May 19, 2015

By Ron Honberg


The U.S. Supreme Court issued a decision on May 18, focused on an issue that has become all too familiar for people living with mental illness and their families. The case, City and County Of San Francisco v. Sheehan, addressed whether police officers have a legal obligation to use crisis de-escalation methods when responding to people they know to be experiencing symptoms of a serious mental illness.

Two San Francisco police officers were called to respond to a woman with mental illness who was in crisis. When they entered her bedroom, she threatened them with a bread knife and told them to leave. They retreated, called for backup, but reentered the bedroom before backup assistance arrived with the intent to subdue the woman with pepper spray. The woman charged at them with the knife and the officers shot her multiple times. Fortunately she survived.

The woman subsequently sued San Francisco and the two officers in federal court, asserting that they failed to take her known mental illness into account by responding in a manner that escalated the situation. The case reached the Supreme Court which reviewed two questions. First, does the Americans with Disabilities Act (ADA) require law enforcement officers to provide accommodations to an individual with a known mental illness who is armed and potentially violent? Second, were the officers in this case entitled to qualified immunity from liability for the injuries suffered by the woman they were responding to?

The Court ruled in favor of the City and Officers on the issue of qualified immunity, holding that they did not violate a “clearly established statutory or constitutional right” when they opened the woman’s door the second time. But, the Court dismissed the ADA question, because San Francisco, after raising this issue in its petition to the Supreme Court, did not argue it either in its brief or in oral arguments before the Court.

By not addressing this issue, the Supreme Court essentially left open the question of whether the ADA applies to police interactions with people in crisis who live with mental illness or other mental disabilities. Based on the facts in this case, it’s questionable whether the Court would have ruled that the ADA requires accommodation in this kind of situation. So, in a way, no ruling is better than one that absolves counties and police of any responsibility. It may be that the issue never need be decided—if reform of the mental health system as a whole cab be achieved,

Why This Case Matters

Police commonly respond to people with mental illness in crisis throughout the United States. Except for mental illness, a call to 911 for assistance with a medical emergency will lead to the arrival of Emergency Medical Technicians (EMTs) trained to respond. However, if a 911 call concerns a mental health emergency, the police are usually the first sent to respond.

A number of communities have responded admirably by implementing Crisis Intervention Team (CIT) programs and training officers on methods for de-escalating crises situations. However, police are still too often thrust into situations involving psychiatric emergencies without necessary training or options for working collaboratively with the mental health system. The consequences can be calamitous, including deaths or serious injuries.

For example, an investigation by the Portland (Maine) Press Herald in 2012 concluded that “at least half of the estimated 375 to 500 people shot and killed by police each year in this country have mental health problems.” In recent years, these problems appear to have worsened as mental health resources have diminished and police assumed even greater responsibility for responding to crises situations. Investigations and lawsuits initiated by the U.S. Department of Justice have revealed

disturbingly high numbers of law enforcement-initiated deaths of individuals with serious mental illness in cities such as New Orleans, Albuquerque, Portland (Oregon) and elsewhere.

Ultimately, the Supreme Court’s decision left unanswered the question of whether communities and counties are legally responsible for training police officers and other first responders on how to effectively and compassionately respond to people experiencing psychiatric crises. The fact of the matter, however, is that the challenge lies with communities to provide mental health services designed both to prevent crises and ensure that people who do experience crises are responded to compassionately and effectively.

Certainly, all communities in the U.S. should implement CIT programs and provide training on crisis de-escalation to their police officers. However, even the best trained officers can only accomplish so much without the support and partnership of the mental health system. If this week’s decision teaches us nothing else, it is that we cannot rely on the courts to determine responsibility for fixing America’s mental health crisis. That responsibility lies with legislators, county leaders, elected officials and others with authority to invest in evidence-based mental health services.

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