The 236:

A Critical Examination of the Relationship

Between Mental Illness and

Police Violence in America

3 December 2018

Final Essay for [REDACTED]

Table of Contents

I. An Overview of the Relationship between Mental Health,

Fatal Encounters with Law Enforcement, and
Institutionalization……………………………………………………………..………………….1

II. The Intentional Dismantling of the Welfare State,

and the Resulting Decline in the Availability and Quality of Mental Health Care……………….3

III. Mentally Ill Individuals are 16 Times More Likely to Die

at Hands of Police. Why?................................................................................................................6

IV. No More Deaths: Recommendations for How to Prevent Killings of

Mentally Ill Individuals by Police through Healthcare Reform
and by Reimagining Law Enforcement Response
to Mental Health Crises………………………………………………………………................11

V. Bibliography………………………………………………………………………………......15
I. An Overview of the Relationship between Mental Health,
Fatal Encounters with Law Enforcement, and Institutionalization

At least one in four individuals killed by police in the United States is suffering from a

severe1, often untreated, mental illness. This figure is likely also an underestimation, due to

incomplete data on the psychiatric condition of police shooting victims (Fuller, Lamb, Biasotti &

Snook, 2015). The vast majority of social programs for these individuals are underfunded,

understaffed, and typically can only intervene when individuals are considered to be violent or

suicidal; therefore, what few programs remain are, by design, unable to provide the preemptive

and ongoing psychiatric and therapeutic treatment necessary for ensuring long-term, sustainable

management of mental health disorders (Position Statement 22: Involuntary Mental Health

Treatment, 2015). The overwhelming economic inaccessibility of medications, doctors, and

treatments even for those who have insurance, and the forced decline of government support for

persons with mental illness since the beginning of the neoliberal era, has culminated in half of

the nearly 8 million Americans with severe mental illnesses being unable to receive care and/or

medication on any given day (Fuller, et al).

Waiting until symptoms are severe and pose a risk to the safety of the individual or

society necessitates that treatment is often administered through forced hospitalization, which

often results in decreased trust between the patient and mental health providers, along with

increased feelings of low self-esteem and stigmatization (Johnson & Stern, 2014). In many cases,

involuntary psychiatric commitment also results in significant financial burdens for the patient

upon release; the average cost after insurance reimbursement for a 7-day hospital stay in the

United States was found to be anywhere between $8,509 at the highest and $3,422 at the lowest

1
A severe mental illness is defined as a psychiatric condition that significantly affects the individual’s thinking,
behavior, and ability to exist in society, such as schizophrenia, some subsets of bipolar disorder, and major
depression that results in suicidality (What Is “Serious Mental Illness” and What is Not?).
(Stensland, Watson & Grazier, 2012). This dissuades or prevents patients from seeking treatment

in the future, even when their crisis is serious. These culminating factors have created a reality in

which mentally ill individuals in America are most often allowed to simply suffer untreated until

their symptoms are overwhelming and manifest in an episode that requires immediate

intervention. Since there are very few reliable, accessible crisis teams to take this role, these

situations most often result in an interaction with police and the carceral system. Police officers

are not social workers and have not been trained to appropriately respond to people experiencing

mental health crises. The statistics reflect this; when data on fatal law enforcement encounters

was examined across Nevada, Canada, Australia, and the United Kingdom, it revealed that

mental illnesses may have factored in up to one half of all deadly police interactions (Fuller, et

al, 2015). Furthermore, incarceration exacerbates mental illness in those who already have it—

and in many cases, imprisonment has resulted in the onset of mental illness symptoms in

previously healthy individuals, a concept known as “prisonization” (Haney, 2018).

In order to reduce the number of civilians killed by the police and to avoid the negative

effects of institutionalization, be it in a psychiatric hospital or a carceral facility, it is clear there

must be imminent focus on reforming the legal system’s response to individuals experiencing

mental health episodes, and create a public system of accessible, affordable healthcare. In order

to begin to understand the complexity of this issue—an often overlooked crisis that resulted in

the preventable deaths of 236 American citizens with mental illnesses in 2017 (Sullivan,

Anthony, Tate & Jenkins, 2018)—it is necessary to first examine the social and political factors

responsible for these statistics, and then explore possible, realistic alternatives to legal and

medical treatment of mental health crises.

