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  source of assistance in helping to arrange treatment for these  individuals. 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.” 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. 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. In addition, DOJ’s Bureau of Justice Assistance (BJA), within  its Office of Justice Programs, has created a compendium of existing  information and research in the field of state and local law enforcement  responses to individuals with mental illness. 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. 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. BOP pre- designates all inmates entering its institutions and assigns initial mental  health and medical screen assignments. 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. Relevant Legislation and  Departmental Efforts 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. 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). Within DOJ, the  Office of the Deputy Attorney General (ODAG) is overseeing components’  efforts. 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  and the Administrative Office of the United  States Courts, and other agencies that the Attorney General  determines appropriate.”  “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.” 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. 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  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  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. One officer, discussing the challenges in  speaking with someone with a mental illness  who may be experiencing delusions, stated  that the person is “wholeheartedly convinced  that what he or she perceives is the true  reality.” 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. 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. 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. 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  turned her away from the scene on multiple occasions, but she continues  to return. Components Have  Some Type of  Training, 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. 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 officers through one of three basic program categories— Center Basic, Center Integrated Basic, and Agency Specific Basic—which  vary in length. Two Center Basic training programs include a 2-hour  module titled Managing Abnormal Behavior, which covers how to identify  common signs of mental disorders (among other things) and how to  handle people exhibiting abnormal behavior. Specifically, this module  examines basic human behavior that may be classified as abnormal,  differentiates between mental disorders, and also covers physical and  organic causes that may be related to abnormal behavior with the  appropriate officer responses. In addition, FLETC informed us that it has  developed scenario-based training in these programs, allowing the  officers or agents to develop decision-making skills in situations involving  people exhibiting abnormal behavior. See appendix II for more  information on FLETC’s training programs. U.S. Secret Service Training  We observed Secret Service training on  Protective Intelligence Questioning for First  Line Officers, which is offered to Uniformed  Division Officers. The course instructor played  the role of three different individuals with  schizophrenia, bipolar disorder, and  sociopathic personality disorder and trained  agents on interacting and interviewing  subjects who attempt to breach the White  House fence. In addition to this module provided to all DHS agents and officers, the  components in our review also offer or are preparing component-specific  training courses. Table 2 lists illustrative examples of DHS training. In addition, TSA has developed a mandatory course entitled Awareness  Training on Mental Health Conditions to be delivered in the classroom  and through scenarios and exercises during fiscal year 2018. This course  is designed to introduce Federal Air Marshals to the fundamentals of  predominant mental disorders, such as schizophrenia or psychosis. All of the DOJ components in our review provide some type of training to  their officers on topics related to responding to incidents involving  individuals with mental illness—as illustrated in Table 3. DHS and DOJ  Components Have  Existing Policies or  Guidance That Addresses  Responding to Individuals  with Mental Illness The law enforcement components within our scope at DHS and DOJ  have policies or guidance in place that addresses responding to incidents  involving individuals with mental illness. Some components’ policies or  guidance specifically addresses mental illness, while others touch on the  issue as part of larger policies on other topics (such as use of force)—as  illustrated in Table 4. All DHS and DOJ  Components Are  Reviewing Policies,  Guidance, and Training to  Align with Departmental  Guidance DHS Efforts to Review Policies, Guidance, and Training  DHS has guidance in place to help ensure that its components have  policies and training that ensure their alignment with section 504 of the  Rehabilitation Act. In 2013 and 2015, respectively, DHS issued a  directive and implementing instruction to its components intended to  strengthen compliance with section 504. These documents required DHS  components to conduct a self-evaluation and prepare a component plan  identifying any policies or practices that may result in a qualified individual  with a disability being excluded from participation in, or being denied the  benefits of, a program or activity. Department of Homeland Security (DHS)  Component Self-Evaluation Tool  The self-evaluation tool that DHS’s Office of  Civil Rights and Civil Liberties developed  requires components to—among other  things—describe whether there is an  established policy ensuring equal treatment  for individuals with disabilities, how the  component’s personnel and procedures  ensure that individuals with disabilities are  treated in a nondiscriminatory manner, and  