Interactions between police and people with mental illness

In this month’s issue, McArdle and co-authors report two cases of pneumomediastinum in patients who had been restrained in police custody in Tasmania (McArdle et al., 2017). Back in June, police in New South Wales shot a mentally ill man who reportedly brandished a large carving knife, ignored commands to drop his weapon and rushed at two officers in a crowded Sydney shopping mall. Three bystanders suffered ‘other bullet or fragment wounds’ (McClellan and Gleeson, 2016). Incidents like these rightly focus attention on the frequency, nature and outcomes of police interactions with persons suffering from a mental illness.

In this brief comment, we review the extent of this issue and report on some of the methods police have employed in their efforts to improve outcomes.

Certainly, such interactions are frequent. In 2013, NSW Police responded to more than 40,000 mental health incidents across the state, representing a significant proportion of all general duties police work (NSW Police Force, 2014). As is the case in all Australian jurisdictions, NSW police are empowered to take a person they reasonably believe to be suffering from the symptoms of a mental illness to a mental health facility for assessment and potential treatment. In 2014–2015, there were 4000 such referrals (NSW Mental Health Review Tribunal, 2015).

Fortunately, it is quite unusual for Australian police to be involved in situations that feature the potential or actual use of deadly force. Nonetheless, across Australia in the two decades prior to 2011, there were 199 shooting deaths in police custody or police custody–related operations (the latter including sieges, raids and pursuits) (Lyneham and Chan, 2013). In nearly half these cases, the persons shot themselves in the presence of police, and in 44% of these self-inflicted injury cases, the persons suffered some form of mental illness at the time of their death. Of the 105 people shot and killed by police over this period, there was evidence of a mental illness in about 42%, with psychotic disorders present in nearly 60% of these.

Of course, concerns of this sort are not limited to gun violence. Of all 700 deaths in police custody and custody-related operations over the same two decades, there were 200 cases where the coroner found that ‘the deceased person was suffering the symptoms of, or had been diagnosed with, a mental illness’ (Lyneham and Chan, 2013: 100).

Police have not been blind to these figures and are taking action aimed at bringing these rates down. New South Wales Police (NSWPOL), for example, has initiated a number of significant measures to enhance its performance in the mental health arena (Chappell, 2013: Ch. 4). Over the past decade, it has introduced and independently evaluated a new and comprehensive 4-day Mental Health Intervention Training programme for 1500 of its operational police across the State as well as numbers of police from other Australian jurisdictions. The programme, which has attracted both national and international attention, strongly emphasises dialogue between police and people living with mental illness and involves mental health professionals in the training process. More recently, NSWPOL have instituted a 1-day mental health training programme for its entire 15,000 strong force – a huge task that is still in progress.

NSWPOL is not alone in introducing measures of this kind. Queensland Police have also initiated mental health training for their field staff (Chappell, 2013: Ch. 5). Queensland and Victorian Police are also trialling a programme in which the response to a mental health incident is by a team, comprising both police and mental health professionals. Best practice models of this type have already been tested in North American police forces with considerable success, and there is every reason to believe that they would also be effective here (Chappell, 2013: Chs 1, 2).

Far more contentious, and less certain of positive outcomes in this area of policing, has been the recent and widespread introduction in Australian police forces of another North American measure, the Taser ‘electric stun gun’. Although generally less lethal than firearms, concerns persist over the procedures around the Taser’s widespread use (New South Wales Ombudsman, 2012). One of the questions that will no doubt feature prominently in the ongoing ‘in house’ review of the NSW police shooting will be why a firearm rather than a Taser was deployed. The health authorities will also need to consider how an involuntary patient was apparently able to leave his place of treatment with subsequent near-fatal consequences.

Of course the responsibility for improving these outcomes lies not just with the police, but with us all. For too long, there has been insufficient dialogue and discussion between law enforcement and health agencies about the management of their respective responsibilities in the area of mental health. Perhaps the lessons to be learned from critical incidents like these in Tasmania and NSW will act as catalysts for change and herald a willingness to explore better ways in which to respond to the needs of mentally ill persons in Australian society.