Vol. 3 - Issue l No. 1 – Spring / printemps 2014

Police Interactions with the Mentally Ill: The Role of Procedural Justice
Farzana B. Kara
Simon Fraser University School of Criminology

Police encounters with mentally ill individuals that involve the use of force by police are
relatively infrequent, but sometimes quite volatile. This article discusses the use of procedural
justice theory in understanding the quality and consequences of such interactions. Procedural
justice theory and its specific application to the police who interact with mentally ill persons are
discussed as a promising approach in improving police-citizen interactions. This paper provides
an empirical basis for understanding the need for evidence-based police policy and practices
when dealing with the mentally ill.
Keywords: police encounters; mentally ill persons; use of force; procedural justice.
Il est assez rare que les rencontres entre les agents de police et les personnes souffrant de maladies
mentales donnent lieu à des démonstrations de force par les policiers, mais ces rencontres
peuvent être volatiles. La désinstitutionalisation des personnes souffrant de maladies mentales,
des services alternatifs peu financés et fragmentés dans la collectivité et les critères de plus en
plus restrictifs d’engagement civil ont contribué à l’augmentation des contacts avec les forces
policières. Les agents de polices doivent faire preuve de retenue dans la force employée contre
les personnes souffrant de maladies mentales. Les besoins sont clairs de former les policiers à
une intervention spécialisée auprès des personnes souffrant de maladie mentale. La théorie de la
justice procédurale propose une méthode prometteuse pour améliorer les relations de la police
avec les citoyens. Selon ce cadre, le traitement équitable d’un individu par un agent d’autorité
come un policier peut influer sur la perception de la légitimité de son intervention, et de toutes
les impressions qui y sont associées, ce qui est d’une importance particulière pour les interactions
entre les policiers et les personnes souffrant de maladie mentale.
Mots clés: rencontres de police; les personnes souffrant de troubles mentaux; l'utilisation de la
force; la justice procédurale.
Introduction
The Police and the Mentally Ill
Several explanations have been advanced from different perspectives to clarify the reasons for the
increasing numbers of contacts between the police and people living with mental illness. Three
major developments are often speculated to have contributed to this increase (Teplin, 1984a). The
policy of deinstitutionalization from mental health facilities that has been implemented over the
past four decades is a central factor that has led to an influx of mentally ill people living in the
community (Lamb et al., 2002), thereby increasing the likelihood of police-mentally disordered
people encounters. In addition, overly restrictive civil commitment criteria and poorly funded and
fragmented community-based mental health services are all interrelated factors that have led to
frequent encounters between the police and the mentally ill.
VOL. 3.1
http://cgjsc.ca

79

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

Deinstitutionalization
The treatment of mental illness has undergone a significant transformation over time, from
institutionalized care in psychiatric hospitals to community-based treatment (U.S. Department of
Justice, 1993). For most of the twentieth century, the treatment of people with serious mental illness
was addressed through institutions like hospitals and asylums (Cook & Wright, 1995). Long-term
confinement in strictly controlled environments, much like prisons, was the norm. In his seminal
work on “total institutions”, Goffman (1961) proffered an analysis of asylums where he described
the role of the institution in forming the patient’s self-identity and the patient’s adjustment to life
inside the mental hospital. His analysis is built on the social structure and social consequences of
institutionalization, not the mental illness itself. Other sociological works were also influential in
highlighting the relationship between social class, urban life and mental illness and the implications
of labeling people living with mental illness (Cook & Wright, 1995). The long-term care of
psychiatric patients in such institutions clearly had harmful consequences including the loss of
liberty, forced dependency, and acceptance of a regimented existence. However, the lack of
effective psychotropic medications precluded managing this population in any other way.
During the 1930s, psychologists began to argue against institutionalization of the mentally
ill, and instead argued for community-based mental health services (Commission for Public
Complaints Against the RCMP, 2010a). Advocates of community-based intervention argued that
the practice of “warehousing” mental patients in asylums was inhumane and not conducive to
treatment (Commission for Public Complaints Against the RCMP, 2010a). Further, by the mid
1950s, the rising costs of mental institutions were creating increasing financial burdens on
governments who were looking for cost-saving alternatives. In addition, with the advent of new
psychotropic medications such as Ziprasidone, Asenapine and Aripiprazole for severe mental
illnesses, patients could be properly treated for their illness while living on their own in the
community (Cook & Wright, 1995).
The social, economic and political conditions during the mid-1900s, discussed above, all
created an environment that called for the deinstitutionalization of the mentally ill. Consequently,
beginning in the 1960s, there was a worldwide trend towards moving psychiatric patients from
mental hospital settings to less restricting settings in the community (Sealy & Whitehead, 2004).
This resulted in drastic downsizing of institutions by eliminating hundreds of psychiatric beds
which were previously meant for mentally ill people (Smyth, 2006). This shift towards communitybased treatment was an approach to mental health that is geared towards the hope of recovery rather
than incapacitation.
While deinstitutionalization was theoretically beneficial in keeping the mentally ill out of
institutions where they were treated with little or no human dignity, in practice, the process was an
abject failure. As institutions began downsizing, hundreds of vulnerable people were displaced to
socially disorganized neighbourhoods such as Vancouver’s notorious Downtown Eastside.
Displacement resulted from the improper implementation of post-deinstitutionalization policies. A
lack of community residential facilities and inadequate mechanisms to ensure the mentally ill
adhered to a consistent treatment plan contributed to the failure of deinstitutionalization. Many of
these people were left to “[claw] out a pitiable existence on [the] streets, in dumpsters, in filthy and
dangerous skid-row hotels or in jails” (Smyth, 2006, p. b4). While there is nothing wrong with the
policy of deinstitutionalization, this shift was not accompanied by the development of communitybased services, an alternative that was never fully implemented. Consequently, many critics argue
that deinstitutionalization has led to large numbers of people, who would once have been inpatients,
VOL. 3.1
http://cgjsc.ca