the component’s process for providing  auxiliary aids and services to ensure effective  communication. The tool also provides  examples of interactions in the areas of  customer service, security, and custody  activities that would likely be compliant, or  possibly noncompliant, with section 504 of the  Rehabilitation Act. In 2016, DHS’s CRCL office issued guidance and a self-evaluation tool to  DHS components on the steps to take in performing the self-evaluation of  their facilities, programs, policies, and practices (to include training). The  guidance also addresses the development and execution of the  components’ plans intended to remedy any areas deemed insufficient in  permitting individuals with disabilities—including mental illness—to  participate fully in the components’ programs and activities. Disability Access Coordinators, who are representatives from each  component charged with overseeing their components’ responses to DHS  Rehabilitation Act guidance, are leading the components’ efforts in  conducting the self-evaluations. CRCL set a deadline for components to  submit all self-evaluations to CRCL for review by the end of August 2017.  As of September 2017, all five components had submitted self- evaluations. CRCL officials explained that as they review self- evaluations, they are looking to see if policies or training for law  enforcement officers’ and agents’ responses to individuals with mental  illness have been identified or otherwise addressed. If not, the officials  indicated that they will request the components identify and address this  topic in their plans for aligning with Rehabilitation Act guidance. The  remaining steps in CRCL’s effort to review and comment on component  plans as of September follow: December 31, 2017: CRCL provides comments to components on the  content of their self-evaluations. February 28, 2018: the components develop and submit their draft  plans for aligning with the Rehabilitation Act guidance. April 30, 2018: CRCL reviews and provides comments on the  components’ draft plans. May 31, 2018: the components address CRCL’s comments and  submit their final plans for alignment with Rehabilitation Act guidance  for approval. DOJ Efforts to Review Policies, Guidance, and Training  DOJ has directed components to review and implement guidance on  addressing individuals with disabilities—including mental illness—and  obligations under section 504. Specifically, in January 2017, DOJ’s then- Deputy Attorney General issued a memo with attached guidance directing  components to review their policies and training and, where necessary,  modify or develop policies and training to implement legal requirements  and principles related to section 504. This guidance identified, among  other things, DOJ’s law enforcement components’ legal obligations under  section 504 as well as the policies and procedures that components must  have so that officers and agents can anticipate and plan for encounters  with members of the public with disabilities. For example, the guidance  states that law enforcement components must train officers and agents  on different types of commonly encountered disabilities; how to identify,  without medical or psychological training, analysis, or diagnosis, common  characteristics and behaviors most often associated with disabilities; and  appropriate responses to the challenges that an encounter with a member  of the public with a disability may present. Training for officers and agents  in effective communication with members of the public with a mental  illness is explicitly referenced in the guidance as well. To date, officials from DOJ’s Office of the Deputy Attorney General  (ODAG)—who are overseeing the components’ efforts—have maintained  communication with the components to confirm that they have begun  reviewing their policies and training to identify any deficiencies or  necessary enhancements pursuant to the January 2017 guidance. During  the course of our review and in part due to our inquiries, in the fall of  2017, ODAG notified the components that they should complete their  reviews by December 2017. ODAG also notified the components that  they should begin implementing any new policies or training identified by  September 2018. In addition, a provision of the 21st Century Cures Act—section 14025— requires DOJ to provide direction and guidance to federal law  enforcement agencies and federal criminal justice agencies on training  programs and improved technologies related to responding to individuals  with mental illness, by December 13, 2017. ODAG officials told us that  the January 2017 guidance addresses the requirement to provide  direction and guidance on training for the DOJ components, but  acknowledged that it does not respond to all of the requirements for the  Attorney General under section 14025 of the 21st Century Cures Act. In  particular, section 14025 requires the Attorney General to provide  direction and guidance to federal law enforcement agencies and federal  criminal justice agencies beyond DOJ in the areas of specialized and  comprehensive training programs to identify and respond to individuals  with mental illness. Section 14025 also calls for direction and guidance on  the establishment and improvement of computerized information systems  to provide timely information related to situations involving individuals with  mental illness. As a result of our questions about whether such efforts would be  developed, on December 7, 2017, DOJ sent a letter from the Principal  Deputy Assistant Attorney General for the Office of Justice Programs to  federal law enforcement partners outlining resources available for federal  law enforcement when considering training or procedures appropriate for  their missions. Specifically, DOJ sent the letter to executive officers within  DOJ, DHS, the Administrative Office of the United States Courts, and  other executive departments that DOJ deemed appropriate. Some  examples of resources that the letter highlights include (1) the Police- Mental Health Collaboration Toolkit, which provides resources