Planning and Implementing a Police-Mental Health Collaboration Program
Effective PMHC programs share a common adherence to the essential elements, but they also differ in some important ways resulting from the variations generally stemming from a community’s needs, resources and limitations. To develop the appropriate type of PMHC program, each community should embark on a planning and discovery process that reflects their unique characteristics.
This section provides an overview of planning and implementing a PMHC program. It focuses on the importance of leadership by chiefs and sheriffs, working collaboratively with mental health and community stakeholders, and a using a multi-step program design process.
Strong leadership is essential for planning and implementing a PMHC program. Law enforcement leaders, chiefs, sheriffs, and directors must make the PMHC program a priority in their own agencies; ensuring qualified personnel and resources are in place to support the planning and implementation process.
Chiefs and sheriffs are in unique positions to provide leadership for a collaborative approach that includes engaging other community stakeholders to ensure effective planning and implementation of a PMHC program. They have the ability to convene other, external leaders with operational decision-making authority from each of the stakeholder agencies, as well as community representatives to form a multidisciplinary executive-level planning committee. This committee would be charged to examine the local challenges and determine the program’s goal, objectives, and design to ensure its development and continuity.
Agency leaders on the planning committee must designate appropriate staff to comprise a program coordination group, which would be responsible for overseeing the day-to-day activities. In some jurisdictions, the two bodies may be the same—particularly those with small agencies, in rural areas, or with limited resources.
Strong support from the behavioral health care agency executive and management staff is essential to a successful PMHC. This support requires a continuous recognition from the director and executive-level staff that the collaboration is an agency priority and is critical to the agency’s mission. When successful, leadership assigns qualified personnel and resources to the PMHC including a designated manager to oversee the operations and serve as the liaison between behavioral health care services, and law enforcement. Champions from the board of directors may also further reinforce these efforts by advocating for the agency’s ongoing commitment to the PMHC and influencing how resources and funds are allocated.
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Partnering with People with Mental Illness and Family Members
People living with mental illness, their family members and advocates are essential partners in police mental health collaborations at every step of program design and implementation. These stakeholders have been directly affected by the mental health crises, and can provide insight into how law enforcement interactions are experienced by the people in crisis and offer ways to improve response. People with mental illnesses and their families can share first-hand learning during PMHC training by sharing their personal experiences. Last, mental health advocates are experts at building relationships and advocating for needed mental health services.
Meeting the challenges associated with police response to people with mental illnesses requires the commitment and participation of many community stakeholders. Stakeholders are those people or entities who are affected, or could be affected, by the service being provided. Stakeholders are individuals, groups, organizations, government departments, and businesses, anyone with a stake or a vested interest in improving responses to people with mental illnesses. They play critical roles in identifying resources and strategies for a PMHC program.
Local partners for the law enforcement agency should include:
- Mental health service providers
- Mental health consumers and their family members and loved ones
- Mental health advocates, such as NAMI
- Other area law enforcement professionals
- Substance abuse treatment providers
- Homeless advocates and housing officials
- Hospital and emergency room administrators
- Other criminal justice personnel such as prosecutors and jail administrators
- Elected officials
- State, local, and private funders
- Community members
In addition to local stakeholders, national-level organizations and associations, such as the National Alliance on Mental Illness (NAMI) and the National Council on Behavioral Health, provide guidance and resources, which can be adapted to each community.
National Behavioral Health and Criminal Justice Organizations
Here is list of national organizations with resources and materials for PMHC programs
Program Design and Implementation
The PMHC program design must be specific to the unique characteristics of the community being served. Each location is characterized by different people, cultures, skills and resources, and the best approach takes these characteristics into consideration. In addition, the program design must be guided by the problem (as described by consumers, committee members or provided credible data sources) in that jurisdiction. There is no “one-size-fits-all” approach that will work in every community.
Further, it is vital that the leaders in law enforcement, mental health, and consumer advocacy understand what obstacles they must overcome to outline steps for the development and success of an appropriate and effective PMHC program. Also, it is important to identify those agency strengths and resources that can address and overcome the identified obstacles.
The key steps to consider are listed here. For a more detailed discussion please see: “Improving Responses to People with Mental Illnesses: Tailoring Law Enforcement Initiatives to Individual Jurisdictions.”
Checklist of Key Steps for Planning, Designing, and Implementing a Police-Mental Health Collaboration Program
Step 1: Understand the problem
- What environmental and community forces are driving current efforts to improve the law enforcement response to people with mental illnesses?
- What data can the planning committee members examine to understand the factors influencing law enforcement responses to people with mental illnesses? Refer to Police-Mental Health Collaborations: Implementing Effective Law Enforcement Responses for People Who Have Mental Health Needs for guidance on collecting and analyzing data for PMHCs.
- What concerns have been raised by people living with mental illnesses, family members and mental health advocates?