80

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

being incarcerated in jails and prisons or becoming homeless when outpatient services are not
available (Lowman, Menzies & Palys, 1987).
It is important to note that deinstitutionalization is not the only reason for increased police
encounters with mentally disordered persons. "Non-Institutionalization" of mentally ill individuals
has been a policy that has been implemented by making the criteria for civil commitment more
restrictive. However, most important is the fact that hospitalizations in the psychiatry wards of
general hospitals are now fairly brief, leading to a revolving-door phenomenon in which patients
are released after short periods of involuntary commitment and come into more frequent contact
with the police.
Community-Based Mental Health Services
The deinstitutionalization movement and its failures was accompanied by reductions in government
spending on mental health services that significantly limited the quantity of treatment programs
available in the community (Commission for Public Complaints Against the RCMP, 2010a). Poorly
funded and fragmented community-based mental health and social services cannot provide
adequate treatment or supervision for people living with mental illness. Consequently, their
condition is likely to deteriorate as their behaviour becomes more difficult to manage. Coupled
with homelessness and poverty, this vulnerable group is likely to find themselves on the streets,
increasing their likelihood of coming into contact with police (Commission for Public Complaints
Against the RCMP, 2010a).
Civil Commitment
The current civil commitment criteria reflect the contextual changes that have occurred over the
past three decades. Involuntary or civil commitment historically, limited the rights of the individual
in favour of social control by compelling non-consensual isolation and treatment (Hermann, 1986).
However, during the 1960s and 1970s, this raised some concern among civil libertarians and social
justice advocates regarding the fairness and constitutionality of such laws. As a result, many of the
reforms that followed were concerned with civil liberties and patient’s rights which produced more
stringent criteria governing commitment and treatment (Teplin, 1984a). Thereafter, the legal
system became the arbiter of the mental health system’s decisions regarding treatment and
hospitalization, particularly concerning involuntary treatment and hospitalization (Hiday, 2011).
Under the old civil commitment criteria, people suffering from any type of mood disorder
or depression could often be civilly committed. However, with the restrictions that have since been
adopted through new legal criteria, a number of jurisdictions now require a finding of
“dangerousness” to self or others and requirements that treatment should be administered in the
least restrictive institutional setting as prerequisites to involuntary civil commitment (Hermann,
1986). The reform of the dangerousness standard in civil commitment law has led to frequent
arrests of mentally ill persons by police (Hiday, 1992). In all other cases, the least
restrictive/intrusive intervention options should be applied. This may result in police encounters
with mentally disordered people who are acting out, but cannot be brought into custody under the
law. The restrictions on the powers of the police to detain and convey individuals into psychiatric
care have necessitated frequent police interactions without long lasting solutions. The result is that
larger numbers of people with mental disorders are living in the community without effective
treatment (Teplin, 1984a), which increases the likelihood of mental
health services (VerdunVOL. 3.1
http://cgjsc.ca

81

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

Jones & MacAlister, 2006). Under mental health legislation, most that their condition will become
worse and their chances of encountering the police increase.
Mental Health Law
In Canada, each province and territory has legislation dealing with the provision
provinces/territories have enacted at least two pieces of legislation: one which deals with the
detention and treatment of mentally ill persons, and the other deals with issues surrounding the
management of estates or personal life (Verdun-Jones & MacAlister, 2006).
Most mental health acts set out the parameters of police involvement with the mentally ill
(Teplin, 1984b). The current B.C. Mental Health Act affords the police with the power to place
mentally ill individuals into police custody, and requires them to transfer the individual to a
psychiatric hospital or mental health facility (Commission for Public Complaints Against the
RCMP, 2008). Under the terms of the Act:
28 (1) A police officer or constable may apprehend and immediately take a person
to a physician for examination if satisfied from personal observations, or information
received, that the person
(a) is acting in a manner likely to endanger that person's own safety or the
safety of others, and
(b) is apparently a person with a mental disorder.
(2) A person apprehended under subsection (1) must be released if a physician does
not complete a medical certificate in accordance with section 22 (3) and (4)…
Mental Health Act Changes
In B.C., the current Mental Health Act has essentially remained unchanged since 1964. In the years
since then, only minor revisions have been made to the act. While the overall differences in the
commitment criteria between the pre-1964 legislation and the new act are not dramatic, some of
the differences are noteworthy. Under the old Mental Hospitals Act, the involuntary commitment
of individuals applied to persons who were certified to be “mentally ill” and requiring “care and
maintenance in a mental hospital” (s. 11). The term “mentally ill person” was defined in s. 2 as:
a person who is suffering from such a disorder of the mind as to require care,
supervision, and control of his own protection or welfare or for the protection of
others, and includes any person of unsound mind also any person who is a lunatic
within the meaning of the Lunacy Act.
Under the current Mental Health Act, civil commitment is only available for those persons who are
suffering from a “mental disorder” and who require “treatment in or through a designated facility”,
who require “care, supervision and control” in such a facility to prevent “substantial mental or
physical deterioration” or for the “protection of the person or the protection of others”, and who
“cannot suitably be admitted as a voluntary patient” (s. 22). A “person with a mental disorder” is
defined in s. 1 as:

VOL. 3.1
http://cgjsc.ca

82

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

a person who has a disorder of the mind that requires treatment and seriously impairs
the person’s ability
(a) to react appropriately to the person’s environment or
(b) to associate with others…
As a result of these changes, police in this province who seek to bring a mentally ill person into
custody, with a view to having them conveyed to a hospital for treatment, are faced with the reality
that a person cannot be involuntarily admitted except in the direst of circumstances. Detention to
ensure a person’s welfare will no longer provide sufficient grounds upon which to justify
involuntary commitment.
Legal Perspective
“The official mandate of the police includes dealing with mentally ill persons” has long been
established (Bittner, 1967, p. 278). Police have a legal obligation to respond to all calls for service
concerning people who are suffering from any mental-health related issues (Commission for Public
Complaints Against the RCMP, 2010b). Police involvement with mentally ill persons is grounded
in two common law principles: the power and responsibility of police to protect the welfare and
safety of the community and their parens patriae duty to protect disabled citizens such as those
suffering from mental illness (Ceyssens, 1994; Lamb et al., 2002; Teplin, 1984b, Teplin, 2000).
Police officers are afforded considerable discretion when dealing with the mentally ill.
While the law legitimizes the power of police to intervene in situations involving mentally ill
persons, it cannot dictate the “appropriate” response (Bittner, 1967, Teplin, 2000). Therefore, it is
ultimately left to the discretionary judgments of the police to determine the most appropriate
disposition when dealing with mentally disordered individuals, which could include transferring
them to a psychiatric hospital, arresting them or informally resolving the matter (Teplin, 2000;
Commission for Public Complaints Against the RCMP, 2010a).
Police are often the first responders to situations involving mentally ill persons; thus, they
are essentially responsible for deciding whether a person is processed through the mental health
system or via the criminal justice system (Menzies, 1987; Lamb et al., 2002), each resulting in a
very different outcome. In their role as “forensic gatekeepers” or “frontline mental health workers”,
the disposition police officers choose is crucial and could potentially lead to criminalization
(Menzies, 1987; Teplin, 2000). While Lamb (2009) argues that the criminal justice system is
inappropriate for dealing with the mentally ill, the police are not entirely at fault for choosing this
route, given their lack of dispositional alternatives and specialized training. Consequently, this can
result in the criminalization of the mentally ill by police in many cases.
The Criminalization of Mental Illness
The criminal justice process, managed by legal agents, tends to criminalize and over-police
marginalized groups such as Aboriginal peoples, the poor and racial minorities. Often, multiple
sites of oppressions exist simultaneously across race, class, and gender boundaries, which can
increase the likelihood of police encounters. Sadly, mentally ill individuals are no exception, and
are yet another example of a marginalized group that is highly criminalized. There is widespread
concern over the inappropriate use of arrest by police to resolve encounters with the mentally ill, a
phenomenon referred to as the “criminalization of the mentally ill” (Abramson, 1972; Teplin,
VOL. 3.1
http://cgjsc.ca

83

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

1984a; Hiday, 1999). Many mentally ill people who were previously treated under the mental health
system are now cycled through the criminal justice system instead (Teplin, 1984a), demonstrating
a classic example of “net-widening”. It is important to recognize that, while mentally ill persons
often come into contact with police as an offender or suspect of alleged criminal behavior, there is
also an increased risk of criminal victimization among persons suffering from mental illnesses,
thereby increasing the likelihood of police encounters (Brink et al., 2011).
There are several social and systemic factors which may result in the mentally ill being
criminalized; however, it is unclear whether this assertion can be empirically supported (Teplin,
1984a). Research in this area has yielded some mixed results. Teplin (1984b) examined police
encounters with mentally ill persons paying particular attention to the decision-making rules
underlying disposition options. She highlighted the relative frequency of each dispositional option
available to police. Her results indicated that hospitalization and arrest were highly infrequent
events, accounting for 0.5% and 16.5% of dispositions respectively. Interestingly, informal
resolution was the most common disposition, being used in 71.8% of cases involving mentally
disordered persons. Further, the study found that, while arrest was not a common disposition used
in police encounters with the mentally ill, the arrest rate was higher in cases involving “suspects
exhibiting signs of serious mental disorder than that for non-mentally ill suspects for similar types
of incidents” (Teplin, 1984b, p. 165). Similarly, Hiday (1999) examined the empirical evidence of
prevailing beliefs about the mentally ill and the criminal justice system, and suggests that
criminalization of the mentally ill is a reality. She too found arrest and incarceration rates to be
much higher for mentally ill persons than for the general population.
In her seminal work on the attitudes of Canadian police officers toward the mentally ill,
Cotton (2004) found that police officers actually displayed a high degree of compassion towards
people suffering from mental illness, and they exhibited a desire to provide them with the
appropriate mental health services. Despite their compassion for people suffering from mental
illness, this marginalized population still suffers a high rate of arrest by police. However, Cotton
(2004) argues that while arrest may be more common among mentally-ill people than nonmentally-ill people, she suggests that this could be attributed to factors other than criminalization
such as lack of dispositional options.
Stigmatization and False Perceptions of Mental Illness
Previous studies have estimated that approximately one in five (20%) Canadian adults will
experience mental illness during the course of their life (Public Health Agency, 2002), ranging
from mild to more severe forms. The serious stigma and discrimination associated with mental
illness continues to be a harsh reality for those living with mental illness, and presents a barrier to
seeking help (Public Health Agency, 2002). Without proper treatment, social support and
community acceptance, a mentally ill individual can become extremely isolated, leading to
thoughts of death or suicide.
The stigmatization and false perceptions of the mentally ill held by many people stem from
a myriad of reasons including a lack of understanding or knowledge about mental illness, lack of
empathy, stereotypes of mentally ill people as violent, dangerous or psychotic, and the tendency to
fear (xenophobia) and exclude (“other”) those who appear to be different (Public Health Agency,
2002; Teplin, 2000). Further, Teplin (2000) argues that society’s tolerance for mentally ill
individuals living in the community seems to be limited, with citizens often turning to the police to
deal with the mentally ill. The impact of this behaviour has far-reaching consequences for the
VOL. 3.1
http://cgjsc.ca