to assist  law enforcement agencies in partnering with mental health providers (and  is discussed later in this report) and (2) a forthcoming “roadmap” planned  for release in 2018 that the Office of Justice Programs and BJA are  developing that will help law enforcement agencies as they plan for  engagement with mental health entities. Stakeholders Cited  Leading Practices  and Tools for Effective  Law Enforcement  Responses, and  Components Have  Generally Leveraged  Information from  Other Knowledgeable  Parties Two Leading Practices  and Four Tools Can  Enhance Officer  Responses to Individuals  with Mental Illness Of the six stakeholders in the field of law enforcement-mental health we  interviewed, all six considered the Crisis Intervention Team Model to be a  leading practice and five considered the Co-responder Model to be a  leading practice—see Figure 2. These practices are typically  implemented at local and state law enforcement agencies. Nevertheless,  certain aspects and associated benefits could be considered in other  settings, such as federal law enforcement operations. In addition, stakeholders cited four key tools that may assist law  enforcement agencies in responding to individuals with mental illness.  These tools can include training guides, summary reports, or model  policies, among other things, as shown in table 5. Components Have  Generally Leveraged  Information from Other  Knowledgeable Parties,  and BJA Is Standing Up a  Training and Technical  Assistance Center DHS and DOJ law enforcement components generally leveraged  information from knowledgeable parties within their departments on  efforts to respond to incidents involving individuals with mental illness. To  enhance information sharing among DHS components, CRCL has  implemented an interagency collaboration mechanism. Specifically,  CRCL officials reported that since June 2016 they have led monthly  coordination conference calls with component Disability Access  Coordinators to collaborate on their respective efforts to complete their  self-evaluations. According to the Disability Access Coordinators, these  sessions have provided a forum to share ideas and lessons learned  across the DHS components. In addition, according to CRCL officials,  once their office receives the components’ self-evaluations and plans, it  aims to disseminate information on lessons learned and effective  practices to all the components. Coordination efforts to leverage information also exist within DOJ.  Specifically, through the efforts to review policies and training under the  January 2017 guidance and provisions of the 21st Century Cures Act  discussed earlier, DOJ’s components have reported taking efforts to  collaborate with one another and share information on training, best  practices and lessons learned. For example, officials from ATF reported  holding meetings with other components to discuss their efforts to  implement the January 2017 guidance. Additionally, BJA officials told us they took part in the ODAG’s working  group in early 2016 when the then-Deputy Attorney General’s January  2017 guidance was in development. Along with BJA, this ODAG working  group included DOJ’s law enforcement components and other offices  within the department. The working group provided a forum to advise  ODAG in developing the January 2017 guidance and discuss issues  surrounding disabilities, which involved responses to individuals with  mental illness. BJA officials told us that they provided to components a  compendium of all its resources available to assist law enforcement’s  response to incidents involving individuals with mental illness. BJA  officials said they later took the most promising of these and folded them  into its Police-Mental Health Collaboration Toolkit. Further, BJA officials  told us that they make all of the resources it develops, including the  Toolkit, publicly available on the BJA website. According to the officials,  these resources are available for all law enforcement agencies, including  federal entities, to review and consider implementing as they deem  appropriate. In addition to these online resources, which facilitate information sharing,  BJA is also planning to release a national CIT curriculum in 2018 that will  serve as a resource that can be tailored to reflect mental health training  and collaboration under development or underway at the local level. The  Office of Justice Programs is supporting a partnership between the IACP  and a research organization to deliver the curriculum to law enforcement  agencies. In addition, BJA—as one of DOJ’s grant-making entities—is  standing up the National Training and Technical Assistance Center to  Improve Law Enforcement Responses to Individuals with Mental Health  Disorders and Intellectual and Developmental Disabilities. BJA officials  reported that in September 2017, BJA selected the awardee to design  and operate the center. Once the center is operational, it will benefit state,  local, and tribal law enforcement entities. In addition, BJA envisions that  the center will facilitate better collaboration between law enforcement  agencies and their mental health partners. A BJA official also  acknowledged that the center could serve as an additional resource for  federal law enforcement agencies to consult as they review their  trainings, policies, and guidance relevant to responding to incidents  involving individuals with mental illness. Agency Comments We provided a draft of this report to DOJ and DHS for their review and  comment. The departments did not provide us with formal written  comments, but did provide technical comments, which we incorporated as  appropriate. We are also sending this report to the appropriate congressional  committees and members. In addition, this report is available at no  charge on GAO’s website at http://www.gao.gov. If you or your staff have any questions, please contact Diana Maurer at  (202) 512-8777 or maurerd@gao.gov. Contact points for our Offices of  Congressional Relations and Public Affairs may be found on the last page  of this report. GAO