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Mechanisms for Advancing Health EquityMental Health and Well-BeingRacism as a Public Health Crisis

Rethinking and Reducing the Role of Law Enforcement in Suicide Prevention Efforts

May 18, 2021


The almost daily news of people of color killed by police officers, along with the almost routine news of rising rates of anxiety and depression as the COVID-19 pandemic drags on necessitates a closer look at the role of policing in suicide prevention activities. According to the New York Times, in roughly a three-week period from the start of the Derek Chauvin trial in the murder of George Floyd until the close of testimony, police killed at least 64 people, over half of whom were Black or Latino/a, and “[m]ore than a dozen involved confrontations with people who were mentally ill or in the throes of a breakdown.”

A primary strategy to improve police response to those who have a mental illness and/or are experiencing a mental health crisis is to advocate for more training of police to team up with mental health professionals, as part of a crisis intervention team, to respond in a way that de-escalates, rather than escalates, a crisis. But models that imagine the police as “co-responders,” “team-members,” and “partners,” are grossly insufficient from an equity perspective. Suicide ideation, suicide attempts, and mental health crisis are not criminal activities; it makes little sense therefore to have police as first-responders, even co-responders, without some specific reason (criteria) that delineates why police presence is necessary in the first place.

Moreover, even though data on policing is severely limited, researchers consistently conclude that people of color (Latinos/as, Native Americans, and Black people) experience disproportionate rates of fatalities by the police. A recent study found that police are five times more likely to shoot and kill Black men over 54 who are unarmed, compared to similarly situated white men; unarmed Black men showing signs of mental illness were also more likely to be fatality shot than their white counterparts.

Consider this reality along with initial research indicating overall suicide rates appear to have declined in 2020, but completed suicides by people of color in Connecticut, Illinois, and Maryland also appear to have risen (measured as “Non-White,” “Black and Hispanic,” and “Black” people, respectively). Maryland presents a compelling picture of just how significant some of these disparities are. During a defined period of government ordered “progressive closure” in response to COVID-19, daily suicides doubled for Black people and declined by almost half for white people, compared to the mean daily count of suicides in 2017 and 2019.Consider also that over a 16 year period, Native Americans were killed by police at a higher per capita rate, relative to other racial groups, and have some of the highest suicide rates. This highlights the flaws of a system that heavily relies on police to respond to public health crises arising from mental illness and suicide risk, whether or not that reliance is by intentional design.  

Health equity is racial equity and racial equity is health equity. This means the two concepts cannot be separated. It does not mean these issues are limited to matters of racial justice; there are broader impacts. Below are three examples involving crisis response and the reduction of access to lethal means (bedrocks of suicide prevention) where law and policy can be used to promote equitable and stronger preventative measures that reduce overreliance on police.

  • 988 Lifeline:  Create mobile crisis response teams composed of mental health professionals and set specific narrow standards for when police officers may be utilized. Explained in more detail here, by July 2022, “988” will be fully activated as a new number to access the National Suicide Prevention Lifeline. Congress has authorized states and tribal governments to collect fees to assist in routing 988 calls and to provide supportive mental health crisis services. Accordingly, some states have introduced legislation to create mobile crisis teams but with different models of what these teams look like. Legislation in California proposes to create 988 mobile crisis support teams, which would primarily include mental health professionals and peer support specialists. It prohibits the mobile teams from partnering with police, by deploying or contacting them, “unless there is an explicit threat to public safety and the situation cannot be reasonably managed without law enforcement assistance.”

    Contrast this with proposed 988 legislation in Nevada, which would allow three types of mobile response teams, including teams: created by a law enforcement agency and composed of psychiatric mental health providers, those providing peer support, and law enforcement. Unlike Nevada, California’s proposed model centers crisis response on qualified mental health professionals and sets specific standards for when police officers should be included.
  • School Tip-Lines: Enact mechanisms for directing tips involving suicide risk and mental health to qualified professionals, setting clear criteria for use of law enforcement. Colorado’s “Safe2Tell” school tip-line was initially implemented for students to report troubling behavior relating to potential school shootings. But Safe2Tell, and similar school tip-lines, have overwhelmingly become vehicles for reporting mental health related issues, including cutting, bullying, depression, and suicide risk. Suicide risk is the highest reported Safe2Tell tip in Colorado, frequently ranking among the highest in other states as well. Until recently, Colorado law required all tips to promptly be directed to the appropriate law enforcement, public safety agency, or school officials. The law does not specify how such decisions should be made. Students reported trauma resulting from police officers showing up at their homes and handcuffing them for mental health issues. This is the one consequence of a system built-around policing and curbing threats to student populations, rather than threats to a student’s own health and well-being, as revealed by the data.

    Colorado amended its law in July 2020 to require standardized protocols for transferring tips relating to mental health or substance abuse to the state’s behavioral health crisis response system. In these cases, promptly directing tips to police, or other listed parties, is no longer required. These are much needed reforms; after the switch to remote learning Safe2Tell tips declined by 7 percent but tips relating to suicide rose by 4 percent. SafeUT is another system that directly connects youth to crisis counselors. These examples show that rethinking the role of police can have positive impacts on suicide prevention, creating better pathways to connect youth to support and lessening the risk of racial and other forms of trauma associated with police encounters.
  • Extreme Risk Protection Orders (ERPOs): Expand ERPO petition and surrender processes.  ERPOs generally allow a person, such as law enforcement or family members to petition a court to temporarily order the removal of a person’s firearms if the person poses a danger to themselves or others. Evidence indicates ERPOs have been impactful in reducing firearm suicides in Indiana and Connecticut, the first states to pass such laws. According to Giffords Law Center, 19 states and D.C. have ERPO laws. A common thread among ERPO laws is that they center intervention and process in law enforcement. For instance, 18 jurisdictions permit police to petition for an ERPO; but only 13 allow family or household members to petition—and fewer still allow mental health care providers, health care providers, or school staff to petition.

    Similarly, after an ERPO is issued, only six states allow individuals to surrender their firearms to someone other than law enforcement (e.g., qualified firearms dealer or eligible individuals). If ERPOs are to maximize their effectiveness as a suicide prevention tool, lawmakers should expand both petition and firearm surrender options. These are rational and equitable changes for ERPOs issued to protect an individual from self-harm and fatality, not harm to others.

Such measures can strengthen suicide prevention by reducing fatal police encounters and directing appropriate mental health services to individuals in crisis. It is essential to reimagine suicide prevention to eliminate unnecessary use of police and to forge a new path forward that does not result in additional trauma or even death of the very persons whose life—and quality of life—suicide prevention advocates are seeking to protect.

This post written by April Shaw, Staff Attorney, Network for Public Health Law – Northern Region Office, with research assistance by Madeline Kim, Public Health Associate – National and Northern Region Offices.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.