Every day, police departments nationwide are called to respond to an astonishing array of situations: crimes, behavioral health crises, lost adults suffering from dementia, and so many others. When the officers arrive, often with no forewarning about what they will find at the scene, they must assess the situation—Are substances involved? Are weapons present? What is the state of each person’s mental health?—and respond accordingly. It falls to the officers to size up what’s going on and address the situation while also working to protect people’s freedom and safety. So much depends on the snap judgments of police officers.
To help prevent potential tragedies when police encounter people in mental health crisis, a Center for Police Training in Crisis Intervention will be based at Boston College’s Connell School of Nursing (CSON). The center will serve as a beacon in the Commonwealth to promote community involvement in policing, research different ways first responders can engage people with behavioral health issues, and promote the adoption of emerging best practices.
The center’s new director and primary investigator is Victor Petreca, an assistant professor at CSON and expert in forensic psychiatry/mental health and nursing with a focus on jail diversion programs, which are designed to offer an alternative to incarceration that may achieve better results for both offenders with behavioral health challenges and the communities in which they live.
“The goal of my research at the center is to develop the knowledge required to help shape an evidence-based practice,” Petreca said. “Though jail diversion programs exist in other states and countries, the evidence about what works is actually very limited, so we need to do more studies in order to develop new and effective methodologies. First and foremost, we want everyone to be safe and to feel safe.”
THE CONTEXT
From the start, it has been important to Petreca to precisely clarify the center’s aims. “A successful jail diversion program is not one that diverts everyone involved in each incident away from jail,” he emphasized. “Some people are more appropriate for the correctional system than the health care system.”
Petreca stressed the importance of the traditional legal system because of the prevalence of two common misconceptions, which he is at great pains to correct. First, he explained, having a mental illness does not absolve someone of responsibility for the crimes he or she commits. “You may have a domestic violence situation in which the aggressor is in fact suffering from mental illness,” he said. “All the same, incarceration may still be the best outcome for all involved.”
The Center for Police Training in Crisis Intervention:
- promotes community involvement in policing
- examines how first responders can engage people with behavioral health issues
- ensures the adoption of emerging best practices
The second crucial misconception involves the perpetrators of the most serious crimes. “With the worst crimes we see,” Petreca explained, “mental illness is actually quite rare. Often, people who do atrocious things do not have serious mental health issues, but we probably think that they do as a way to ‘other’ the perpetrators of the crimes we find most appalling. These labels and stigmas affect how we see mental illness and criminal behavior and conflate the two in unproductive ways.”
In spite of these misconceptions, however, Petreca is very firm on the crucial truth that informs the center’s work: forcing persons with serious mental illness through the legal system isn’t good for the person involved, the community, the police, or even, ultimately, the health care system.
“If a person suffers from schizophrenia and is arrested for trespassing, nobody’s interests are served,” he said. “If the root health concerns aren’t addressed, the police may be forced to respond to calls again and again, and the person involved may not get the care they need until they show up at an emergency room. This scenario is more dangerous and more costly than an effective jail diversion program. Instead, we must ask: what steps can be taken to get the person out of the revolving door with the legal system?”
THE RESEARCH
In his work at the center, Petreca is using what’s known as a sequential-intercept model, which assesses the stage (or intercept) in the legal and health care systems where a person gets the mental health care he or she needs. At intercept zero, a person may reach out to a crisis line and get help without any interaction with the police at all. At intercept one, a person may interact with the police but be diverted away from the legal system. And at intercept two, a person may be legally directed into a substance treatment program and emerge, even if their treatment is successful, with a criminal record. Unfortunately, it’s not easy to know why some diversions produce good outcomes and others don’t.
The challenge, Petreca said, is determining “what variables predict a successful diversion. It’s not just that there are so many factors to consider, there are also so many different ethics that we value: beneficence, justice, autonomy. Because of all these competing values and variables, it’s not always easy to measure success.”
Petreca and his diverse team of analysts and researchers are looking to determine how many people can be safely diverted at intercept one. To that end, he and his team are considering dozens of variables to determine how they correlate with different outcomes. These include time of day; sex, race, ethnicity, and other demographic markers; whether a chargeable offense has been committed; and the presence of a clinician on the response team, among many others.
Because this problem is so complex and the interactions of different variables are so difficult to evaluate simultaneously, Petreca will leverage the power of emerging AI technology to consider as many variables as possible. “AI can run endless scenarios to test different combinations of approaches. Some variables make a big difference and some turn out to make no difference at all. The more we know, the more the program will succeed.”
The ultimate goal is to develop a decision tree that first responders can rely on in a behavioral crisis incident: if drugs are present, for instance, the first responders would take this action; if drugs are absent, they may do the opposite. “The hope is that the tree will help responders safely make nuanced judgment calls that necessarily involve so much complexity and subjectivity,” Petreca said.
THE IMPACT
Petreca and his team expect the decision tree to help the center fulfill the second part of its mandate: training police officers to effectively respond to behavioral crises. By law, no less than half of patrol officers in every Massachusetts municipality must now have this training, and no less than a quarter of their overseers must have it as well. In a state with 167 different municipal police forces, this requirement entails a massive undertaking for the center and its partner training organizations.
Fortunately, Petreca has encountered a series of police forces not just willing but eager to adopt the tools the center provides. “Police departments recognize their community’s needs and have been not only welcoming but excited for the resources and support,” he said. “Law enforcement stepped up to meet community needs by teaming up with experts to better handle behavioral crises, showing a strong commitment for better solutions.”
William Evans, BC’s executive director of public safety, chief of police, and the former Boston Police Commissioner, echoed Petreca. “Police officers recognize the value in having agencies like this to help them,” he said. “Most police departments have known for a long time that mental health is a serious concern, but they just didn’t always have the tools to engage a behavioral crisis effectively.
“That’s why I love Victor’s focus: he isn’t there to criticize anybody, but to make the relationship between the police and the medical profession better,” Evans said. “I give him a lot of credit for stepping up and taking a leading role.”
Not only does this enthusiastic and public engagement from police forces make it easier for the center to effectively conduct its training, it may help promote community involvement in ways that help prevent people from reaching intercept two. “Many people dealing with a behavioral crisis fear the police,” Petreca said. “Perhaps if they knew and understood that there’s a jail diversion program, they would be less hesitant to call and get help.”
At this early stage, Petreca can’t say—and won’t predict—which variables will turn out to be most important for the success of jail diversion programs. He did, however, recently publish a study in the Journal of Advanced Nursing—“The Nurse-Police Assistance Crisis Team (N-PACT): A new role for nursing”—calling for the inclusion of nurses in multidisciplinary first-responder teams. “Because nurses can do physical exams and many of them have mental health training, I’d like to see if they can help produce better outcomes,” he said.
Whichever interventions prove to be most effective, Petreca sees them as building on the good work already being done. “I hope the broader BC community realizes how deeply police officers are driven by care for the community,” he said. “It’s just remarkable how much effort they put into being better at their jobs.”
The Massachusetts Department of Mental Health is supporting the establishment of the Center for Police Training in Crisis Intervention.
The Center team comprises:
- Director/primary investigator
- Research assistants
- Program manager who is a licensed social worker
- Data analyst
- Implementation specialist
- Consultants/trainers
- Nurses/mental health clinicians
- Undergraduate research fellows