staff that made significant contributions to this report  are listed in appendix III. Appendix I: Objectives, Scope and  Methodology This report addresses the following key questions: (1) What challenges, if  any, do federal law enforcement officers at selected Department of  Homeland Security (DHS) and Department of Justice (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 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 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 6 below because they  comprise nearly all of the federal law enforcement officers in these  agencies. To identify challenges that federal law enforcement officers and agents at  our selected DHS and DOJ components face when responding to  incidents involving individuals with mental illness, we held discussion  groups of six to eleven agents or officers within each component in our  scope. We worked with officials at each component to identify officers and  agents with varied tenures and experiences. We held semi-structured in- person and telephone discussion groups using a script and set of  questions. Discussion groups are not designed to provide generalizable  or statistically reliable results; they are instead intended to generate in- depth information about the reasons for the discussion group participants’  attitudes on specific topics and to offer insight into their concerns. During  the discussion groups, we asked officers and agents what challenges  they face when responding to incidents involving individuals with mental  illness, among other topics. We moderated each discussion to keep  participants focused on the specified issues within discussion time  frames. Participants identified challenges when we explicitly asked them  to do so, or during the course of the discussion. We took detailed notes  on each discussion and documented the perspectives participants raised  in each discussion group. We then summarized the information collected  and identified common themes. Because our questions were open-ended  and designed to allow participants to discuss any challenges they may  have experienced, we cannot determine whether the absence of a  particular concern or challenge by a group of officers or agents is an  indication that they did not experience the concern or that they did not  raise it when asked broadly about the topic. While these participants’ perspectives cannot be generalized to their  entire component or all law enforcement components, their views  provided insights into the challenges federal law enforcement officers and  agents face when responding to incidents involving individuals with  mental illness. We have relied on the observations gathered during these  discussion groups to answer this reporting objective as the officers and  agents are uniquely positioned to speak to their experiences, and any  challenges they face, responding to incidents involving individuals with  mental illness. To identify the training, policies, and guidance in place, we reviewed  documents from each of our selected law enforcement components,  when available, to examine their nature and scope. We further reviewed  information on the duration, requirements, and delivery mechanism of the  training. We then summarized and verified this training information with  each component through email documentation. For the policies, we  reviewed the documentation to determine whether it was specific to  responding to incidents involving individuals with mental illness or  whether mental illness was contained within a larger directive. We also  reviewed 2018 budget justification documents for each component in  order to identify changes in staffing levels or training plans that might be  related to officers’ and agents’ response to incidents involving individuals  with mental illness. We also interviewed officials responsible for the  development or delivery of training, policies, or guidance from the  components in our scope to gather additional information that could help  prepare federal law enforcement officers and agents to respond to  incidents involving individuals with mental illness. In addition, since  section 504 of the Rehabilitation Act of 1973, as amended, prohibits  discrimination on the basis of disability, which includes mental illness, in  federally funded and federally conducted programs and activities, we  took steps to understand the section’s applicability to federal law  enforcement operations. 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 officials from the  departmental offices overseeing these component efforts—DHS’s Office  of Civil Rights and Civil Liberties (CRCL) and DOJ’s Office of the Deputy  Attorney General (ODAG). To identify leading practices or tools stakeholders cited for effective law  enforcement responses to incidents involving individuals with mental  illness, we used a multi-stage process Specifically, we:  1.  conducted a search of databases, such as ProQuest and Scopus, and  organizational websites, such as those from the Council of State  Governments, Justice Center (CSG JC) and Police Executive  Research Forum (PERF), to identify published work related to law  enforcement responses to individuals with mental illness that had  been published on or after January 1, 2007 (the last 10 years).  2.  reviewed the 96 published research papers and articles that our initial  search yielded and then refined our selection criteria to include only  those that were literature reviews, meta-analyses, or summary papers  published by academics, think tanks and advocacy groups, or  government agencies. We reviewed summary articles rather than all  the primary research articles to balance breadth, depth, and  efficiency. After refining our search, there were 16 documents that  met our selection criteria.  3.  reviewed the 16 to identify any potential leading practices. We  determined that a practice was potentially leading if it was found in at  least one of the remaining 16 articles and was a law enforcement –  mental health program. Using these criteria, we identified two  potential leading practices.  4.  