A22 GAO Report 18-229 FEB 2018.pdf

FEDERAL LAW

ENFORCEMENT

DHS and DOJ Are Working to Enhance Responses to Incidents Involving Individuals with Mental Illness Accessible Version

Report to Congressional Committees

February 2018

GAO-18-229

United States Government Accountability Office

United States Gov ernment Accountability Office

Highlights of GAO-18-229, a report to congressional committees

February 2018

FEDERAL LAW ENFORCEMENT

DHS and DOJ Are Working to Enhance Responses to Incidents Involving Individuals with Mental Illness

What GAO Found Law enforcement officers and agents from the Departments of Homeland Security (DHS) and Justice (DOJ) cited a number of challenges in our discussion groups related to their response to incidents involving individuals with a mental illness.

Challenges Identified in Law Enforcement Officer and Agent Discussion Groups

All of the federal law enforcement components in GAO’s review either offer, receive, or are developing some form of training to their law enforcement officers and agents that addresses responding to incidents involving individuals with a mental illness. Further, all components have relevant policies or guidance in place, and all are undertaking efforts to enhance their practices in accordance with departmental guidance. Since DHS and DOJ components have varying missions and operational needs and interact with the public in different capacities, the nature and scope of training, as well as the number and duration of courses offered in response to individuals with mental illness varies; however, they generally include elements focusing on de-escalation and communication.

In addition, DHS and DOJ both have efforts underway to have components review their training and policies under departmental guidance and plan to begin implementing any changes by 2018.

Stakeholders cited leading practices and tools for effective law enforcement responses, and DHS and DOJ components have generally leveraged information from other knowledgeable parties. For example, the Crisis Intervention Team approach involves training selected law enforcement officers on mental health topics and dispatching those officers on mental-health related calls. While models like this are typically used by state and local law enforcement agencies, their benefits could be considered in other settings such as federal law enforcement. DHS and DOJ officials are also using collaborative mechanisms within their departments, such as conference calls and working groups with officials, that have helped them leverage information from knowledgeable parties. In addition, DOJ’s Bureau of Justice Assistance (BJA), which supports programs and initiatives in the areas of law enforcement, among other activities, has developed and makes publicly available resources such as its Police-Mental Health Collaboration Toolkit. BJA also is working to stand up a national training and technical assistance center to improve law enforcement responses to people with mental illness. While aimed at state, local, and tribal law enforcement, a BJA official also acknowledged that the center could serve as an additional resource for federal law enforcement agencies to consult as they review relevant trainings, policies, and guidance on this topic.View GAO-18-229. For more information, contact Diana Maurer at (202) 512-8777 or MaurerD@gao.gov.

Why GAO Did This Study Law enforcement encounters with individuals with mental illness may require special training and skills and can sometimes involve volatile situations, risking tragic injuries or even death.

The 21st Century Cures Act includes a provision for GAO to review the practices that federal first responders, tactical units, and corrections officers (for the purposes of this study, “law enforcement officers and agents”) are trained to use in responding to incidents involving individuals with mental illness. This report addresses

(1) challenges that federal law enforcement officers and agents face;

(2) applicable training, policies, and guidance; and (3) existing leading practices, relevant tools, and efforts to leverage information.

GAO selected the five DHS and five DOJ law enforcement components (e.g., Secret Service, Federal Bureau of Investigation) that represent the largest concentration of law enforcement officers within the two departments. GAO reviewed the training, policies, and guidance in place, as well as efforts to enhance them, and discussed these matters with knowledgeable officials. In addition, GAO held discussion groups with a nongeneralizable sample of law enforcement officers and agents, selected through component contacts, to discuss their perspectives. GAO also reviewed studies on law enforcement responses to individuals with mental illness to help identify leading practices and tools and interviewed stakeholders, selected through a structured process, to obtain their perspectives.

http://www.gao.gov/products/GAO-18-229 http://www.gao.gov/products/GAO-18-229 mailto:MaurerD@gao.gov

Page i GAO-18-229 Federal Law Enforcement

Contents Letter 1

Background 6 Discussion Groups Identified Several Challenges that Officers and

Agents Encounter When Responding to Incidents Involving Individuals with Mental Illness 12

Components Have Some Type of Training, Policies, and Guidance Related to Mental Illness, and Reviews to Enhance Practices are Underway 16

Stakeholders Cited Leading Practices and Tools for Effective Law Enforcement Responses, and Components Have Generally Leveraged Information from Other Knowledgeable Parties 25

Agency Comments 29

Appendix I: Objectives, Scope and Methodology 32

Appendix II: Description of the Federal Law Enforcement Training Centers (FLETC) Basic Training Programs

