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Communication inhibitors: Dilemmas in community partnerships amidst mental health crises in Texas

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Published onOct 29, 2024
Communication inhibitors: Dilemmas in community partnerships amidst mental health crises in Texas
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ABSTRACT

Community partnerships between police departments, social services, and healthcare providers continue to struggle in various ways, with mental health crisis response remaining a primary yet fragmented service delivery. Using the nodal governance perspective, this paper provides qualitative insight into the existing communication and resource barriers between law enforcement personnel and social service providers in a large urban county in Texas. Four key themes are presented: staff and resource availability, continuity of care, staff personnel and characteristics, and communication efficiency. Policy implications are also discussed, with the study’s findings supporting the prioritization of building stronger communication between existing social service providers, ensuring interagency cooperation and performance improvements, and striving toward productive data sharing between these organizations. Keywords: Mental health, crisis response, dual dispatch, policing mental illness, and social services


Over the last decade, police departments, mental health professionals, and government bodies have recognized the need for immediate specialized responses to individuals undergoing an acute mental health crisis. Many policing agencies have partnered with mental health professionals to respond to the growing number of deadly encounters between police and people undergoing a mental health crisis. For example, many agencies have established Crisis Intervention Teams (CITs) and specialized training for officers and dispatchers by mental health clinicians and family advocates to recognize and de-escalate volatile situations (Watson & Fulambarker, 2012). Furthermore, specially trained officers can make referrals and serve as resource brokers to connect individuals to resources.

Officers usually respond to emergency mental health calls using a tactical approach that prioritizes officer safety and crime control over de-escalation. For example, officers are trained to respond to aggressive individuals by cycling through use-of-force options ranging from strong verbal commands to less-lethal and lethal weapons. This approach has led to injuries and deaths, such as the 2015 case of a schizophrenic man carrying a screwdriver who was shot seconds into an encounter with Dallas Police. This was despite the man’s mother warning the dispatcher of her son’s condition. Officers simply saw the potential weapon in his hands as a threat and his refusal to comply (McLaughlin, 2015).

Furthermore, even when officers are dealing with mental health crises, the usual approach is to quickly handcuff the individual and transport them to a hospital that is authorized to treat mental patients before moving on to the next call. Most officers are not familiar with the range of services and resources available. These individuals may be quickly released by the hospital without further assistance and referrals. This often drives a repeated cycle where individuals suffering from mental health disorders encounter police with another potentially deadly encounter. This growing problem is exacerbated by the growing homeless population and access to illicit drugs.

In recent years, a collaborative model has emerged between police, mental health services, and social workers that seek to break the dangerous cycle to find help for individuals in need. This holistic approach includes individualized case management, training, and long-term police involvement. In North Texas, policing agencies are partnering with mental health service providers to find more permanent solutions. These partnerships demonstrate how interdependent they are, with each organization having unique functions and assets. This collaborative model of policing was stressed under the nodal governance model of security, which stresses a network of interconnected cooperative alliances between stakeholders (nodes) that share assets (see Shearing & Wood, 2003; Burris et al., 2005). Ideally, specially trained officers can provide physical safety by having mental health professionals interact with individuals to defuse the situation and provide long-term services.

Despite the benefits of collaborative relationships, ideological differences and practical complications often hamper their effectiveness. This study examines cultural and structural factors between police and service providers from a sample of North Texas service collaborations that affect service delivery using qualitative interview data from representatives of each stakeholder. Specifically, issues of staffing resources, continuity of care, and stakeholder characteristics are assessed from the perspectives of law enforcement and service providers. Cultural and structural factors, including divergent goals and conflicting measures of success, often undermine the benefits of full partnerships.

As the second largest state in the nation, Texas residents are at a disservice by the behavioral health services shortage (Simpson, 2023), which correspondingly impacts people who encounter police. This qualitative analysis provides a deeper insight into the absent resources between law enforcement agencies and social service providers in Texas. Specifically, this study describes the challenges in coordinating resources and communication between law enforcement personnel and social service providers, both clinical and non-clinical staff. The respondents highlighted clinical resource scarcity, such as medication and hospital beds, variations in staff characteristics that impact service delivery, and how the lack of communication between all key players impedes individual progress. More importantly, these impediments prolong a person with mental illness’ repeated encounters with the criminal justice system. The results suggest direct and explicit communication between social service providers and law enforcement agencies remains pertinent.

Literature Review

Deinstitutionalization is widely known as a historical social movement that failed to establish resource provision and swift assistance for people with mental illness. In the 1940s, the federal government focused on mental health policy and created the National Institute of Mental Health (NIMH). In 1963, John F. Kennedy passed the Community Mental Health Act (CMHA) to decrease the number of institutionalized individuals in large mental hospitals and offer more localized mental health centers (Erickson, 2021). This vision never materialized as planned. The states that built community mental health centers and the federal government, through NIMH, had a difficult time regulating these centers. Most of these facilities failed to provide the extensive services required to effectively work with individuals with severe mental illness (see Erickson, 2021; Roth, 2021). Overall, this transition rearranged responsibilities in care and response among community services, without clear direction or encouragement for dual response and appropriate diversion programs, and it left a vulnerable population with little mental health resources. Unfortunately, this lack of resources and unpreparedness persists today among law enforcement professionals and social service personnel when working with the mentally ill in the community (Watson et al., 2021).