II. The Intentional Dismantling of the Welfare State,
and the Resulting Decline in the Availability and Quality of Mental Health Care

In order to understand the lack of public support for persons with mental illness, it is

essential to explore the history of the social safety net in the United States. The New Deal of the

1930s ushered in a period of guaranteed social support through programs like Social Security and

widespread access to public goods such as transportation, education, and public spaces. Though

supposedly universal, this new “social wage” was mainly reserved for white, male Americans;

65% of African-Americans were ineligible for Social Security the year it was signed into law

(Coates, 2018). The way that white America thrived from 1935 to 1965 was by denying people

of color and women their owed amount of social capital through systems of oppression like Jim

Crow. Their portion of the social wage was then redistributed to white, middle-class America in

the form of the interstate system, home loans, schools and hospitals, and more (Prashad, p. 192,

2005). Johnson’s Great Society policies in the 1960s originally expounded upon the New Deal,

extending services like healthcare to more Americans than ever before with Medicare and

Medicaid. This was soon followed by the passage of the landmark Civil Rights Act of 1965,

which suddenly rendered the intentionally racially-exclusive nature of the New Deal and the War

on Poverty illegal. Finally, it seemed that Americans of every race could expect to reap the

bounty of the social safety net. Before this could become a reality, however, social pressure

from the upper echelons of American society—politicians, business owners, and powerful

individuals who were not willing to look beyond their entrenched racism—coalesced old racial

hatred and exclusion into new law and order politics meant to undermine the social wage; in

essence, the systemic denial of people of color into the prosperity of American society was

reproduced again through a series of cuts to social benefits, in order to “produce …

subordination without the vulgarity of Jim Crow” (Prashad, p. 193). A new era of American
public policy, specifically redesigned to continue to deprive certain peoples their right to

participate in and reap the benefit of society, had begun. This would have crushing effects for

everyone dependent on the state, including the poor of every race and especially the mentally ill.

Concurrent with the desire to continue to exclude black Americans from social services

was also the desire to settle unrest, stop violence, and crack down on what was perceived to be

record-high numbers of crimes committed in the country during the late 1960s. Poverty was

understood to cause crime, but criminal activity was falsely (due to racist notions and statistics

like those found in Johnson’s Secretary of Labor’s report “The Negro Family”) attributed to

“community behavior and not structural exclusion” (Hinton, 2015, p. 103). Believing

impoverished communities to be inherently more criminal or predisposed to violence, there was

a subsequent push for the heavy involvement of law enforcement in social programs originally

created to address poverty, and the adoption of community policing meant that police presence

and “soft surveillance” (Hinton, p. 107) became an everyday fact of life for already-marginalized

Americans. A significant part of the restructuring of American society following the Civil Rights

Act was the shift from funding and augmenting War on Poverty programs to assimilating public

funds and programs into the War on Crime. During the late 1960s through the 1990s, the budget

kept increasing for law enforcement, while money for necessary social services—such as public

hospital beds for the treatment of psychiatric patients—was routinely nowhere to be found. By

1996, the government was spending more annually on law enforcement budgets than it was on

Aid to Families with Dependent Children (Prashad, p. 194). The trend has continued into the

present day, and directly affects the lives of those with mental illness; between 2009 and 2011,

mental health funding was cut by an alarming 4 billion USD (Fisher, 2013).
 This process of revoking funding for community programs while increasing the scope of

law enforcement has had specific, and severe, repercussions for the mentally ill. The shuttering

of state psychiatric hospitals and the transfer of much of mental healthcare from the public to

private sector in the 50s and 60s has resulted in more than 100,000 individuals with the most

severe mental illnesses living on the streets without proper access to a hospital bed or treatment

(Fuller, et al, 2015). While deinstitutionalization was well-intentioned, since involuntary

commitment for long periods of time has a myriad of negative psychological effects, the

community-based clinics that were intended to take the place of institutions and continue

offering assistance to the severely mentally ill were never realized due to the cuts to the welfare

state. Since this occurred simultaneously with the mass expansion of community policing, these

vulnerable individuals are now at a high risk for encountering police officers, because there are

often no other agencies to call when they experience episodes, and they often end up committed

in jails and prisons instead. Additionally, these individuals are the focus of many 911 calls for

minor civil infractions such as disturbing the peace and loitering; if they survive their encounters

with police, these individuals often find themselves cycled endlessly between the criminal justice

system for failing to pay fines, back to living on the streets, and receiving their healthcare in

emergency rooms (Fuller, et al). In Chicago in 2012, six of the twelve city public health clinics

were shut down due to a lack of funding (Fisher, 2013). The intentional relegation of societal ills

to law enforcement agencies has been overwhelmingly successful when considered in the realm

of mental health treatment and policy and has made punitive police interactions a fact of life for

individuals in most need of compassion and treatment.