84

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

mentally ill and the community such as increased surveillance of marginalized groups, involuntary
civil commitment, or the use of incarceration. The Canadian Alliance for Mental Illness and Mental
Health (CAMIMH) has identified educating the public and media about mental illness to combat
any preconceived notions, stereotypes or fear as a necessary first step towards addressing this
situation.
Police Use of Force
Police use of force involving the mentally ill is an issue that has caused serious concern in recent
years. Several cases involving police use of force have resulted in trauma, injury and even death.
However, as previously mentioned, police encounters with the mentally ill involving use of force
are quite rare, but several high profile cases have elevated the importance of this issue.
Under s. 25 of the Criminal Code, police are granted the authority to use force including lethal
force:
25. (1) Every one who is required or authorized by law to do anything in the
administration or enforcement of the law…
(b) as a peace officer or public officer…
is, if he acts on reasonable grounds, justified in doing what he is required or
authorized to do and is using as much force as is necessary for that purpose.
Subsection (1) “creates a legal justification for individuals, including police officers, to use as much
force as is necessary in the administration and enforcement of the law provided their actions are
required or authorized and they act on reasonable grounds” (MacAlister, 2010, p. 77). However,
Blumberg (1993) notes that many changes in the statutes, administrative policies and policies
pertaining to police use of force, have occurred. For instance, s. 25 of the Criminal Code has been
supplemented by policy in various police agencies which affects police authority to use force. In
B.C., these policies are created by each individual police department under the authority of the
Police Act - Use of Force Regulation. In Vancouver, for example, police regulations authorize
police officers to use force in order to forcibly take someone believed to be mentally ill to a hospital
for treatment if they reasonably believe that person is incapable of making a rational decision about
whether to accept or refuse medical treatment due to their mental condition (Regulations and
Procedures Manual, c. 1.2.2).
While the police have been granted the authority to use force in carrying out their duties,
they must be careful to ensure they only use a level of force that is reasonable in the circumstances.
Verdun-Jones and MacAlister (2006) have shown that police will be liable in negligence for
improper use of force in bringing a mentally disordered person into their custody, and even criminal
culpability for assault may follow if they use excessive force in taking a person with a mental
disability into their care under mental health legislation.
Increased Police Training
In contemporary society, police interactions with the mentally ill have become part of the nature of
policing. Research has suggested a high number of calls for service involving mentally ill persons
in some jurisdictions (Wilson-Bates, 2008; Cotton & Coleman, 2008). The City of Vancouver
reported that 31% of police incidents involved mentally ill persons, with this percentage rising to
VOL. 3.1
http://cgjsc.ca