Professionals who encounter people in crisis can be unprepared and unqualified (Allen & Tracy, 2009; Natarajan et al., 2016). Bohrman and colleagues (2018) identified dispatch operators and collateral contacts who do not provide enough detailed information regarding crisis response, leaving police officers to rely solely on their physical surroundings and onsite behavior to respond efficiently. Similarly, Willis and colleagues (2021) found differences in crisis intervention team (CIT) response times after an individual was identified as someone with a co-occurring disorder compared to those with solely a serious mental illness (SMI). Specifically, CIT responses were 22% times quicker for those with a co-occurring disorder experienced (Willis et al., 2021). However, people with mental illness or substance use disorders are among the increasing number of individuals who have repeated contact with the police in general (Juarez et al., 2021; Pepler & Barber, 2021). The increase in the number of contacts and attention drawn toward persons with mental illness in crises unfolds the growing concern for community service providers, law enforcement agencies, and public policy.

Additionally, police play a dual role of law enforcement and social workers when working with this population (Bennett, 2017). This dual role may frustrate officers, which can influence police misconduct and the use of force against persons with mental health concerns (Lane, 2019). Furthermore, mental health-related service calls may be perceived as duties outside of police work. Police departments that collaborate with social service agencies can streamline communication and offer prevention strategies that reduce police use of force during mental illness-related interactions. While nearly 69% of police chiefs agreed collaborations with social workers would reduce casualties in their interviews, Lamin & Teboh (2016) noted hesitation in establishing these dual dispatches.

One of the vital elements to ensure appropriate care for vulnerable populations, such as persons with mental illness, is providing structured, person-centered, and gentle assistance from caring staff (Allen & Tracy, 2009). Job descriptions that are considered entry-level or placeholder positions can impact an individual’s work ethic, performance, and, for positions that require direct care, can negatively affect passionate service delivery. Hill and Fouts’ (2005) study suggested employees who lack interpersonal skills, productivity, and dedication jeopardize social costs and an agency’s reputation. Establishing community partnerships between police officers and social service employees can prepare officers through training that includes recognizing signs of mental illness, differentiating mental illness from common distress, and stabilization techniques, which include proper communication skills (Lamin & Teboh, 2016). This is not a criticism of said positions but a call to magnify the impact of underqualified individuals to positively contribute to unique needs and effectively respond during a crisis.

Texas

The state of Texas paints a unique picture as it relates to the criminal justice system’s response to those with mental illness. According to NAMI (2021), over 3 million adults in Texas have a mental health condition and less than half received some time of care in the previous year. Additionally, 1 in 4 people with a serious mental illness has been arrested. According to Mental Health America (2024), in 2022, Texas ranked 33rd among states regarding mental illness prevalence and rates of access to care for adults and 41st for youth. Meanwhile, Natarajan and colleagues (2016) described Texas jails as dangerous and frightening places for individuals with mental illness who would highly benefit from effective community collaborations between correctional facilities and behavioral health centers.

Murphy and Barr (2015) noted a financial restriction within the criminal justice system, affecting how the system responds and assists offenders with mental health needs. With weak communication between law enforcement, community support and social services, the criminal justice system and government resources block opportunities for ensuring adequate response and wellness for individuals. The ideas behind partnerships, collaborations, and communication imply integration and facilitating support and systematic, valuable contributions. However, the failure to provide sufficient support and resources to provide adequate response bolsters an already “broken” system of care that is further exacerbated by poor coordination with law enforcement entities. Moreover, persons with mental health needs are among the most vulnerable populations who frequently intersect unintentionally with the justice system.

Method

The purpose of this qualitative study was to gather pertinent information related to law enforcement partnerships with social service providers. Specifically, this study explored the intersection between law enforcement partnerships and mental health service providers in North Texas. In other words, this study focuses on the cross-system collaboration between police departments, clinical staff, and non-clinical staff relating to mental health crises. The collaborative experiences of five police departments and two different social service providers were represented in this study. The main research question was “What were the challenges in communication between police departments and social service providers when responding to mental health crises in the community?”

Employing a convenience sample of known professionals through social network recruitment, 17 law enforcement officials and mental health professionals (licensed and non-licensed) were recruited. Licensed staff included those with a clinical license, such as a Licensed Professional Counselor (LPC) or a Licensed Master Social Worker (LMSW), and non-licensed staff were professionals without a clinical background and were primarily case managers. Six of the participants were known and directly approached by the first author, indicating eleven participants were recruited through the snowball sampling procedure. This convenience sampling technique also influenced the geographic focus of this study, justified by Murphy and Barr’s (2015) policy analysis that focused on Texas and Natarajan and colleagues’ (2016) policy report on Texas’ crisis related to treating inmates with mental illness. Approximately 22 professionals received an electronic invitation to participate in the study, yielding a 74% participation rate.

