“You need to get on the gurney now,” the police officer said, leaning toward me.
This was a pivotal moment in my life — my first psychotic episode — but one I cannot remember. Looking back through the haze of psychosis, I see only the rough outline of a police officer standing in the door of my apartment. I was on a knife’s edge without knowing it. If I had resisted arrest, brandished something resembling a weapon, or reached for the officer’s gun, I might well be dead.
Nothing in my past foreshadowed this moment. I had graduated from Princeton summa cum laude and Phi Beta Kappa. After Yale Law School, I clerked for two federal judges. And in the days leading up to the police encounter, I won my first jury trial.
What could have been the end for me turned out to be a new beginning. I made a career change, from litigation associate to law professor. For the past 13 years I have taught, researched, and written about mental health law, including criminal justice issues. One of my ideas to reduce suicide is now law in three states. The most important thing I’ve learned from years of cycling into and out of depression is that it always gets better. But recovery for many is only possible if they, like me, survive potentially fatal interactions with police.
As the Washington Post recently reported, police shot and killed at least 1,055 people nationwide in 2021. This startling number doesn’t include killings by other methods, like chokeholds or knees on the back of the neck. The Treatment Advocacy Center, a mental health advocacy organization, has estimated that individuals with untreated mental illness are 16 times more likely to be killed by the police. (The problem may be even worse for black individuals with mental illness.)
Considering these statistics, I’m disturbed that I can barely remember that critical juncture in my life. But what is much more disturbing is that I had so little control over my behavior at the time. I was in the grip of extreme mania and my first psychotic episode. I threw a sock out of the window as a signal to a secret cabal. In my mind, I had beaten God in a game of poker and had unlocked the secrets of the universe. I refused to sleep and refused to get dressed.
There is no question I was seriously impaired, but was I dangerous? In hindsight, the answer is plainly no. I am told I followed the officer’s instructions and the interaction ended exactly as it should have: with me in an ambulance on my way to the hospital. But police don’t have the benefit of hindsight; they must make life-and-death decisions not knowing how they’ll turn out.
Hindsight is not available to police officers, but history is. We know the outcomes of past interactions between police and people in mental health crisis like me. One objective way to assess the dangerousness of individuals with mental illness in police encounters is to compare the number of individuals with mental illness killed by the police with the number of police officers killed by individuals with mental illness.
From the beginning of 2017 through the end of 2020, police killed 356 individuals where the initial reason for the encounter was mental illness, erratic behavior, or suicide, and no weapon or threat to others was noted, according to the police reform organization Campaign Zero. That’s a lot of people, but maybe all those police killings were justified by a high risk of danger posed by individuals with mental illness? If that were true, one would expect many police officers to have died at the hands of individuals with mental illness. In fact, FBI crime data shows only one police officer in the entire country during this four-year period was killed “handling [a] person with mental illness.”
There is growing support for reforms including: (1) more and better police training, and (2) specialized mental health crisis response teams. However, implementation of these measures is happening far too slowly, and the delay is producing tragic results. In 2013, Lenora Bonds called 911 because her son Terrence Harris was suffering from a mental health crisis. The Chicago Police Department responded: “The first police sergeant who arrived at the scene was trained to manage mental health crises, but the three officers who subsequently shot Harris to death were not.” Bonds’ lawsuit does not allege excessive force: Harris was wielding knives and actually stabbed one officer. Her theory instead is that the encounter might not have turned deadly if all of the police officers had been properly trained.
The percentage of police officers nationwide who have completed meaningful mental health training remains low. The most popular and well-studied training program was developed in Memphis and is called Crisis Intervention Team or CIT. In 2019, only 15 to 17% of police agencies had CIT programs and within these agencies the training was usually voluntary. Of course, the officers who least need the training are probably the ones most likely to volunteer for it. The death of Harris, along with the broader statistics, show that mental health training should be required for every officer.
Even if properly trained, a police officer responding to a mental health crisis should be paired with a mental health professional. Such an interdisciplinary crisis response team is appropriate when the subject individual has a weapon and poses an immediate threat to others. Many police departments recognize the need for this type of team, but still fall short. On February 1, 2022, after a more than hourlong standoff, Los Angeles police killed a disturbed 23-year-old man who was wielding a knife. The Chief of Police explained that the mental health crisis response team was unable “to make it across the city to the scene to better communicate with the man.” Apparently, the vast city of L.A. has just one team. If a crisis response team can’t make it to a scene in over an hour, it’s useless.
Training and resources will help, to be sure, but if we really want to bring down the number of individuals with mental illness killed by police, we need to think beyond law enforcement. In an ideal world, we would eliminate mental health crises altogether through better treatment in the community. Unfortunately, even with unlimited resources, some mental health crises are unavoidable. For example, I was receiving excellent medical care through employer-provided health insurance at the time of my psychotic break. When the crisis nonetheless came, my wife was forced to call 911. She explained the situation and asked for an ambulance. She got a police officer instead.
No reasonable amount of training will ever turn the average police officer into a mental health expert. We’re simply asking for too much from the police. When there is no weapon or immediate threat, a crisis team comprised solely of mental health professionals is the better response. Eugene, Oregon pioneered this approach decades ago in a program called CAHOOTS. CAHOOTS has been highly effective and it avoids unnecessary burdens on police: Out of roughly 24,000 calls in Eugene and neighboring Springfield CAHOOTS responded to in 2019, only 311 required police backup. And CAHOOTS is now offering training to organizations across the country.
Lawyers, both in court and as public citizens, are uniquely well-positioned to spur police reforms. Prosecutors are already charging and securing criminal convictions of police officers in the most egregious cases. And while the qualified immunity doctrine provides broad protection in civil suits, lawyers are seeking to narrow or overturn that doctrine in court and in Congress. In the meantime, a majority of federal courts have recognized that the Americans with Disabilities Act (ADA) requires police officers during arrest to reasonably accommodate mental disabilities. What this means in a particular case may be fact-specific, but first responders will only be able to make those assessments and to avoid systematic ADA violations through more and better mental health training and specialized crisis response teams.
Too many people with mental illness are killed by the police. But this tragedy is not inevitable. We know that specialized crisis response teams can reduce the death toll. Further delay in creating and mobilizing these teams will cost hundreds of lives, perhaps including mine.