85

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

42% in the downtown eastside (Wilson-Bates, 2008). Given the marked increase in police
interactions with the mentally ill in recent years, it is imperative that police are better trained and
educated in how to effectively deal with persons who are mentally ill. Cotton & Coleman (2008)
suggest a substantial increase over the past several years in the level (basic and in-service) of
training provided for police officers to ensure their actions are in accordance with “best practices”.
However, there is no universal model that has been consistently applied in police training.
Of the models that have emerged, the Crisis Intervention Team (CIT) model (premised on
the Memphis model) is highly regarded as a “best practice” in the police response to the mentally
ill (Griffiths, 2008; Cotton & Coleman, 2010). One of the greatest strengths of this model is that it
involves collaboration between law enforcement and mental health services, thereby providing a
specialized response. Developed in 1988, the CIT program provides special training for police to
effectively assist them in safely responding to mentally ill persons (Compton et al., 2011). Further,
this specialized training allows police to ensure that individuals living with mental illness can
obtain the appropriate mental health services in the community (Compton et al., 2011). While the
role of police is not the same as a mental health professional such as a psychiatrist, as first
responders to incidents involving the mentally ill, it is beneficial and imperative for police officers
to have a understanding of, and empathy for, the plight of the mentally ill (U.S. Department of
Justice, 1993). For example, it is important for police to recognize the various forms of mental
illness and the differences in symptomology which are central to such encounters.
The Vancouver Police Department (VPD) adopted the CIT model as part of a five-year
development plan for new constables (Cotton & Coleman, 2010). Given the use of a systems
approach coupled with comprehensive training for officers, this model has the potential to
significantly improve police interactions with the mentally ill. Many police departments in the U.S.
that have implemented the CIT model have reported many positive benefits and changes including
quicker response times, frequent referrals to treatment, and lower arrest rates of mentally ill persons
(Hails & Borum, 2003). Despite these positive developments seen elsewhere, the VPD temporarily
implemented the CIT model as a pilot project and with little evaluation research conducted to
measure its effectiveness, no longer offers this program to officers. The VPD has recently
abandoned its intensive program of training, involving some 32 hours of instruction with respect to
police encounters with mentally disordered individuals. There will now be a province-wide
program of training (applicable to both the RCMP as well as the various municipal police
departments). It will consist of only 8 hours of in-person training and the completion of a 2-hour
on-line tutorial. This means that the VPD is no longer committed to the Memphis Model.
Interestingly, research indicates that many police officers feel that they are inadequately trained in
dealing with the mentally ill and additional training would be useful to avoid potentially volatile
encounters (Watson & Angell, 2007).
Procedural Justice
As previously mentioned, the need for additional, specialized police training involving the mentally
ill is only one facet in improving police encounters. However, understanding the nature of police
interactions with mentally ill individuals requires “a well-developed and explicit theoretical
understanding of [these] interactions” through the application of a procedural justice framework
(Watson & Angell, 2007, p. 787). This may supplement enhanced training by changing the
dynamics of police-citizen encounters in a way that increases the perception of legitimacy in the
way mentally disordered people believe they are being treated.
VOL. 3.1
http://cgjsc.ca

86

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

Procedural Justice Theory
Tyler’s (1990) work on legitimacy provided the basis for the notion of procedural justice. The idea
that perceived fairness is essential for ensuring the perceived legitimacy of authoritative decision
makers, particularly with respect to marginalized populations, has been applied to many decisionmaking contexts. These include civil commitment, mental-health/drug courts, treatment for mentalhealth patients, the placement of patients in seclusion/restraints and prison discipline, as well as
encounters with the police. Legitimacy is incredibly important in these various contexts and
perceived procedural justice seems to be an important element in maintaining it. It is not just a
matter of ensuring compliance but goes beyond this and involves therapeutic factors that can assist
in the recovery process for individuals who have been traumatized by negative experiences with
authority figures in the past. In this sense, perceived procedural justice could also be associated
with Therapeutic Jurisprudence, which is now a dominant framework for analysis of authoritative
decision-making processes.
Procedural justice theory is essentially a theory that involves “procedural fairness for civil
dispute resolution” (Solum, 2004, p. 181). The theory is premised on the notion of fairness in the
way a person is treated by an authority figure, thereby shaping the process and ultimately the
outcome of an encounter (Watson & Angell, 2007). When applying this perspective to police
encounters with mentally ill persons, the way in which an officer treats a person suffering from
mental illness is thought to affect whether the encounter results in cooperation or resistance. The
legitimacy of state agents is likely determined by the fairness afforded to those with whom they
came into contact, notwithstanding race, class, and gender issues. For marginalized people such as
the mentally ill, who often have a fear of authority, the way in which they are treated is arguably
more important than the outcome of a dispute (Watson & Angell, 2007). Given the complicated
history and relationship between the subjects of such encounters and the police, applying a
procedural justice framework can improve the nature of police interactions involving the mentally
ill (and other marginalized groups).
Among certain groups in society, interactions with police can be quite intense, often arising
from social, cultural, economic and ethnic differences. Consequently, racial minorities and other
marginalized groups, such as the mentally ill, can be quite sensitive to prejudicial and disrespectful
behaviour from police (Mastrofski et al., 2002). Many social scientists have argued that
“disrespectful behavior from the police reduces the citizen’s sense of procedural justice and fair
play” (Mastrofski et al., 2002, p. 520). Further, coercive tactics used in an effort to gain compliance
can potentially backfire and decrease cooperation. That is, individuals who experience inequitable
treatment are less likely to assist the state or its agents and are more likely to resist, which
contributes to undermining their legitimacy.
When police come into contact with individuals suffering from mental illness, if handled
inappropriately, this vulnerable group’s perception of police can be seriously damaged. The
increase in the number of police interactions with the mentally ill over the last several decades
points to the urgency of developing alternative frameworks for shaping these encounters. The
application of a procedural justice model in this area can serve as a positive way to change the
nature of police encounters.