III. Mentally Ill Individuals are 16 Times More Likely to Die at Hands of Police than
Any Other Demographic. Why?

Understanding that the vast majority of individuals suffering from mental health

conditions are unable to access treatment and care still does not entirely elucidate why these

people are so vulnerable to police brutality. The explanation primarily returns to the fact that a

severe mental illness, when left untreated, will often result in a crisis that necessitates some kind

of intervention. Due to the dismantling of the public healthcare system described above, this

often, out of a lack of any other options, is handled by law enforcement agents.

A person experiencing a mental health episode severe enough to warrant immediate

intervention is in an altered state, one which poses significant barriers to perceiving, processing,

and responding to the world around them as they usually would; suicidal ideation, paranoia, or

delusional thinking can severely reduce one’s ability to comprehend and follow day to day life,

let alone police orders (Vitale, p. 82). Training police to recognize signs of suicidality or severe

mental illness is inherently difficult and problematic; officers are not doctors and cannot be

reasonably expected to make the kind of accurate, clinical assessments in the field which could

offer them insight on the best way to manage the situation. For this reason, mental illness crisis

response should not be handled by the police at all. Despite widespread police training that

emphasizes the necessity for nonviolent de-escalation in these situations, standard protocol is

still for officers to arrive on the scene and immediately begin shouting commands and

brandishing weapons—two acts which often appear extremely threatening to individuals in crisis

and can cause them to flee or slip into delusions further, inspiring violent police response. If the

person is violent or intends to evade police, seeing that the officer is armed may cause them to

escalate the situation violently to protect themselves or to wound the officer before they can be

apprehended; it has been proven that there would be fewer police deaths if officers carried no
weapons at all (Vitale ,p. 26, 2018). Additionally, some individuals may be physically unable to

hear and respond to commands due to their condition, which can be perceived as noncompliance

and therefore turns the individual into a threat in the officer’s mind (Vitale, p. 78).

Once someone is perceived as a potential threat, there is a high likelihood that the officer

will respond with lethal force; this can be attributed to military-style training scenarios that show

repeated scenarios and examples of how routine interactions with the public, such as traffic

stops, can turn deadly for officers in a split second. In this way, the police are systematically

trained to view any hint of threat as “us versus them” moments, where its either the citizen’s life

or theirs; the dedication to officer safety takes precedence over any trainings that might instruct

police on how to operate with sensitivities to mental health episodes (Vitale, p. 10). In calls

regarding someone experiencing a mental health crisis, societal prejudice against the mentally ill

and the readiness to classify severely mentally ill individuals as inherently dangerous and violent

(Corrigan & Watson, 2002) often results in officers responding to mental health calls with the

assumption that they will be entering an already threatening situation. This likely makes them

quicker to react with lethal force.

The combination the officer’s concern for their life during every interaction with citizens

and the stigma against severely mentally ill people has resoundingly been a deadly

amalgamation, such as is evidenced in the 2015 police shooting of Jason Harrison. Harrison was

a 39-year-old schizophrenic black man who was killed by Dallas police officers when his mother

called 911 after he refused to take his medication. Although Harrison’s mother had often called

the police to help her with her son and they knew he was in crisis, the police shot Harrison

multiple times mere seconds after he refused to drop a screwdriver he was holding—he was not

threatening the officers in any way, according to an officer’s body camera footage, but since he
did not drop the ‘weapon’ after the fourth command, he was killed. The officer faced no criminal

charges (McLaughlin, 2015). Unfortunately, this is not an uncommon occurrence; police often

routinely shoot individuals, especially those with mental illnesses, on sight who are perceived to

be in possession of ‘weapons’; these items have ranged from screwdrivers to brooms (Ovalle,

2016) to hammers. This phenomenon occurs all over the nation. In 2014, Phoenix police

attempted to take 50-year-old Michelle Cusseaux into mental health custody following a court

order and forced their way into her apartment when she did not answer the door. Upon finding

her, she raised a hammer above her head in a way that was deemed ‘threatening’ and was fatally

shot; the officer faced no charges and was simply demoted for violating department policy

(Wasser, 2016).

The reason officers face such impunity in killing someone even when it was proven that

their life was not directly threatened is largely due to the 1989 Supreme Court case Graham v.

