Since the 1960s, the percentage of individuals with mental illness being treated in a hospitalized setting has decreased dramatically in an effort to move care away from institutional settings into a wider range of community-based treatment. This process, known as “deinstitutionalization,” has been driven in part by limited funding available for mental health services, changes in treatment philosophy, and medical advancements. According to a 2015 Federal Bureau of Investigation (FBI) publication, one result from this shift is that local police departments have had to meet the growing needs of individuals suffering mental health emergencies (e.g., a schizophrenic episode), and are often the first source of assistance in helping to arrange treatment for these individuals. Similarly, the IACP reports that police officers often have to “manage situations that result from a history of mental health policy and legislative decisions made by federal and state governments.” According to the IACP, law enforcement officers—generally local police—may then find themselves serving in a role similar to that of a social worker in attempting to locate treatment services for such individuals. The IACP also reports that such increasing interactions may result in individuals with mental illness being arrested and placed in jail, rather than receiving treatment from mental health facilities. This can result in a cycle of arrest, imprisonment, and recidivism for such individuals. In addition, interactions between law enforcement officers and individuals with mental illness have the potential to escalate into violence. In recent years, a number of professional organizations and advocacy groups such as IACP, the Police Executive Research Forum (PERF), the National Alliance on Mental Illness, and Council of State Governments Justice Center (CSG JC) have researched and advocated for different approaches that may reduce the likelihood of violent encounters or help officers connect the individuals they encounter with proper treatment services. In addition, DOJ’s Bureau of Justice Assistance (BJA), within its Office of Justice Programs, has created a compendium of existing information and research in the field of state and local law enforcement responses to individuals with mental illness. Federal law enforcement officers and agents may interact with individuals displaying signs of mental illness in a number of different types of incidents while performing their various missions, such as protecting federal property or officials or when apprehending subjects of an investigation. Figure 1 provides one example of a possible incident an officer or agent might experience and the response options available. Generally, when federal officers and agents encounter individuals displaying signs of mental illness—and there is no evidence of a federal crime—they may refer them to local law enforcement or health care providers to assess their mental health and determine whether they need further health care. If local providers determine that such care is needed, it is generally provided through a voluntary or involuntary commitment to a local mental health services provider. One exception to this is for correctional officers and other staff within BOP, as these staff interact with individuals with a diagnosed mental illness as part of their daily duties in ensuring a secure prison environment. BOP pre- designates all inmates entering its institutions and assigns initial mental health and medical screen assignments. Throughout an inmate’s incarceration, BOP’s psychologists, psychiatrists, and qualified mid-level practitioners can determine a new mental health care level following a review of records and a face-to-face clinical interview. Under section 504 of the Rehabilitation Act of 1973, as amended, discrimination on the basis of disability in federally funded and federally conducted programs and activities is prohibited. A person with a disability includes anyone who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such an impairment. DHS and DOJ both currently have efforts underway, in various stages of development, to have their components review their existing policies, guidance, and training in response to departmental guidance on addressing individuals with disabilities and obligations under section 504. Pursuant to departmental guidance, after completing their reviews, components are to determine areas that could be enhanced. Within DHS, components have been asked to report on the status of their efforts to DHS’ Office for Civil Rights and Civil Liberties (CRCL). Within DOJ, the Office of the Deputy Attorney General (ODAG) is overseeing components’ efforts. In addition, the 21st Century Cures Act requires the Attorney General to provide direction and guidance for the following by December 13, 2017: “Programs that offer specialized and comprehensive training, in procedures to identify and appropriately respond to incidents in which the unique needs of individuals who have a mental illness are involved, to first responders and tactical units of—(A) Federal law enforcement agencies; and (B) other Federal criminal justice agencies, such as and the Administrative Office of the United States Courts, and other agencies that the Attorney General determines appropriate.” “The establishment of, or improvement of existing, computerized information systems to provide timely information to employees of Federal law enforcement agencies, and Federal criminal justice agencies to improve the response of such employees to situations involving individuals who have a mental illness.” According to the DHS and DOJ law enforcement officers and agents we interviewed, they are not positioned to diagnose any specific mental health condition that an individual might have, as they are not trained mental health professionals. However, responding to incidents involving individuals with mental illness can be challenging for multiple reasons, including determining whether the person is suffering from a mental illness or from another issue, such as