Joe Biden wants a psychiatrist or psychologist to accompany law-enforcement on calls

[FrankLake]

do you think something like this would be affective? why or why not?

Would you be interested in a job like that?

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[WisNeuro]

Many jurisdictions already embed MH professionals with law enforcement, or have specific MH resource units that respond to such calls. At least in the jurisdictions I am familiar with, these are usually social workers. Probably more cost effective than doctoral level providers .Additionally, many of the cases would require case management, probably also more helpful.

 

[wolfvgang22]

I wouldn't be opposed to such a job if the compensation and responsibilities were reasonable. That said, it is probably more economical to utilize social workers and specially trained police units with a psychiatrist available in an ER providing supervision, as is done in some places already. Mostly larger cities have this already but are understaffed.

 

[WisNeuro]

I wouldn't be opposed to such a job if the compensation and responsibilities were reasonable. That said, it is probably more economical to utilize social workers and specially trained police units with a psychiatrist available in an ER providing supervision, as is done in some places already. Mostly larger cities have this already but are understaffed.

This is the key issue. One of the metro PDs has an embedded SW, note the singular. So, it'd be fairly hard to look at meaningful outcome data with relatively few interactions overall. That being said, I am all about expansion of MH within PD settings, or MH units taking over certain responsibilities. Most likely an initial startup cost that will have to be eaten, but if properly tied into local healthcare systems, probably a substantial net savings in the long-term if done right.

 

[deleted480308]

do you think something like this would be affective? why or why not?

Would you be interested in a job like that?

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It’s absurd, no way that expense is affordable

 

[Stagg737]

do you think something like this would be affective? why or why not?

Would you be interested in a job like that?

clip:

Not effective at all, there aren't enough psychiatrists, or probably even total physicians, in the country to do this. Even the suggestion of having a psychiatrist or PhD/PsyD level psychologist go to every call is laughable. Having someone "on call" as a standby to remotely advise police and evaluate once a patient is brought in is something I think would be feasible in most major metros, but actually having someone ride along? Not a chance.

You could not pay me enough money to do a job where I'd ride along with police. If that were my only career option after residency, I would legitimately consider leaving right now.

 

[PikminOC]

It’s absurd, no way that expense is affordable

Do the Democrats ever care about cost?

 

[dl2dp2]

NYPD has embedded lawyers, apparently.

I'd do it but it'd have to be the right price. And my prices are very high LOL.

 

[Sushirolls]

Its a horrible idea.

-Not fiscally viable.
-Waste of education for a Psychiatrist/Psychologist to be there.
-Some people are truly exhibiting criminal behavior and need to be incarcerated, this almost is the delegating the role of a judge at time of crisis to some one say this is criminal vs not. Psych/Psych typically take criminality very seriously with complete forensic level evaluations and even scales testing out malingered symptoms.

Too much to type. Just dumb, pure dumb idea.

 

[Sushirolls]

Nor should there even be a Social Worker at each call either.

 

[wolfvgang22]

Do the Democrats ever care about cost?

Do Republicans either? Let's not talk about the deficit under the current administration, even prior to COVID.

 

[WisNeuro]

Nor should there even be a Social Worker at each call either.

Political soundbite aside, if you take every political soundbite at its literal word, that's your problem. But, by and large, the proposals and real world uses of the SW embedding are not meant to be accompanying PD on every call. Rather, they are utilized in specific instances, generally not instances of unstable, violent behavior. At least the one here is meant to work with things such as chronically homeless, suicidal intent, or other MH urgent/crisis situations.

 

[Mad Jack]

do you think something like this would be affective? why or why not?

Would you be interested in a job like that?

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More importantly, who does he think would want such a job

 

[Mad Jack]

Its a horrible idea.

-Not fiscally viable.
-Waste of education for a Psychiatrist/Psychologist to be there.
-Some people are truly exhibiting criminal behavior and need to be incarcerated, this almost is the delegating the role of a judge at time of crisis to some one say this is criminal vs not. Psych/Psych typically take criminality very seriously with complete forensic level evaluations and even scales testing out malingered symptoms.

Too much to type. Just dumb, pure dumb idea.

It's like the ridiculousness of an inpatient consult service x100

 

[adaptation1]

lol what am I going to do at the call? stand there and eat chips? I'd be quite useless in these type of situations.