To participate in this study, respondents had to be at least 18 years of age, work in a specific urban county in Texas, and have a knowledge of mental health crisis response. Specifically, this included having experience in working with people with mental illness. Some participants had experience in working with those with a dual diagnosis, or a mental illness and an intellectual disability. Among the law enforcement professionals, all participants had at least five years of law enforcement experience. Non-clinical social service professionals held at least two years of social work experience, and clinical social service professionals held at least three years of practice with their respective clinical licensure. Table 1 illustrates participant information.


Table 1: Participant demographics

Professional Title

Educational Attainment

Experience

LCP I

LPC License

3

LPC II

LPC License

10

PD

LMSW

3

APD

B.S. in Psychology

7

Case Manager I

B.A. in Psychology

7

Case Manager II

B.A. in Social Work

3

Program Manager

B.S. in Criminal Justice

3

PMHC

LPC License

17

Police Lieutenant

LPC License

20

Police Sergeant I

B.A. in Philosophy

15

Police Sergeant II

Some college

18

Police Corporal

B.A. in Criminal Justice

17

MHPO I

B.S. in Psychology

15

MHPO II

B.S. in Criminal Justice

17

MHPO III

High School Diploma

18

MHPO IV

Some college

6

MHPO V

Some college

25

Note: N = 17. Experience refers to the total years of experience in their field. PD is short for Program Director. APD is short for Assistant Program Directory. MHPO is short for Mental Health Police Officer, while PMHC is short for Police Mental Health Coordinator. Based on each respondent’s education and organization, their title varied. For this study, these acronyms do not reflect the respondent’s professional title.


There were three different interview instruments used in the semi-structured interviews, depending on the respondent’s profession. Whether a respondent was a police officer, licensed staff, or non-licensed staff dictated which instrument would be used in the interview. Different instruments were necessary to tailor the conversation based on the respondent’s profession and daily activities. The questionnaire was constructed by a thorough literature review and discussed among the authors of this study to enhance content validity. Thus, all instruments were divided into four sections: (1) respondent’s employment demographics; (2) respondent’s education; (3) profession-specific questions; and (4) respondent’s employment protocol regarding mental health crisis response. Mental health crisis response was broadly defined as a professional responding to and aiding an individual with mental illness who is experiencing a crisis.

The first author conducted one-on-one semi-structured interviews with open-ended questions to garner a better understanding of how law enforcement professionals and social service providers independently and collaboratively respond and assist to people exhibiting a mental health crisis. A semi-structured approach was appropriate for this study, allowing each respondent to describe their experiences and elaborate respectively. All 17 interviews were conducted face-to-face in the fall of 2019, with only the first author and one respondent present in the interview.

In efforts to reduce coercion and additional employer influences, all respondents were given a choice to interview in the setting, date, and time of their preference. All interviews were held in a private office or professional setting, such as a conference room, to maintain confidentiality and decrease the likelihood of any work-related interruption. This study was approved by a university Institutional Review Board (IRB).

Data Analysis

All semi-structured interviews were audio-recorded utilizing the first author’s Voice Memo application for Apple iPhones. The first author also took field notes during each interview, providing insights and interpretations of what each interview presented. The iPhone and the computer, where the interviews were stored and uploaded, had password-protected technology, with only the first author having access. The interviews were then transcribed verbatim in Microsoft Word for thematic analysis to find commonalities within the data. Thematic content analysis and narrative analysis were appropriate for this study to reveal patterns in the qualitative material and identify core consistencies (Patton, 2014). A codebook was also developed to determine the categories and themes across interviews. Although the analyses uncovered various themes (see Juarez et al., 2021), for this analysis, the authors focused on four themes: (1) staff and resource availability; (2) continuity of care; (3) staff personnel and characteristics; and (4) communication efficiency.

Results

Staff and Resource Availability

A common theme among study participants (n = 9) was the absence of mental health clinicians, case managers, and police officers with basic mental health response and crisis intervention knowledge. All police departments (N = 5) were represented, and one service provider (n = 1) was represented in this subtheme. Furthermore, the participants noted that both mental health professionals and law enforcement professionals are overwhelmed with the intensive assistance and care mental health crises demand.

A police corporal believed that because there is a small number of open beds in state hospitals, psychologists are pressured into diagnosing a person with something and discharging the person from the hospital. A mental health peace officer described the barrier between effective mental health treatments and correctional facilities as staff availability:

... lots of times, the system is so overwhelmed. Like, if I try to get someone to call [a non-profit organization] right now, typically, it’s like a four-month wait. So, what [is the person in a mental health crisis] supposed to do for four months, and that’s not [non-profit organization]’s fault. They’re overwhelmed with the need.

The same mental health peace officer also stated that availability gets age and gender-specific, as there can be more resources for kids and not so much for males. He stated: “It’s so geared to a very niche clientele.” Hospital staff can range from psychiatrists and psychologists to social workers and other liaisons, to assuage a crisis. In addition, the mental health peace officer described a situation from the morning of the interview and referred to hospitals as having a standing-room-only intake process.