VOL. 3.1
http://cgjsc.ca

87

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

Elements of Procedural Justice
Watson and Angell (2007) have identified three fundamental aspects to the procedural justice
model. These include participation, dignity, and trust. Being an active participant in a dispute
involves ‘having a voice’ by allowing one to convey their own perspective and to be heard by the
decision maker. Dignity involves the respect and civility one is accorded, and having one’s rights
acknowledged. Trust involves the extent to which the authority figure is concerned with the welfare
of the individual. If these elements are consistently applied by police when dealing with mentally
ill persons, they can significantly increase the perceived legitimacy of the police. Watson & Angell
(2007) further argue that, if procedural justice is applied early in an encounter, it is likely to have
the greatest impact.
Research
There have been several studies published on police encounters with the mentally ill that have
specifically focused on the attitudes and perceptions of police officers towards the mentally ill
(Teplin, 1984b; Hiday, 1999; Cotton, 2004). Often, police officers have preconceived notions about
particular groups that they encounter such as the mentally ill. In addition, these encounters between
the police and the mentally ill are likely to occur in socially disorganized neighbourhood contexts
which can exacerbate the situation. These neighbourhoods tend to attract people who suffer from
mental illnesses and who are also likely to be unemployed and poor (Silver, 2000). Police
encounters in poor, disenfranchised neighbourhoods usually involve people from a lower socioeconomic stratum, and tend to occur more frequently than police encounters in more affluent
neighbourhoods. How the police perceive, and subsequently treat, particular groups are often the
result of multiple social and systemic factors. As well, the characteristics of mentally ill persons
can also affect how they are perceived by the police.
Conversely, a paucity of research exists regarding the perceptions of people living with
mental illness towards police. In their seminal work, the first of its kind from B.C., the study by
Brink and his colleagues (2011) examined how people suffering from severe mental illnesses
perceive police. The major goal of this study was to “improve the understanding of how people
with mental illness perceive and interact with the police”, guided by procedural justice theory
(Brink et al., 2011, p. 7). Participants in this study were comprised of people suffering from various
mental illnesses who had contact with the police. A participatory action group approach was
employed as well as different methods for collecting data including interviews (n=60), surveys
(n=244), and focus groups (n=28) (Brink et al., 2011).
This study produced interesting results about the nature of police interactions with the
mentally ill and attitudes toward the police. The survey results indicated that people living with
mental illnesses tend to have more negative views of the police compared to the general population;
at the same time, people suffering from mental illness in B.C. are also more likely to come into
contact with police compared to the general population (Brink et al., 2011). Overall, three-quarters
of survey participants indicated that they held a positive view (attitude) of police regarding the
respect and legitimacy of their role; similarly, survey participants generally indicated that they were
satisfied with their police encounter, and also satisfied with how the police handled their situations,
although there was some degree of variability (Brink et al., 2011).
Underlying the above mentioned findings is the relationship between procedural justice
and satisfaction. Participants indicated that the more respect and dignity they received during an
VOL. 3.1
http://cgjsc.ca

88

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

interaction with police, and the greater the degree to which the process was perceived as
procedurally fair, the more likely they were to be satisfied with the process (Brink et al., 2011).
While not all participants in this study reported a positive experience, this study provides evidence
for consistently applying a procedural justice framework to police encounters with the mentally ill,
which is an obvious and essential way of improving future interactions.
The philosophy behind procedural justice theory is quite commonsensical in that one would
expect state agents to always employ the elements of this framework when dealing with citizens,
to elicit cooperation and compliance, regardless of race, class or gender differences. Given the
power differential that exists among police and citizens, increasing the legitimacy of police would
benefit the entire community.
Conclusion
The frequency of interactions between the police and mentally ill individuals has increased in recent
years. These encounters have attracted considerable public and media attention, particularly when
police encounters with the mentally ill result in serious injury or death. The shift from institutionbased care for persons suffering from mental illness to community care has expanded the role of
police in their lives (Cotton, 2004). As police officers have become first responders to incidents
involving mentally ill persons, this has created a number of challenges given their inability to
effectively deal with these situations. These challenges include concerns over the appropriate use
of force with this population, the criminalization of the mentally ill, and the stigmatization and false
perceptions police hold towards those individuals living with mental illness (Courey & McDonald,
2009).
Improving police interactions with mentally ill persons requires adhering to “best
practices” in this area. The most widely cited way of improving police encounters with the mentally
ill has been increased (specialized) training for police officers (Commission for Public Complaints
Against the RCMP, 2010). However, increased police training involves more options for police to
manage mentally ill individuals by employing the least restrictive measures, not by using more
force. In addition, the use of mobile crisis teams and accessible community-based mental health
and social services are also needed. Further, a collaborative approach among the criminal justice
and mentally health systems would be very beneficial as police cannot be solely responsible for
dealing with this issue.
Applying a procedural justice framework to police interactions with mentally ill persons
(and other marginalized groups) has the potential to profoundly change the nature of these police
encounters. Despite the simplicity of the theory, it highlights how police or other authorities are
perceived by others based on the way in which they are treated. If mentally ill persons perceive that
they were treated by the police in a procedurally fair manner with decency and respect, they are
more likely to acknowledge the legitimacy of their authority which will likely produce compliance
and cooperation. If, however, persons with mental illness experience a police interaction in which
they were not treated in accordance with the principles of procedural justice, they are more likely
to resist authority. Future research should seek to determine if the presence or absence of perceived
procedural justice in an encounter between a police officer and a mentally-disordered person affects
the extent to which that person is likely to cooperate with treatment personnel at a later time.
Understanding police encounters involving persons suffering from mental illness is enhanced
through the application of theory, which provides new ways to identify and implement effective
responses.
VOL. 3.1
http://cgjsc.ca