Connor, which found that officers were justified in using force during arrests if they “reasonably

believe[d]” the individual posed a threat to them or someone else, and that the “split-second

nature of police decision making” should be considered when cases are brought to court (Vitale,

p. 19). These two things are typically more than enough to exonerate police of guilt in the

shooting of mentally ill people, especially considering that the jurors responsible for convicting

the offending officers will likely hold the same negative stereotypes and fears of the inherent

criminality of mentally ill people (Corrigan & Watson, 2002) that the police possess. There are

few repercussions for police officers who kill the mentally ill. Another large contributor to the

indemnity is that there is only one federal database which seeks to collect data on the mental

health status of people slain by police; additionally, accurate information on any type of police

brutality across all 50 states is difficult, if not impossible, to ascertain, due to the fact that
submission of data to even Congressionally-mandated databases is entirely voluntary. Only 36

states have contributed each year to the federal arrest-related deaths (ARD) database, and the

state of Georgia has never submitted a single piece of data (Fuller, et al, 7). Funding for these

programs often expires, which in the case of the ARD database, resulted in an almost decade-

long blind spot in police brutality data from 2006-2014. Most of the data about police violence

that the public has access to is compiled from a list of independent organizations, such as the

Washington Post, which keeps its own tally of mentally ill police shooting victims (Fuller, et al).

It is difficult to quantify the disturbingly high number of mentally ill murdered by police in

America as an epidemic in the eyes of the law if, according to the government, such statistics do

not exist. One of the reasons that mentally ill people are routinely killed by police is because they

are allowed to be, without recourse or repercussion.

There are a variety of other factors that cause mentally ill individuals to come into

frequent, and therefore potentially deadly, contact with law enforcement. As previously

discussed, homeless individuals are forced to interact continuously with the criminal justice

system, and this can have devastating effects for the homeless with psychiatric disabilities. One-

third of homeless people have untreated, severe mental illnesses (Mondics, 2014), and a lack of

reliable housing or income only serves to exacerbate their symptoms, make what little treatment

exists much harder to obtain, and therefore increases the chance that they will exhibit symptoms

of their disorder in public and be more likely to come into contact with police. Although the

Department of Justice found that it violated the Eighth Amendment’s protection against cruel

and unusual punishment to criminally charge someone for sleeping outside when there were no

beds or housing available for them (Badger, 2015), 33% of all US cities still have city-wide bans

on sleeping in public, and violation of the ban could result in fines or arrests (Vitale, p. 92).
When homeless people are ticketed and fined for minor infractions like sleeping outdoors, they

rarely have the ability to pay the fee, which results in further interactions with the criminal

justice system. As fines continue to build without payment, they will often be arrested and serve

short jail sentences; this only contributes to their inability to find stable housing or employment,

as their interactions with social assistance will be frequently interrupted and their “rap sheet” of

minor offenses will show on background checks when applying for jobs or apartments (Vitale, p.

91). This almost guarantees that the person will come into contact with police again, whether it is

for the crime of simply being homeless, or because their symptoms have been so augmented by

this cycle of instability that they experience a crisis in public which garners police attention. If

the individual in crisis is also under the effects of alcohol or drugs—approximately 38% of

homeless people also suffer from alcohol dependency and 26% struggle with substance

addictions (Substance Abuse and Homelessness, 2009), conditions that, similarly to mental

illnesses, require an amount of support, treatment, and stability to overcome that is simply not

available while living on the street—it greatly increases the likelihood that they will be viewed

as unpredictable or a threat, which will increase their chance of being fatally shot by police.

The reason that mentally ill people are sixteen times more likely to die at the hands of the

police is because they have a high statistical likelihood of interacting with police due to systemic

denial of the ability to live in a society that offers them treatment, compassion, understanding

and care. They have been forced to go without the medicine or therapy necessary to treat their

disorders and are often unable to maintain steady housing or employment and therefore must live

on the street, an act which is not illegal in and of itself but is treated as such by our city laws. Not

only are they subject to a judicial system that intentionally excludes them from statistics of

police brutality and allows law enforcement extreme latitude for exercising fatal force against
them, but they also live in a society that expects police officers to handle mental health crises

without proper training, and has provided no public infrastructure to provide the support and

healthcare necessary for their long-term well-being and overall health. The murder of mentally ill

individuals at the hands of police is, by all accounts, a form of state-sanctioned violence.

IV. No More Deaths: Recommendations for How to Prevent Killings of Mentally Ill
Individuals by Police through Healthcare Reform and by Reimagining Law
Enforcement Response to Mental Health

So what are we going to do about it?