A mental health peace officer from a different police department believed hospital discharges occur not just because the person is no longer a harm to themselves or because the person appears to be stable but because the facility is “extraordinarily overburdened.” The same mental health peace officer expressed that hospitals are not large enough, do not have enough clinicians and staff, and there are not enough bed spaces to assist every person exhibiting a mental health crisis. This is frustrating for both clinicians and law enforcement professionals.

Other participants noted that the lack of availability is centered on social workers. A police mental health coordinator elaborated on her previous work experience in social work and mental health clinicians in general:

There’s such a high turnover in our treatment providers that by the time you get your treatment provider up to date and educated on what’s out there and how to navigate those systems, they’re so burnt out because they’re underpaid and overutilized that we see a high turnover and it’s hard to keep our high, solid caseworkers, honestly.

The mental health coordinator believed social workers need higher pay, adequate training, and a management supervisor. A case manager or social worker’s caseload can get up to one hundred people who must be seen monthly. These monthly visits are state-funding requirements that, if jeopardized, may lead to programmatic funding reductions. The mental health coordinator also stated:

If we are paying [social workers] $30,000 to $40,000 a year, I mean you are just not gonna keep a good person. It takes somebody with a master’s degree, I mean they may do that right out of school but they’re going to get burnt out. And so, I think we have to expand all of our treatment centers and all of our systems and we’ve got to pay all of our people to keep them.

Nonetheless, social workers are not the only professionals with caseloads. A mental health peace officer explained, “The caseload is enormous,” and affirmed the crisis intervention unit is understaffed. The same mental health peace officer stated that patrol officers are just as overwhelmed, but patrol officers outnumber mental health peace officers in that specific unit. A different mental health peace officer supported the previous mental health peace officer’s opinion on caseload size. This mental health peace officer stated, “The insane caseload that we have is insanely high, and we can’t keep up with the limited number of officers we have.” The mental health peace officers added that patrol officers are also “understaffed,” which also poses a challenge to the department.

A different mental health peace officer from the same police department shared the same perspective:

If there were just more programs in place to keep these people- more case managers, I think more than anything, to keep them on their routines, to have support systems because a lot of the chronic ones out there, their families have given up on them and it’s hard.

The same mental health peace officer elaborated on how social workers can continue monitoring a person’s progress and “keep them on task,” which can keep them from regularly encountering law enforcement.

In terms of resource availability, a police sergeant expressed how the lack of medication availability in correctional facilities is a large barrier for inmates with mental health needs. More specifically, prescriptions change over time, affecting what is available onsite if at all. The police sergeant described bipolar disorder medication as a medication that “change[s] over time because of the way that bipolar disorder works.” If an inmate with bipolar disorder is in prison long-term, then the inmate may have trouble accessing their bipolar medication. “A large portion of our prison systems probably are overloaded with medical and mental health staffing is also an issue,” said the sergeant.

In the private sector, facilities are also underfunded and vary in terms of the treatments the prison offers. The police sergeant explained inconsistent counseling sessions, independent or group sessions, as well as family counseling sessions, are interrupted by the facility’s priority to “just do the bare minimum to keep people alive,” which can include “not providing mental health services.” This statement justifies this sergeant’s strong emphasis on ensuring continuity of care upon release, as some people “turn out being worse going in than whey they were put in.” A case manager believed “proper support” in correctional facilities, such as prisons, includes “proper counseling from a licensed profession.” Due to limited funding, the case manager suggested: “to save cost, a counseling intern with oversight from a licensed and experienced professional” could also help the mentally ill receive proper treatment and support.

Alternatively, a police lieutenant noted that the barrier is technically not while a person is in a correctional facility but when the person leaves the facility:

It’s kind of the aftercare part where I see more of the issues because while they are there, they are being supported, they are being taken care of, and they are on their medication. Maybe they are in a group, or they have kind of a supportive environment for them. It’s confined, it’s in structure, it’s controlled, and then, “Okay, now you can leave.”

When the person exits from any correctional facility, the continuity of care often struggles, whether this is connecting with a mental health professional, resources, or establishing and continuing mental health care. The same police lieutenant identified transportation and location as barriers for people with mental health needs, as mental health crises can then become cyclical without a “safety net.” The apparent issue, from the lieutenant’s perspective, is officer availability to continue follow-up visits more than just a couple of times after the initial crisis.

Continuity of Care

Some of the study participants (n = 5) discussed a need for an alternative setting to incarceration for people with mental health needs. Only two police departments (n = 2) and one social service provider (n = 1) were represented in this subtheme. A commonality among the participants was the suggestion for non-profit organizations and other community partnerships to work alongside law enforcement agencies. To ensure people with mental health needs are receiving the medications or treatments needed, it would behoove the criminal justice system to have alternative resources to appropriately serve offenders with mental illness.

Both the program manager overseeing jail staff and a mental health peace officer advocated for diversion programs to assist individuals with frequent police contact. The program manager specified that the “frequent fliers” would benefit from “evidence-based approaches that actually work as opposed to what makes people feel good based on their biases.” The mental health peace officer suggested that keeping a consistent and strong rapport between law enforcement and the person who is frequently in crisis could facilitate future responses and ideally decrease the number of times police encounter the person in crisis.

