If denied entry, disengage. If a person facing involuntary hospitalization becomes combative or refuses services, disengage. No more restraints. No more forced entry. Leave and try again later.
De-escalation is the essence of the Boston Police Department’s new rules of engagement, distributed departmentwide last week, for interacting with people in mental health crises. The guidelines, effective immediately, call for calm and measured responses and attention to the needs of the person in crisis, and affirm that “persons suffering from possible mental illness are afforded the same constitutional rights as everyone else.”
“It gives us protocols where there were none before,” said Sergeant Detective John Boyle, the police spokesman. “It’s a coordinated response to mental health issues.”
Mental health workers and advocates said that the new protocols are a positive response to 2020′s season of unrest and subsequent rallying cries for reforming police agencies. Too often, they say, interactions between police and someone experiencing a mental health crisis ends badly, if not fatally. Police agencies across the country have been responding with new tactics, teams, and policies.
Under Boston’s new policy, officers are instructed to be more cautious about intervening when performing mental health wellness checks under the state’s Section 12 law that allows authorities to hospitalize someone for psychological evaluation if they pose a threat to themselves or others.
“Absent the subject posing a likelihood of harm to officers or others, it may be more prudent to disengage or provide assistance to the subject at a later time when they are not in crisis,” according to the new guidelines issued by Acting Police Commissioner Gregory P. Long.
Boston police shot and killed a 31-year-old Black man with schizophrenia in October 2016 after his mother called 911 because he was acting erratically. Police said Terrence Coleman attacked an emergency worker with a knife, but his mother said her son had no weapon.
According to a Washington Post database that tracks every person killed by a police officer since 2015, 23 percent of victims killed by police nationwide were experiencing mental illness. In Massachusetts that number is 31 percent, according to the same database.
Jenifer Urff, spokeswoman for the Massachusetts Association for Mental Health, said the new policy aligns with the association’s values and practices.
“Absent a danger to others, stepping back from the situation to provide support almost always is a better choice than the use of force,” Urff said.
“When someone is faced with involuntary commitment, they may reasonably be afraid and unwilling to cooperate,” she said. “When police are involved, that may heighten their sense of fear, creating a dangerous situation that too often results in injury or death.
“The risk of violence is even greater for people of color, so developing new approaches is critical.”
It is crucial to know and believe that mentally ill people are not inherently dangerous, said Laura Domanico, a licensed mental health counselor in Cambridge.
“This change in policy appears to be a great initial step toward incorporating mental health professionals’ perspective into police work, rather than viewing mental illness as criminal,” she said.
“In the past, I’ve seen individuals experiencing mental health concerns have their rights infringed upon solely because of their mental health status,” Domanico said. “Clearly, as a society, we need to continue making changes in order to support rather than punish the disenfranchised, including honoring all individuals’ rights to self-determination.”
The Boston guidelines also formalize involvement of the police department’s Street Outreach Unit when serving Section 12 orders, as well as clinical experts from the police department’s BEST staff, a team of counselors who accompany police on mental health calls.
Since 2011, police have worked with counselors from BEST — the Boston Emergency Services Team. In 2019, BEST’s five counselors handled nearly 10,000 calls to Boston police involving an “emotionally disturbed person.”
While the state’s Section 12 law allows police to involuntarily hospitalize someone if they pose a harm, it does not spell out how the process should be handled.
“I think that’s where the blurriness comes from, police department to police department,” said Lauren Roy, of the Mental Health Legal Advisors Committee.
Involuntary hospitalizations sometimes make things worse rather than better, leading to job and housing losses, school disruptions, and fodder for custody battles and criminal charges, said Coco Holbrook, also of MHLAC.
“A Section 12 means a huge loss of liberty,” Holbrook said. “That’s a pretty drastic reason to enter a person’s home, over a concern.”
Oftentimes, someone in crisis prefers not to engage with a doctor or a paramedic or an authority figure, Roy said. “They prefer not to have clinical folks involved in wellness checks at all,” she said. Typically, they would rather have a friend, relative, or peer, someone they relate to.
Several cities have taken similar policing steps in the last year.
In Chicago, mental health clinicians instead of uniformed police officers will respond to certain 911 calls. Denver police are hiring more social workers and mental health professionals.
Lynn has been working over the last year to develop a new crisis response team. For years, Cambridge has trained officers through a partnership with the National Alliance on Mental Illness Massachusetts.
Police agencies historically weren’t designed to deal with mental health crises, yet police nationwide spend approximately 20 percent of their time responding to mental health calls, according to a 2017 study released by the Treatment Advocacy Center.
After 2020′s summer protests, Boston Mayor Martin J. Walsh’s budget pledged $2 million for 15 more crisis responder positions. Ten of the positions have been filled, Boston police said.
The current city budget promises “a transformative investment in alternative policing” and includes $1.75 million for that purpose for the city’s Office of Health and Human Services.
The first step spelled out by the Boston Police Department’s new policy is for a street outreach officer to partner with a BEST counselor when a call comes in and then to collaborate with a police supervisor. Together they would decide how to respond and who to send on the call — a uniformed officer, a paramedic, a BEST officer, or someone else.
If uniformed officers are sent and the person is compliant, police would take them to a hospital emergency department for evaluation. If the person is noncompliant, police “shall calmly explain the situation and offer available services,” the policy states. “If the subject refuses or becomes combative, officers shall disengage and leave the subject in place.”
In the past, social workers, doctors, or sometimes relatives, could seek a mental health wellness check. If nobody answered the door when police knocked with a property manager, officers would sometimes go inside without a Section 12 order.
But not anymore. The policy says forced entry should be avoided, unless “exigent” circumstances exist. It does not describe the criteria for exigent circumstances.
In a section on suicides, the policy informs that it is not against the law for a person to kill themselves in their home and “not all calls for a suicidal subject require force.”
Recognizing that mental health calls can be “dynamic and volatile,” neither officers nor supervisors will be disciplined if the situation goes awry.
“To encourage officers to make difficult but necessary decisions about when, whether, and how to serve a Section 12,” the policy says, “no discipline will be issued for reasonable, good-faith decisions that engagement or disengagement was appropriate and justified, or that de-escalation measures were available and exhausted.”