LO59: Police use of force and subsequent emergency department assessment-mental health concerns are the driving force behind ED use and choice of transport mode

Introduction: We examined persons transported to hospital after police use of force to determine whether Emergency Department (ED) assessment and/or mode of transport could be predicted. Methods: A multi-site prospective consecutive cohort study of police use of force with data on ED assessment for individuals ≥18 yrs was conducted over 36 months (Jan 2010-Dec 2012) in 4 cities in Canada. Police, EMS and hospital data were linked by study ID. Stepwise logistic regression examined the relationship between the police call for service and subject characteristics on subsequent ED assessment and mode of transport. Results: In 3310 use of force events, 86.7% of subjects were male, median age 29 yrs. ED transport occurred in 26% (n=726). Odds of ED assessment increased by 1.2 (CI 1.1, 1.3) for each force modality >1. Other predictors of ED use: if the nature of police call was for Mental Health Act (MHA) (Odds 14.3, CI 10.6, 19.2), features of excited delirium (ExD) (Odds 2.7, CI 1.9, 3.7), police-assessed emotional distress (EDP) not an MHA (Odds 2.1, CI 1.5, 3.0) and combined drugs, alcohol and EDP (Odds 1.7, CI 1.9, 3.7). Those with alcohol impairment alone were less likely to go to ED from the scene: OR 0.6 (CI 0.5, 0.7). EMS transported 55% of all patients (n=401), although police transported ~100 people who EMS attended at the scene but did not subsequently transport. For patients brought to the ED, 70% had a retrievable chart (512/726) with a discernible primary diagnosis: 25% for physical injury, 32% for psychiatric and 43% for drug and/or alcohol intoxication. For use of force events that began as MHA calls, patient transport was more often by police car than ambulance OR 1.8 (CI 1.2, 2.5), while those with drug intoxication or ≥3 ExD features were more often brought by ambulance: odds of police transport 0.5 (CI 0.3, 0.9) and 0.4 (CI 0.3, 0.7). Violence or aggression did not predict mode of transport in our study. Conclusion: About one quarter of police use of force events lead to ED assessment; 1 in 4 patients transported had a physical injury of some description. Calls including the Mental Health Act or individuals with drug intoxication or excited delirium features are most predictive of ED use following police use of force. In MHA calls with use of force, persons are nearly twice as likely to go to ED by police car than by ambulance.

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Involuntary admissions under the Mental Health Act 2007 (New South Wales): A comparison of patients detained by ambulance officers, medical practitioners and accredited persons in an emergency department

Emergency Medicine Australasia ◽

10.1111/1742-6723.12138 ◽

2013 ◽

Vol 25 (6) ◽

pp. 544-549 ◽

Cited By ~ 13

Author(s):

Dawn Cutler ◽

Mechelle Smith ◽

Timothy Wand ◽

Timothy Green ◽

Michael Dinh ◽

...

Keyword(s):

Mental Health ◽

Emergency Department ◽

New South ◽

New South Wales ◽

Medical Practitioners ◽

Mental Health Act ◽

South Wales

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Police use of force standards and mental health crises in the United States: Identifying research and policymaking targets

International Journal of Law and Psychiatry ◽

10.1016/j.ijlp.2021.101750 ◽

2022 ◽

Vol 80 ◽

pp. 101750

Author(s):

Heather Zelle ◽

Sharon Kelley ◽

Elisha R. Agee ◽

W. Luke Siebert

Keyword(s):

Mental Health ◽

United States ◽

Use Of Force ◽

The United States ◽

Police Use Of Force

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Assessing the capability of a co-responding police-mental health program to connect emotionally disturbed people with community resources and decrease police use-of-force

Journal of Experimental Criminology ◽

10.1007/s11292-020-09434-x ◽

2020 ◽

Cited By ~ 1

Author(s):

Etienne Blais ◽

Marjolaine Landry ◽

Nicolas Elazhary ◽

Sebastian Carrier ◽

Anne-Marie Savard

Keyword(s):

Mental Health ◽

Emotionally Disturbed ◽

Health Program ◽

Use Of Force ◽

Mental Health Program ◽

Community Resources ◽

Police Use Of Force

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How Were Encounters Initiated That Resulted in the Fatal Shooting of Civilians by Police?

10.31235/osf.io/jsg5h ◽

2017 ◽

Author(s):

Emma Frankham

Keyword(s):

Mental Health ◽

Descriptive Analysis ◽

Use Of Force ◽

Washington Post ◽

Police Use Of Force ◽

Police Contact ◽

Crucial Information ◽

Race Ethnicity ◽

The Individual ◽

Basic Statistical Analysis

An abbreviated version of this paper has been published in Contexts: http://journals.sagepub.com/doi/full/10.1177/1536504218776970..........................................................................................................This paper examines police-public encounters that resulted in the fatal shooting of civilians during 2015 and 2016. Data published by The Washington Post is merged with data collected by the author regarding how encounters were initiated. Descriptive analysis and basic statistical analysis is performed and the results indicate that how police contact was initiated varies by race/ethnicity, age, sex, mental health status, and whether (or how) the individual killed by police was armed with a weapon. The implications of the results for understanding police use of force are discussed. This paper recommends that databases on civilian fatalities include information on how contact was initiated. Without this crucial information, understandings of police use of force are incomplete.

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The potential for violence in arrests of persons with mental illness

Policing An International Journal of Police Strategies and Management ◽

10.1108/pijpsm-07-2013-0076 ◽

2014 ◽

Vol 37 (2) ◽

pp. 404-419 ◽

Cited By ~ 21

Author(s):

Philip Mulvey ◽

Michael White

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Health Problems ◽

Use Of Force ◽

Health Problems ◽

Self Report ◽

Police Departments ◽

Maricopa County ◽

Police Use Of Force ◽

Content Type

Purpose – The purpose of this paper is to determine whether police use of force and suspect resistance are more likely to occur in arrest encounters involving suspects with mental health problems. Design/methodology/approach – The study uses data from interviews with 942 individuals recently arrested by officers in more than a dozen different police departments in Maricopa County, Arizona in 2010. Both logistic and ordinal regression analyses are used to predict two models of suspect resistance (resistance in the current arrest, resistance in a previous police contact) and three models of police use of force (any force in the current arrest, ordinal measure of force in the current arrest, and any force in a previous contact). Findings – The results provide empirical support for a link between mental illness and increased resistance against the police. With regard to arrestee mental illness and use of force, the results are mostly consistent with prior research suggesting a null relationship, with an important caveat involving greater use of higher level, weapon force. Research limitations/implications – The study suffers from the traditional limitations associated with self-report data, and the generalizability of the findings beyond arrest encounters in Maricopa County is not known. The explanatory power of the multivariate models was relatively weak, suggesting a good degree of unexplained variance. Practical implications – The non-significant relationship between arrestee mental illness and use of force is consistent with efforts by police to improve their response in these complex encounters. The significant weapon-force finding may suggest that police respond to the affronts of mentally ill suspects differently than affronts from other suspects. The non-significance of key extra-legal factors suggests that police decisions to use force were not influenced by arrestee race/ethnicity, age, or social standing. Originality/value – Unlike previous studies, the current research uses self-reported measures of mental health problems. The current study also examines arrests from more than a dozen different police departments.

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