and aim to remedy the deep racism in the criminal legal system, mental health care systems, and social services that has made Black people who experience mental health emergencies more likely to be arrested, harmed by police, jailed, and denied access to appropriate health care. They also recognize the pervasive racism, sexism, and ableism that contribute to police and broader society perceiving certain behaviors as “disruptive” or threatening. They are grounded in the reality that police and criminal legal systems were not designed to—and should not handle mental health emergencies.