drug addiction, and communicating with the person, for example, when a person may be suffering from delusions. These officers and agents face these challenges while also being responsible for ensuring their own safety and that of others in the area. Some of the common challenges officers and agents identified during our discussion groups follow. Identifying Whether an Individual Has a Mental Illness Some officers and agents in our group discussions stated that when encountering individuals displaying erratic behavior (e.g., rapid or nonsensical speech, paranoid or delusional statements), it can be difficult to determine if that behavior is attributable to a mental illness or the influence of drugs. Specifically, Border Patrol agents—who are broadly responsible for preventing the illegal entry or exit of people and goods at places other than ports of entry—stated that determining whether someone has a mental illness or is experiencing other issues is challenging and may be complicated by language barriers. Border Patrol agents may at times encounter large groups of people attempting to cross the border at one time and thus have limited time to make that determination. ATF officers—who may encounter individuals with a mental illness who are targets of an investigation—commented that incidents may involve an individual who could suffer a mental illness (treated or untreated), or be under the influence of alcohol or drugs. Unless the individual discloses his or her condition, or family or friends are there to explain the condition, officers would not know the cause of the individual’s behavior. They explained that if mental health information about a suspect is known in advance of an operation, officers can adjust their approach; however, they told us that most of the time they do not know if someone has a mental health condition and how it might present itself. Similarly, an FBI police officer—who may encounter individuals displaying signs of mental illness if those individuals enter an FBI office—told us that it can be challenging to deal with an individual who is acting erratically, not knowing precisely whether the behavior is attributable to a mental illness, and there may be limited time available to address an individual posing a safety risk. BOP corrections officers also echoed this challenge. They said that despite having back-up mental health staff on call, their initial reaction to an inmate exhibiting some type of erratic behavior has to be fairly quick to secure the safety of the staff and other inmates. Officers and agents across components and departments made clear that they are not mental health professionals or psychologists and, as such, are charged with responding to the behaviors that are exhibited to secure the scene. Communicating with Individuals with a Mental Illness Some of the officers and agents in our discussion groups stated that communicating effectively with someone exhibiting signs of a mental illness and understanding what he or she may be going through or how he or she sees reality can be challenging. One officer told us that trying to make individuals who may have a mental illness understand that their reality is not everyone else’s reality is particularly challenging. This was very difficult, for example, for Secret Service Uniformed Division officers who explained that they encounter individuals when providing security along the White House fence and for FPS officers, who often encounter individuals displaying signs of mental illness near or in federal buildings that they are assigned to protect. As the Secret Service officers explained, even if individuals exhibit delusional behavior, so long as they have not broken any laws, then they are free to be near protected federal venues and the officers are limited in any actions they can take. One officer, discussing the challenges in speaking with someone with a mental illness who may be experiencing delusions, stated that the person is “wholeheartedly convinced that what he or she perceives is the true reality.” Officers and agents who we met with in CBP reported that they rely on common sense to dictate appropriate action and use reasonable efforts to protect themselves and others. They noted that additional training on communicating effectively with individuals suffering from mental illness could be beneficial. The challenges noted above in identifying causes of erratic behavior or effectively communicating with individuals with a mental illness can make it difficult for officers to resolve a tense situation or apprehend an individual (if necessary) as securely or peacefully as possible. For example, Border Patrol agents stated that ensuring that such encounters are resolved safely for the individuals involved and other members of the public is their biggest challenge. It might require removing someone in distress from a group of individuals that he or she may be traveling with or keeping him or her calm. When someone is in an extreme state of panic, emotional distress, or anger, officers try to remove the person from the group to prevent a potential incident from escalating quickly. Operating with Limited Access to Mental Health Resources Officers and agents also stated that a limited number of mental health professionals available within their components or through local agencies can pose a challenge in helping persons with mental illness receive necessary treatment. As such, they must rely on state and local entities in the area (e.g., law enforcement, hospitals) to provide assistance for individuals. Federal Air Marshals—who provide protection at airports and other transportation modes—we spoke with explained that since they do not have holding facilities to secure individuals with mental illness, they are reliant on local law enforcement and mental health professionals to manage an incident. Officers and agents highlighted the importance of maintaining close relationships with state and local partners and added that trained mental health professionals provide an excellent resource. In addition, officers