Step 2: Articulate program goals and objectives
- What are the program’s overarching goals?
- What are the program’s objectives?
- How will the program serve people experiencing mental illness in your community?
- How will the program support public safety?
- How will program development include community perspectives and buy-in?
Step 3: Detail jurisdictional characteristics and their influence on program responses
- What law enforcement agency resources are relevant in planning a PMHC program?
- What mental health system resources are relevant in planning a PMHC program?
- What resources do mental health advocacy organizations have to offer in planning a PMHC program?
- What information is available from trained peer specialists familiar with your local social service system and criminal justice system?
- What state laws are relevant in planning a PMHC program?
- What demographic and geographic community considerations are relevant in planning a PMHC program?
Step 4: Establish response protocols
- What law enforcement responses are necessary?
- What mental health system responses are necessary?
- How can related agencies, such as emergency communications and emergency medical services support your response?
- Can mental health peer specialists be integrated into your crisis response?
- What other responses or resources are necessary?
Step 5: Determine training requirements
- How many hours of training will be provided?
- Who will receive this training?
- What topics will the training cover?
- Who will provide the training?
- What training strategies will be employed?
- What curriculum will be used for the training?
- How will mental health advocates participate in training development?
- How will trainees interact with people living with mental illness and their family members during training?
Step 6: Identify data-collection procedures to track performance
- What data will be collected to measure whether goals and objectives have been achieved?
What data collection strategies will be used?
- How will data collection capture whether people living with mental illness and their family members are satisfied with outcomes of the program?
- How will data collection capture information about outcomes for the individual in crisis (e.g., whether the person received treatment, whether the person was arrested)?
- Who will be responsible for the measuring performance?
- How will the evaluation be used to make improvements to the program?
- What resources and partnerships are needed to objectively collect and analyze data?
Planning and Implementing PMHCs
It is vitally important for the chief to take an active leadership role in implementing agency-wide strategies to deal with persons coping with mental health issues or intellectual/developmental disabilities.
Police leaders need to focus on data-driven strategies to find effective solutions. There are many questions a chief needs to answer before moving forward, including the number of calls for service involving people with mental illnesses, available resources, training, information-sharing and privacy issues, and more.
To have successful interactions, the chief must be at the forefront as a leader on this issue, along with ensuring successful buy-in from officers throughout the agency, and strong, effective partnerships with mental health professionals. The PMHC program must be incorporated into agency goals and made an operational priority, taking its place on the chief's "dashboard." Support from all staff, top-to-bottom, is necessary for the efficacy and success of the PMHC program.
Issues related to people with mental illness need champions within the police agency, or else they run the risk of falling through the cracks. Some police agencies appoint an officer or commander to oversee the planning and implementation of the initiative. In addition, they serve as the agency's primary liaison with mental health providers and other stakeholders. These liaison officers can be particularly effective for problem-solving location-specific issues to reduce and prevent crimes, disorder, and calls for service at current and potential hot spots.
For additional information, see:
Approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year, and approximately 1 in 25 adults in the U.S.—10 million, or 4.2%—experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities (National Alliance on Mental Illness).
The number of contacts law enforcement has with people with mental illnesses varies by community, and can be hard to document if the calls are not properly identified and coded. An estimated 7 percent of police contacts in jurisdictions with 100,000 or more people are with individuals with mental illness (Deane, et al.). The majority of these encounters are with individuals suspected of committing low-level, misdemeanor crimes, or who are exhibiting nuisance behavior. Many communities report that the number of contacts has been increasing, sometimes precipitously, in recent years (San Diego Association of Governments).
People with mental illnesses, most of whom have co-occurring substance use disorders, are over-represented at every stage of the criminal justice system. Researchers documented serious mental illnesses in 14.5 percent of males in jail and 31 percent of females in jail (Steadman, et al.); these rates are more than three to six times those found in the general population (Kessler, et al). Generalized to the fact that almost 13 million jail admissions occur annually, more than 2 million bookings of people with serious mental illnesses occur annually (Snyder, et al).
For additional information, see:
- National Alliance on Mental Illness, "Mental Health by the Numbers."
- M. W. Deane, H. J. Steadman, R. Borum, B. M. Veysey, J. P. Morrissey, "Emerging Partnerships between Law Enforcement and Mental Health," Psychiatric Services, January 1999 Vol. 50 No. 1.
- San Diego Association of Governments, "Mental Health Calls for Service to Law Enforcement Continue To Increase – Possible Reasons and Possible Solutions from the Field," May 2016.
- H. J. Steadman, F. C. Osher, P. C. Robbins, B. Case, and S. Samuels, "Prevalence of Serious Mental Illness among Jail Inmates," Psychiatric Services 60, no. 6 (2009): 761-765.