Much attention has been given to attempting to create more comprehensive police

training programs on how to de-escalate interactions with mentally ill people. This approach

ignores the fact that police “warrior-mentality” training (Vitale, p. 10) is a large part of the

problem in the first place, since police are taught to react immediately and forcefully in any

circumstance where they could possibly be threatened, which is antithetical to how most persons

with mental illness need to be treated in a time of crisis. Additionally, since police are not mental

health professionals, they cannot— and should not—be diagnosing and attempting to make

clinical judgements in the field. Training alone cannot rectify the problem of police brutality.

However, there are some police reform alternatives that may be more effective and realistic,

although they require a complete reimagining of the police’s role in crisis response. The

Memphis Police Department began experimenting in 1988 with selecting a few key active-duty

officers to respond to mental health calls, and offering them rigorous training on the common

symptoms and types of mental health disorders, the appropriate de-escalation tactics and

treatments for each, and the ability to make the kind of assessments mental health workers could

do in the field in order to identify the best next steps for treatment. This program became the

“Memphis Model” of crisis intervention, alternatively known as Crisis Intervention Training,

which has shown to be successful in cities where it has been adopted (Fuller, et al, p. 10). The

failing of this approach is that police cannot reroute mentally ill people to appropriate public

services for treatment if they do not exist, and the necessary services overwhelmingly are not

available. This type of response merely resolves their problem in the short-term and almost

necessitates that further punitive interaction will occur when they inevitably experience another

crisis. Additionally, the police are still allowed and motivated to use forceful arrest if their de-

escalation tactics do not work, which will always be more dangerous for mentally ill people. A

somewhat more promising approach that is now common in Europe and Canada is to include

trained, civilian mental health workers on these types of calls who take the lead and involve the

officers as a complete last resort, only if they are completely unable to resolve and respond to the

crisis on their own. These mental health workers have the proper training to make accurate

assessments about people with mental health conditions and can stabilize them while connecting

them to appropriate outpatient services, which reduces the number of arrests, use of excessive

force, and the amount of forced hospitalization, the negative effects of which were discussed at

the beginning of the paper (Vitale, p. 84, 2018).

Since it is impossible to completely prevent mentally ill individuals and law enforcement

from ever interacting, it is necessary to prudently consider and enact reforms to the criminal

justice system that allow for fairer and less lethal treatment for the mentally ill—but the fact

remains that police should not be the first responders to people experiencing a mental health

crisis, and have become such only due to the systematic dismantling of public and accessible

mental health care. This is a problem that needs immediate rectification. Focusing solely on

police reforms to remedy the issue does not address the root cause of why so many persons with

mental illness come into contact with the criminal justice system in the first place, and even the
best trained, most well-intentioned officer can never be a suitable replacement for long-term,

pre-emptive treatment. Police reform efforts also do nothing to address the root causes of

problems like instability in housing and societal stigma faced by people with mental illnesses;

merely resolving part of the issue still means that the high likelihood of further lethal interaction

still exists. An ideal solution would be that the majority of mental health crises are addressed

before a 911 call is ever made, and this can only occur through the revitalization and funding of

appropriate outpatient care, lowering the cost of and increasing the accessibility of prescription

medication, and expanding the availability of robust and affordable treatment teams comprised

of doctors, behavioral therapists, and networks of support for the persons with mental illness and

their family. Even individuals with the most severe mental health disorders, such as paranoid

schizophrenia, can live full, independent, safe and rewarding lives when provided with long-term

care, and stable housing and income. Medication on its own is not an effective or sustainable

form of treatment; support networks are required to ensure that the individual continues to take

their medication and check-in frequently with their care team, another thing that is not possible

without a place to live and reliable treatment (Vitale, p. 89).

The epidemic of police brutality against the mentally ill is a tragedy that is entirely

preventable. Understanding how the historical and intentional dismantling of social support for

people with mental illnesses has contributed to this crisis, and recognizing that these statistics are

not due to criminality or violence inherent to persons with psychiatric disabilities but is directly

due to the systemic denial of care, the criminalization of homelessness, the negligence of our

government to recognize victims of police violence, and brutality on part of law enforcement and

the criminal justice system makes it evident that this problem is due to a failure on behalf of the

federal government. Now that the problem has been defined, it is easy to see that there are clear,
attainable solutions to implement that can immediately improve the lives of those with mental

illness and serve to protect them from further law enforcement violence. Police officers can

respond to calls alongside mental health care workers who are more equipped to handle the

situation, can be held responsible for using excessive force against unarmed mentally ill people,

and the availability of more comprehensive and accessible psychiatric care will ensure that most

mental health crises are resolved before police are even involved.

There is no need for a 237th.

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