Editor's Note
Enforcing
solutions
Cooperative
efforts between health care and law enforcement spell better
treatment for the mentally ill
Beth Ulrich, Ed.D.,
RN, South Central Editor
February
5, 2001
The
criminalization of mental illness in our country-a crime
in itself-directly and indirectly affects us all. When the
number of people with mental illness in jails exceeds that
of patients in treatment facilities, the results cause everyone
to suffer.
The
majority of people with mental illnesses benefit from treatment.
Left untreated because they lack mental health insurance-or
any health insurance-or because of a dearth of community
mental health services, they become time bombs waiting to
explode.
At the
most basic level, we need mental health equity in health
insurance plans and mental health services for people without
insurance. Until we have those, however, we must better
deal with the reality that thousands of people have untreated
mental illnesses.
Several
best practices have been identified across the country:
-
The
formation of police department Crisis Intervention Teams
(CITs).
-
The
availability of psychiatric emergency service centers
or emergency rooms with staff trained in dealing with
mental health crisis situations.
-
Implementation
of transition programs that work intensively with offenders
who have mental illness and/or mental retardation during
parole or probation periods.
Experience
shows that CITs are a highly effective best practice in
several major cities. CIT police officers trained to quickly
identify signs of mental illness can de-escalate mental
health crises. If someone with mental illness is accused
of a felony or any lesser offense, officers know how to
communicate effectively with him or her to prevent or minimize
negative behavior.
An unexpected
benefit of the training is that officers in Houston have
reported success in using their CIT communication techniques
to help settle domestic disputes.
Key
to the success of CITs is a close working relationship with
psychiatric emergency service centers or emergency rooms,
where staff members know how to quickly assess the mental
health status of offenders and initiate treatment if necessary.
Incarcerating
an individual in a mental health crisis only exacerbates
the crisis. By working with health care professionals trained
to identify and treat mental health problems, police officers
often can obtain treatment for the offenders rather than
incarcerating them for minor offenses stimulated by their
mental illness. This leads to improved care and decreased
use of court resources on cases that mental health professionals
can and should handle.
In Houston,
while designing the NeuroPsychiatric Center psychiatric
emergency services, the staff worked closely with law enforcement
agencies to ensure that the officers would have the resources
they need–resources an ER normally would not have,
such as a holding area that meets law enforcement needs
and a computer system that allows Houston Police Department
officers to enter charges on-site. Officers then can quickly
resolve case dispositions and get back on the streets to
do what they do best.
Another
best practice involves preventing recidivism by working
intensively with people with mental illness and/or mental
retardation who are parolees or are on probation. The key
elements of the most successful programs include:
-
Coordination
with the criminal justice system
-
Intensive
case management
-
Mental
health and/or substance abuse counseling and treatment
-
Housing
and food assistance and life skills training
While
providing these elements may sound costly, the benefits
far outweigh the financial and societal costs. In fact,
the programs actually reduce costs.
As nurses,
we frequently encounter opportunities to influence how other
professionals, such as police officers, respond to and treat
people with mental illness and/or mental retardation.
Sometimes
we also can implement a program or help with training in
programs such as the CITs. By knowing best practices such
as those described above and in this issue's cover article
and by taking advantage of opportunities that arise, nurses
ultimately can improve society by decreasing the criminalization
of those with mental illnesses.
Beth
Ulrich, ED.D., RN
What
do you think?
Email us at
editor@nurseweek.com
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