Treatment Advocacy Center’s Hancq Testifies on Police Responses to Mental Health Crises
By Treatment Advocacy Center News
Treatment Advocacy Center Director of Research Elizabeth Sinclair Hancq testified today, August 13, before the Pennsylvania House Democratic Policy Committee on how police handle mental health calls.
Below is the full text of her opening statement to the Committee:
Chairman Sturla, Representative O’Mara and members of the committee, thank you for the opportunity to testify before you today regarding this timely and important topic on law enforcement’s role in mental health crisis response.
My name is Elizabeth Hancq and I am here representing the Treatment Advocacy Center, a national non-profit dedicated to eliminating barriers to treatment for people with severe mental illness, such as schizophrenia and severe bipolar disorder. I am also here as a citizen of Pennsylvania with special interest in the actions of this committee, residing in Philadelphia. I am the Director of Research at the Treatment Advocacy Center, where I lead the Office of Research and Public Affairs. We conduct policy research on the impact of severe mental illness on public service systems with the goal of increasing the public’s understanding of severe mental illness.
The Treatment Advocacy Center has more than 20 years of research expertise in a variety of topics regarding severe mental illness. Relevant to today’s hearing includes our research work in:
- the role of law enforcement in mental illness crisis response, and
- how people with severe mental illness are overrepresented in the criminal justice system. For example, in Pennsylvania, there are approximately 15,515 people with severe mental illness in the state’s jails and prisons.
According to an analysis the Treatment Advocacy Center did in 2015, published in a report titled, Overlooked in the Undercounted, people with severe mental illness are 16 times more likely to be shot and killed by police than people without mental illness. A large driver of this disparity is due to the disproportionate volume of contact between individuals with serious mental illness and law enforcement. Therefore, reducing the number of contacts between law enforcement officers and people with severe mental illness is the single most immediate, practical strategy to reduce fatal police encounters for individuals with mental illness.
Law enforcement officers are the front lines of psychiatric care, charged with responding to, handling and even preventing mental illness crisis. This is in part due to the limited community treatment options and the continuing shortage of psychiatric inpatient beds. This results in people in need of mental health treatment not being able to receive care until a crisis occurs and law enforcement intervenes.
The role of law enforcement in mental illness crisis response is an enormous portion of police department resources and budgets. Responding to and transporting individuals with mental illness occupies more than one-fifth of law enforcement officers’ time, according to an analysis the Treatment Advocacy Center conducted in 2019 and published in the report, Road Runners.This time is a result of the:
- overrepresentation of people with mental illness in the criminal justice system,
- length of time mental health crisis service calls take,
- long distances law enforcement must travel to find available mental health resources, and
- time officers must wait while transporting individuals in crisis to an emergency department.
Based on a qualitative analysis of the results, the lack of appropriate mental health treatment services in the community is the most prominent factor contributing to law enforcements’ outsized role in mental health crisis response.
There are several potential solutions to reduce the burden on law enforcement in responding to mental health crises, several of which that are already available to the estimated 335,00 individuals with severe mental illness in the state of Pennsylvania. These include:
- Law enforcement-based specialized response: Only officers who are dedicated and genuinely interested in working with individuals in psychiatric crisis are trained and dispatched to the field. The most common example of this are Crisis Intervention Team (CIT) programs. A 2016 survey of law enforcement officers conducted in Pennsylvania by the Mental Health and Justice Center of Excellence found a high involvement of counties throughout the Commonwealth in CIT training, with 3,484 patrol officers trained in CIT among 15 different programs. All surveyed CIT programs included a training component for Veterans, putting Pennsylvania in line with current best practices.
- Law enforcement-based specialized mental health response: Law enforcement partners with mental health professionals to attend to crisis situations, commonly referred to as co-responder models.
- Mental health-based specialized mental illness response: Response models rely entirely on mental health professionals, such as a mobile crisis or assertive community treatment teams, and work with law enforcement as partners when appropriate or needed. In Delaware County, this team is called the Crisis Connects Team.
- Centralized crisis centers: Offer an alternative to jail or crowded emergency departments by being accessible, providing quick intake and drop-off procedures for law enforcement, and specializing in care for people with mental illness and/or substance use disorders. Delaware County has such a program, called the Crisis Response Center.
- Data solutions: Integrated data systems among health and criminal justice sectors to identify repeat users of community resources and intervene before crises occur.
- Telepsychiatry: Using telepsychiatry technology, mental health providers offer assessment and treatment planning via video chat.
- It is important to note, analysis of the 2019 survey results uncovered that, on average, more than one-quarter (26%) of transports of individuals with severe mental illness conducted by law enforcement were for high utilizers—individuals who had three or more service encounters with law enforcement in one month.
High utilizers are often found to be individuals with severe mental illness, who cannot, on their own, recognize their need for treatment no matter how clear the symptoms may be to others. This lack of insight, also referred to as anosognosia, has been identified as a primary factor in treatment non-adherence and impacts as many as half of individuals with bipolar disorder or schizophrenia. As a result, these individuals often find themselves caught in the revolving door of hospitalization and incarceration.
In 2018, the Pennsylvania General Assembly passed legislation to amend the Mental Health Procedures Act to authorize counties to implement assisted outpatient treatment (AOT) programs. AOT is the practice of placing individuals with severe mental illness who have a history of treatment non-adherence and inpatient hospitalization under a non-punitive civil court order to follow a prescribed treatment plan while living in the community.
AOT is proven to reduce individual’s contact with law enforcement, as well as the incidence and duration of psychiatric hospitalization, homelessness, and incarceration. Additionally, it improves the health and social outcomes of individuals with severe mental illness by allowing earlier intervention to help prevent the revolving door of hospitalization and/or incarceration. Finally, AOT saves money.
Over the past decade, AOT has reached national prominence as an evidence-based practice. Currently, 47 states and the District of Columbia have laws that allow for AOT to be practiced. With passage of the 21st Century Cures Act in 2016, a federal grant program was established for communities to develop AOT programs, which was renewed earlier this year. The U.S. Department of Justice certified AOT as an effective program to reduce crime. The American Psychiatric Association and other prominent mental health organizations have endorsed AOT as an effective tool to promote recovery. Research studies and experiences across the country have consistently validated the efficacy of assisted community treatment.
Despite the fact that the bill passed the Pennsylvania General Assembly unanimously, to date, not one county in the state has taken advantage of the law.
Representative O’Mara and members of the committee, I thank you for the attention on this important issue. I am available to answer any questions.