and agents in some discussion groups noted there may be training offered by state or local agencies related to understanding and responding to individuals with mental illness that could be leveraged by federal agencies. Officers and agents reported, however, that it can be difficult for the components to find the time and resources to send officers to the trainings. According to USMS officers— who provide security at federal courthouses and oversee transport of federal prisoners—this is particularly challenging in small offices where there may be very few staff. Frequently Encountering the Same Individuals Another common challenge noted in discussion groups was that officers and agents repeatedly encounter the same individuals with mental illness. Officers and agents explained that they can sometimes apprehend individuals who are creating a disturbance, but these individuals often cannot be charged with a federal crime. As such, following the apprehension, the officers and agents release these individuals to local or state authorities who may transport them to local providers for a mental health evaluation. Typically, if the local providers determine a commitment is necessary, they will hold these individuals at a hospital or clinic for up to 72 hours. According to the officers and agents in our discussion groups, many of these individuals return after they are released and the officers and agents encounter them time and again, with very little that they can do to provide these individuals with assistance. According to the officers and agents, incidents involving frequent encounters with the same individuals can take time away from performing other important activities. Secret Service Uniformed Division officers told us they repeatedly encounter the same individuals with mental illness and know some of these individuals very well. For example, Secret Service officers stated that when performing their duties in patrolling the grounds of the White House, they have had frequent encounters with a woman who believes she has family members living in the White House. The officers have turned her away from the scene on multiple occasions, but she continues to return. All of the law enforcement components in our scope offer training directly, receive training through FLETC, or are developing some training on responding to incidents involving individuals with mental illness. Agency and FLETC training includes courses on communication, de-escalation, and suicide prevention (related to federal inmates). Since these components have varying missions and operational needs and interact with the public in different capacities, the nature and scope of this training, as well as the number of courses and the duration of courses offered varies. For example, BOP’s staff—including food service workers and nurses, as well as correctional officers—have daily contact with inmates with mental illness and can act as “first responders” when situations merit. According to BOP officials, training is offered to all staff in all of its institutions on mental health and working with the mentally ill, along with courses on communication, de-escalation, suicide prevention, and use of force. As another example, ATF’s agents told us they have less routine contact with individuals with mental illness, but ATF offers a course to its agents on de-escalation concepts and tactics, which addresses responding to incidents involving individuals with mental illness, as well as crisis intervention training to its cadre of crisis negotiators. Further, some of the components’ training is mandatory and offered annually through class instruction or online portals. These courses may be offered to new hires or available to tenured officers. In addition, some components’ training courses are delivered as stand-alone sessions, while others may be modules within a larger course exploring other law enforcement topics. Three DHS operational components in our scope, in addition to FLETC, offered some type of training specifically for their officers and agents. Another one (TSA) has training in development as of October 2017, on topics related to responding to incidents involving individuals with mental illness. FLETC explained that it provides basic training to all DHS law enforcement officers through one of three basic program categories— Center Basic, Center Integrated Basic, and Agency Specific Basic—which vary in length. Two Center Basic training programs include a 2-hour module titled Managing Abnormal Behavior, which covers how to identify common signs of mental disorders (among other things) and how to handle people exhibiting abnormal behavior. Specifically, this module examines basic human behavior that may be classified as abnormal, differentiates between mental disorders, and also covers physical and organic causes that may be related to abnormal behavior with the appropriate officer responses. In addition, FLETC informed us that it has developed scenario-based training in these programs, allowing the officers or agents to develop decision-making skills in situations involving people exhibiting abnormal behavior. See appendix II for more information on FLETC’s training programs. U.S. Secret Service Training We observed Secret Service training on Protective Intelligence Questioning for First Line Officers, which is offered to Uniformed Division Officers. The course instructor played the role of three different individuals with schizophrenia, bipolar disorder, and sociopathic personality disorder and trained agents on interacting and interviewing subjects who attempt to breach the White House fence. In addition to this module provided to all DHS agents and officers, the components in our review also offer or are preparing component-specific training courses. Table 2 lists illustrative examples of DHS training. In addition, TSA has developed a mandatory course entitled Awareness Training on Mental Health Conditions to be delivered in the classroom and through scenarios and exercises during fiscal year 2018. This course is designed to