asked individual and organizational stakeholders to validate whether  these were leading practices and to identify any additional leading  practices that we might have missed. In order for us to consider an  independent researcher as a stakeholder, the individual needed to  have (a) authored or co-authored at least 2 of the 16 documents that  met our search criteria as outlined earlier and (b) been recommended  by another stakeholder. These criteria yielded two independent  researchers from whom to solicit views. In order for us to consider an  organization as a stakeholder, the organizations needed to have  either (a) conducted research on law enforcement responses to  individuals with mental illness; (b) administered law enforcement- mental health collaborative programs; or (c) launched a national  campaign on law enforcement responses to individuals with mental  illness. After reviewing the websites of organizations that potentially  met these criteria, we selected four organizations from which to solicit  views. In addition, we selected individuals within the organizations as  knowledgeable stakeholders if they were either (1) recommended by  another stakeholder; or (2) managed a law enforcement-mental health  program or national campaign. As a result of these steps, we  identified and interviewed six stakeholders (two independent  researchers and four organizations) to gather their broad views of the  dynamic between law enforcement and individuals with mental illness;  to obtain their observations of any practices or tools, such as training  guides or reports that have been used to enhance officer response;  and to provide feedback on leading practices. The six selected  stakeholders were:  Amy Watson, Ph.D.: Professor at the Jane Addams College of  Social Work, University of Illinois at Chicago. Melissa Reuland, M.S.: Research Fellow at the Police Foundation  and Senior Research Program Manager at Johns Hopkins School  of Medicine, Department of Psychiatry. Council of State Governments, Justice Center (CSG JC): 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. International Association of Chiefs of Police (IACP): a professional  association for law enforcement, representing more than 30,000  members in more than 150 countries. IACP aims to advance the  law enforcement profession through advocacy, outreach,  education, and programs. National Alliance on Mental Illness: a national grassroots mental  health organization dedicated to building better lives for the  millions of Americans affected by mental illness. Police Executive Research Forum (PERF): 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. After reaching out to each researcher and organization, we then sent a  follow up written request to each of them to attempt to achieve consensus  on whether or not the two practices we identified through our search—the  Crisis Intervention Team (CIT) Model and the Co-responder Model— should be considered leading. We also took note of any tools they  mentioned and probed further to understand their origins and intent. We  confirmed with all six of the selected stakeholders that the CIT Model met  our definition of leading practice and confirmed with five out of the six  stakeholders that the Co-responder Model met our definition. Some  stakeholders also identified other practices as leading; however, none of  those practices had at least two other stakeholders confirm it as a leading  practice. In addition, to determine how DOJ and DHS components leverage  information from other knowledgeable parties, such as experts,  associations, or colleagues in other components, we reviewed relevant  documentation on these efforts, as available. We also interviewed agency  officials from the components in our scope who are responsible for the  development or delivery of training or policies. 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. Appendix II: Description of the Federal Law  Enforcement Training Centers (FLETC)  Basic Training Programs FLETC provides basic training to all Department of Homeland Security  (DHS) law enforcement officers through one of three basic program  categories, which vary in length, described as follows: Center Basic is a FLETC training program category in which  personnel from various agencies are provided with the critical  competencies of a specific job, job series, or a group of closely related  job series. FLETC provides all instruction. Training is offered in three  basic training programs: Criminal Investigator Training Program,  Uniformed Police Training Program and the Land Management Police  Training Program. Center Integrated Basic is a FLETC training program category that  provides entry-level law enforcement officers or direct law  enforcement support personnel from a single partner organization with  the core competencies of a specific job series or a group of closely  related job series. FLETC provides all common and basic core  foundational instruction (i.e., firearms, physical techniques, etc.). This  category of training includes eight specific programs. Agency-Specific Basic is a training program category designed to  provide entry-level law enforcement officers or direct law enforcement  support personnel with instruction necessary to meet a single  agency’s mission-specific basic training needs. Generally, Agency- Specific Basic courses precede or follow a Center Basic training  program, with partner organizations providing the majority of the  instruction. Agency-Specific Basic covers an additional 59 training  programs. Appendix III: GAO Contact and Staff  Acknowledgments GAO Contact Staff  Acknowledgments In addition to the contact named above, Joy A. Booth (Assistant Director)  and Adam Couvillion (Analyst-in-Charge) managed this assignment.  Kisha Clark, Eric Hauswirth, Gina Hoover, Susan Hsu, Candace Silva- Martin, Michael Silver, Janet Temko-Blinder, and Adam Vogt made key  contributions to this report.
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. 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. 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.