Appendix III: GAO Contact and Staff Acknowledgments 41

Appendix IV: Accessible Data 42

Data Tables 42

Tables

Table 1: Department of Homeland Security and Department of Justice Federal Law Enforcement Components Selected for GAO’s Review and Their Missions 3

Table 2: Examples of Department of Homeland Security (DHS) Operational Components’ Training Content Related to Officers’ Response to Incidents Involving Individuals with Mental Illness, as of October 2017 17

Table 3: Examples of Department of Justice (DOJ) Components’ Training Content Related to Officers’ Response to Incidents Involving Individuals with Mental Illness, as of October 2017 19

Table 4: Examples of Policies and Guidance at Departments of Homeland Security (DHS) and Justice (DOJ) Components Related to Officers’ Response to Incidents Involving Individuals with Mental Illness, as of October 2017 20

Table 5: Stakeholder-Cited Tools that May Enhance Law Enforcement Responses to Incidents Involving Individuals with Mental Illness 27

Table 6: Department of Homeland Security and Department of Justice Federal Law Enforcement Components Selected for Review and Their Missions 32

Accessible Data for Figure 2: Stakeholder-Cited Leading Practices for Effective Law Enforcement Responses to Incidents Involving Individuals with Mental Illness 42

Figures

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Figure 1: Illustrative Example of an Incident at a Federal Facility Involving Federal Law Enforcement and an Individual Displaying Signs of a Mental Illness 10

Figure 2: Stakeholder-Cited Leading Practicesa for Effective Law Enforcement Responses to Incidents Involving Individuals with Mental Illness 26

Accessible Data for Highlights Figure: Challenges Identified in Law Enforcement Officer and Agent Discussion Groups 42

Accessible Data for Figure 1: Illustrative Example of an Incident at a Federal Facility Involving Federal Law Enforcement and an Individual Displaying Signs of a Mental Illness 42

Abbreviations ATF Bureau of Alcohol, Tobacco, Firearms and Explosives BJA Bureau of Justice Assistance BOP Federal Bureau of Prisons CBP U.S. Customs and Border Protection CIT Crisis Intervention Team CRCL Office for Civil Rights and Civil Liberties CSG JC Council of State Governments Justice Center DEA U.S. Drug Enforcement Administration DHS Department of Homeland Security DOJ Department of Justice DSM-IV Diagnostic and Statistical Manual of Mental Disorders, 4th edition FBI Federal Bureau of Investigation

FLETC Federal Law Enforcement Training Centers FPS Federal Protective Service IACP International Association of Chiefs of Police ICE U.S. Immigration and Customs Enforcement ODAG Office of the Deputy Attorney General PERF Police Executive Research Forum Section 504 Section 504 of the Rehabilitation Act of 1973, as amended TSA Transportation Security Administration USMS U.S. Marshals Service

Page iii GAO-18-229 Federal Law Enforcement

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Page 1 GAO-18-229 Federal Law Enforcement

441 G St. N.W.

Washington, DC 20548

February 8, 2018

Congressional Committees:

According to the International Association of Chiefs of Police (IACP), law enforcement officers nationwide are increasingly called upon to respond to and intervene on behalf of people affected by mental illness.1 Based on estimates from the Substance Abuse and Mental Health Services Administration—an agency within the Department of Health and Human Services—44.7 million adults in the United States had a mental illness in

2016.2 Since law enforcement officers can encounter individuals affected by mental illness in the course of their duties, the nature of their interaction has become an issue of national concern. In particular, research has demonstrated that such encounters:

· may require special training and skills to address;

· may depend on the availability of community and mental health resources for a positive outcome;

· are often time-consuming and difficult for law enforcement officers to resolve;

· typically involve repeat contacts with individuals who have unmet mental health needs; and

1IACP, Improving Police Response to Persons Affected by Mental Illness, Report from the March 2016 IACP Symposium, Alexandria, Virginia (2016). IACP is a professional association for law enforcement that aims to advance the law enforcement profession through advocacy, outreach, education and programs. For the purpose of our review , w e used the definition of mental illness that the National Alliance on Mental Illness developed, w hich is: “a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day.” The National Alliance on Mental Illness is an association of local aff iliates, state organizations and volunteers w ho w ork to raise aw areness and provide support and education on various issues related to mental illness.

2Substance Abuse and Mental Health Services Administration (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52).

Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://w ww.samhsa.gov/data/. In that report, adults w ith a mental illness w ere defined as having any mental, behavioral, or emotional disorder in the past year that met criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), excluding developmental disorders and substance use disorders.

Letter https://www.samhsa.gov/data/

· can involve volatile situations, risking tragic injuries or even death.

Such concerns and potential safety issues underscore the importance of developing tailored approaches, training, and policies to help guide police departments and law enforcement officials.

