Commentary: Decision-making by front-line service providers--attitudinal or contextual.

Research by Watson et al. on police decision-making determined that prior knowledge of mental illness would have some impact on an officer’s reaction to a mentally ill person if the person was in need of assistance, was a victim, or was a witness, although it would not make any difference in dealing with a suspect. The authors have attempted to explain their conclusions on the basis of labeling and attribution theories. Is decision-making by front-line service providers influenced by prior knowledge that a potential service recipient is mentally ill and, if so, to what extent? What specific impact, positive or negative, would it have on the ultimate service provision, in view of the fact that all decision-making is inherently biased by educational, social, cultural, political, and regional persuasions? Is decision-making influenced by attitudes and beliefs toward the mentally ill? Is it also affected by contextual factors, as opposed to mere knowledge that a person is mentally ill? Labeling theory focuses on the reaction of an individual or group of individuals and the subsequent effects of those reactions. Attribution theory explains how individuals interpret events as they occur and how that interpretation relates to thinking and behavior. When it is known that a person acts “weird” or “crazy,” she or he is ostracized or isolated from society and potentially labeled as someone needing a different approach and interaction from the normal, or average, person. The very labeling of an individual as schizophrenic or psychotic evokes a stereotypical and stigmatizing representation, not only among the media but also among service providers and society at large. I argue that decision-making is heavily influenced by this stereotypical representation of the person labeled schizophrenic, and consequently the service provider acts in a predictable manner. Garfinkel observed that jurors arrive at decisions on guilt or innocence of a defendant on certain situational cues and subsequently organize their thought processes during the trial to confirm the alreadyformed conclusions. Hence, an image of rational decision-making is projected. Similarly, I assert that a front-line service provider with prior knowledge has already formed a decision with regard to the person with mental illness based on his or her own cognitive schema of mental illness and, as a result, arrives at an action that confirms the decision. In a larger clinical and service context, the findings of Watson et al. have implications for how front-line service providers such as family service workers, probation and parole officers, correctional officers, and police officers behave toward the mentally ill at initial contact, if they have prior knowledge of the subject’s illness and other “ pejorative labels” depicting mental illness. The Epidemiological Catchment Area Study and World Health Organization have determined that approximately 20 percent of the general population suffers from identifiable mental disorders. Deinstitutionalization of the mentally ill has led to a large number of mentally ill homeless people who are subject to virtually no supervision or treatment and consequently come into contact with law enforcement officials and other service providers. Police officers and family service workers encounter people in Dr. Daniel is Clinical Professor of Psychiatry, University of Missouri, Columbia, MO, and Director of Psychiatric Services, Department of Corrections, State of Missouri, Jefferson City, MO. Address correspondence to: Anasseril E. Daniel, MD, Forensic Psychiatric Services, 33 E. Broadway, Suite 115, Columbia, MO 65203. E-mail: aedaniel@aol.com