- R. C. Kessler, C. B. Nelson, K. A. McKinagle, M. J. Edlund, R. G. Frank, and P. J. Leaf, "The Epidemiology of Co-Occurring Addictive and Mental Disorders: Implications for Prevention and Service Utilization," American Journal of Orthopsychiatry 6 (1996): 17–31.
- H. N. Snyder, W. J. Sabol, T. D. Minton, "Arrest in the United States, 1990–2010," (Washington, DC: Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2012).
Though tragic and violent incidents involving people with mental illness are rare, they draw intense media and public attention. This creates misperceptions about the relationship of mental illness to violence and unfortunately increased stigma and discrimination. There is no doubt that many individuals with mental illnesses who commit violent crimes must be held responsible for their actions. However, it is important to remember that most violence in this country is not committed by people who have a mental illness, and most people with mental illnesses are not violent.
The risk of violence statistically attributable to serious mental illness is estimated to be 3 to 5 percent; this is comparable to rates among persons without mental illnesses (Friedman). Because serious mental illness affects a small percentage of the population, it makes— at most—a very small impact on the overall level of violence in society. In fact, people with serious mental illnesses are anywhere from 2.5 times to nearly 12 times more likely to be victims rather than perpetrators of violence (Choe, et al; and Hiday, et al.).
For additional information, see:
- Richard A. Friedman, "Violence and Mental Illness—How Strong is the Link?" New England Journal of Medicine 355 no. 20 (2006), 2064–2066.
- J.Y. Choe, L. A. Teplin, and K. M. Abram, "Perpetration of Violence, Violent Victimization, and Severe Mental Illness: Balancing Public Health Concerns," Psychiatric Services 59, no. 2 (2008): 153–164.
- V.A. Hiday, J.W. Swanson, M.S. Swartz, R. Borum, and H.R. Wagner, "Criminal Victimization of Persons with Severe Mental Illness," Psychiatric Services 50, no. 4 (1999): 62–68.
When discussing people with mental illnesses in criminal justice settings, it is important to keep in mind the heterogeneity of this group. They differ in their demographics, seriousness of their mental illnesses, charge levels, access to community supports, and criminogenic risks (i.e., the factors that affect how likely they are to engage in criminal behavior). There are three primary factors that drive law enforcement encounters with people with mental illnesses: homelessness and visibility, substance use, and limited access to mental healthcare.
First, people with mental illnesses are over-represented in homeless populations and, as such, they are more visible to law enforcement. Their problematic behaviors (e.g., public disturbance, panhandling and public intoxication), which stem from lack of treatment, attract attention. As an indicator of how visibility may play a role in their arrest: incarcerated persons with mental illnesses are much more likely to have been homeless at the time of their arrest than those without mental illnesses (Ditton).
Second, people with mental illnesses are about three times more likely to develop a co-occurring substance use disorder than the general population (Reiger, et al.). This increased prevalence of substance use disorders over the course of their lifetimes, combined with an overall increase in arrests for drug-related offenses, means that more people with mental illnesses will be arrested. Research has found that nearly three-quarters of men and women with mental illnesses in jails also have a co-occurring substance use disorder (Abram and Teplin).
Third, the limited access to over-burdened community-based treatment may make individuals with untreated symptoms more likely to be arrested. Individuals with mental illness who encounter police are too frequently incarcerated—often for misdemeanant or non-violent infractions—rather than connected with treatment services, simply because of a lack of community resources. If there are no alternatives to incarceration for people with a serious mental illness, officers feel that their only option is to book that person into jail to ensure their safety.
For additional information, see:
- Paula Ditton, "Mental Health and Treatment of Inmates and Probationers," (Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 1999).
- D. Hasin and B. Kilcoyne, “Comorbidity of psychiatric and substance use disorders in the United States: current issues and findings from the NESARC,” Current Opinion in Psychiatry 25 no. 3 (May 2012): 165–171.
- K. M. Abram and L. A. Teplin, "Co-Occurring Disorders among Mentally Ill Jail Detainees: Implications for Public Policy," American Psychologist 46, no. 10 (1991) 1036-45.
- German Lopez, "How America's Criminal Justice System became America's Mental Health System," Vox.com, March 1, 2016.
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.
- Arlington (MA) Police Department
- Bexar County (TX) Police Department
- Harris County (TA) Police Department
- Houston (TX) Police Department
- Los Angeles (CA) Police Department
- Madison County (TN) Sheriff's Office
- Madison (WI) Police Department
- Miami-Dade County (FL) Police Department
- Portland (ME) Police Department
- Salt Lake City (UT) Police Department
- Tucson (AZ) Police Department
- University of Florida Police Department
- Wichita (KS) Police Department
- Yavapai County (AZ) Police Department
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.
The fourteen 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
Complete the TA request form.
For questions not addressed by the Law Enforcement Mental Health Learning Site web page, contact [email protected]