We Need to Depolice Mental Illness Health Care—Now | Opinion

On October 18, 2016, police officers shot and killed Deborah Danner, a woman with schizophrenia experiencing a mental health crisis, in her apartment. Ms. Danner was not alone in suffering this fate. Nearly 25 percent of all people killed by the police in America since 2015 have had mental illness, a total of almost 1,500 people. And they have been disproportionately Black, like Ms. Danner.

But it's not only marginalized people of color with mental illness who are targeted by police. A dangerous policing mentality toward the mentally ill also routinely sabotages hospital treatment, even of the more privileged. It's why as a board-certified psychiatrist, I have come to believe that depolicing healthcare is essential for protecting all of us.

Because the truth of the matter is, when it comes to psychiatry, patients sometimes become agitated or distressed, an event we call a "behavioral emergency" in health care. Agitated behavior unfortunately can cause injuries in the same way that an intentional security threat might. But behavioral emergencies are drastically different to security threats, because they hold no criminal intent. Rather, they begin when patients have trouble coping with sad news, when marginalized patients are provoked by discriminatory provider behaviors, and—most often—when patients become confused or disoriented by severe medical and psychiatric disease.

And therein lies the problem: Police brutality like that which killed Deborah Danner in New York exists because most cities use the same personnel and protocols to respond to community behavioral emergencies as they would criminal threats. You can see this at work in the story from earlier this year about Karen Garner, a 73-year-old Colorado woman with dementia, whose arm was broken and shoulder dislocated by police.

Due to mounting pressure, the Biden administration has dedicated federal funding to the tune of $1 billion to finally prioritize distinct, depoliced community behavioral emergency interventions. This funding is a good start toward rectifying over-policed community responses, but there remains an alarming failure to even recognize over-policing in hospital medicine.

And there's an irony at work here. After all, we depend on hospitals' emergency protocols to save our lives during strokes, heart attacks, unexpected deliveries, and every other medical disease. Yet any time patients demonstrate behavioral distress, hospitals nationwide train staff to page the police instead of a doctor, even if that behavioral distress stems from the medical reason they were admitted to the hospital in the first place. None of the standardized emergency code suggestions from 21 available state hospital associations distinguished emergency protocols for behavioral emergencies from unarmed security threats.

And policed hospital policies harm all of us, not just people from marginalized communities. Consider that one in three seniors has Alzheimers or dementia and risks becoming disoriented and combative when very medically ill. Their agitation is often interpreted as "hospital violence," as there exists no standardized hospital protocol distinguishing Alzheimers agitation from unarmed intruders. That's why seniors are the most likely to be physically restrained during medical hospitalization: "Confusion" prompts fully 25.4 percent of restraints.

It's not just seniors, though; children with Autism often cannot communicate that they are visibly upset because of surgical pain. And hospitals routinely criminalize moments when families protest mistreatment or raise their voices after receiving bad news about a loved one's medical course.

Depolicing hospital medicine advances equity for patients of all races and ages.

Let me be clear: I am by no means suggesting that healthcare workers should subject themselves to injury. Every patient and provider, including myself, unequivocally has the right to return home safely to our loved ones. But police presence for non-criminal events often escalates patient distress rather than reducing it, thereby inviting more injuries. Furthermore, no study demonstrates the superiority of paging police for medical emergencies. Policed interventions harm patients and providers alike.

Well-researched, effective solutions readily exist that advance clinical care while maintaining safety without relying upon psychiatric resources. But all too often, quality improvement efforts adopt a lens of "mental illness" and "violence reduction" instead of "clinical care." These clinical solutions are most often left unfunded, as they are wrongly perceived as being expensive and low-yield by "only" benefitting marginalized patients of color or those with mental illness.

To those with the legislative and administrative influence, I would urge you to recognize that neglecting the vulnerable will result in neglect to all of us. It's time to depolice hospital medicine.

Carmen Black, MD, is assistant professor of psychiatry at Yale University and a Public Voices Fellow of The OpEd Project.