An LPC suggested that diversion opportunities, whether it is “finding places or creating different opportunities” for people with mental illnesses or psychiatric disorders would be more proactive than locking them up and ignoring their mental health needs. If correctional facilities had a way to divert to facilities out in the community with programs and services, then the mentally ill could be “linked” to then have intervention opportunities to not just attend to their illnesses or disorders but also to increase the chances of success out in the community and opportunities. The LPC stated:

Diversion opportunities are common in the mid-west, and there are some in the northwest as well, where police officers can drop off people that they suspect have a mental illness. They don’t take them to jail, or a dunk tank, they just let them go to like a 24-hour facility, watch them, and get them connected to the local mental health authority.

Once the person is detoxed, then they can reconnect with authority for further assistance and crisis stabilization. However, this is dependent upon the individual’s capacity and whether they have existing supports or have additional hindrances.

A police lieutenant also felt a need for “diversionary procedures” that come directly from the court system. These “procedures” would consist of mental health consultants to assist police officers and detectives and act as liaisons when they “have a case that involves a mental health component” and the case is being investigated. Not all police departments have mental health units that focus only on mental health crimes and investigations. With these diversionary procedures, the responder would be able to determine if the person “needs more of a mental health treatment or whether they need to be in jail with mental health treatment” by using “diversionary tactics.” The same police lieutenant acknowledged an officer in the mental health unit actively works with Tarrant County’s housing authority to help people get into a housing diversion slot.

On a separate account, a clinical crisis assistant program director felt the issue in successfully providing continuity of care is “the lack of government funding.” From this, the assistant program director encourages staff personnel to be “mindful” of the population they are working with, as the “way people talk to someone who cannot process emotions like the average person can affect the person’s trust with police officers and medical providers.”

Staff Personnel and Characteristics

The third theme of this qualitative study included insights from three of the five police departments (n = 3) represented, with input from six respondents (n = 6). The lack of staff availability and mental health education results in clinical professionals and law enforcement professionals being responsible for determining if a person is no longer a harm to themselves or a harm to the public. One of the biggest challenges when ensuring continuity of care is assessing whether the current crisis is no longer posing an immediate risk or harm to others, as each profession has a specific protocol and is under intense pressure. However, due to the lack of funding, staff availability, and mental health education, clinicians and health providers must focus on the immediate crisis at hand and handle the situation to the best of their availability while responding appropriately.

A police sergeant expressed that when psychiatric hospitals discharge a person with a mental illness who is in crisis, police officers become responsible to take action and prevent a future crisis:

... because they were no longer considered a danger to themselves or others. If you ask an officer, any officer, that deals anything with mental health issues, they will say the ones that actually need the help, [local psychiatric hospital] seem to kind of just push aside because they are so understaffed or so over-worked. The ones that don’t need the help, they’re so interested in getting them admitted.

The police sergeant believed psychiatric hospitals lack funding for staff availability, which ultimately affects the people seeking mental health treatment and contributes to the revolving crisis cycle. From the law enforcement perspective, the police sergeant feels that if something happens to a person who is discharged from any facility, society will “point at the police department for not doing their job.”

A police lieutenant also advocated specifically for correctional officers to take into consideration that when a person with a mental health need is incarcerated, “they don’t always get their medications right away like they should,” and sometimes, the person may go “days without their medication, which can mess up their whole system, hormones, and everything.” No law enforcement professional or any professional for that matter should “try to have power over [incarcerated individuals],” as this can lead the mentally ill person to believe that the corrections officer or the working professional is “just another person telling them what to do and they don’t quite understand the effects afterward,” said the same police lieutenant.

A unique argument came from a mental health peace officer, who claimed that staff at group homes that house mentally ill people are not trained appropriately to work with this population. The mental health peace officer stated there is not just a lack of group home staff, and group home staff are often not “mental health or crisis trained.” This impedes staff from having a decent understanding of what mental illness and psychiatric disorders look like and how to treat them. If group home staff were trained appropriately, then “it might alleviate some of the calls that go out to patrol,” said the same mental health peace officer.

The notion of empathy was brought up in a couple of interviews. Participants believed empathy itself is not the only solution, but the way a person approaches the situation and their willingness to address the behavior and current situation first, rather than focusing on the criminal offense. The same LPC feels that a lot of people who rely on substance use drugs and alcohol to make themselves feel better and loved:

I think loving them and helping them understand [their diagnosis] is going to be here and there’s nothing that’s gonna take [it] away necessarily, but there are things that can be given that can make [their] life more manageable.

The LPC added that social workers sometimes find themselves doing the bare minimum and not wanting to be in the field. The effort is sometimes absent, which feeds into the disappointment the mentally ill often experience with social services. The same LPC stated that instead of empathizing with a person and “feeling sorry” for them, social workers and mental health professionals should encourage the person and “walk alongside [them] and help [them] get to where [they] want to go.”