introduce Federal Air Marshals to the fundamentals of predominant mental disorders, such as schizophrenia or psychosis. All of the DOJ components in our review provide some type of training to their officers on topics related to responding to incidents involving individuals with mental illness—as illustrated in Table 3. The law enforcement components within our scope at DHS and DOJ have policies or guidance in place that addresses responding to incidents involving individuals with mental illness. Some components’ policies or guidance specifically addresses mental illness, while others touch on the issue as part of larger policies on other topics (such as use of force)—as illustrated in Table 4. DHS Efforts to Review Policies, Guidance, and Training DHS has guidance in place to help ensure that its components have policies and training that ensure their alignment with section 504 of the Rehabilitation Act. In 2013 and 2015, respectively, DHS issued a directive and implementing instruction to its components intended to strengthen compliance with section 504. These documents required DHS components to conduct a self-evaluation and prepare a component plan identifying any policies or practices that may result in a qualified individual with a disability being excluded from participation in, or being denied the benefits of, a program or activity. Department of Homeland Security (DHS) Component Self-Evaluation Tool The self-evaluation tool that DHS’s Office of Civil Rights and Civil Liberties developed requires components to—among other things—describe whether there is an established policy ensuring equal treatment for individuals with disabilities, how the component’s personnel and procedures ensure that individuals with disabilities are treated in a nondiscriminatory manner, and the component’s process for providing auxiliary aids and services to ensure effective communication. The tool also provides examples of interactions in the areas of customer service, security, and custody activities that would likely be compliant, or possibly noncompliant, with section 504 of the Rehabilitation Act. In 2016, DHS’s CRCL office issued guidance and a self-evaluation tool to DHS components on the steps to take in performing the self-evaluation of their facilities, programs, policies, and practices (to include training). The guidance also addresses the development and execution of the components’ plans intended to remedy any areas deemed insufficient in permitting individuals with disabilities—including mental illness—to participate fully in the components’ programs and activities. Disability Access Coordinators, who are representatives from each component charged with overseeing their components’ responses to DHS Rehabilitation Act guidance, are leading the components’ efforts in conducting the self-evaluations. CRCL set a deadline for components to submit all self-evaluations to CRCL for review by the end of August 2017. As of September 2017, all five components had submitted self- evaluations. CRCL officials explained that as they review self- evaluations, they are looking to see if policies or training for law enforcement officers’ and agents’ responses to individuals with mental illness have been identified or otherwise addressed. If not, the officials indicated that they will request the components identify and address this topic in their plans for aligning with Rehabilitation Act guidance. The remaining steps in CRCL’s effort to review and comment on component plans as of September follow: December 31, 2017: CRCL provides comments to components on the content of their self-evaluations. February 28, 2018: the components develop and submit their draft plans for aligning with the Rehabilitation Act guidance. April 30, 2018: CRCL reviews and provides comments on the components’ draft plans. May 31, 2018: the components address CRCL’s comments and submit their final plans for alignment with Rehabilitation Act guidance for approval. DOJ Efforts to Review Policies, Guidance, and Training DOJ has directed components to review and implement guidance on addressing individuals with disabilities—including mental illness—and obligations under section 504. Specifically, in January 2017, DOJ’s then- Deputy Attorney General issued a memo with attached guidance directing components to review their policies and training and, where necessary, modify or develop policies and training to implement legal requirements and principles related to section 504. This guidance identified, among other things, DOJ’s law enforcement components’ legal obligations under section 504 as well as the policies and procedures that components must have so that officers and agents can anticipate and plan for encounters with members of the public with disabilities. For example, the guidance states that law enforcement components must train officers and agents on different types of commonly encountered disabilities; how to identify, without medical or psychological training, analysis, or diagnosis, common characteristics and behaviors most often associated with disabilities; and appropriate responses to the challenges that an encounter with a member of the public with a disability may present. Training for officers and agents in effective communication with members of the public with a mental illness is explicitly referenced in the guidance as well. To date, officials from DOJ’s Office of the Deputy Attorney General (ODAG)—who are overseeing the components’ efforts—have maintained communication with the components to confirm that they have begun reviewing their policies and training to identify any deficiencies or necessary enhancements pursuant to the January 2017 guidance. During the course of our review and in part due to our inquiries, in the fall of 2017, ODAG notified the components that they should complete their reviews by December 2017. ODAG also notified the components that they should begin implementing any new policies or training identified by September 2018. In addition, a provision of the 21st Century Cures Act—section 14025— requires