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THE CORRECTIONAL OFFICER STOCKHOLM SYNDROME: MANAGEMENT IMPLICATIONS
The Effects of Psychiatric
Deinstitutionalization on Community Policing
By
KEVIN M. GILMARTIN, Ph.D.
Published in Police Chief Magazine - December 1986
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
L. Teplin, “Criminalizing Mental Disorder: The Comparative Arrest
Rates of the Mentally Ill” American Psychologist 1984 Vol. 39 Vo. 7
pp. 794-803
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