Study: Mental Health Help Is Crucial For People in Police Custody

A new study from the U.K. suggests that people detained in police custody may have higher rates of untreated mental illnesses than the general population, calling attention to the need for increased mental health help instead of additional policing.

The researchers interviewed 40% of people entering police custody of one South London police station over a two-week period. They found that these people, 66% of which committed non-violent offenses, had a higher rate of experiencing the following mental health conditions:

• Major depressive episode
• Psychosis
• Personality Disorder
• Suicidality

The study was published in the Criminal Behaviour and Mental Health journal in April.

Roger McIntyre, MD, FRCPC, professor of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders Psychopharmacology Unit at the University Health Network, who was not involved in the study, tells Verywell that far too often, people struggling with mental illness are sent to jail instead of receiving mental health treatment.  "The largest mental health care facility in the United States is the LA County Jail," he says. "That clearly is not acceptable to us as a society. You wouldn't put people with diabetes in jail as the primary place of treatment."

A Need for Treatment

The study also looked at the correlation between the type of mental health condition that a person had and whether or not their needs were met. All participants in this study consented to participate and had to have the capacity to give informed consent.

The researchers found that of those entering police custody who were interviewed, a quarter of people had prior contact with a psychiatrist or community mental health team, but only 17% of people reported taking psychotropic medication, despite rates of experiencing a major depressive episode (22.4%), suicide risk (17.9%), lifetime psychotic disorder (19.4%) and personality disorder (20.9%) being higher than that figure.

McIntyre says that untreated mental health needs of people who are detained risk experiencing "extraordinary distress" and may have trouble functioning. "Some conditions put them at high risk of doing harm to themselves," he says. "So, there's tremendous suffering along with tremendous functional impairment and the risk for suicide."

The need for housing was the largest unmet need of people who were interviewed for this study. "Addressing housing issues, alongside those concerning mental health issues, are crucial to reducing/preventing reoffending and the likelihood of courts remanding to prison detainees that are homeless and mentally ill," the researchers wrote.

Incarceration and Mental Health

Previous research illustrates that, like with people in police custody, people incarcerated in prisons have higher rates of mental illness.

A 2019 meta-analysis published in the PLOS One journal found that incarcerated people experience higher levels of post-traumatic stress disorder (PTSD). The researchers wrote that "the disorder typically remains undiagnosed and untreated within prison settings."

Susan Hatters-Friedman, MD, DFAPA, the Phillip J. Resnick Professor of Forensic Psychiatry at Case Western University in Ohio, tells Verywell that it may be common for people to overlook the trauma that people in jails and prisons experience. "When people who don't work in this area think of the jail or prison population, they think a lot about substance abuse or personality disorders, but it's also these high rates of untreated mental illness and post-traumatic stress," she says.

Both studies highlight the importance of people in custody getting appropriate mental health treatment and the need for trust between individuals and the providers who treat them.

"If the patient isn't able to trust the doctor or the social worker, then they're not going to be feeling comfortable reporting honestly of the symptoms that they're having," Hatters-Friedman says. "They may be, for example, under-reporting what they're experiencing, then they're going to either not qualify for a diagnosis and for treatment, or they're not going to get the right treatment. "

Alternatives to Policing

Different initiatives have launched around the world to attempt to address how people with mental illness are treated by the police. This includes the United States, where a December 2015 report from the Treatment Advocacy Center found that people with mental illness are 16 times more likely to be killed in an encounter with the police.

One of these initiatives includes diversion centers, Hatters-Friedman says, which aim to support people experiencing a mental health crisis by enrolling them in rehabilitation programs instead of taking them into police custody. "That will, of course, continue to require police training about how you pick up which people are experiencing mental illness and would be taken to a diversion center," she says. Hatters-Friedman also cites courts especially made to hear cases from people whose mental illness may have impacted a crime they committed, as another good step.

Communities of color, McIntyre says "have an understandable loss of trust in law enforcement, and they're less likely to want law enforcement involved in their matters." McIntyre suggests that it may be more appropriate for an acute mental health crisis team to be called instead of the police, and if a person is at risk for harming others, the police should work alongside a crisis team.