The Impact of Mental Health Treatment Services on Individuals with Mental Illness Who Have Multiple Encounters with Law Enforcement

Background/Purpose: Persons with mental illness (PwMI) represent 26% of individuals in jails (BJS, 2017) and it is estimated that between 7% and 10% of all law enforcement encounters are with PwMI (Deane, Steadman, Borum, Veysey, & Morrissey, 1999). While research has broadly focused on interactions between PwMI and law enforcement, little is known about individuals with mental illness who come to the attention of law enforcement on multiple occasions. This exploratory study asked: Do PwMI who have multiple encounters with law enforcement for mental health issues have higher risk factors for criminal encounters? How do their law enforcement encounters intertwine with mental health treatment services?

Methods: Law enforcement call reports (CRs) were collected over 3 years from one Midwestern county where 25% of officers received training in the identification of mental health symptoms. A subsample of 53 individuals were found in CRs who had two or more encounters with law enforcement. These individuals were then tracked within law enforcement and mental health treatment data over the same period. Data extracted from the CR included: demographic information, the type of call as either mental health/suicide or a criminal offense, and the date. Mental health treatment data included the dates and levels of mental health services received. Levels of services include low-, medium-, and high-intensity treatment. Treatment data also noted if the individual had a co-occurring substance use disorder (COD). Data analysis includes descriptive and bivariate analyses, and cox regression analysis was used to determine if the time to next law enforcement interaction after initial mental health treatment resulted in an increased risk of criminal contact with law enforcement.

Results: The sample consisted of 64% male, 80% White, and 46% had a co-occurring mental health/substance use disorder. Participants had a total of 219 interactions with police over the three-year period, with a majority (57.5%, n=126) being coded as mental health contacts. The data reflected a statistically significant decrease in mental health interactions with law enforcement after their initial mental treatment (t(32)=-2.146, p<.05); with 14 PwMI having no further criminal or mental health interactions after receiving mental health treatment. Cox regression hazard ratio (HR) results indicated that the risk of the next criminal interaction with law enforcement after mental health treatment was 2.22 times higher for those who identified as COD (HR=2.215; 95% CI: 1.005-4.883, p<.05).

Conclusion and Implications: Findings from this exploratory study show the positive impact of mental health treatment in reducing recidivism, and the impact of training law enforcement to recognize the presence of mental illness when responding to crisis. It also demonstrates the pervasiveness of COD among persons with repeated interactions with the police. The findings also emphasize how PwMI with a COD are at higher risk of recidivism. The study underscores the importance of integrated services for CODs in the criminal justice systems, as a tool in reducing recidivism.