Police Decision-Making in Encounters with Persons with Mental Health Conditions: Content Analysis of Officers’ Narrative CIT Reports



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Police maintain a lot of discretion in their interactions with persons with mental health conditions (MHC), and the decisions police officers make during those encounters can influence the way the subject reacts, the outcome of the encounter, and to what extent that individual becomes involved in the criminal justice system or community-based treatment. As decision-making is an internal cognitive process, it cannot be easily observed or measured. Yet, understanding officers’ decisions is crucial to understanding and guiding their behavior. This analysis examined information contained in police officers’ own reports to determine what factors were most salient to an officer’s decisions during such interactions. With cooperation from a police agency in southwestern Virginia, officers’ written narratives describing these encounters were analyzed to identify what factors officers deemed noteworthy and explanations for any decisions made. Qualitative content analysis of CIT reports revealed themes across officers’ interactions with individuals with MHCs. The first step to any encounter was problem diagnosis. In some cases, MHCs were readily disclosed, but in other cases, officers observed the emotional, behavioral, and cognitive symptoms of the subject they were interacting with to assess the status of their mental health. Officers also assessed the situation, the contextual events leading up to the current encounter, and any evidence corroborating or contradicting the subject’s account of events. Once the possibility of an MHC had been deemed likely, the officer next made an assessment of dangerousness. In this sample, danger to oneself was more prevalent than danger to others, but indications of either provide the legal basis for police intervention. This assessment of dangerousness carries the most weight in determining the outcome of an encounter, as the presence of danger to oneself or others limits the outcome to Emergency Custody Order (ECO) or voluntary admission. The subject’s willingness to seek treatment was influential in the final stage of decision-making; in this sample, 32% of subjects agreed to voluntarily admit themselves to the hospital for further assessment, and formal police apprehension was not necessary. Fifty-five percent resulted in an ECO, while 11% were released with no further action taken when danger was deemed unlikely. Comparative analyses across officer and call characteristics were also conducted on the basis of these results. The findings from this study have implications for timely policy changes and evidence-based practice. Understanding officers’ thought processes during their interactions with persons with MHCs could lead to better training and more effective and efficient decision-making. It may also influence police response and resource allocation to better ensure the most appropriate outcome is provided to individuals experiencing a mental health crisis.