SUMMARY - When De-escalation Fails: The Use of Force in Mental Health Calls

A man in psychotic crisis is approached by police who attempt to calm him, who speak slowly and clearly, who give him space and time, and gradually he deescalates, sits down, accepts transport to the hospital - the encounter resolved without force because time and training were available. Another man in similar crisis encounters officers who approach rapidly, who shout commands, who escalate when he does not comply, and the encounter ends with tasers deployed, with him face-down on the pavement, with force that leaves injuries requiring hospitalization before any psychiatric care can begin. A woman experiencing a mental health emergency is restrained by officers who hold her down, compress her chest, and maintain the restraint until she stops breathing - the force that was supposed to control her killing her instead. A family calls for help with their adult child in crisis and watches helplessly as officers deploy force they never imagined, the help they called for becoming violence they cannot stop. A department implements crisis intervention training and use of force during mental health calls decreases significantly, the training demonstrating that different response produces different outcomes. When de-escalation fails - or is never attempted - force becomes the response to mental health crisis. The question of when force is necessary, when it is excessive, and whether it should ever be the response to health emergency is literally life and death.

The Case Against Force in Mental Health Response

Advocates argue that mental health crisis is health emergency, that force is inappropriate response to health emergency, and that lethal outcomes from force during mental health calls represent system failure.

Mental health crisis is not crime. People in psychiatric crisis are experiencing medical emergencies. Responding with force treats illness as threat. The framework that allows force in response to illness is fundamentally wrong.

Force often escalates crisis. Aggressive response to someone in altered mental state often makes things worse. What might have resolved with time and patience becomes violent encounter when force is introduced. De-escalation works; force does not.

Lethal force has no place in mental health response. When someone dies during response to mental health call, the system has failed. No mental health crisis justifies lethal response. Deaths should be prevented, not explained.

From this perspective, reform requires: removing police from mental health response wherever possible; eliminating lethal weapons from mental health calls; training in de-escalation for any who do respond; and accountability when force produces harm.

The Case for Force as Last Resort

Others argue that some crisis situations involve danger that requires force, that officers and others must be able to protect themselves and others, and that force should be last resort rather than prohibited.

Some situations are genuinely dangerous. Mental health crisis can involve weapons, violence against others, and situations where people may be harmed. Responding without capacity to use force when necessary may result in injuries or deaths. Some force capacity must exist.

Officers are not social workers. Expecting police to respond to dangerous situations without ability to protect themselves is unrealistic. If police are responding to mental health calls, they must be equipped to handle danger. The question is whether police should respond, not whether responding officers should have force capacity.

De-escalation does not always work. Even with perfect training and patient approach, some situations cannot be de-escalated. When all alternatives have failed and someone is about to harm others, force may be only option. Last resort does not mean never.

From this perspective, force should: be absolute last resort after all alternatives exhausted; be proportional to actual threat; be subject to accountability and review; and ideally be unnecessary because different responders are sent.

The Responder Question

Should responders with force capacity respond to mental health calls?

From one view, armed officers should not be primary responders to mental health crisis. Mental health professionals, crisis teams, and peers can respond to most mental health calls without weapons. Armed backup can be available for situations that require it. Separating mental health response from armed response prevents most force incidents.

From another view, situations cannot always be predicted. Calls that seem like mental health calls may involve danger. Having force capacity available protects responders and others. Co-response that pairs mental health professionals with officers may address both needs.

Who responds shapes what force is available.

The Training Question

Can training reduce force in mental health response?

From one perspective, Crisis Intervention Team training and similar programs teach de-escalation techniques that reduce force incidents. Training works when implemented properly. Investment in training produces measurable results.

From another perspective, training changes individual behaviour but does not change fundamental dynamics. Armed officers in enforcement role will use force regardless of training when situations escalate. Training cannot overcome structural factors. System change, not just training, is needed.

How training is valued shapes investment and expectation.

The Accountability Question

What happens when force during mental health calls causes harm?

From one view, officers who use excessive force during mental health calls should face accountability. Deaths during mental health response should be investigated independently. Lack of accountability enables continued harm.

From another view, officers responding to dangerous situations should not face prosecution for split-second decisions. Second-guessing creates hesitation that endangers officers. Accountability must be balanced against officer safety.

How accountability is approached shapes incentives for force use.

The Question

When someone dies during response to a mental health call, what has the response accomplished? If de-escalation works most of the time, why is force used so often? When force escalates crisis rather than resolving it, who benefits from the force? If mental health crisis is health emergency, why do we send people with weapons? What would mental health response that never required force look like? And when the help kills, what kind of help is that?