Over the past two decades, the streets of America's cities have become home for an increasing number of chronically mentally ill individuals, and the special problems they pose have exacerbated the traditional burdens of' the American law enforcement officer. Researchers report as much as a 225 percent increase between 1975 and 1979 in mental illness related incidents involving police contact. (1)

The traditional manner in which American psychiatry treated chronically mentally ill individuals underwent drastic philosophical changes in the 1960s and '70s. During this period, the belief that mentally ill individuals should be released from the nation's state hospitals and returned to local communities-labeled "deinstitutionalization"-became the goal of institutional psychiatry. Deinstitutionalization programs reduced the psychiatric inpatient populations nationally by 65 percent between 1968 and 1978, with the number falling from 399,000 in 1969 to 132,000 by 1980.

These programs were met with controversy at the community level, beginning with the mental health professionals who became responsible clinically for these individuals. Later, the controversy spread to the law enforcement profession, which is held accountable to the community for controlling the behavior of these people. Local and county psychiatric hospitals, traditionally the referral point for commitment procedures, began closing their doors in the faces of community law enforcement officers presenting chronically mentally ill citizens, as inpatient placement became more restricted on both philosophical and legal grounds. While 75 percent of psychiatric treatment was taking place on an inpatient basis in 1955, today 75 percent of treatment is performed on an outpatient basis. (2)

Deinstitutionalization Costs
The prevailing theory behind deinstitutionalization was that the system of 647 mental health centers created by the 1963 Community Mental Health Act-in combination with breakthroughs in the development of anti-psychotic medications would adequately meet the needs of tile deinstitutiorialized psychiatric subpopulation. The predictions, however, were grossly inaccurate. Tens of thousands of psychiatrically disturbed persons were dumped into communities across the country, filtering downward from voluntary programs of community-based treatment to lives of transience and vagrancy.

"Psychiatric ghettos," small geographic pockets in many metropolitan areas that became acceptable zones for deviant and psychiatrically disturbed behavior were created, thus completing the transition from "back wards to back alleys." Harvard professor James Q. Wilson, in his 1975 book Thinking About Crime, describes this occurrence as a traditional sign that the cycle of urban decay is underway. Transients and disturbed individuals move in, informal controls break down, and stable residences and businesses relocate. By default, law enforcement has become both the guardian of and custodian for the transient mentally ill population residing on the streets of the nation's communities.

At the same time that American psychiatry was moving toward community-based treatment, the courts began handing down decisions that greatly restricted involuntary hospitalizations, further limiting the practical options available to the line police officer.

In 1975, for the first time, the United States Supreme Court heard a case concerning the rights of a civilly committed psychiatric patient. In O'Connor v. Donaldson (422, U.S. 563, 1975), attempting to define a standard for involuntary hospitalization, the Court ruled that the state cannot detain a non-dangerous psychiatric patient who is capable of surviving in the community-either by himself or with the help of friends and family. This decision established the ability to survive as the standard for the involuntary hospitalization of non-dangerous individuals, deemed intrusive any attempts by the state to provide help to a sick or disturbed person through hospitalization-simply a means of disposing of aberrant behavior. Suzuki v. Quisenbery (411 E Supp. 11 13, 1976) expanded the "survival" standard by developing a two-pronged test for civil commitment: First, a person could not be hospitalized simply because of mental illness; and second, only those individuals who were proven substantially dangerous to themselves or others could be involuntarily hospitalized. Suzuki further outlined 12 safeguards relating to the level of judicial review or procedural guidelines for emergency commitment, which apply the rules of evidence for criminal proceedings to the “survival" standard for commitment.

Although this shift to the "least restrictive environment" is appropriate in many cases, in many others it is entirely inadequate, leaving it to the criminal justice system to both protect and control these individuals. Even when admission for the mentally ill individual is granted, hospitalization is little more than a revolving door for patients. The average length of hospital stays for civilly committed patients dropped from 421 days in 1969 to an average of 189 days in 1978, with the result that the same officers are dealing with the same psychiatric patients on a daily basis, interrupted only briefly by short periods of hospitalization.

Law Enforcement's Response
The law enforcement profession has thus become responsible for solving the community problems created by homeless, psychiatrically disturbed individuals. The theory that mentally ill persons will be assimilated back into the community has not become a reality; some studies suggest that roughly 70 percent of Americans believe that the chronically mentally ill should be removed from the streets and detained for their own well-being .(3) Yet the law enforcement administrator who maintains a reactive posture, assuming that the psychiatric community will address the dilemma of transient, mentally ill individuals, will find his/her officers resorting to the short-term solution of arresting more and more mentally ill subjects. Recent studies have shown that arrest rates for individuals demonstrating symptoms of mental illness are significantly higher than for individuals without such symptoms, Ill other behaviors being equal.