To date, most efforts to promote such training or policies have been focused on state and local law enforcement agencies, such as police departments. While federal law enforcement agencies typically do not serve as first responders to emergency calls, they do interact with the public in the course of their duties and can encounter individuals with mental illness. At the federal level, the Department of Homeland Security (DHS) and Department of Justice (DOJ) are responsible for enforcing many laws regarding the safety and security of the United States, and these two departments house the majority of federal law enforcement officers nationwide.

Page 2 GAO-18-229 Federal Law Enforcement

The 21st Century Cures Act4 includes a provision for us to review, among other things, practices that federal first responders, tactical units, and corrections officers are trained to use in responding to incidents involving individuals with mental illness.5 This report addresses the following key questions: (1) What challenges, if any, do federal law enforcement officers and agents at selected DHS and DOJ components face when responding to incidents involving individuals with mental illness? (2) What type of training, policies, and guidance, if any, are in place at selected DHS and DOJ components to prepare federal law enforcement officers and agents for responding to incidents involving individuals with mental illness? (3) What leading practices or tools have relevant stakeholders cited for effective responses to incidents involving individuals with mental

3Specif ically, DHS’s mission includes preventing terrorism and enhancing security;

managing and securing the nations’ borders; administering and enforcing immigration law s; and securing cyberspace. DOJ’s mission includes enforcing the law and defending the interests of the United States according to the law , ensuring public safety against threats foreign and domestic, providing federal leadership in preventing and controlling crime, and ensuring fair and impartial administration of justice for all Americans.

4Pub. L. No. 114-255, div. B., tit. XIV, subtit. B, § 14026, 130 Stat. 1033, 1310-11 (2016).

The provision for our study is contained in Division B—the Helping Families in Mental Health Crisis Reform Act of 2016.

5For the purposes of our review , w e focused on federal law enforcement off icers, tactical units, and correctional off icers, referring to all under the general term “law enforcement off icers” from here forw ard. We use the terminology “off icers and/or agents” to reflect the varying job titles and responsibilities that individuals w ithin these components have. We did not include contractors in the scope of our review .

illness, and how have DHS and DOJ components leveraged information from other knowledgeable parties?

We focused our review on the training, policies, and guidance put forth by the DHS and DOJ components listed in table 1 below because they comprise nearly all of the federal law enforcement officers in these departments.

Table 1: Department of Homeland Security and Department of Justice Federal Law Enforcement Components Selected for

Page 3 GAO-18-229 Federal Law Enforcement

GAO’s Review and Their Missions

Component Mission Department of Homeland Security Federal Law Enforcement Training Centers (FLETC)a

Provides career-long training to law enforcement professionals to help them fulf ill their responsibilities safely and proficiently. Under a collaborative training model, FLETC’s federal partner organizations deliver training unique to their missions, w hile FLETC provides training in areas common to all law enforcement off icers, such as f irearms, driving, tactics, investigations, and legal training.

Federal Protective Service

(FPS)

Provides integrated security and law enforcement services, such as conducting facility security assessments; responding to crimes and other incidents to protect life and property; and detecting, investigating, and mitigating threats to more than 9,500 federal facilities nationw ide.

Transportation Security Administration (TSA)

Protects the nation’s transportation systems to ensure freedom of movement for people and commerce. TSA does this by, among other things, deploying Federal Air Marshals on U.S. aircraft w orldw ide. Our review focuses on TSA’s Federal Air Marshals, w ho are to detect, deter, and defeat criminal and terrorist activity targeting transportation systems.

U.S. Customs and Border Protection (CBP)

Protects the borders of the United States from dangerous people and materials, w hile facilitating law ful international travel and trade.

U.S. Immigration and Customs Enforcement (ICE)

Protects the United States from cross-border crime and illegal immigration that threaten national security and public safety. ICE executes this mission through enforcement of federal statutes and focuses on immigration enforcement, preventing terrorism, and combating the illegal movement of people and goods. Our review focuses on ICE’s Homeland Security Investigations off ice, w hich investigates cross-border criminal activity, and ICE’s Enforcement and Removal Operations unit, w hich identif ies and apprehends removable aliens, detains them w hen necessary, and removes illegal aliens from the United States.

U.S. Secret Service Provides physical protection to the nation’s highest elected leaders and visiting foreign dignitaries, as w ell as for facilities and major events, and safeguards the payment and f inancial systems of the United States from a w ide range of f inancial and computer-based crimes.

Department of Justice Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF)

Investigates and seeks to prevent federal offenses involving the unlaw ful use, manufacture, and possession of f irearms and explosives, acts of arson and bombings, and illegal traff icking of alcohol and tobacco products.

