Crisis, mental health and people who cannot comply

The mobile crisis worker, Nadia Kerr, arrived at Tidewater Park seventeen minutes after Malhotra and Reyes. She had worked with Owen Pelley before and greeted him by name. For about seven minutes, the call seemed to be ending well. Pelley sat on the bench, Kerr crouched to talk with him, and Malhotra stood back. Then Kerr gently said that she thought he needed to go to the hospital tonight to get some sleep and see a doctor. Pelley stood up. 'No. No hospital. They'll lock me up.' He started walking fast, then almost jogging, toward Harbor Street, where cars were passing at about thirty miles an hour, looking over his shoulder at the officers as if they were chasing him.

Desjardins stops the footage there. 'Everything up to this point was de-escalation done well,' he says. 'Now the officers have about six seconds before Owen is in the road. This lesson is about people in crisis: why they are overrepresented in use-of-force incidents, why they often cannot follow commands, and how the law treats force used to protect a person from themselves.'

People in crisis and police force

People experiencing mental health crises make up a small share of police calls but a much larger share of serious use-of-force incidents and deaths. Studies of fatal police shootings in the United States have consistently found that about a fifth to a quarter of the people killed had signs of mental illness. These findings led to the spread of Crisis Intervention Team (CIT) programs, first developed in Memphis, Tennessee, in 1988 after police there shot and killed a man in crisis, and to newer models in which mental health professionals respond with or instead of officers.

The reasons are not mysterious. People in crisis are often frightened and confused. Some are hearing voices or believe they are being persecuted, as Pelley did. Some are intoxicated, sleep-deprived or in physical distress. Some are holding objects, such as knives or bottles, for reasons that make sense to them but look threatening to others. And many are less able than other people to understand and follow police commands quickly. A person who cannot comply, facing officers who expect compliance, is a set-up for force unless the officers recognize what is happening.

Cannot comply versus will not comply

The most important distinction in this lesson is between a person who will not comply and a person who cannot. A person who will not comply understands the instruction and chooses to resist it. A person who cannot comply may not hear the instruction, may not understand it, may be physically unable to do it, or may be so overwhelmed by fear or by symptoms that they cannot organize a response. The same outward behavior, such as standing still while an officer shouts 'Get on the ground', can come from either.

Lesson 9 returns to the medical side, including the controversial term excited delirium. For now, the rule is the one introduced in lesson 2: treat non-compliance as information. Ask whether the person can hear, understand and do what is being asked, adjust the communication, and give more time wherever the situation allows.

People in crisis with weapons

Some of the most dangerous calls involve a person in crisis holding a knife, a bottle or another edged or improvised weapon. Training once taught that an officer within twenty-one feet (the so-called twenty-one-foot rule) of a person with a knife was in mortal danger. The original research, by Dennis Tueller in 1983, actually showed that a person could cover twenty-one feet in about a second and a half, and that officers needed distance and cover to have time to react. It was never meant as a rule that officers could shoot anyone with a knife inside that distance, and modern training stresses the opposite lesson: create more distance, use cover and keep talking, because distance and time are what keep everyone alive.

At Tidewater Park, the officers never closed the distance while Pelley held the bottle, even when he waved it. Reyes later said that she was frightened when he took two quick steps toward Malhotra at about minute four. 'But Dev just stepped back behind the planter and kept talking,' she said, 'and Owen stopped.' Malhotra explained that he had decided, before he even got out of the car, that he would keep at least 23 feet and the planter between them for as long as Pelley held anything.

Legal authority to intervene with a person in crisis

Police often have authority to take a person in crisis into custody even when no crime has been committed. In Ohio, section 5122.10 of the Revised Code allows a police officer, among others, to take a person into custody and transport them to a hospital for examination if the officer has reason to believe that the person has a mental illness and represents a substantial risk of physical harm to themselves or others if allowed to remain at liberty pending examination. Other states have similar laws, usually called emergency detention or emergency hospitalization. The mental health course (LES-114) covers these powers in detail. What matters here is that an emergency hold is a seizure under the Fourth Amendment, so force used to carry it out must be objectively reasonable, as lesson 5 explains.

At Tidewater Park, the officers had grounds before Pelley moved toward the road: he had threatened people with a broken bottle, he appeared to have a mental disorder, and he had told Kerr he had not slept or eaten properly in days. When he walked fast toward the traffic, the risk of serious physical harm to himself became immediate. Malhotra shouted, 'Owen, stop, the cars!' and when Pelley did not stop, Malhotra and Reyes took hold of his arms at the curb. Lesson 5 examines whether that was lawful and why.

Crisis teams and alternative responses

Many U.S. cities now have teams that pair officers with mental health workers or send mental health workers without police to some calls. Examples include the CAHOOTS program in Eugene, Oregon, which has sent medics and crisis workers to calls since 1989, and Denver's Support Team Assisted Response (STAR) program, launched in 2020. The national 988 Suicide and Crisis Lifeline, launched in July 2022, gives people another way to get help. These programs do not remove police from every crisis call, but they change who arrives and what options are available.

The Tidewater Park call shows both the value and the limits of these programs. Kerr's arrival was the right step, and she knew Pelley. But a crisis worker cannot physically stop a person from walking into traffic, and Kerr later said she did not expect Pelley to bolt. 'The right people were there,' Haddad says. 'What we could have done better was plan with Nadia before she told him about the hospital: where the officers would stand, what we would do if he ran, which side the road was on.' That point returns in lesson 12.

Planning the handover

Haddad's point about planning with Kerr applies to every call where officers hand a person in crisis to someone else, whether a crisis worker, a paramedic or a family member. The moment of handover is often the moment of greatest risk, because it is when the person learns what is going to happen next. A short plan, agreed out of the person's hearing, makes it much less likely that the officers will be caught off guard.

Suicide risk on force calls

Some people in crisis want to die, and a few of them behave in ways that seem intended to make police use lethal force, for example by advancing on officers with a weapon or pretending to have a gun. Researchers and police trainers sometimes call this suicide by cop, although many mental health professionals prefer terms such as victim-precipitated or officer-involved suicide. Studies of police shootings have found that a meaningful share of them involve people who appear to have been suicidal. These situations are extremely difficult for officers, because the person may truly present a lethal threat even though their underlying goal is their own death.

The response is the same as on other crisis calls, only more so: maximize distance and cover, slow everything down, use one calm voice, ask directly about suicide where it is safe to do so, and bring in crisis negotiators and mental health professionals as early as possible. Officers who are involved in such incidents often carry lasting distress, even when their actions were lawful and unavoidable. Lesson 11 covers support for officers after serious force incidents.

Family members and caregivers

Family members, roommates and caregivers are often the people who call police and the people who know the person best. They can tell officers what has worked before, what frightens the person, whether they take medication and whether they have weapons at home. They can also help calm the person, or, in some cases, make things worse. Officers should ask them for information early, keep them safe and, where it helps, involve them in the conversation. Pelley's sister, reached by phone during the review, said he had been off his medication for two weeks and was terrified of being held in hospital after a bad experience two years earlier. That information, had it been available on the night, would have changed how the hospital was raised with him.