In an era where law enforcement agencies nationwide struggle to recruit and retain officers, the same agencies continue to find themselves taxed with addressing mental health crises.

While mental health response has has always been a challenge in the U.S., health leaders have reported seeing an increase in the need for mental health services during the COVID-19 pandemic, and officers are often on the front lines, responding to calls for mental health emergencies.

“As citizens, we need to realize this is not something that’s like ‘Oh my goodness, let me stay away from it.’ This is an illness just like other illnesses,” said Athens, Ala., Police Chief Floyd Johnson. “The end game is not the same, but we need to realize you don’t know who’s gonna be next. It could be us, it could be our children. It could be our parents; it could be our spouse … so there’s a percentage of those that are diagnosed, and those that are undiagnosed that just simply have issues that go on every day.”

From homelessness, shoplifting, disorderly conduct, obstruction, criminal trespass, or threats of harming oneself or others, police responding to such calls say the incidents often involve mental health — both from undiagnosed persons and, more often, diagnosed mental health patients.

Baldwin County, Ga., Sheriff Bill Massee said he knows the struggle of encountering mental health all too well.

When the area’s Central State Hospital — known for housing patients being treated for mental health disorders — closed more than a decade ago, it left law enforcement to pick up the pieces of many of its residents now out in the community and not taking their medications.

“It just made the problem much worse. When they first closed the hospital it filled up the emergency rooms in Middle Georgia,” Massee said. “Occasionally, EMS will respond to them, but many times if we’re called and a law has been broken and we have to detain them, then we transport. and sometimes, they’ll become combative with EMS, and we will transport them to the hospital for EMS.”

Mental health services lacking, often prolonging officer response times

Many areas, especially rural communities, have seen the loss of hospitals and mental health access over the decade.

When responding to a mental health emergency, Baldwin County deputies now have to transport patients some 100-plus miles to Atlanta, or often further to Augusta or Moultrie, for in-patient services, Massee said.

“Occasionally we’ll have a few beds open up closer to us, a few in Macon. But from a practical standpoint, we don’t make plans to go there. We normally project that we’ll be going at least to Augusta, the state hospital,” Massee said.

Access to mental health care appears to be more of an issue primarily in the South, according to a 2022 ranking by Mental Health America, a nonprofit promoting mental health and preventing mental illness through advocacy, education, research and services.

MHA ranks Georgia 48th in mental health access, followed by Florida, Alabama, and then Texas ranking last on the list.

The access measures include access to insurance, access to treatment, quality and cost of insurance, access to special education, and workforce availability.

“That’s our biggest problem; we don’t have enough clinical beds,” Massee said. “The main thing we want to do is to get them back on medication or to assist them. We don’t look at mental illness as a crime, but occasionally crime is committed by someone who’s mentally ill — and we realized that the mental illness is the driver of the crime and we try, if we can, not to hold people responsible.”

Massee estimates that approximately 25 percent of inmates in jails and prisons have mental health issues.

“So we have re-institutionalized people from a clinical setting to a correctional setting. (As) law enforcement, we do get a lot of the mental health issues by default. Luckily, we’ve had people overall who are professional and try to deal with it, but it is a problem,” he said.

Similar sentiments ring across various agencies regarding the impact of mental health calls on law enforcement.

Lt. Ricky Long of the Dalton Police Department in Georgia said the local Emergency Medical Services often responds to such calls with officers to provide on-scene evaluation, and transport to a local hospital if necessary. On some calls that requires further mental health aid; Long said officers reach out to the state’s mobile crisis team, which generally takes an hour to arrive on the scene.

“Hopefully one of our officers out there is (Crisis Intervention Training) certified, and most of the time they just sit and talk to him (or her),” he said. “Sometimes that’s all they want. I know of cases where the person was trying to harm himself and officer puts them in handcuffs just to protect them and then sit and talk (until) the (state crisis team) gets there.”

With Alabama next to last on the list for mental health access, Johnson said it’s often impossible to even find bed space for a three-day mental health evaluation for someone in need of transport for services.

“I would say way less than half are we able to get a bed to have them evaluated,” Johnson said. “I would go as far as saying a quarter of our patients that we believe need some type of evaluation or some type of mental health care, at least in my area, that we’re able to actually get them into a into a three-day evaluation period and get them treated.”