Federal Bureau of Prisons

(BOP)

Confines offenders in the controlled environments of prisons and community-based facilities that are safe, humane, cost-eff icient, and appropriately secure, and that provide w ork and other self-improvement opportunities to assist offenders in becoming law -abiding citizens. As part of its duties, BOP is responsible for delivering medically necessary health care to inmates in accordance w ith proven standards of care, including medical, dental and mental health.

Page 4 GAO-18-229 Federal Law Enforcement

Component Mission Federal Bureau of Investigation

(FBI)

Protects the nation from terrorism, espionage, cyber-attacks, and major criminal threats through intelligence-gathering and law enforcement responsibilities. Our review focuses on the FBI’s Special Agents, w ho are primarily responsible for executing this mission, as w ell as FBI Police Off icers, w ho provide security at FBI facilities.

U.S. Drug Enforcement Administration (DEA)

Enforces the controlled substances law s and regulations of the United States and brings to the criminal and civil justice system of the United States, or any other competent jurisdiction, those organizations and principal members of organizations involved in the grow ing, manufacture, or distribution of controlled substances appearing in or destined for illicit traff ic in the United States.

U.S. Marshals Service (USMS) Provides federal judicial security, apprehends fugitives and non-compliant sex offenders, secures and transports federal prisoners from arrest to incarceration, executes federal court orders, seizes and manages assets acquired through illegal means, and assures the safety of endangered government w itnesses and their families.

Source: GAO summary of information from components. | GAO-18-229

Note: According to data the departments provided to us, as of the end of fiscal year 2016, the DHS components above—excluding FLETC—employed 42,823 of 43,222 law enforcement officers within DHS, and the DOJ components above employed 43,502 of 43,639 law enforcement officers within

DOJ.

aFLETC information is presented in this table as the component provides various types of training to a number of federal law enforcement agencies. However, we do not consider it an operational law enforcement component for our subsequent discussions of training in place across DHS components.

To identify the challenges that federal law enforcement officers and agents at our selected DOJ and DHS components face when responding to incidents involving individuals with mental illness, we held discussion groups with six to eleven agents or officers within each selected component to ask about their experiences. We worked with officials at each component to identify officers and agents with varied tenures and experiences. We then summarized the information collected from the discussion groups and identified common themes across the selected components. We worked closely with the departments to organize these discussion groups; however, these officers’ and agents’ perspectives cannot be generalized to their entire components or to all federal law enforcement components. Nevertheless, their views provided valuable insights into the challenges they face on the job.

To identify the training, policies, and guidance in place, we reviewed documents from each of our selected law enforcement components, when available, and conducted interviews with officials at the selected components responsible for the development or delivery of training or policies. We also reviewed fiscal year 2018 budget justifications for each of our selected components to identify changes in staffing levels or training plans that may be related to officers’ and agents’ response to incidents involving individuals with mental illness. In addition, since section 504 of the Rehabilitation Act of 1973, as amended (section 504) prohibits discrimination on the basis of disability, which includes mental illness, in federally funded and federally conducted programs and activities, Page 5 GAO-18-229 Federal Law Enforcement

6 we took steps to understand the section’s applicability to federal law enforcement operations.7 Specifically, we reviewed departmental guidance related to section 504 and reviewed the selected components’ documentation of efforts to review their training, policies, and procedures in accordance with that guidance. We also interviewed department and component officials familiar with the review efforts.

To identify leading practices stakeholders cited for effective law enforcement responses to incidents involving individuals with mental illness, we used a multi-stage process. We first conducted a search of databases and organizational websites to identify published work related to law enforcement responses to individuals with mental illness that had been published on or after January 1, 2007. We then narrowed our search and reviewed only literature review articles, meta-analyses, and summary papers published by academics, think tanks and advocacy groups, or government agencies to identify any potential leading practices.8 Through our review, we identified two potentially leading practices in the field of law enforcement responses to incidents involving individuals with mental illness.

Next, we identified potential stakeholders through a search of literature review articles, meta-analyses, and organizational websites related to law enforcement responses to incidents involving individuals with mental illness. Through our review of these documents and websites, we selected six stakeholders in the field of law enforcement-mental health to solicit their opinions on leading practices. These stakeholders consisted

629 U.S.C. § 794. A person w ith a disability includes anyone w ho has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such an impairment. The definition of disability for purposes of § 504 of the Rehabilitation Act is derived from the Americans w ith Disabilities Act. 29 U.S.C. § 705(9); 42 U.S.C. § 12102.

7Regulations and guidance issued by both DOJ and DHS provide that section 504 generally applies to all programs and activities of each department. For example, DOJ guidance states that DOJ’s obligations under section 504 and implementing regulations “apply to all members of the public w ith disabilities w hom the Department serves or encounters as part of the Department’s traditional law enforcement programs and activities.” How ever, according to this same guidance, “[e]xigencies, dangers, and safety considerations, how ever, play a signif icant role in determining w hether and to w hat extent an accommodation [for a member of the public w ith a disability] is reasonable.”