DOJ to provide direction and guidance to federal law enforcement agencies and federal criminal justice agencies on training programs and improved technologies related to responding to individuals with mental illness, by December 13, 2017. ODAG officials told us that the January 2017 guidance addresses the requirement to provide direction and guidance on training for the DOJ components, but acknowledged that it does not respond to all of the requirements for the Attorney General under section 14025 of the 21st Century Cures Act. In particular, section 14025 requires the Attorney General to provide direction and guidance to federal law enforcement agencies and federal criminal justice agencies beyond DOJ in the areas of specialized and comprehensive training programs to identify and respond to individuals with mental illness. Section 14025 also calls for direction and guidance on the establishment and improvement of computerized information systems to provide timely information related to situations involving individuals with mental illness. As a result of our questions about whether such efforts would be developed, on December 7, 2017, DOJ sent a letter from the Principal Deputy Assistant Attorney General for the Office of Justice Programs to federal law enforcement partners outlining resources available for federal law enforcement when considering training or procedures appropriate for their missions. Specifically, DOJ sent the letter to executive officers within DOJ, DHS, the Administrative Office of the United States Courts, and other executive departments that DOJ deemed appropriate. Some examples of resources that the letter highlights include (1) the Police- Mental Health Collaboration Toolkit, which provides resources to assist law enforcement agencies in partnering with mental health providers (and is discussed later in this report) and (2) a forthcoming “roadmap” planned for release in 2018 that the Office of Justice Programs and BJA are developing that will help law enforcement agencies as they plan for engagement with mental health entities. Of the six stakeholders in the field of law enforcement-mental health we interviewed, all six considered the Crisis Intervention Team Model to be a leading practice and five considered the Co-responder Model to be a leading practice—see Figure 2. These practices are typically implemented at local and state law enforcement agencies. Nevertheless, certain aspects and associated benefits could be considered in other settings, such as federal law enforcement operations. In addition, stakeholders cited four key tools that may assist law enforcement agencies in responding to individuals with mental illness. These tools can include training guides, summary reports, or model policies, among other things, as shown in table 5. DHS and DOJ law enforcement components generally leveraged information from knowledgeable parties within their departments on efforts to respond to incidents involving individuals with mental illness. To enhance information sharing among DHS components, CRCL has implemented an interagency collaboration mechanism. Specifically, CRCL officials reported that since June 2016 they have led monthly coordination conference calls with component Disability Access Coordinators to collaborate on their respective efforts to complete their self-evaluations. According to the Disability Access Coordinators, these sessions have provided a forum to share ideas and lessons learned across the DHS components. In addition, according to CRCL officials, once their office receives the components’ self-evaluations and plans, it aims to disseminate information on lessons learned and effective practices to all the components. Coordination efforts to leverage information also exist within DOJ. Specifically, through the efforts to review policies and training under the January 2017 guidance and provisions of the 21st Century Cures Act discussed earlier, DOJ’s components have reported taking efforts to collaborate with one another and share information on training, best practices and lessons learned. For example, officials from ATF reported holding meetings with other components to discuss their efforts to implement the January 2017 guidance. Additionally, BJA officials told us they took part in the ODAG’s working group in early 2016 when the then-Deputy Attorney General’s January 2017 guidance was in development. Along with BJA, this ODAG working group included DOJ’s law enforcement components and other offices within the department. The working group provided a forum to advise ODAG in developing the January 2017 guidance and discuss issues surrounding disabilities, which involved responses to individuals with mental illness. BJA officials told us that they provided to components a compendium of all its resources available to assist law enforcement’s response to incidents involving individuals with mental illness. BJA officials said they later took the most promising of these and folded them into its Police-Mental Health Collaboration Toolkit. Further, BJA officials told us that they make all of the resources it develops, including the Toolkit, publicly available on the BJA website. According to the officials, these resources are available for all law enforcement agencies, including federal entities, to review and consider implementing as they deem appropriate. In addition to these online resources, which facilitate information sharing, BJA is also planning to release a national CIT curriculum in 2018 that will serve as a resource that can be tailored to reflect mental health training and collaboration under development or underway at the local level. The Office of Justice Programs is supporting a partnership between the IACP and a research organization to deliver the curriculum to law enforcement agencies. In addition, BJA—as one of DOJ’s grant-making entities—is standing up the National Training and Technical Assistance Center to Improve Law Enforcement Responses to Individuals with Mental Health Disorders and Intellectual and Developmental