Every day, police departments nationwide are called to respond to an astonishing聽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鈥擜re substances involved? Are weapons present? What is the state of each person鈥檚 mental health?鈥攁nd respond accordingly. It falls to the officers to size up what鈥檚 going on and address the situation while also working to protect people鈥檚 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鈥檚 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鈥檚 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.
鈥淭he goal of my research at the center is to develop the knowledge required to help shape an evidence-based practice,鈥� Petreca said. 鈥淭hough 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.鈥�
THE CONTEXT
From the start, it has been important to Petreca to precisely clarify the center鈥檚 aims. 鈥淎 successful jail diversion program is not one that diverts everyone involved in each incident away from jail,鈥� he emphasized. 鈥淪ome people are more appropriate for the correctional system than the health care system.鈥�
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. 鈥淵ou may have a domestic violence situation in which the aggressor is in fact suffering from mental illness,鈥� he said. 鈥淎ll the same, incarceration may still be the best outcome for all involved.鈥�
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. 鈥淲ith the worst crimes we see,鈥� Petreca explained, 鈥渕ental 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 鈥榦ther鈥� 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.鈥�
In spite of these misconceptions, however, Petreca is very firm on the crucial truth that informs the center鈥檚 work: forcing persons with serious mental illness through the legal system isn鈥檛 good for the person involved, the community, the police, or even, ultimately, the health care system.
鈥淚f a person suffers from schizophrenia and is arrested for trespassing, nobody鈥檚 interests are served,鈥� he said. 鈥淚f the root health concerns aren鈥檛 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?鈥�
THE RESEARCH
In his work at the center, Petreca is using what鈥檚 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鈥檚 not easy to know why some diversions produce good outcomes and others don鈥檛.
The challenge, Petreca said, is determining 鈥渨hat variables predict a successful diversion. It鈥檚 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鈥檚 not always easy to measure success.鈥�
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. 鈥淎I 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.鈥�
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. 鈥淭he hope is that the tree will help responders safely make nuanced judgment calls that necessarily involve so much complexity and subjectivity,鈥� 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. 鈥淧olice departments recognize their community鈥檚 needs and have been not only welcoming but excited for the resources and support,鈥� he said. 鈥淟aw enforcement stepped up to meet community needs by teaming up with experts to better handle behavioral crises, showing a strong commitment for better solutions.鈥�
William Evans, 香蕉秀鈥檚 executive director of public safety, chief of police, and the former Boston Police Commissioner, echoed Petreca. 鈥淧olice officers recognize the value in having agencies like this to help them,鈥� he said. 鈥淢ost police departments have known for a long time that mental health is a serious concern, but they just didn鈥檛 always have the tools to engage a behavioral crisis effectively.
鈥淭hat鈥檚 why I love Victor鈥檚 focus: he isn鈥檛 there to criticize anybody, but to make the relationship between the police and the medical profession better,鈥� Evans said. 鈥淚 give him a lot of credit for stepping up and taking a leading role.鈥�
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. 鈥淢any people dealing with a behavioral crisis fear the police,鈥� Petreca said. 鈥淧erhaps if they knew and understood that there鈥檚 a jail diversion program, they would be less hesitant to call and get help.鈥�
At this early stage, Petreca can鈥檛 say鈥攁nd won鈥檛 predict鈥攚hich 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鈥斺�淭he Nurse-Police Assistance Crisis Team (N-PACT): A new role for nursing鈥濃�攃alling for the inclusion of nurses in multidisciplinary first-responder teams. 鈥淏ecause nurses can do physical exams and many of them have mental health training, I鈥檇 like to see if they can help produce better outcomes,鈥� he said.
Whichever interventions prove to be most effective, Petreca sees them as building on the good work already being done. 鈥淚 hope the broader 香蕉秀 community realizes how deeply police officers are driven by care for the community,鈥� he said. 鈥淚t鈥檚 just remarkable how much effort they put into being better at their jobs.鈥�
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