A mental health peace officer explained that communication between police officers or mental health clinicians with a person in crisis should be approached with a “relaxed demeanor, even if it’s a hostile encounter.” Still, professionals must be able to protect themselves and the person they are assisting. The mental health peace officer provided an example of responding to a person with schizophrenia:

If you go in there and they’re amped up, you know, and they are hearing multiple stimuli and multiple voices, and you don’t know what they’re hearing, your communication has to be different. It has to be slow and methodical because you have to be able to pierce through those other voices to actually make sure that they are actually hearing me. I like to do things as slowly and methodically as possible.

The same mental health peace officer explained that mental health peace officers in the unit are not restricted to the radio, allowing officers to spend as much time on site as needed. “If I needed to spend 24 hours with an individual, I can,” affirmed the mental health peace officer.

In adopting a person-centered approach, the person suffering from a mental illness or psychiatric disorder can help the person learn more about their specific diagnosis and be able to make choices about how they want to get better, or even if they want to be treated at that particular time. Participants stated that ongoing crisis response training and a basic understanding of mental health would benefit all professionals involved in how encountering mental health crises and learning about person-centered language.

Communication Efficiency

Lastly, in identifying barriers to effective mental health service delivery, five study participants (n = 5) referred to communication as a critical component in assisting people with mental illness. Two of the five police departments (n = 2) participating in the study and one of the social service providers (n = 1) were represented in this subtheme.

A program manager over correctional staff noted that all professionals who become involved in a mental health crisis are on “different agendas,” due to the specific approaches and regulations each is responsible for completing:

... because the law enforcement community has a certain approach, and the courts have another approach, and the defense attorneys have another approach, and even sometimes within [non-profit organization], different units have different agendas, and there tends to be a lot of siloing, where people say, “I’m gonna stay in my lane, focus on my thing, and I don’t really care what you’re working on, so I’m gonna do my thing and then I’m gonna go home and live my life.”

Law enforcement professionals and mental health professionals must be transparent in communicating with one another to better serve people in crisis. The same program manager described how these professionals “are working in the same direction” and are working to keep the “community safe and improving the lives of people.” Instead of siloing each other and not wanting to help one another, “we should try to work together to see what we can do to get Releases of Information from the client to see if there’s a way the client will agree to communicate with us,” said the program manager.

Similarly, a police sergeant identified the communication between police officers and outreach groups must improve. Without proper communication, mental health professionals and law enforcement professionals can sometimes find a person is receiving or has received in the past, “duplicate services or something was missed.” The same police sergeant added the follow-ups police officers conduct could help prevent these duplications, or the follow-ups can help officers direct a person to mental health resources. There needs to be an effort exerted toward communicating efficiently between law enforcement professionals and mental health professionals overall.

Internal communications within the agency, organization, psychiatric hospital, or the police department are also highly encouraged. A police lieutenant shared, “Mental health is so fluid, sometimes it is subjective.” From this, police officers are “encouraged to share their encounters and follow-ups with people in the community,” even if they are with the same person. The police lieutenant stated:

Most of the time, the end result is not really what I am looking at. The end result is more of, you know, how you interacted and what plan you set up. We try to stress it’s not the end result. It’s really how the interaction went and are they okay with the decision.

The study participants thoroughly explained the benefits of community collaboration when assessing people in crisis with mental health needs. Proactive and efficient communication methods were also emphasized by participants, as communication can sometimes hinder professional help. A common theme throughout discussions was the need for additional funding to continue building these partnerships and strengthen the treatment and resource availability.

Discussion

This qualitative analysis shows ideological differences between police and service providers that manifest in conflicting attitudes and divergent goals. This can mean deadlines being ignored by one group misunderstandings on what each group needs and can provide, creating potential frustrations between individuals. Inter-agency communications are key to addressing and ameliorating the inefficiencies that already exist. Inter-agency conflicts and miscommunication can disrupt services, a major factor in effective service delivery. These results are consistent with the existing research.

Using the nodal governance perspective, these conflicts are not unexpected. According to Shearing and Wood, 2007, p. 147, “Nodes relate to one another, and attempt to mobilise and resist one another, in a variety of ways so as to shape matters in ways that promote their objectives and concerns.” This does not necessarily mean each actor is selfish, but instead, structurally bound by their respective definitions of successful outcomes. For example, police are fundamentally law enforcers, and police officers are credited for performing activities related to crime control, such as those defined by the Uniform Crime Reports. Service providers’ successful outcomes, in contrast, are defined by successful treatments and services.

There continues to be a disconnect between the criminal justice system and the public health system (Root, 2020). The most important collateral consequence of this disconnect is the mentally ill being left for the criminal justice system to handle many of these individuals. A staggering number of 44% of jail inmates reported that a mental health provider told them that they have a mental disorder (Bronson & Berzofsky, 2017). Even more individuals with mental illness encounter police, yet we have no solid plan to deal with these individuals in the criminal justice system, while many continue their criminal history accumulation. This requires that individuals working in the criminal justice system should have knowledge and understanding of mental illness to effectively interact with these individuals.