Disabilities. BJA officials reported that in September 2017, BJA selected the awardee to design and operate the center. Once the center is operational, it will benefit state, local, and tribal law enforcement entities. In addition, BJA envisions that the center will facilitate better collaboration between law enforcement agencies and their mental health partners. A BJA official also acknowledged that the center could serve as an additional resource for federal law enforcement agencies to consult as they review their trainings, policies, and guidance relevant to responding to incidents involving individuals with mental illness. We provided a draft of this report to DOJ and DHS for their review and comment. The departments did not provide us with formal written comments, but did provide technical comments, which we incorporated as appropriate. We are also sending this report to the appropriate congressional committees and members. In addition, this report is available at no charge on GAO’s website at http://www.gao.gov. If you or your staff have any questions, please contact Diana Maurer at (202) 512-8777 or maurerd@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff that made significant contributions to this report are listed in appendix III. This report addresses the following key questions: (1) What challenges, if any, do federal law enforcement officers at selected Department of Homeland Security (DHS) and Department of Justice (DOJ) components face when responding to incidents involving individuals with mental illness? (2) What type of training, policies, and guidance, if any, are in place at selected DHS and DOJ components to prepare federal law enforcement officers for responding to incidents involving individuals with mental illness? (3) What leading practices or tools have relevant stakeholders cited for effective responses to incidents involving individuals with mental illness, and how have DHS and DOJ components leveraged information from other knowledgeable parties? We focused our review on the training, policies, and guidance put forth by the DHS and DOJ components listed in table 6 below because they comprise nearly all of the federal law enforcement officers in these agencies. To identify challenges that federal law enforcement officers and agents at our selected DHS and DOJ components face when responding to incidents involving individuals with mental illness, we held discussion groups of six to eleven agents or officers within each component in our scope. We worked with officials at each component to identify officers and agents with varied tenures and experiences. We held semi-structured in- person and telephone discussion groups using a script and set of questions. Discussion groups are not designed to provide generalizable or statistically reliable results; they are instead intended to generate in- depth information about the reasons for the discussion group participants’ attitudes on specific topics and to offer insight into their concerns. During the discussion groups, we asked officers and agents what challenges they face when responding to incidents involving individuals with mental illness, among other topics. We moderated each discussion to keep participants focused on the specified issues within discussion time frames. Participants identified challenges when we explicitly asked them to do so, or during the course of the discussion. We took detailed notes on each discussion and documented the perspectives participants raised in each discussion group. We then summarized the information collected and identified common themes. Because our questions were open-ended and designed to allow participants to discuss any challenges they may have experienced, we cannot determine whether the absence of a particular concern or challenge by a group of officers or agents is an indication that they did not experience the concern or that they did not raise it when asked broadly about the topic. While these participants’ perspectives cannot be generalized to their entire component or all law enforcement components, their views provided insights into the challenges federal law enforcement officers and agents face when responding to incidents involving individuals with mental illness. We have relied on the observations gathered during these discussion groups to answer this reporting objective as the officers and agents are uniquely positioned to speak to their experiences, and any challenges they face, responding to incidents involving individuals with mental illness. To identify the training, policies, and guidance in place, we reviewed documents from each of our selected law enforcement components, when available, to examine their nature and scope. We further reviewed information on the duration, requirements, and delivery mechanism of the training. We then summarized and verified this training information with each component through email documentation. For the policies, we reviewed the documentation to determine whether it was specific to responding to incidents involving individuals with mental illness or whether mental illness was contained within a larger directive. We also reviewed 2018 budget justification documents for each component in order to identify changes in staffing levels or training plans that might be related to officers’ and agents’ response to incidents involving individuals with mental illness. We also interviewed officials responsible for the development or delivery of training, policies, or guidance from the components in our scope to gather additional information that could help prepare federal law enforcement officers and agents to respond to incidents involving individuals with mental illness. In addition, since section 504 of the Rehabilitation Act of 1973, as amended, prohibits discrimination on the basis of disability, which includes mental illness, in federally funded and federally conducted programs and activities, we took steps to understand the section’s applicability to federal law enforcement operations. Specifically, we reviewed departmental