89

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

Acknowledgements
The author would like to thank Dr. Simon Verdun-Jones for reviewing an earlier version of this
manuscript. This article substantially benefited from his invaluable comments and suggestions.
About the Author
Farzana Kara is a Master’s student at Simon Fraser in the School of Criminology. She can be
reached at fbk@sfu.ca.
References
Abramson, M. (1972). The criminalization of mentally disordered behavior: Possible side effects
of a new mental health law. Hospital and Community Psychiatry, 23, 101-105.
Bittner, E. (1967). Police discretion in emergency apprehension of mentally ill persons. Social
Problems, 14, 278-292.
Blumberg, M. (1993). Controlling police use of deadly force: Assessing two decades of progress.
In R.G Dunham and G.P Alpert (Eds.), Critical Issues in Policing: Contemporary Readings
(2nd ed) (pp. 467-492). Prospect Heights: Waveland Press.
Brink, J., Livingston, J., Desmarais, S., Greaves, C., Maxwell, V., Michalak, E., Parent, R., VerdunJones, S., nd Weaver, C. (2011). A Study of How People with Mental Illness Perceive and
Interact with the Police. Calgary, Alberta: Mental Health Commission of Canada.
Available online at: http://www.mentalhealthcommission.ca
Carman, T. (2012). B.C. police need better training in dealing with mentally ill, survey finds. The
Vancouver
Sun.
Available
online
at:
http://www.vancouversun.com/news/police+need+better+training+dealing+with+mentall
y+survey+finds/6280473/story.html#ixzz1quhdEelx
Ceyssens, P. (1994). Legal Aspects of Policing. Toronto: Earlscourt Legal Press.
Commission for Public Complaints Against the RCMP. (2008). Legal Analysis of Issues Pertaining
to People with Mental Disorders in Contact with the Criminal Justice System: Framework
Overview. Available online at: http://www.cpc-cpp.gc.ca/prr/rep/sir/mental-policeeng.aspx
Commission for Public Complaints Against the RCMP. (2010a). Policing Persons with Mental
Illness: Issues and Trajectories. Available online at: http://www.cpccpp.gc.ca/prr/rep/sir/mental-traject-eng.aspx

VOL. 3.1
http://cgjsc.ca

90

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

Commission for Public Complaints Against the RCMP. (2010b). Police Interactions with People
Suffering from Mental Health-related Issues. Available online at: http://www.cpccpp.gc.ca/prr/rep/sir/mental-index-eng.aspx
Community Relations Service, U.S. Department of Justice. (1993). Principles of good policing:
Avoiding violence between police and citizens.” In R.G Dunham and G.P Alpert (Eds.),
Critical Issues in Policing: Contemporary Readings (2nd ed) (pp. 182-207). Prospect
Heights: Waveland Press.
Cook, J.A., and Wright E.R. (1995). Medical sociology and the study of severe mental illness:
Reflections on past accomplishments and directions for future research. Journal of Health
and Social Behavior, (Extra Issue): 94-114.
Compton M.T., Broussard B, Munetz M, Oliva J.R., and Watson, A.C. (2011) The Crisis
Intervention Team (CIT) Model of Collaboration between Law Enforcement and Mental
Health, in Police Practices and Their Impact on Society. New York: Nova Science
Publishers, Inc.
Cotton, D. (2004). The attitudes of Canadian police officers toward the mentally ill. International
Journal of Law and Psychiatry, 27, 35-146.
Cotton, D., and Coleman, T.G. (2008). A Study of Police Academy Training and Education for New
Police Officers Related to Working with People with Mental Illness. Report prepared on
behalf of the Police/Mental Health Subcommittee of the Canadian Association of Chiefs
of Police and the Mental Health and the Law Advisory Committee of the Mental Health
Commission
of
Canada.
Available
online
at:
http://www.mentalhealthcommission.ca/SiteCollectionDocuments/PoliceProject/aa%20ac
ademy%20report-MHCC_FINAL.pdf
Cotton, D., and Coleman, T.G. (2010). Police Interactions with Persons with a Mental Illness:
Police Learning in the Environment of Contemporary Policing. Report prepared for the
Mental Health and the Law Advisory Committee and Mental Health Commission of
Canada.
Available
online
at:
http://www.mentalhealthcommission.ca/SiteCollectionDocuments/PoliceProject/Police%
20Learning%20Model_Jul%2023%20(4).pdf
Courey, L. and McDonald, D. (2009). Mental Health Issues in Policing. Presentation to the
Canadian ssociation of Police Boards.
Criminal Code, R.S.C. 1985, c. C-46.
Goffman, E. (1961). Asylums: Essays on the Social Situation of Mental Patients and Other Inmates.
Garden City, N.Y.: Anchor Books.
VOL. 3.1
http://cgjsc.ca