However, the qualitative findings of this study indicate that professionals still believe there is an absence of mental health clinicians, social workers, and police officers with mental health response and crisis intervention knowledge. In Texas in 2016, more than 80% of Texas counties were designated Mental Health Professional Shortage Areas and the COVID-19 pandemic only exacerbated this shortage (Simpson, 2023). The shortage in staff may also trigger a scarcity of medication, both variation and quantity. By improving communication and dispatch responses, those with mental illness are ensured to be under safe care with interdisciplinary response strategies.

Continuity of care when these individuals have contact with the criminal justice system and after can only increase the likelihood of success for these individuals and reduce the likelihood that they will cycle through the criminal justice system in the future. Previous research has found that people with a mental illness, especially those with co-occurring disorders, have higher recidivism rates than people without mental illness (Bales et al., 2017; Wilson et al., 2014; King et al., 2022). This relationship is complex; however, research suggests that these individuals who engage in treatment are less likely to recidivate (Zgoba et al. 2020).

As the respondents claimed, staff characteristics are critical to rapport building and the overall interaction with individuals experiencing a crisis. While the study’s respondents described burnout and low pay as elements that contribute to staff turnover, these limitations call for a need for community collaborations between police departments, and clinical and non-clinical staff. Furthermore, the lack of mental health awareness and education related to threat and discharge assessment should be further examined. Respondents from this study referred to how negative outcomes post-discharge may place blame on police officers given the expectation our first responders are held to.

This qualitative analysis is consistent with the recommendations to enhance mental health awareness and encourage community diversion (Lamb & Weinberger, 2017; Stewart et al., 2017). Mental illness is one of the most stigmatized health conditions in our society despite almost 58 million Americans (23%) experiencing a mental illness and approximately 14 million (5%) living with a SMI (SAMHSA, 2023). Police officers and social service providers recognize the challenges to ensuring continuity of care through reoccurring crisis intervention training. COVID amplified mental health concerns with the World Health Organization (2022) reporting a 25% increase in the prevalence of anxiety and depression in the world and approximately 41% of U.S. adults experiencing high levels of psychological distress (Pasquini & Keeter, 2022). This stigma must be significantly reduced for the criminal justice system to help, not punish, these individuals. With the growing number of citizens with mental illnesses across the country, first responders, specifically police officers, are held high in expectation to assess crisis situations appropriately.

Policy Implications

Despite the high burdens and costs that society takes on due to mental illness in society, public support for resource allocation to increase mental health seems to be low. For example, in 2016, 42% of Americans reported they would pay $50 more annually in taxes to improve the mental health system (McGinty, Pescosolido, Goldman, & Barry 2018). However, key stakeholders such as policing agencies and nonprofit organizations are realizing the need and benefits of collaboration. The partnerships in Texas are just one example of this collaborative effort.

Anytime institutional networked arrangements are made, there are inevitable challenges in defining roles, sharing resources, and interfacing with oftentimes rigid bureaucratic structures. These challenges are not new and similar to collaborative efforts with prisoner reentry, where a variety of cultural and structural issues between a network of police and nonprofit organizations revealed divergent successful outcomes and incentive structures often led to confusion for former inmates (Nhan et al., 2017). Similar issues are present with persons suffering from mental illness and their families. However, these difficulties can be ameliorated with a combination of public education, training, and mental health diversion programs.

Public Education

Public education campaigns are a key policy element that is often overlooked that could increase understanding, support, and responsivity for treating the mentally ill in non-criminal justice arenas. This could ultimately reduce societal stigmatization around mental illness that many consider these individuals as dangerous and criminal instead of persons in need of assistance. These perspectives often are derived from inaccurate news and entertainment media portrayals that emphasize the dangerousness, unpredictability, and criminality elements of mental illness that impair self-esteem, help-seeking behavior, and other factors to recovery (Stuart, 2006).

Better public understanding can increase support for resources toward treatment instead of punishment. A survey of healthcare professionals showed support for mental health campaigns that should start early with delivery in elementary schools beyond broadcasting over television and web-based outlets and should consider cultural contexts to include family units and diverse cultures (Pawluk & Zolezzi, 2017). However, changing public perceptions using education campaigns is difficult. A survey of over 1,200 members of the general population measuring the effects of a mental health campaign on schizophrenia and alcoholism comparing the Changing Minds campaign between an experimental and control group showed largely ineffective results (Luty et al., 2018). As such, public campaigns should be part of a multi-pronged approach that includes training.

Training

Training is twofold. First, everyone in law enforcement and the criminal justice system should be trained and have an increased understanding of mental illness. More officers need to be trained and reoccurring training should take place among the individuals on the co-response team. In Texas, officers without an Intermediate or higher proficiency certification must complete crisis intervention training within a 4-year training cycle (TCOLE, 2023). Officers must take their own initiative and resources for additional trainings and certifications.

Second, these individuals should be trained in knowing what mental health agencies and resources are available in their community. Police partnerships with non-profit organizations and community agencies can provide critical educational and training opportunities to address the lack of personnel. Interagency training and communication can also help agencies close loopholes and increase the continuity of care of individuals.

