As stories from around the country attest, Melissa Perez’s death was no isolated incident. People with mental disorders are up to 16 times more likely to be killed by police than people without those disorders (Fuller et al., 2015). For people of color, that elevated risk is more than doubled, and for people with other marginalizing factors (e.g., lower incomes), that risk continues to increase (Green & Peneff, 2021). While statistics are sometimes hard to find or fully grasp, individual stories of violence are easy to find, and here are just a few:

• Raul de la Cruz was one of more than 170,000 so-called “E.D.P.” or “emotionally disturbed person” calls for New York City police in 2022. Officers shot de la Cruz repeatedly, less than 30 seconds after arriving on the scene in response to a call for medical help from his concerned father (Meko & Kriegstein, 2023).
• In the summer of 2021, Arcadio Castillo III was shot dead by police in his parents’ home. Arcadio’s mother, Misty (figure 5.3), had been trying unsuccessfully to get mental health treatment for her son. On this occasion, Misty called the police for assistance; she told them Arcadio was mentally ill, using substances, and had a knife. Five minutes later, an officer burst into the home and shot Arcadio: “[The officer] didn’t try to calm him down. He just came in and immediately shot my son” (Selsky & Willingham, 2022).
• In October 2022, the family of Daniel Prude, a Black man experiencing an apparent drug-involved mental health crisis, was killed by police in an encounter where he was reportedly held, naked, in the street and placed in a “spit hood.” Prude’s family settled a multimillion-dollar lawsuit against the Rochester, New York, police department involved in Prude’s death, but the police did not admit liability, and no officers were ever charged criminally (Clifford, 2022).
• Takar Smith, a father of 6, was killed by Los Angeles police in January 2023. Takar was at the home of his wife, Shameka, in violation of a restraining order. Shameka called the police to get help for Takar; she told dispatch that Takar was mentally ill. When police arrived, Takar grabbed a knife from the kitchen. He was on his knees on the kitchen floor, holding the knife over his head, when officers shot him. The officers never attempted to bring in the mental health support team that was available to them (KCAL News, 2023). Takar had schizophrenia and, like Daniel Prude, he was Black, placing him at a particularly dangerous intersection with respect to police. While people with mental disorders are at increased risk of being killed by police, Black people are already almost three times more likely than white people to be killed by police in any law enforcement encounter, even though they are less likely to be armed (Shadraven et al., 2021).

Despite a universal desire to the contrary, violent encounters like these examples continue to happen when police are called to mental health crises. Police arrive armed with guns and sometimes without training or mental health backup. People in crisis are unpredictable, and sometimes they (like any other person) have access to weapons. A person in crisis may also be more likely to resist arrest, inviting the use of force by police (Green & Peneff, 2021). Typically, even where tragic outcomes occur, reviews of officer conduct typically conclude that police acted according to policy amid chaotic and dangerous circumstances. While these conclusions may reveal a reluctance to hold officers accountable, some also validate that these encounters are, in fact, very difficult to manage safely (Manfield, 2022).

Role of Untreated Mental Disorders

Police contact with people with mental disorders is not rare, and these instances seem to be increasing in frequency (Abramson, 2021). This is likely true in part because high-needs people, such as those with untreated or undertreated serious mental illness, are now more commonly part of our larger communities. This should be a cared-for group in our communities, but as we have learned, many people with mental disorders receive inadequate care, placing them at greater risk of problems that may draw police attention (Cruz Guevarra & Wilson, 2019).

Oregon is emblematic of these problems, reportedly ranking 48th among the states for access to care, but it is far from alone (Levinson, 2021). According to the U.S. government, over 14 million adults in this country experienced serious mental illness in 2021, and more than half of them (51.5%) reported that their mental health care needs were not met (Substance Abuse and Mental Health Services Administration [SAMHSA], 2021). Additionally, more than 46 million people over age 12 (about 17% of the population) met the applicable DSM-5 criteria for having a substance use disorder in 2021. Of these, nearly 30 million have an alcohol use disorder, and 24 million have a drug use disorder. An overwhelming 94% of these people struggling with substances received no treatment for their disorder in that year, and nearly all of them reported they did not believe they needed treatment (U.S. Department of Health and Human Services, 2023).

Impact of Substance Use Disorders and Homelessness

Along with huge numbers of people impacted by mental disorders, and a troubling lack of treatment, there is also a slow national retreat from drug-related incarcerations. This trend has kept more people with substance use disorders in the community rather than jailed. The turn away from mass incarceration is generally a welcome shift that reflects our growing distaste for jailing people with mental health disorders. However, this shift has often occurred without a corresponding uptick in community treatment options or engagement. One example is Oregon’s Measure 110, decriminalizing possession and use of drugs, which was enthusiastically passed by voters in 2020 with the expectation that it would keep around 3,700 people out of jail or prison each year (Selsky, 2020). However, the systems and programs needed to adequately support those thousands of people with substance use disorders were slower to materialize. Alongside anecdotal reports of Measure 110 success was undeniable evidence of many people left untreated (figure 5.4) (Levinson, 2023). In 2024, the Oregon legislature partially reversed course, once again moving to criminalize small amounts of drugs.

When people’s needs for resources or care are not met, they are increasingly likely to experience crises. Where housing availability is scarce, as it is in Oregon and elsewhere, people are at greater risk of being unhoused—one more factor that can exacerbate mental disorders. Moreover, where people are unhoused, the crises they experience are far more likely to happen in public spaces and draw police responses (Cruz Guevarra & Wilson, 2019).

Police as Crisis Responders

Everyone—from behavioral health providers to advocates to criminal justice professionals, including the police—seems to agree that police are not best suited to tend to people with mental disorders in crisis (Wesolowski, 2022). However, police remain on the front lines and are still most likely to respond to situations involving problems associated with mental disorders (USA Facts, 2023). The inevitable presence of weapons, threat of arrest, and availability of use of force that accompany a police response serve to escalate even situations that, prior to police arrival, may have been less volatile. Responding to these calls also takes up a significant portion of the average police officer’s workday (figure 5.5). Nationally, it is estimated that up to 20% of police responses involve mental-health related calls (Westervelt, 2020).

In most cases, of course, police officers are able to resolve their calls safely, and those stories do not generally make the news. However, if police fail to do so, then the person they were called to help can become the person they harm or even kill. For communities and for the police officers dedicated to serving and protecting their communities, these outcomes are unacceptable. Efforts to avoid bad outcomes should include measures that, first, reduce the frequency of police encounters with people with mental disorders and, second, when encounters are required, ensure they are handled more effectively.

Licenses and Attributions for Policing People with Mental Disorders

Open Content, Original

“Policing People with Mental Disorders” by Anne Nichol is licensed under CC BY 4.0.

Open Content, Shared Previously

Figure 5.4. Drug abuse at the Park and Ride apparently by G Witteveen is licensed under CC BY NC 2.0.

All Rights Reserved Content

Figure 5.3. Photo of the police department in Salem, Oregon by Max Rae on Flickr is licensed under CC BY-NC-ND 2.0.

Figure 5.5. Photo of policeman by Jacky Lam on Unsplash.