8By using the term “leading practices,” w e refer to practices that are generally effective w hen off icers or agents apply them w hen responding to incidents involving individuals w ith mental illness even if robust evaluations of such practices’ effectiveness have not been conducted or have show n mixed results.

of four organizations and two independent researchers who have either published research or implemented programs, among other criteria, related to law enforcement responses to incidents involving individuals with mental illness. Specifically, we asked stakeholders to validate that the two practices that we had initially identified were in fact leading practices, and to provide any additional leading practices.

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To determine if DOJ and DHS components leverage information from other knowledgeable parties, we conducted interviews with or gathered written information from agency officials from the selected components who are responsible for training and policy development. Further details about our scope and methodology can be found in Appendix I.

We conducted this performance audit from February 2017 through February 2018 in accordance with generally accepted government auditing standards. Those standards require that we plan and perform an audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives.

Background

Law Enforcement Interaction with Individuals with Mental Illness

Since the 1960s, the percentage of individuals with mental illness being treated in a hospitalized setting has decreased dramatically in an effort to move care away from institutional settings into a wider range of community-based treatment. This process, known as “deinstitutionalization,” has been driven in part by limited funding available for mental health services, changes in treatment philosophy, and medical advancements. According to a 2015 Federal Bureau of Investigation (FBI) publication, one result from this shift is that local police departments have had to meet the growing needs of individuals suffering mental health emergencies (e.g., a schizophrenic episode), and are often the first

9For the purposes of our report, stakeholders are either academic or independent researchers or advocacy groups w ho are know n to have substantial know ledge or expertise in the area of law enforcement responses to incidents involving individuals w ith mental illness.

source of assistance in helping to arrange treatment for these individuals.

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Similarly, the IACP reports that police officers often have to “manage situations that result from a history of mental health policy and legislative decisions made by federal and state governments.”11 According to the IACP, law enforcement officers—generally local police—may then find themselves serving in a role similar to that of a social worker in attempting to locate treatment services for such individuals. The IACP also reports that such increasing interactions may result in individuals with mental illness being arrested and placed in jail, rather than receiving treatment from mental health facilities. This can result in a cycle of arrest, imprisonment, and recidivism for such individuals.12 In addition, interactions between law enforcement officers and individuals with mental illness have the potential to escalate into violence.

In recent years, a number of professional organizations and advocacy groups such as IACP, the Police Executive Research Forum (PERF), the National Alliance on Mental Illness, and Council of State Governments Justice Center (CSG JC) have researched and advocated for different approaches that may reduce the likelihood of violent encounters or help officers connect the individuals they encounter with proper treatment services.13 In addition, DOJ’s Bureau of Justice Assistance (BJA), within its Office of Justice Programs, has created a compendium of existing

10Wilcox, Nicolas, M.S., “The Importance of Mental Health Training in Law Enforcement”, FBI Law Enforcement Bulletin, July 8, 2015.

11IACP, Improving Police Response to Persons Affected by Mental Illness, Report from the March 2016 IACP Symposium, Alexandria, Virginia (2016).

12We have related w ork review ing the incarceration of offenders w ith mental illness and strategies for reducing recidivism among such offenders that w ill be issued in early 2018.

21st Century Cures Act, Pub. L. No. 114-255, § 14016, 130 Stat. at 1306-07.

13PERF is an independent research organization that seeks to identify best practices on issues such as reducing police use of force; developing community and problem-oriented policing; and evaluating crime reduction strategies. CSG JC is a national nonprofit organization that serves policymakers at the local, state, and federal levels from all branches of government. It aims to provide practical, nonpartisan advice and consensus-driven strategies, informed by available evidence, to increase public safety and strengthen communities.

information and research in the field of state and local law enforcement responses to individuals with mental illness.

Page 8 GAO-18-229 Federal Law Enforcement

Federal law enforcement officers and agents may interact with individuals displaying signs of mental illness in a number of different types of incidents while performing their various missions, such as protecting federal property or officials or when apprehending subjects of an investigation. Figure 1 provides one example of a possible incident an officer or agent might experience and the response options available.

