This section discusses the appropriate disposition options chosen by the officer based on the nature of the situation as determined in the assessment phase - including the behavior of the person with mental illness, established protocols, and the availability of community resources. 

The availability of community resources is dependent on a complex set of circumstances.  For example, the advent of managed care and other changes in the broader health care system, as well as in the delivery of mental health services, have resulted in hospital consolidation, the shift to ambulatory care, and changes in emergency room procedures in almost every community in the country. In many places, practices in place just a few years ago no longer apply today. Due to factors well beyond the control of mental health services, it can be difficult to admit patients to a hospital or other medical facility. For this reason, law enforcement officers and others should stay abreast of how mental health services are delivered in their community.

Spurred by the new health care realities, mental health service providers in many communities have developed protocols intended to ensure that appropriate professionals see emergency psychiatric patients in a timely manner. Models differ among communities due to numerous factors, but the most effective approaches seem to share certain characteristics, such as having staff who can respond quickly and make an assessment of the needs of each person who comes to them.

In rural settings, where hospitals or treatment centers may be located far from some communities, officers face challenges related to time and travel, in addition to the obstacle of identifying appropriate resources for someone they believe needs treatment. Increasingly, communities are using technology - "telemedicine" - for initial assessments. Alternatively, communities rely on general health care practitioners or lesser credentialed professionals to provide these assessments, which, while not ideal, may be the only means available with current system and resource constraints. Still, there are many instances in which long distances need to be traveled in order to connect a person in need of treatment with appropriate services. Generally, law enforcement agencies are called on for transportation in these cases. (See Policy Statement 18:  Development of Treatment Plans, Assignment to Programs, and Classification / Housing Decisions, for more on telemedicine.)

The range of response options should always include the option of disengagement when the person is not a danger to him or herself or to others and has not committed a serious crime. Disengagement from police contact should not be interpreted to mean that no assistance is offered.  What it can be interpreted to mean is that officers can and should provide referrals to appropriate mental health services and supports in such instances.

Departments should be aware that the simple presence of a law enforcement officer implies a certain amount of power - many people interpret whatever an officer says as something they must do.  Officers should make clear that it is voluntary for people with mental illnesses - those who are not a danger or have not committed a serious crime - to follow their suggestions for referral and treatment.  True problem solvers will help the person with mental illness overcome such barriers to initial treatment as transportation problems or fear of traveling alone.

The following recommendations suggest ways to facilitate the appropriate disposition for the full range of people with mental illness who may encounter the police.  The sections recommend procedures that enhance emergency evaluations, promote referral to support services, provide information to victims and families, and facilitate transportation and detention when necessary. Detailed policy recommendations on report writing and other incident documentation procedures are included in Policy Statement 5: Incident Documentation.

Recommendations:

a.

Institute a flowchart that matches hypothetical situations with disposition options.

b.

Designate area hospitals or mental health facilities as disposition centers that facilitate intake for people with mental illnesses who require emergency psychiatric evaluation.

c.

Ensure that comprehensive emergency psychiatric services are available to law enforcement agencies for around-the-clock intake, 24 hours a day, 7 days a week.

d.

Formalize agreements between law enforcement and mental health partners participating in protocols.

e.

Ensure that mental health services and supports are available for every person in need.

f.

Ensure that specially trained mental health professionals are available to respond to scenes involving barricaded or suicidal suspects.

g.

Provide information to victims with mental illness and their families to help prevent revictimization and increase understanding of criminal justice procedures.

h.

Inform affected third parties, including victims, minors and the elderly, about what to expect and what community resources are available.

i.

Disengage or transport the person to the appropriate facility with the least restrictive restraint possible.

j.

Conduct suicide screening for all people with mental illness who are detained for a short time in a police lock-up or jail.