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An irrational, agitated man emerges from a house, holding a gun to the head of his girlfriend--and then shoots her in front of police who have been trying to negotiate her release and his surrender. He is almost simultaneously downed by a police sniper. His goal had been "suicide by cop."

A despondent man tears his socks into thin strips just hours after his arrest and incarceration, ties one end to the bedpost and the other around his neck, and lies down on the floor to strangle himself. He becomes one of many jailhouse suicides.

The human impact is tragic for all involved. The families of the mentally ill--who often are the ones summoning police when their relative is out of control--typically insist a different approach could have prevented the death of their loved ones. The involved officers, who are trained to protect life rather than take it, often feel remorse and psychological anguish because they feel they could do nothing to prevent the death.

When lawsuits follow, as they often do, the financial impact on the local governing body can also be devastating, especially in small and rural communities, draining resources and forcing up the price of insurance.

There is no easy solution. But managing the risk that law enforcement faces related to untreated mental illness can be accomplished through training, accurate assessment and accreditation.

THE SCOPE OF THE PROBLEM

Experts who have studied both suicide by cop and jailhouse suicides have documented the growth of the problem. A February 2005 briefing paper from the Treatment Advocacy Center, a national nonprofit organization dedicated to the treatment of severe mental illnesses, provided an overview of several studies and efforts to track statistics. Among its findings:

* The number of New York City police responses to complaints about "emotionally disturbed persons" rose from about 20,000 in 1980 to almost 65,000 in 1998. In California, sheriffs reported that 9 percent of all calls were related to a mental-illness crisis.

* In 1998, a law-enforcement officer was more likely to be killed by a person with mental illness (13 percent of the instances) than by a person with a prior arrest for assaulting police or resisting arrest (11 percent of the instances).

* People with mental illness are killed by police in justifiable homicides at a rate nearly four times greater than general public members. Nearly one-third of those killed in police shootings in New York City in 1999 were mentally ill. Experts find that, nationally, between 10 percent and 15 percent of all police shootings involve a mentally ill person who purposefully provokes police (i.e., suicide by cop).

* In addition, a study released in 2005 by the U.S. Department of Justice's Bureau of Justice Statistics found a suicide rate of 47 per 100,000 jail inmates in 2002, more than four times the rate of suicides in the general population. The rate translated into 314 jail suicides--more than 15 times the number of jail deaths attributed to homicide. Almost half of the jail suicides occurred during the inmate's first week in custody.

LIABILITY FOR THE LAW

The statistics make it clear that mental illness poses a growing challenge for law-enforcement officers on the street who must cope with irrational and often deadly situations. Besides the human consequences, encounters with the mentally ill also leave law-enforcement agencies at risk for liability.

The typical lawsuit faced by agencies often targets the way the mentally ill person had been handled. When a police officer responds to a call, the mental-health issues of these suspects can be masked by abuse of alcohol and drugs, making it difficult for even the well-trained officer to use the sensitivity and effective techniques required to handle a mentally ill person.

When an encounter ends with the death or injury of the mentally ill person, family members can be outraged and seek compensation from the government agency. They might accuse officers of failing to recognize that the person had mental problems and of reacting with inappropriate actions or more force than necessary. The family could claim that the officers took actions that made the situation worse rather than capably neutralizing the person.

Once a mentally ill person is arrested and taken to jail facilities, new potential liabilities arise. Law-enforcement agencies might be sued for failing to both identify the person's mental-health issue and provide appropriate health care. Health-care options in jails are often limited or even completely unavailable for the type of special needs presented by mentally ill inmates.

While arrangements are in place with outside medical facilities, such as hospitals with mental-health services, jails might have limited capability to transport prisoners for treatment. Agencies also could stand accused of endangering the mentally ill person by neglecting to post a suicide watch or respond to obvious symptoms if the inmate injures or kills himself.

In addition, liability can extend beyond the mentally ill person who has been arrested. If he is housed with a cellmate and then attacks or injures that person, the cellmate could file suit against the agency for failing to provide adequate protection and creating a dangerous situation through inappropriate placement. Jails with limited space are often faced with the difficulty of finding a way to segregate mentally ill inmates so they are not a danger to others.

This latter liability cannot be addressed simply by placing a mentally ill person in isolation. A recent spate of lawsuits--many filed by the American Civil Liberties Union in federal court--have challenged the practice of using isolation. These suits maintain that isolation is dangerous for the mentally ill, noting that those placed in solitary confinement are more likely to injure themselves or attempt suicide. Lawsuits have been filed against Massachusetts, Indiana and Colorado, among other states, arguing that such practices are unconstitutional.

Recent settlements in New York and Indiana have eliminated the isolation option and increased mental-health services to prisoners. Other states already have taken action legislatively to bar the practice.

Despite these recent filings, overall, lawsuits against law-enforcement agencies on mental-health issues are declining as agencies become more aware of the dangers and improve training and procedures.

The risk of liability, however, continues to be a major concern as agencies struggle to do the right thing under difficult circumstances.

The real solution to mental illness does not lie with law-enforcement agencies but with the need for society to increase funding for mental-health services and institutions.

But until that day comes, law-enforcement officers will continue to be faced with the day-to-day risks of handling mentally ill people who are threatening others or themselves.

To manage those risks, law-enforcement jurisdictions need to prepare their officers before a crisis confronts them. Training, proper assessment and accreditation can all make a positive difference.

DENNIS MOLENAAR, J.D., a former law-enforcement officer, is second vice president and national director of risk control for the public-sector services, bond and financial products, and oil and gas business units of Travelers.

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July 1, 2007

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