Agency heads agree that, in recent years, the goal of mental health-related response is calm the person in crisis by talking to them, avoiding arrests if no crime has been committed.

Massee said that a deputy transporting a patient takes away 20 percent of police manpower at a time in Baldwin County, since on average about five deputies are scheduled per shift. Depending on the severity of the call, more than one officer could respond.

“If deputies transport someone, that’s one person out of the loop for four or five hours to go to Augusta and back or to Moultrie,” he explained. “We do have two people here that do nothing but transports, but many times they’re busy on other transports. So we do have to take a deputy off the road.”

Sometimes, emergency rooms are the only option as an alternative to jail for mental health related response in areas where mental health bed space is limited or further away for treatment.

“Some (of the patients) you can leave up there, some you don’t. (Emergency rooms) try to streamline as quick as they can, but it’s usually a three to four hours,” Johnson said.

Lack of available bed space near Athens, Ala., Floyd said, leaves people who haven’t committed a crime from getting the mental health help they may be in need of.

He explained that if the person doesn’t agree to go to hospital or a facility, officers typically call a state mental health officer, but if no bed space is available, then it’s impossible to order an evaluation.

“If it’s just a person that’s got an issue or is off their medication and they’re causing the issue but it’s not life threatening, we’re not going to be able to help you, unfortunately,” he said. “The only thing we can do is come back and try again.”

Responding to mental health calls can be time consuming for officers — from on-scene de-escalations, transporting to emergency rooms or various facilities, or speaking with clinicians at the various facilities.

Officers aren’t health professionals

While officers undergo training — whether mental health specific or crisis intervention — to prepare for such responses, law enforcement leaders say the training doesn’t fully prepare them to address mental health encounters.

The Washington Post, which has tracked data of people killed by police since 2015, reports that approximately 25 percent of people killed by police have a mental illness.

Massee noted that BCSO is currently 15 deputies short, thus sending deputies to a two-week mental health training class (or Crisis Intervention Training) would take away manpower from the streets.

“I’ve only had one or two of our officers go because we’re so short, I can’t send them,” he said. “I can’t send them to a 40-hour (weekly) school (for) two weeks. I don’t have the staffing or the money to do so.”

Many of his deputies, he said, do go through mental illness trainings in the jail where staff encounter mental health issues daily.

“That doesn’t make us nurses, but it does give us exposure and training hours that is mandated that we do every year,” Massee said.

Long is a CIT instructor who teaches the course twice a year. Dalton Police Department, he said, has a few officers — approximately a third of its manpower — in the field who have received CIT and who often respond to calls believed to be mental health-related, if they are available.

“(CIT) trains them to be able to recognize the signs and symptoms of somebody in a mental health crisis,” he explained. “Obviously, we’re not mental health professionals, so sometimes they miss those cues because, you know, we’re all human. But they’re trained to look for those signs and symptoms of a person in crisis, whether it be schizophrenia or even Alzheimer’s. People with Alzheimer’s present symptoms of a mental health crisis, which Alzheimer’s is, but not the way people think of mental health.”

Many departments are just trying to fill vacancies, so many officers do not receive in-depth training at levels needed to deal with mental health.

Chief Johnson said at his Alabama-based agency, most of his officers have an in-person training with a state mental health officer at least every one or two years, and de-escalation training is required of all officers.

“There’s a lot of specialized trainings, but some departments are big enough that you can have a specialized training and you can have officers that are dedicated just to do that,” Johnson said. “Our smaller department … not the case. Your officer responding to a wreck is going to be the same guy that’s handling your next mental health issue.”

Because of the lack of extensive mental health training response, more law enforcement manpower or assistance could often be necessary.

“You never ever, unless you just really know what you’re dealing with, want to have one officer. and depending on what’s happened and why you’re there to start with, you may want more than two officers,” Johnson said. “So you’ve at least taken two to three patrol cars off street. … I run six to seven cars at a time. So at least half of my staff at the moment could be tied up on (a) mental health call.”

Johnson continued, “We’re being asked as law enforcement (to) do something that we’re not designed to do. But if it is what we’re gonna have to do, then by all means, give us the resources and the training to be able to do it. My biggest problem is we’ll go out there, we find these people who need help, but there’s not a place to get them to.”