RESEARCH WEEKLY: What we don’t know is hurting us

(Dec. 16, 2015) Two days before the Treatment Advocacy Center released its new study on the role of mental illness in fatal police encounters, an essay by a group of Harvard University researchers was published about the nation’s lack of reliable data on deadly law enforcement incidents.

In “Police killings and police deaths are public health data and can be counted,” the authors liken deaths that result from police encounters to other conditions that pose a preventable or treatable threat to public health. They report, for example, that the estimated 2015 civilian deaths resulting from fatal law enforcement encounters by mid-September exceeded 2015 deaths in the US for pneumonia and influenza, measles, malaria, mumps – “diseases of considerable concern,” as the authors put it – and were on a par with the national number of cases of Hepatitis A. Nancy Krieger et al. propose that “law-enforcement-related deaths be treated as a notifiable condition” and tracked by public health departments in real-time to provide “data needed to understand and prevent the problem.” Like epidemics, the authors say, police use of deadly force can “imperil communities’ social and economic well-being.”

“We have a world-class public health system that reports, nationally, in real-time, on numerous notifiable diseases and also on deaths occurring in 122 cities with populations (more than) 100,000,” Krieger wrote. “It is stunning that we in the US must turn to a UK newspaper website (The Guardian) for timely and detailed reporting on deaths due to police violence.”

Even More Stunning
What we find even more stunning is how brazenly, completely – even systemically – the US government fails to track or report the variable of severe mental illness in a host of public health and policy arenas that imperil individuals and communities far more widely than any of the diseases cited by the authors. “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Police Encounters” found that only one federal data system has ever set out to “systematically collect and publish mental health information” about victims of fatal police incidents. Operated by the Bureau of Justice Statistics, the Arrest-Related Deaths program is currently suspended because the data available for its reports “did not meet the agency’s quality standards.”

What we don’t know does hurt us. In a data-driven world, failing to quantify the real and significant impacts untreated mental illness exerts upon our public health, criminal justice, social services and other systems makes it easier to ignore those impacts and thus not seek to prevent them. From all appearances and reliable anecdote, severe mental illness is a factor in a minimum of 1 in 10 law enforcement responses, 1 in 5 incarcerations, 1 in 4 fatal police encounters, 1 in 3 solitary confinements, 1 in 3 men living homeless on the streets. “Overlooked in the Undercounted” concluded that reducing encounters between on-duty law enforcement and individuals with the most severe psychiatric diseases may represent the single most immediate, practical strategy for reducing the use of deadly force by officers in the United States. Reducing untreated mental illness might similarly reduce a host of other impacts from overcrowding in emergency rooms to homicides in families.

We need and deserve more than appearances and anecdote to understand these conditions – and prevent them.

Filling the Gaps
The Treatment Advocacy Center from its founding in 1998 has produced original research that makes use of what official data, verifiable anecdote, international research and other reasonably reliable sources are available to fill in gaps left by the neglect of mental illness as a significant public health condition. Our reports and findings to date include:

• “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Police Encounters”: individuals with untreated mental illness are 16 times more likely to die after being stopped or approached by law enforcement than other civilians.
• “The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey”: the number of mentally ill persons in prisons and jails in 2012 was 10 times the number remaining in state hospitals; in 44 of the 50 states and the District of Columbia, a prison or jail in that state holds more individuals with serious mental illness than the largest remaining state psychiatric hospital.
• “Mental Health Commitment Laws: A Survey of the States”: only 18 states recognize the need for treatment as a basis for civil commitment to a hospital; in the other 32, grave disability or danger to self or others must develop before the state can order treatment for individuals too ill to seek care. 
• “No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals”: public psychiatric beds for individuals with acute or chronic psychiatric disease decreased 14% from 2005 to 2010 and sunk to a per capita level not seen in the US since 1850.

Author and mental health advocate Pete Earley on Monday named the Treatment Advocacy Center the “most impactful mental health group in 2015.” Announcing the selection on his widely read blog, Earley wrote that the Treatment Advocacy Center has with its research “consistently and unrelentingly revealed flaws in our system that need repair – and it’s done it louder and often more effectively than other advocacy organizations. (It’s also done it on a yearly budget of slightly more than $1 million — that’s not much in Washington’s advocacy circles.)”

References:
Krieger, N., et al. (8 December 2015). Police killings and police deaths are public health data and can be counted. PLOS Medicine. 
Fuller, D., et al. (2015). Overlooked in the Undercounted: The Role of Mental Illness in Fatal Police Encounters. Treatment Advocacy Center.
Torrey et al. (2014). The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey. Treatment Advocacy Center. 
Stettin, B., et al. (2013). Mental Health Commitment Laws: A Survey of the States. Treatment Advocacy Center.
Torrey et al. (2012). No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals. Treatment Advocacy Center.
Earley, Pete. (2015). My Choice for Most Impactful Mental Health Group in 2015: Treatment Advocacy Center. Official website of Pete Earley.