These arrests typically are less often the result of criminal intent than a reflection of the arrestee's inability to function in the community. For example, many are arrested for such charges as disturbing the peace, criminal trespass, defrauding an innkeeper, etc, While at first glance incarceration might appear to be a concrete remedy to the problems faced on the street, the reality is that taking the chronically mentally ill individual into custody and forcing the criminal justice system to solve the problem denies justice to all concerned; the arrestee, the public, and the police officers themselves.

Only about 12 percent of the mentally ill individuals taken into custody are arrested for charges serious enough to warrant incarceration for a significant period of time if convicted. Moreover, 54 percent of mentally ill arrestees are found incompetent to stand trial in cases that progress that far. The purely reactive arrest strategy not only fills the criminal court calendar and burns out the law enforcement officer, it become, an intense financial and management problem for detention facilities.

At the point of arrest, law enforcement funds are inappropriately shifted to the mental health area, with law enforcement agencies rather than state hospitals becoming the intake and housing units for the mentally ill. At the detention level, surveys find the inmate populations to be between 50 and 60 percent mentally ill, with a successful suicide rate three times that of the general population. A further complication is that over 60 percent of law enforcement detention facilities have no regularly available doctor. (4)

Obviously, a proactive approach is required, and several elements are important to the implementation of such an approach. First, since research suggests that law enforcement officers are more likely to arrest a mentally ill individual than someone not showing symptoms of mental illness, officers must receive adequate training in the recognition and handling of such cases. This training should cover not only the identification of symptoms of mental illness, but also strategies for communicating with and handling the psychiatric patient without sacrificing humane treatment or concern for officer safety.

Second, law enforcement agencies must negotiate with local hospitals to develop policies and procedures for mental illness cases, perhaps implementing “no-decline” agreements that would significantly increase the options for the criminal justice system. (5) For such an agreement to be effective however, both law enforcement and the psychiatric community must put aside their mutual stereotypes and antagonisms.

Third, officers must have adequate information on statutory guidelines for law enforcement initiated involuntary psychiatric commitment. Symptoms of mental illness need not be portrayed as criminal behavior to facilitate arrest if that same behavior will serve as the basis for civil petition for involuntary hospitalization. As previously noted, the standards for civil commitment have become rigorous since O'Connor, but with enough background information, a law enforcement officer can often meet the Court's two-pronged standard of apparent mental illness and specific acts considered dangerous to the individual or others. However, only thorough training in this area can develop the officer's expertise with regard to procedures that meet statutorily required standards.

Law Enforcement agencies can also initiate innovative pre-arrest diversion systems. The field officer coming into contact with the psychiatric offender requires more options than making an arrest or leaving the scene without resolving basic issues. A pre-arrest diversion program, in the form of a mobile crisis unit consisting of local mental health professionals in cooperation with law enforcement officers, would free the officer from having to make custody-related decisions until other options are reviewed. Non-dangerous offenders would be handed over directly to crisis teams, allow officers to answer other calls or resume patrol activities and avoid the down-time associated with waiting in emergency rooms or other treatment centers. Such pre-arrest programs already implemented in a number of cities, require fiscal support, as well as the cross training of mental health and law enforcement personnel if they are to be successful.

In summary, the past two decades have seen drastic increases in the number of mentally ill individuals released into the community. Initially hailed as the "Magna Carta of the mentally ill", deinstitutionalization has become trans-institutionalization with the population of psychiatric patients having been shifted from state hospitals to the streets and eventually local jails. The civil libertarians' "least restrictive environment" has turned out to be the criminal justice system. Symptoms of mental illness have become elements of crimes. If law enforcement is to avoid being inundated by these social problems, a proactive response that links community resources to the actual area of need is critical.

1. J.C. Bonovitz and J.S. Bonovitz "Diversion of the Mentally Ill into the Criminal Justice System: The Police Intervention" American Journal of Psychiatry 1981, Vol 138, No. 7 pp 973-976
2. R. Michels "Psychiatry on the Couch" Time 1979 Vol 113 No. 14 pp 74-82
3. S. Pam A and Milton J. Bachlin "Civil Liberties v. Involuntary Hospitalization" American Journal of Psychiatry, 1975 Vol. 132 No. 2 pp 189-192
4. U.S. Dept. of Justice Bureau of Justice Statistics, Jail Inmates Bulletin NCJ 87161 Rockville, MD National Criminal Justice Reference Center
5. L. Teplin, "Criminalizing Mental Disorder: The Comparative Arrest Rates of the Mentally Ill" American Psychologist 1984 Vol. 39 Vo. 7 pp. 794-803