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The transfer of responsibility for individuals with serious mental illnesses from mental health professionals to law enforcement officers is incompatible with good psychiatric care. The current situation is victimizing both the patients and the law enforcement officers. The situation could be improved by the following:

  1. Collect better data. The US Department of Justice, through the FBI and Bureau of Justice Statistics, must collect more complete data on justifiable homicides committed by law enforcement officers. Currently, the quality and quantity of the data varies widely from state to state. The collection of reliable data is a legitimate federal responsibility and should be financed by the Department of Justice. This would allow the comparison of state data to identify states where such homicides are more or less frequent. Circumstances around each such homicide, including the history of psychiatric treatment and the identity of the most recent treating facility, should be included in reports on each case so that proper responsibility may be assigned. The collection of this psychiatric information can be justified under HIPPA regulations as part of Public Interest and Benefit Activities, to wit, “Covered entities may disclose protected health information to public health authorities authorized by law to receive such information for preventing or controlling disease, injury, or disability.”
  2. Return the ultimate responsibility for individuals with serious mental illnness to mental health officials. Each justifiable homicide that occurs should be assumed to involve both the law enforcement officer and the failed mental health treatment system. Why was the mentally ill person not being treated? Who is responsible? When the Department of Justice investigates possible excess justifiable homicides, as they have done in Seattle, Portland and New Orleans, the investigations should focus equally on possible failures of the mental health treatment system as on the possible failures of the law enforcement system. Similarly, when legal liability is being assessed, mental health officials should be held equally as liable as law enforcement officials.
  3. Use assisted outpatient treatment (AOT) to reduce officer-involved tragedies. Many of the mentally ill individuals who are victims of justifiable homicides are well-known to law enforcement officials. Indeed, every police and sheriff department in the country can name a small number of individuals in their community who are at highest risk for becoming the victims of justifiable homicides. Most such individuals have already had interactions with law enforcement officers and demonstrated their propensity for violent behavior when they are not taking the medication needed to control the symptoms of their mental illness. Such individuals are obvious candidates for mandated outpatient treatment.

AOT specifies that individuals with serious mental illnesses who have demonstrated dangerousness may be court-ordered to take medication for their psychiatric disorder as a condition for living in the community. Provision for AOT exists in all states except five (Connecticut, Maryland, Massachusetts, New Mexico, Tennessee) but is little used in most states. The US Department of Justice has deemed AOT to be an “effective” and “evidence-based” practice for reducing crime and violence. Studies of AOT have shown it to decrease psychiatric hospitalizations, homelessness and victimization. Most pertinently, AOT has been shown to decrease arrests or days incarcerated in four studies22,23,24,25 and to decrease violent behavior by mentally ill persons in three studies.23,26,27 In addition, AOT has been shown to save money. The selective and appropriate use of AOT for individuals with serious mental illnesses would probably decrease by half the approximately 250 such homicides each year associated with attacks on law enforcement officers, thus saving approximately 125 lives a year and preventing the wounding of many others who are not killed. Such use of AOT would significantly improve the professional lives of law enforcement officers as well as the lives of the individuals with severe mental illness.