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Managing

Police-Mental Health Collaboration (PMHC) Toolkit

Managing Police-Mental Health Collaborations

A comprehensive PMHC program affects several different law enforcement functions. Many agencies designate an individual to be the program manager or coordinator. The program manager’s role requires a person with targeted experience and knowledge to coordinate the diverse components of the PMHC program. For smaller agencies, the program manager’s role can be collateral duty. In other agencies, it may be a part-time or a full-time position. Some of the nation’s mid-sized and larger agencies have established organizational units or divisions to demonstrate that the PMHC program is an agency priority. This also allows the agency to enhance program coordination and oversight.

This section provides an overview of the agency functions that play a key role in ensuring the success of the PMHC program, including:

  • Policies and Procedures
  • Call-taking and dispatching procedures
  • Protocols to divert individuals from the criminal justice system
  • Partnership agreements with mental health providers
  • Information-sharing protocols

Sharing Program Management with Community Partners

PMHCs benefit when law enforcement collaborates with, and are inclusive of, mental health service delivery partners and mental health advocates—including people living with mental illnesses and their families. Including community organizations and advocates as partners raises awareness of program successes and enhances community trust in the program.  These partners can also help sustain the program over the long term by seeking funding opportunities, cultivating champions or educating elected officials.  Ensure these stakeholders are engaged as equal partners in your taskforce or steering committee.

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Policies and Procedures

Written policies and procedures play an important role in the overall management and success of a PMHC program. They provide law enforcement agency employees with a clear understanding of the PMHC program by:

  • Affirming agency principles.
  • Delineating procedures for carrying out program activities.
  • Providing critical information for working with mental health partners.

Some agencies use one written directive for the entire program, while others reference the PMHC program in several, relevant directives.

Examples of Policies

Call Taking and Dispatching

Call takers and dispatchers are key partners in the successful management and coordination of a PMHC program. 911 emergency dispatch centers are often the first point of contact for mental health calls for service. Determining that mental illness is a factor in a call for service is an essential first step to providing appropriate police response. To facilitate coordination between the PMHC program and dispatch center, many agencies have developed protocols and specific questions to aid call takers and dispatchers gather critical information, which is then conveyed to the officers. This is essential for officer safety and will allow for consideration of the most appropriate response.

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Community-based Resources

Community-based mental health resources and services play key roles in the operations and success of PMHC programs by offering immediate alternatives to incarceration for people with mental illness. To that end, many communities are establishing crisis care centers, which reduce overreliance on both jail and hospital emergency rooms and allow officers to return to service in a timely manner.

Carefully cultivating and managing relationships with mental health care providers ensure that officers are aware of these resources and use them in accordance with rules and admission criteria.

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Partnership Agreements

The success of these programs often rests on the ability of law enforcement and mental health agencies to effectively work together. Interagency agreements, such as memorandums of understanding (MOUs) are effective mechanisms to:

  • Delineate role and responsibilities
  • Identify resources to be contributed
  • Document joint policies and procedures

One of the challenges to collaboration is sharing an individual’s information between law enforcement and mental health providers. However, this can be addressed through an agreement such as a memorandum of understanding or an information-sharing agreement, or another type of interagency agreement. What is of critical importance, is that collaborating partners have a clear understanding of what information can and cannot be shared. The agreed-upon protocols should then be documented within the partnership agreement.

Information Sharing

Examples of MOUs

FAQs

Managing

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 t​o 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:

  1. Are you aware of or does the person have mental health issues?
  2. 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 pos​sible 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.

Focused Tools for Law Enforcement

Many communities struggle with the PMHC program design process. Communities are unsure how to design and develop a PMHC program that meets their distinct needs and challenges. One way to increase knowledge of PMHCs, is to review programs that other jurisdictions have developed and tailor those programs to your specific community needs.

Law Enforcement agencies interested in expanding their knowledge base, starting, or enhancing a PMHC, can contact The U.S. Department of Justice’s Bureau of Justice Assistance (BJA) or BJA’s Training and Technical Assistance (TTA) Provider. BJA supports these urban and rural police departments to act as host-sites to visiting law enforcement agencies and their mental health partners.

Located across the country, these learning sites represent a diverse cross-section of perspectives and program examples and are dedicated to helping other jurisdictions improve their responses to people with mental illnesses.

Opportunities

The ten learning sites host site visits from interested colleagues and other local and state government officials, answer questions from the field, and work with BJA’s TTA provider to develop materials for practitioners and their community partners.

TTA is provided to law enforcement agencies and their community partners in an effort to assist with the development or implementation of PMHC strategies. Supplemental funds can be made available to agencies that are interested in visiting the learning sites. This is a focused approach intended to provide your agency with access to outstanding peer resources for police-mental health collaboration programs.

To request TTA and receive confirmation within 36 hours of your request

For frequently asked questions about the Law Enforcement Mental Health Learning Sites, access the TA FAQs.

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Law Enforcement Learning Sites

Support jurisdictions in exploring strategies to improve the outcomes of encounters between law enforcement and people who have mental illnesses.

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Please submit questions, policies and training materials that can benefit others for review and consideration.

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