Mental Health Diversion Programs

In the previous few decades, we have seen an increase in initiatives to divert individuals toward public health outlets rather than jail for first-time and low-level offenders. One such approach is mental health specialty courts. These courts were created in the mid-1990s to divert individuals with mental health disorders away from the criminal justice system. Most of these courts give treatment as an option instead of jail time. In Texas, there are only 14 counties with recognized mental health court programs (Texas Judicial Commission on Mental Health, 2023). These courts develop partnerships with public and community agencies and organizations to offer treatment and rehabilitation services to the defendant. These courts can increase the continuity of care and agency communication to optimize the treatment of the defendant.

Crisis Intervention Training (CIT) provides police officers with training on mental illness and de-escalation tactics (see Bonfine et al., 2014; Mulay et al., 2016). These teams are formed as police units and these officers are trained to respond to mental health offenders and offer them treatment or social services if available. Several national and international organizations, such as CIT International and the National Alliance on Mental Illness (NAMI) have created communities, sponsored research, provided training, and put forth best practices for interested law enforcement organizations. Despite the proliferation of CITs, there are still challenges and shortcomings to its implementation. Many departments and officers still use traditional methods of restraints as part of their response to crisis situations, such as handcuffing individuals as a safety measure as opposed to calm talk and de-escalation. Moreover, some agencies and officers merely see CIT training as a “check-the-box, 4-hour exercise” without understanding the true intent and principles of CIT (Westervelt, 2020). Fort Worth Police Department has a CIT team of six law enforcement officers trained and TCOLE-certified as mental health peace officers. Their primary purpose is to “reduce the hazards associated with interactions between law enforcement and people suffering from mental illness as well as proactively engaging mental health consumers who pose a threat to the community as a whole” (para. 3) while a secondary purpose is to reduce return calls with these individuals “ultimately freeing patrol officers to provide better service to the community” (para. 4). Often, success of individuals in mental health crises is not the primary purposes of these teams.

An additional approach that focuses on individuals in mental health crises includes non-police crisis teams, who usually work separately from police but can be called to a police scene. Several cities, including Houston, Round Rock, and Austin have these teams. For example, Austin has an Expanded Mobile Crisis Outreach Team (EMCOT) that works with first responders to co-respond to mental health crisis calls, to divert these individuals from jail bookings and emergency department admissions. This team is also on-site at jail facilities to provide support for individuals being released (Integral Care, 2017). This team works with individuals in real time to provide assessment, screening, and triage for their mental health crises and connects individuals with community-based resources for a longer-term solution (Austintexas.gov, n.d.). However, when an individual needs custodial care in a mental health facility, in the state of Texas, law enforcement, a judge, or a legal guardian must be present to admit someone (when it is not voluntary) (Bostwick, 2024).

Conclusion

The mental health crisis in the United States is a growing problem that states and municipalities are struggling to handle. While this study captures a snapshot of crisis response in one region in Texas, new paradigms and approaches are organically emerging as mental health and law enforcement organizations are collaborating and sharing resources. This is consistent with the body of literature that posits that police for decades have been taking on a role as just one stakeholder in security networks to manage an increasingly complex world (See Burris et al., 2005). The respondents of this study represented five different police departments and two separate social service agencies. Geographically, it was to the authors’ knowledge that there has not been a qualitative study concentrated in this region. However, such collaborations come with difficulties and challenges as different organizations and entities interface.

At a more micro level, the effectiveness and capacity of collaborations and specialized units are only as good as the individuals who do the work. We have seen from the interviews the toll and frustrations of navigating the assortment of stakeholders when trying to help individuals with mental health in crisis. This includes difficulties in the law enforcement and legal space that are focused on incapacitation and more punitive solutions as well as trying to convince a public that largely misunderstands the complexities of the problem to change the narrative. There is an imperative need for interagency cooperation and performance improvement to encourage transparency and clear collaboration in the community as it relates to crisis response. Finding solutions is difficult and this study serves as a small, yet significant starting point.

This study takes a snapshot of a mental health collaboration between law enforcement and mental health service providers in North Texas. As these collaborative networks are becoming more common and CITs are being adopted by police agencies, more research is warranted comparing different locations for generalizability. While these networks and partnerships may differ in terms of what mental health resources each stakeholder possesses, we feel these inter-agency frictions exist and are similar due to inherent cultural and structural factors.

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Contributors

Alessa Juarez, Ph.D., is an Assistant Professor of Criminal Justice at the University of North Texas (UNT). Her research interests focus on human trafficking, sexual violence, comparative criminology, and police interactions with vulnerable populations. Her recent research has been featured in Justice Policy Journal.

Kendra Bowen is an Associate Professor of Criminology & Criminal Justice at Texas Christian University. Her research interests focus on sexual violence, case processing, and policing. Her recent research has been published in the Journal of Crime and Justice, Policing: An International Journal, and Family & Intimate Partner Violence Quarterly.

Johnny Nhan is a Professor of Criminology & Criminal Justice and Associate Dean of Graduate Studies at Texas Christian University. He has published in different areas of policing and the criminal justice system, primarily focusing on technology, processes, and partnerships between criminal justice actors and organizations.

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