guidance related to section 504 and reviewed the selected components’ documentation of efforts to review their training, policies, and procedures in accordance with that guidance. We also interviewed officials from the departmental offices overseeing these component efforts—DHS’s Office of Civil Rights and Civil Liberties (CRCL) and DOJ’s Office of the Deputy Attorney General (ODAG). To identify leading practices or tools stakeholders cited for effective law enforcement responses to incidents involving individuals with mental illness, we used a multi-stage process Specifically, we: 1. conducted a search of databases, such as ProQuest and Scopus, and organizational websites, such as those from the Council of State Governments, Justice Center (CSG JC) and Police Executive Research Forum (PERF), to identify published work related to law enforcement responses to individuals with mental illness that had been published on or after January 1, 2007 (the last 10 years). 2. reviewed the 96 published research papers and articles that our initial search yielded and then refined our selection criteria to include only those that were literature reviews, meta-analyses, or summary papers published by academics, think tanks and advocacy groups, or government agencies. We reviewed summary articles rather than all the primary research articles to balance breadth, depth, and efficiency. After refining our search, there were 16 documents that met our selection criteria. 3. reviewed the 16 to identify any potential leading practices. We determined that a practice was potentially leading if it was found in at least one of the remaining 16 articles and was a law enforcement – mental health program. Using these criteria, we identified two potential leading practices. 4. asked individual and organizational stakeholders to validate whether these were leading practices and to identify any additional leading practices that we might have missed. In order for us to consider an independent researcher as a stakeholder, the individual needed to have (a) authored or co-authored at least 2 of the 16 documents that met our search criteria as outlined earlier and (b) been recommended by another stakeholder. These criteria yielded two independent researchers from whom to solicit views. In order for us to consider an organization as a stakeholder, the organizations needed to have either (a) conducted research on law enforcement responses to individuals with mental illness; (b) administered law enforcement- mental health collaborative programs; or (c) launched a national campaign on law enforcement responses to individuals with mental illness. After reviewing the websites of organizations that potentially met these criteria, we selected four organizations from which to solicit views. In addition, we selected individuals within the organizations as knowledgeable stakeholders if they were either (1) recommended by another stakeholder; or (2) managed a law enforcement-mental health program or national campaign. As a result of these steps, we identified and interviewed six stakeholders (two independent researchers and four organizations) to gather their broad views of the dynamic between law enforcement and individuals with mental illness; to obtain their observations of any practices or tools, such as training guides or reports that have been used to enhance officer response; and to provide feedback on leading practices. The six selected stakeholders were: Amy Watson, Ph.D.: Professor at the Jane Addams College of Social Work, University of Illinois at Chicago. Melissa Reuland, M.S.: Research Fellow at the Police Foundation and Senior Research Program Manager at Johns Hopkins School of Medicine, Department of Psychiatry. Council of State Governments, Justice Center (CSG JC): a national nonprofit organization that serves policymakers at the local, state, and federal levels from all branches of government. It aims to provide practical, nonpartisan advice and consensus- driven strategies, informed by available evidence, to increase public safety and strengthen communities. International Association of Chiefs of Police (IACP): a professional association for law enforcement, representing more than 30,000 members in more than 150 countries. IACP aims to advance the law enforcement profession through advocacy, outreach, education, and programs. National Alliance on Mental Illness: a national grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. Police Executive Research Forum (PERF): an independent research organization that seeks to identify best practices on issues such as reducing police use of force; developing community and problem-oriented policing; and evaluating crime reduction strategies. After reaching out to each researcher and organization, we then sent a follow up written request to each of them to attempt to achieve consensus on whether or not the two practices we identified through our search—the Crisis Intervention Team (CIT) Model and the Co-responder Model— should be considered leading. We also took note of any tools they mentioned and probed further to understand their origins and intent. We confirmed with all six of the selected stakeholders that the CIT Model met our definition of leading practice and confirmed with five out of the six stakeholders that the Co-responder Model met our definition. Some stakeholders also identified other practices as leading; however, none of those practices had at least two other stakeholders confirm it as a leading practice. In addition, to determine how DOJ and DHS components leverage information from other knowledgeable parties, such as experts, associations, or colleagues in other components, we reviewed relevant documentation on these efforts, as available. We also interviewed agency officials from the components in our scope who are responsible for the development or delivery of training or policies. We conducted this performance audit from February 2017 through February 2018 in accordance with generally accepted government auditing standards. Those standards require that we plan