Resolving mental health-related calls in contexts of limited resources: An observational study of police work in Chicago.

INTRODUCTION Data on fatal outcomes of police encounters, combined with evidence on the criminalization of people with mental illnesses, reveal a grave need to improve outcomes for individuals with mental illnesses who come into contact with police. Current efforts are hampered by a lack of in-depth knowledge about the nature of nature and context of these encounters. AIM/QUESTION Building on previous findings from a larger study on the nature and outcomes of mental health-related encounters with police in Chicago, this paper examines officer perspectives on the unmet needs of individuals and their families and the ways in which the mental health and social system environment constrains officers' abilities to be responsive to them. METHODS Findings are drawn from qualitative data produced through 36 "ride-alongs" with police officers. Field researchers conducted open-ended observations of police work during routine shifts and carried out interviews with officers - according to a ride-long question guide - during periods of inactivity or between calls for service to ask about experiences of mental health-related calls. Field notes describing their observations and ride-along interviews were analyzed inductively using a combination of open and focused coding. RESULTS Officers responded to a variety of mental health related calls revealing complex, unmet needs at individual and family levels. A common theme related to officers' perceptions that "going off meds", combined with other situational factors resulted in police being involved in behavioral health situations. The data also revealed broader aspects of the health and social system that, in officers' minds, constrain their ability to effect positive outcomes for people and their families, especially in the long term. DISCUSSION Findings beg the larger question of what it is we, as a society, should expect of police in the handling of mental health-related calls, given their concerns with the wider health and social service system that they experience as deficient. At the same time, the view that "going off meds" is a common trigger of mental health-related events should be interpreted with care, as it may signal, or perhaps serve as a shorthand for more complex health and social needs that could be obscured by a pharmacological or medicalized perspective on mental illness. This is an important area of future inquiry for research at the intersection of policing and mental health nursing. IMPLICATIONS FOR PRACTICE The contribution of police to the wellness and recovery of people and their families is constrained by the ability of the community health and social service system to do its job. A wave of new initiatives designed to enhance the interface between police and the medical community hold out hope for alleviating officers' concerns about whether they can work in tandem with the rest of the system to make a difference. For now, we suggest that what we can expect of police is to implement "principled encounters" that ensure public safety while achieving harm reduction, self-determination and the reduction of stigma. Mental health nurses are well positioned to assist with officer training and provide support to officers responding to mental health related situations. However, the fields of policing and nursing practice may not yet fully understand the individual, family and community dynamics driving calls for police service. The notion of "gone off meds" should be interrogated as a potential trope that obscures a whole-of -person approach and whole system approach to mental health crisis response and care.