Generally, when federal officers and agents encounter individuals displaying signs of mental illness—and there is no evidence of a federal crime—they may refer them to local law enforcement or health care providers to assess their mental health and determine whether they need further health care.15 If local providers determine that such care is needed, it is generally provided through a voluntary or involuntary commitment to a local mental health services provider. One exception to this is for correctional officers and other staff within BOP, as these staff interact with individuals with a diagnosed mental illness as part of their daily duties in ensuring a secure prison environment.16 BOP pre-designates all inmates entering its institutions and assigns initial mental

14BJA aims to provide leadership and services in grant administration and criminal justice policy development to support local, state, and tribal justice strategies to achieve safer communities. BJA supports programs and initiatives in the areas of law enforcement, justice information sharing, managing offenders, combating drug crime and abuse, crime prevention, and protecting vulnerable populations, among other things.

15The nature of these interactions by federal law enforcement off icers and agents may vary greatly depending on the nature of each component’s mission. For example, according to FBI off icials, FBI Special Agents apprehending a subject displaying signs of mental illness do not refer that individual to local law enforcement or health care providers, but w ould carry out the arrest w arrant or arrest on probable cause.

16By statute, BOP is required to provide for suitable housing and the safekeeping, care, and subsistence of all persons charged w ith or convicted of offenses against the United States. See 18 U.S.C. § 4042(a)(2).

health and medical screen assignments.

Page 9 GAO-18-229 Federal Law Enforcement

17 Throughout an inmate’s incarceration, BOP’s psychologists, psychiatrists, and qualified mid-level practitioners can determine a new mental health care level following a review of records and a face-to-face clinical interview.

17After inmates enter an institution, and w ithin timeframes dependent upon the mental health screen assignment, BOP completes a psychology intake screening and assigns inmates a mental health care level ranging from 1 to 4, depending on the inmates’ level of mental health care needs. Mental health care level 1 inmates show no signif icant level of functional impairment associated w ith mental illness and demonstrate no need for regular mental health interventions, w hile mental health care level 4 inmates are those requiring acute care in a psychiatric hospital. We have previously reported on mental health care and general medical care in BOP. See GAO, Bureau of Prisons: Timelier Reviews, Plans for Evaluations, and Updated Policies Could Improve Inmate Mental Health Services Oversight, GAO-13-1 (Washington, D.C.: July 17, 2013), and Bureau of Prisons: Better Planning and Evaluation Needed to Understand and Control Rising Inmate Health Care Costs, GAO-17-379 (Washington, D.C.: June 29, 2017).

http://www.gao.gov/products/GAO-13-1 http://www.gao.gov/products/GAO-17-379

Figure 1: Illustrative Example of an Incident at a Federal Facility Involving Federal

Page 10 GAO-18-229 Federal Law Enforcement

Law Enforcement and an Individual Displaying Signs of a Mental Illness

Note: The figure above is a general i llustration of how a federal law enforcement officer or agent might respond to and resolve a disturbance at or near a federal facil ity. It is not intended to address a “typical” incident for any of the components in our review because the missions and activities of each component vary significantly and officers and agents interact with the public in different capacities.

For example, Federal Protective Service or Secret Service officers and agents might be more likely to experience this type of incident when protecting federal facil ities than Bureau of Prisons correctional officers operating within prisons or than Federal Bureau of Investigations agents conducting investigations would be.

Relevant Legislation and Departmental Efforts

Page 11 GAO-18-229 Federal Law Enforcement

Under section 504 of the Rehabilitation Act of 1973, as amended, discrimination on the basis of disability in federally funded and federally conducted programs and activities is prohibited.18 A person with a disability includes anyone who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such an impairment.

DHS and DOJ both currently have efforts underway, in various stages of development, to have their components review their existing policies, guidance, and training in response to departmental guidance on addressing individuals with disabilities and obligations under section 504.

Pursuant to departmental guidance, after completing their reviews, components are to determine areas that could be enhanced. Within DHS, components have been asked to report on the status of their efforts to DHS’ Office for Civil Rights and Civil Liberties (CRCL).19 Within DOJ, the Office of the Deputy Attorney General (ODAG) is overseeing components’ efforts.20

In addition, the 21st Century Cures Act requires the Attorney General to provide direction and guidance for the following by December 13, 2017:

· “Programs that offer specialized and comprehensive training, in procedures to identify and appropriately respond to incidents in which the unique needs of individuals who have a mental illness are involved, to first responders and tactical units of—(A) Federal law enforcement agencies; and (B) other Federal criminal justice agencies, such as [BOP] and the Administrative Office of the United States Courts, and other agencies that the Attorney General determines appropriate.”

1829 U.S.C. § 794. “Federally conducted programs and activities” include those of federal law enforcement agencies.

19DHS CRCL promotes civil rights and civil liberties in policy creation and implementation by advising DHS leadership and personnel, communicates w ith individuals and communities w hose civil rights and civil liberties may be affected by DHS activities, and leads DHS equal employment opportunity programs, among other things.

20DOJ ODAG advises and assists the Attorney General in formulating and implementing DOJ policies and programs and in providing supervision and direction to all organizational units of DOJ.