and perform an audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives. FLETC provides basic training to all Department of Homeland Security (DHS) law enforcement officers through one of three basic program categories, which vary in length, described as follows: Center Basic is a FLETC training program category in which personnel from various agencies are provided with the critical competencies of a specific job, job series, or a group of closely related job series. FLETC provides all instruction. Training is offered in three basic training programs: Criminal Investigator Training Program, Uniformed Police Training Program and the Land Management Police Training Program. Center Integrated Basic is a FLETC training program category that provides entry-level law enforcement officers or direct law enforcement support personnel from a single partner organization with the core competencies of a specific job series or a group of closely related job series. FLETC provides all common and basic core foundational instruction (i.e., firearms, physical techniques, etc.). This category of training includes eight specific programs. Agency-Specific Basic is a training program category designed to provide entry-level law enforcement officers or direct law enforcement support personnel with instruction necessary to meet a single agency’s mission-specific basic training needs. Generally, Agency- Specific Basic courses precede or follow a Center Basic training program, with partner organizations providing the majority of the instruction. Agency-Specific Basic covers an additional 59 training programs. In addition to the contact named above, Joy A. Booth (Assistant Director) and Adam Couvillion (Analyst-in-Charge) managed this assignment. Kisha Clark, Eric Hauswirth, Gina Hoover, Susan Hsu, Candace Silva- Martin, Michael Silver, Janet Temko-Blinder, and Adam Vogt made key contributions to this report.

Summary: Law enforcement encounters with individuals with mental illness may require special training and skills and can sometimes involve volatile situations, risking tragic injuries or even death. The 21st Century Cures Act includes a provision for GAO to review the practices that federal first responders, tactical units, and corrections officers (for the purposes of this study, “law enforcement officers and agents”) are trained to use in responding to incidents involving individuals with mental illness. This report addresses (1) challenges that federal law enforcement officers and agents face; (2) applicable training, policies, and guidance; and (3) existing leading practices, relevant tools, and efforts to leverage information. GAO selected the five DHS and five DOJ law enforcement components (e.g., Secret Service, Federal Bureau of Investigation) that represent the largest concentration of law enforcement officers within the two departments. GAO reviewed the training, policies, and guidance in place, as well as efforts to enhance them, and discussed these matters with knowledgeable officials. In addition, GAO held discussion groups with a nongeneralizable sample of law enforcement officers and agents, selected through component contacts, to discuss their perspectives. GAO also reviewed studies on law enforcement responses to individuals with mental illness to help identify leading practices and tools and interviewed stakeholders, selected through a structured process, to obtain their perspectives. Law enforcement officers and agents from the Departments of Homeland Security (DHS) and Justice (DOJ) cited a number of challenges in our discussion groups related to their response to incidents involving individuals with a mental illness. All of the federal law enforcement components in GAO's review either offer, receive, or are developing some form of training to their law enforcement officers and agents that addresses responding to incidents involving individuals with a mental illness. Further, all components have relevant policies or guidance in place, and all are undertaking efforts to enhance their practices in accordance with departmental guidance. Since DHS and DOJ components have varying missions and operational needs and interact with the public in different capacities, the nature and scope of training, as well as the number and duration of courses offered in response to individuals with mental illness varies; however, they generally include elements focusing on de-escalation and communication. In addition, DHS and DOJ both have efforts underway to have components review their training and policies under departmental guidance and plan to begin implementing any changes by 2018. Stakeholders cited leading practices and tools for effective law enforcement responses, and DHS and DOJ components have generally leveraged information from other knowledgeable parties. For example, the Crisis Intervention Team approach involves training selected law enforcement officers on mental health topics and dispatching those officers on mental-health related calls. While models like this are typically used by state and local law enforcement agencies, their benefits could be considered in other settings such as federal law enforcement. DHS and DOJ officials are also using collaborative mechanisms within their departments, such as conference calls and working groups with officials, that have helped them leverage information from knowledgeable parties. In addition, DOJ's Bureau of Justice Assistance (BJA), which supports programs and initiatives in the areas of law enforcement, among other activities, has developed and makes publicly available resources such as its Police-Mental Health Collaboration Toolkit. BJA also is working to stand up a national training and technical assistance center to improve law enforcement responses to people with mental illness. While aimed at state, local, and tribal law enforcement, a BJA official also acknowledged that the center could serve as an additional resource for federal law enforcement agencies to consult as they review relevant trainings, policies, and guidance on this topic.