This week, Mad in America explores three new studies around mental health crisis calls involving police. The first study finds that patients and service users are reluctant to contact police during crisis due to fear and mistrust. The second finds that patients and service users are often exposed to harm when police are involved in mental health crisis calls including death, physical injury, and trauma. The third finds that police officers themselves report a lack of training and guidance around mental health related crises while patients and service users often fear and distrust officers.

Patients and Service Users Report Reluctance to Call Police for Mental Health Crises

A new article published in Progress in Community Health Partnerships finds that participants have some reluctance to call the police for emergency mental health issues due to fear and mistrust. Instead, community members would prefer to have trained behavioral health or medical professionals respond to mental health crisis calls. This study, led by Jennifer L. Hefner from Ohio State University, also reports that participants desire more mental health and de-escalation training for police.

The goal of this study was to examine community members’ perceptions and experiences of how police respond to 911 calls involving a mental health emergency. Working with a community advisory board, the authors recruited 30 people from Columbus, Ohio to participate in semi-structured interviews around police responses to mental health emergencies. In order to be included in the current research, participants had to have personal knowledge of at least one 911 call involving a mental health crisis. This included callers, witnesses, the person for whom 911 was called, and close friends and family. These interviews were recorded, transcribed, and coded for recurring themes.

The authors identified four major themes in the interview data. (1) “Varied police demeanor across incidents within a neighborhood” dealt with the significantly different response to mental health crises displayed by different officers. While some officers were compassionate and helpful, others were aggressive and apathetic. Participants noted that while it is “dangerous to be Black in any neighborhood,” the demeanor of the responding officer can lead to significantly different experiences and outcomes. One participant said “a different cop can make all the difference.” A mother of a child with chronic mental health issues said that she had experienced police respond without using force even when weapons were involved. However, she noted that “they pick and choose [when to respond negatively]. You [responding officer] don’t have to yell; you can just talk.”

(2) “Reluctance to call the police for mental health crises” revealed that many community members avoided calling the police due to fear and past negative experiences. Participants reported both individual and community-wide reluctance to call the police in emergency mental health situations. One participant said “I will do everything I can to not have to call 911 ever,” with another reporting “I don’t call the police; I don’t care for them.” Participants said that community members’ reluctance to call police was related to fear and negative consequences of involving police with mental health emergencies. “It’s fear. It’s fear of, ‘are they gonna look at me as a suspect?’ It’s fear that something else is gonna happen other than what I am calling for help.”

(3) “Police need increased training in behavioral health disorders and de-escalation tactics” dealt with community members’ perception of police as poorly trained. One parent that had called the police said “In situations like this [a BH crisis], I don’t know anything about their training. Do they really understand what’s happening? There’s a stigma surrounding mental health already, you know?” Participants suggested that police could benefit from scenario-based training and psychiatric evaluations. One participant said “there needs to be better training on how to talk to people with compassion.”

(4) “Strong support for a non-police response” showed that participants would prefer having an option to request professionals that are trained in dealing with mental health crises rather than police for mental health calls. One participant said:

This study had three main limitations. The small sample size, while appropriate for a qualitative study, limits generalizability of the findings. All participants were recruited from Columbus, Ohio, further limiting generalizability. This research was designed to examine community perspectives and experiences and did not report on actual outcomes, such as injuries, arrests, and hospitalizations resulting from emergency calls.

Patients and Service Users Often Experience Fear, Coercion, and Harm from Police

A new international study published in the International Journal of Mental Health Nursing finds that mental health service users and patients often reported negative experiences of police involved mental health crisis calls. This included coercion, fear and intimidation, trauma, physical injuries, and death. This research, led by Emilie Hudson from the University of Montréal in Canada, also finds that when police engaged in calm communication and displayed empathy during emergency mental health calls, patient and service user experiences were significantly more positive.

The goal of this study was to examine how patients, service users, and carers experienced emergency mental health calls involving police and specialized police mental health teams. The authors undertook a narrative review of previous research around this topic. In total, they included 33 studies published in English and French that investigated patient, service user, and carer experiences of police-only and specialized police mental health team responses to emergency mental health calls. Included studies came from eight countries including the UK, US, Canada, Australia, Germany, France, the Netherlands, and New Zealand.

The authors found five major themes in the included studies. (1) “Initiating and navigating the crisis response” involved carers’ experience of how difficult it is to assess risk in real-time, attempts to deescalate before involving police, and conflicted feelings around police involvement often related to previous negative experiences. Carers often described calling the police as an act of desperation and were frustrated that their loved one’s mental health was rarely addressed. Carers also expressed guilt over involving police and reported that the decision to involve police could result in strained family relationships. Service users and carers described how the initial response could drastically affect outcomes and the overall experience of police involved mental health crisis calls. For example, calm arrivals in unmarked cars with fewer responders tended to deescalate the situation. Responses in private settings were also more positively experienced. A participant from one study said:

(2) “Interacting and communicating during the response” dealt with how police officers’ style of communication could lead to significantly different experiences for service users and patients. Positive experiences involved officers treating patients and service users as people rather than threats. Calm communication, empathy, transparency about what responders were doing, and involving the patient or service user in decisions all resulted in more positive experiences. Commands, threats, dismissal, intimidation, and rapid escalation all contributed to negative experiences.