· “The establishment of, or improvement of existing, computerized information systems to provide timely information to employees of Federal law enforcement agencies, and Federal criminal justice agencies to improve the response of such employees to situations involving individuals who have a mental illness.”

Page 12 GAO-18-229 Federal Law Enforcement

Discussion Groups Identified Several Challenges that Officers and Agents Encounter When Responding to Incidents Involving Individuals with Mental Illness According to the DHS and DOJ law enforcement officers and agents we interviewed, they are not positioned to diagnose any specific mental health condition that an individual might have, as they are not trained mental health professionals.22 However, responding to incidents involving individuals with mental illness can be challenging for multiple reasons, including determining whether the person is suffering from a mental illness or from another issue, such as drug addiction, and communicating with the person, for example, when a person may be suffering from delusions. These officers and agents face these challenges while also being responsible for ensuring their own safety and that of others in the area. Some of the common challenges officers and agents identified during our discussion groups follow.

Identifying Whether an Individual Has a Mental Illness

Some officers and agents in our group discussions stated that when encountering individuals displaying erratic behavior (e.g., rapid or nonsensical speech, paranoid or delusional statements), it can be difficult to determine if that behavior is attributable to a mental illness or the influence of drugs. Specifically, Border Patrol agents—who are broadly responsible for preventing the illegal entry or exit of people and goods at places other than ports of entry—stated that determining whether

21Pub. L. No. 114-255, § 14025, 130 Stat. at 1310.

22BOP employs mental health professionals such as psychologists or psychiatrists at each of its institutions. These staff are trained to diagnose mental illness and share their assessments w ith correctional off icers and other staff. In addition, each institution has medical and mental health profiles of each inmate in its care.

someone has a mental illness or is experiencing other issues is challenging and may be complicated by language barriers. Border Patrol agents may at times encounter large groups of people attempting to cross the border at one time and thus have limited time to make that determination. ATF officers—who may encounter individuals with a mental illness who are targets of an investigation—commented that incidents may involve an individual who could suffer a mental illness (treated or untreated), or be under the influence of alcohol or drugs.

Unless the individual discloses his or her condition, or family or friends are there to explain the condition, officers would not know the cause of the individual’s behavior. They explained that if mental health information about a suspect is known in advance of an operation, officers can adjust their approach; however, they told us that most of the time they do not know if someone has a mental health condition and how it might present itself.

Similarly, an FBI police officer—who may encounter individuals displaying signs of mental illness if those individuals enter an FBI office—told us that it can be challenging to deal with an individual who is acting erratically, not knowing precisely whether the behavior is attributable to a mental illness, and there may be limited time available to address an individual posing a safety risk. BOP corrections officers also echoed this challenge.

They said that despite having back-up mental health staff on call, their initial reaction to an inmate exhibiting some type of erratic behavior has to be fairly quick to secure the safety of the staff and other inmates. Officers and agents across components and departments made clear that they are not mental health professionals or psychologists and, as such, are charged with responding to the behaviors that are exhibited to secure the scene.

Communicating with Individuals with a Mental Illness

Some of the officers and agents in our discussion groups stated that communicating effectively with someone exhibiting signs of a mental illness and understanding what he or she may be going through or how he or she sees reality can be challenging. One officer told us that trying to make individuals who may have a mental illness understand that their reality is not everyone else’s reality is particularly challenging. This was very difficult, for example, for Secret Service Uniformed Division officers who explained that they encounter individuals when providing security along the White House fence and for FPS officers, who often encounter individuals displaying signs of mental illness near or in federal buildings that they are assigned to protect. As the Secret Service officers

Page 13 GAO-18-229 Federal Law Enforcement explained, even if individuals exhibit delusional behavior, so long as they have not broken any laws, then they are free to be near protected federal venues and the officers are limited in any actions they can take.

Officers and agents who we met with in CBP reported that they rely on common sense to dictate appropriate action and use reasonable efforts to protect themselves and others. They noted that additional training on communicating effectively with individuals suffering from mental illness could be beneficial.

The challenges noted above in identifying causes of erratic behavior or effectively communicating with individuals with a mental illness can make it difficult for officers to resolve a tense situation or apprehend an individual (if necessary) as securely or peacefully as possible. For example, Border Patrol agents stated that ensuring that such encounters are resolved safely for the individuals involved and other members of the public is their biggest challenge. It might require removing someone in distress from a group of individuals that he or she may be traveling with or keeping him or her calm. When someone is in an extreme state of panic, emotional distress, or anger, officers try to remove the person from the group to prevent a potential incident from escalating quickly.