91

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

Hails, J and Borum, R. (2003). Police training and specialized approaches to respond to people with
mental illness. Crime & Delinquency, 49(1), 52-61.
Hermann, D.H.J. (1986). Barriers to finding effective treatment: A critique of revisions in
procedural, substantive, and dispositional criteria in involuntary civil commitment. 39
Vanderbilt
Law
Review,
39,
83-106.
Available
online
at:
http://heinonline.org/HOL/Page?handle=hein.journals/vanlr39&div=13&g_sent=1&colle
ction=journals
Hiday, V.A. (1992). Civil commitment and arrests: An investigation of the criminalization thesis.
Journal of Nervous and Mental Disease, 180, 141-214.
Hiday, V.A. (1999). Mental illness and the criminal justice system. In A. V. Horowitz and T. L.
Scheid (Eds.), A Handbook for the Study of Mental Health: Social Contexts, Theories, and
Systems (pp. 508-525). New York: Cambridge University Press.
Hiday, V.A. (2011). Community systems collide and cooperate: Control of deviance by the legal
and mental health systems. In B.A. Pescosolido, J.K. Martin, J.D. McLeod, and A. Rogers
(Eds.), Handbook of the Sociology of Health, Illness, and Healing: A Blueprint for the 21st
Century (pp. 159-170). New York: Springer.
Lamb, H. R., Weinberger, L.E., and DeCuir, W.J. (2002). The police and mental health. Psychiatric
Services, 53, 1266-1271.
Lowman, J., Menzies, R.J., and Palys, T.S. (1987). Transcarceration: Essays in the Sociology of
Social Control. Aldershot: Gower.
MacAlister, D. (2010). Police-Involved Deaths: The Failure of Self-Investigation. Final Report.
Vancouver:
B.C.
Civil
Liberties
Association.
Available
online
at:
http://beta.images.theglobeandmail.com/archive/00968/B_C__Civil_Libertie_968881a.pd
f
Mastrofski, S.D., Reisig, M.D., and McCluskey, J.D. (2002). Police disrespect toward the public:
An encounter-based analysis. Criminology, 40, 519-552.
Mental Health Act, R.S.B.C. 1996, c. 288.
Mental Hospitals Act, R.S.B.C. 1948, c. 201.
Menzies, R. J. (1987). Psychiatrists in blue: Police apprehension of mental disorder and
dangerousness. Criminology, 25, 429-452.
Police Act - Use of Force Regulation, B.C. Reg. 211/2000.
VOL. 3.1
http://cgjsc.ca

92

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

Public Health Agency of Canada. (2002). A Report on Mental Illnesses in Canada. Available online
at: http://www.phac-aspc.gc.ca/publicat/miic-mmac/chap_1-eng.php
Reuland, M, Schwarzfeld, M, and Draper, L. (2009). Law Enforcement Responses to People with
Mental Illnesses: A Guide to Research-Informed Policy and Practice. New York: Council
of
State
Governments
Justice
Center.
Available
online
at:
http://consensusproject.org/downloads/le-research.pdf
Regulations and Procedures Manual (n.d.). Vancouver Police Department. Available online at:
http://vancouver.ca/police/assets/pdf/manuals/vpd-manual-regulations-procedures.pdf
Sealy, P. and Whitehead, P.C. (2004). Forty years of deinstitutionalization of psychiatric services
in Canada: An empirical assessment. Canadian Journal of Psychiatry, 49, 249-256.
Silver, E. (2000). Race, neighborhood disadvantage, and violence among persons with mental
disorders: The importance of contextual measurement. Law and Human Behavior, 24, 449456.
Smyth, M. (2006). Deinstitutionalization deemed a failure. The Province. Available online at:
http://www.canada.com/theprovince/news/story.html?id=24b5f60a-825b-48b4-acd8a603e55a6068
Solum, L.B. (2004). Procedural justice. Southern California Law Review, 78, 181.
Sunshine, J and Tyler, T.R. (2003). The role of procedural justice and legitimacy in shaping public
support for policing. Law and Society Review, 37, 513-548.
Teplin, L.A. (1984a). The criminalization of the mentally ill: Speculation in search of data. In L.A.
Teplin (Ed.), Mental Health and Criminal Justice (pp. 63-85). Beverley Hills: Sage
Publications.
Teplin, L.A. (1984b). Managing disorder: Police handling of the mentally ill. In L.A. Teplin (Ed.),
Mental Health and Criminal Justice (pp. 157-175). Beverley Hills: Sage Publications.
Teplin, L.A. (2000). Keeping the peace: Police discretion and mentally ill persons. National
Institute of Justice Journal, 244, 8-15.
Tyler, T.R. (1990). Why people obey the law? New Haven: Yale University Press.
Tyler, T.R., and Huo, Y.J. (2002). Procedural justice and decision acceptance. In T.R Tyler and
Y.J. Huo (Eds.), Trust in the Law: Encouraging Public Cooperation with the Police and
Courts (pp. 49-58). New York: Russell Sage Foundation.
Verdun-Jones, S and MacAlister, D. (2006). Introduction to Criminal and Civil Law. Toronto:
Nelson.
VOL. 3.1
http://cgjsc.ca

93

 Vol. 3 - Issue l No. 1 – Spring / printemps 2014

Watson, A.C., and Angell, B. (2007). Applying procedural justice theory to law enforcement’s
response to persons with mental illness. Psychiatric Services, 58, 787-793.
Wilson-Bates, F. (2008). Lost in Transition: How a Lack of Capacity in the Mental Health System
is Failing Vancouver's Mentally Ill and Draining Police Resources. Report prepared for
the Vancouver Police Department.

VOL. 3.1
http://cgjsc.ca

94