(3) “Perceptions of safety, risk, and coercion during the response” mostly involved experiences of coercion and being treated as a risk by responding officers. Patients and service users reported formal coercion including forced transport, detention, arrest, physical restraint, and the use of force and weapons. Informal coercion included threats, intimidation, persuasion, and use/abuse of implicit authority associated with police uniforms and weapons.

There was evidence in some included studies that risk was interpreted through stereotypes of dangerous “mentally ill” people. Characteristics such as race, indigenous status, homelessness, age, and gender could also affect how patients and service users were perceived, with minorities and men often perceived as higher risk. The authors note that having mental health experts as part of the response team did not always decrease experiences of coercion. Some patients and service users described the inclusion of mental health experts in police emergency responses as a “double layer” of coercion, with both police and clinical authority exerting influence simultaneously.

(4) “The harms of police involved crisis responses” included death, fear and intimidation, humiliation and loss of dignity, physical injury, trauma, distrust of police and mental health services, avoidance of future help seeking, and disengagement from treatment. The authors note that harm was present both in responses involving just police, and those with a combined police and mental health team.

(5) Under “improving police responses” participants suggested:

• more mental-health professionals in crisis responses;

• calm, respectful and trauma-informed communication;

• active listening and de-escalation;

• greater involvement of service users and carers in decisions;

• culturally responsive care;

• better coordination between police, health and community services;

• reduced visibility of police where appropriate;

• meaningful post-crisis follow-up; and

• greater availability of community-, health- and peer-led alternatives.

This study had five main limitations. The first author conducting the screening and eligibility decisions for included studies alone. Included studies disproportionately focused on negative experiences. Included studies came from high-income countries with rural and remote settings underrepresented. Only studies included in French and English were included. There was insufficient research on how race, gender, indigenous status, etc. affect encounters with police during mental health crisis calls.

Patient and Service Users Report Fear and Distrust of Police, While Police Report Inadequate Training Around Mental Health

A new study published in the Journal of Police and Criminal Psychology finds that mental health patients and service users had negative experiences of police interactions including fear, mistrust, and crisis-related behaviors behaviors being misinterpreted as aggression. This study, led by Tyson Alker from the University of the Sunshine Coast in Australia, additionally finds that police report inadequate preparation for dealing with mental health crises.

The goal of this research was to bring together contemporary research findings on police interactions with people in mental health crisis. This includes both perspectives from patients and service users as well as police. The authors performed a systematic review of previous research on this topic. Included studies focused on police interactions with people dealing with mental health issues that were published between January 2015 and July 24, 2025. Each study had to be published in English and involve adult participants and sworn police officers. In total, the authors examined data from 20 studies, mostly from the UK, Australia, and Canada.

Included studies revealed that most police interactions involving people with mental health issues were the result of an acute mental health crisis or safety concern and not related to criminal activity. Patients and service users often had repeated contact with police, suggesting a pattern of police involvement with mental health crises. Outcomes varied significantly, with arrest, involuntary transportation, and use of force being common results.

Patients and service users reported fear and distrust towards police. They also experienced their own crisis-related behaviors being misinterpreted as aggression by police. Police officers reported inadequate preparation for dealing with calls involving mental health issues. They had limited training and unclear guidance around these issues, which resulted in many officers depending on intuition or trial-and-error approaches to mental health calls. Police also reported that they were often the only responders due to the limited capacity of mental health services.

This study had four main limitations. Most of the included studies came from Australia, Canada, and the UK, and were all published in English, limiting generalizability to other populations. The authors did not explore long-term outcomes of police encounters. The included studies used various designs, outcomes, and measures. Most studies that included perspectives of people with mental health issues focused on autism spectrum diagnoses, further limiting generalizability to other populations.

****

Alker, T., Hine, K., McKillop, N., & Prenzler, T. (2026). De facto mental health responders: A contemporary systematic literature review of police encounters with persons experiencing mental illness. Journal of Police and Criminal Psychology. (Link)

Hefner, J. L., Noghrehchi, P., David, S., Pandey, S., & Bevis, L. E. (2026). A community-engaged qualitative study of police response to 911 calls for behavioral health crises. Progress in Community Health Partnerships: Research, Education, and Action, 20(1). (Link)

Hudson, E., Lessard‐Deschênes, C., Michaud, A. D., & Goulet, M. (2026). From care to coercion: Service user and Carer experiences of police‐involved mental health crisis responses. International Journal of Mental Health Nursing, 35(3). (Link)