Operating with Limited Access to Mental Health Resources

Officers and agents also stated that a limited number of mental health professionals available within their components or through local agencies can pose a challenge in helping persons with mental illness receive necessary treatment. As such, they must rely on state and local entities in the area (e.g., law enforcement, hospitals) to provide assistance for individuals. Federal Air Marshals—who provide protection at airports and other transportation modes—we spoke with explained that since they do not have holding facilities to secure individuals with mental illness, they are reliant on local law enforcement and mental health professionals to manage an incident.

Page 14 GAO-18-229 Federal Law Enforcement

23 Officers and agents highlighted the importance of maintaining close relationships with state and local partners and added that trained mental health professionals provide an excellent resource.

23The Federal Air Marshals instructors w ith w hom w e met largely train Visible Intermodal Prevention and Response teams that consist of Federal Air Marshals, Behavioral Detection Officers, Transportation Security Specialists-Explosives, Transportation Security Inspectors, and Canine teams w ho w ork closely w ith federal, state, and local law enforcement partners and stakeholders in the aviation and surface transportation sectors.

One officer, discussing the challenges in speaking with someone with a mental i llness who may be experiencing delusions, stated that the person is “wholeheartedly convinced that what he or she perceives is the true reality.”

Source: GAO observation. | GAO-18-229

In addition, officers and agents in some discussion groups noted there may be training offered by state or local agencies related to understanding and responding to individuals with mental illness that could be leveraged by federal agencies.

Page 15 GAO-18-229 Federal Law Enforcement

24 Officers and agents reported, however, that it can be difficult for the components to find the time and resources to send officers to the trainings. According to USMS officers— who provide security at federal courthouses and oversee transport of federal prisoners—this is particularly challenging in small offices where there may be very few staff.

Frequently Encountering the Same Individuals

Another common challenge noted in discussion groups was that officers and agents repeatedly encounter the same individuals with mental illness.

Officers and agents explained that they can sometimes apprehend individuals who are creating a disturbance, but these individuals often cannot be charged with a federal crime. As such, following the apprehension, the officers and agents release these individuals to local or state authorities who may transport them to local providers for a mental health evaluation. Typically, if the local providers determine a commitment is necessary, they will hold these individuals at a hospital or clinic for up to 72 hours. According to the officers and agents in our discussion groups, many of these individuals return after they are released and the officers and agents encounter them time and again, with very little that they can do to provide these individuals with assistance.

According to the officers and agents, incidents involving frequent encounters with the same individuals can take time away from performing other important activities.

Secret Service Uniformed Division officers told us they repeatedly encounter the same individuals with mental illness and know some of these individuals very well. For example, Secret Service officers stated that when performing their duties in patrolling the grounds of the White House, they have had frequent encounters with a woman who believes she has family members living in the White House. The officers have

24Training courses that focus on mental health aw areness offered by other entities, such as state and local law enforcement agencies, may be available to federal off icers and agents. Generally, federal off icers and agents are made aw are of internal and external training opportunities through their internal component learning systems and email notif ications.

turned her away from the scene on multiple occasions, but she continues to return.

Components Have Some Type of Training, Page 16 GAO-18-229 Federal Law Enforcement

Policies, and Guidance Related to Mental Illness, and Reviews to Enhance Practices are Underway

DHS and DOJ Components Offer, Receive, or Are Developing Some Type of Training Related to Mental Illness

All of the law enforcement components in our scope offer training directly, receive training through FLETC, or are developing some training on responding to incidents involving individuals with mental illness. Agency and FLETC training includes courses on communication, de-escalation, and suicide prevention (related to federal inmates). Since these components have varying missions and operational needs and interact with the public in different capacities, the nature and scope of this training, as well as the number of courses and the duration of courses offered varies. For example, BOP’s staff—including food service workers and nurses, as well as correctional officers—have daily contact with inmates with mental illness and can act as “first responders” when situations merit. According to BOP officials, training is offered to all staff in all of its institutions on mental health and working with the mentally ill, along with courses on communication, de-escalation, suicide prevention, and use of force. As another example, ATF’s agents told us they have less routine contact with individuals with mental illness, but ATF offers a course to its agents on de-escalation concepts and tactics, which addresses responding to incidents involving individuals with mental illness, as well as crisis intervention training to its cadre of crisis negotiators. Further, some of the components’ training is mandatory and offered annually through class instruction or online portals. These courses may be offered to new hires or available to tenured officers. In addition, some components’ training courses are delivered as stand-alone sessions, while others may be modules within a larger course exploring other law enforcement topics.

Training DHS Components Offer

Three DHS operational components in our scope, in addition to FLETC, offered some type of training specifically for their officers and agents.

Another one (TSA) has training in development as of October 2017, on topics related to responding to incidents involving individuals with mental illness.

FLETC explained that it provides basic training to all DHS law enforcement…