 

[calvnandhobbs68]

So yes, this is overkill. Probably have a crisis social worker on call to go with police on likely psychiatric crisis situations or situations where it's obvious someone probably needs de-escalation. It would also help triage out some of the situations where someone who's just acting like a criminal gets brought to the ER (or might get people brought in who are actually manic/psychotic but are being called because they're wandering the streets acting weird).

Police don't get the best training in the world in de-escalation (or at least aren't necessarily deploying this successfully in many critical situations). There are quite a few recent well-publicized events of police seriously injuring or killing someone who was likely just developmentally delayed or psychotic/manic. This would be most helpful in smaller areas, many larger cities already have some kind of mobile crisis/mental health service staffed with social workers who goes out to see SI/psychosis/mania calls instead of PD.

I don't know if people really realize how much crap gets dumped on PD/EMS lap that they don't really have a lot of training in or aren't really trained to handle. Basically anyone can call 911 for anything and they have to send someone out there if it remotely sounds like a problem. Whittling down this proposal to an actual cost-effective suggestion, he's just talking about what's already done with crisis services in cities that have them.

 

[Shufflin]

do you think something like this would be affective? why or why not?

Would you be interested in a job like that?

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Do I get a tranquilizer gun filled with a haldol/ativan/benadryl cocktail?

 

[Sushirolls]

Doubtful... we're trying to improve the law enforcement experience, and will send out a law enforcement specific press ganey surveys after every call out. Your only cocktail will be a new branded (costly) FDA approved drug patent, that comes in lavender scent, infused with CBD oil and needs to be applied as cream to maximize the healing and detoxifying properties of lavender with the Haldol/ativan/benadryl. This new practice venue will be the real "interventional psychiatry."

 

[Stagg737]

This would be most helpful in smaller areas, many larger cities already have some kind of mobile crisis/mental health service staffed with social workers who goes out to see SI/psychosis/mania calls instead of PD

And this is where the true problem lies imo. The places that would benefit from this the most are the same places that struggle to attract psychiatrists to normal outpatient or inpatient positions. What psychiatrist, psychologist, or even SW is going to move to BFE for an embedded position at rural police stations?

Doubtful... we're trying to improve the law enforcement experience, and will send out a law enforcement specific press ganey surveys after every call out. Your only cocktail will be a new branded (costly) FDA approved drug patent, that comes in lavender scent, infused with CBD oil and needs to be applied as cream to maximize the healing and detoxifying properties of lavender with the Haldol/ativan/benadryl. This new practice venue will be the real "interventional psychiatry."

Every MH worker will get a bottle of Spravato...

 

[Old&InTheWay]

I think we should just replace most of the police with social workers who could do the community outreach/social work part of policing. The police would sit in their stations, like firefighters do, waiting to be called out when they are actually needed/wanted.

Its not surprising the police are constantly using unnecessary force; they go out looking for and expecting trouble. If the firefighters patrolled neighborhoods like the police currently do, you know they’d sometimes “choke” (as POTUS would say) too, and start hosing down some poor guy smoking a cigarette or sitting by the fire pit.

Now social workers, they’d go out looking for and expecting to find people who need help. And then they would find them. They’d probably choke sometimes too, but I’d rather have someone accidentally get some empathic listening that they didn’t need than shot.

 

[deleted480308]

I think we should just replace most of the police with social workers who could do the community outreach/social work part of policing. The police would sit in their stations, like firefighters do, waiting to be called out when they are actually needed/wanted.

Its not surprising the police are constantly using unnecessary force; they go out looking for and expecting trouble. If the firefighters patrolled neighborhoods like the police currently do, you know they’d sometimes “choke” (as POTUS would say) too, and start hosing down some poor guy smoking a cigarette or sitting by the fire pit.

Now social workers, they’d go out looking for and expecting to find people who need help. And then they would find them. They’d probably choke sometimes too, but I’d rather have someone accidentally get some empathic listening that they didn’t need than shot.

Shy of serving subpoenas exactly what calls that cops go out to all the time would be more appropriate for a social worker?

 

[FlowRate]

I wouldn't be opposed to such a job if the compensation and responsibilities were reasonable. That said, it is probably more economical to utilize social workers and specially trained police units with a psychiatrist available in an ER providing supervision, as is done in some places already. Mostly larger cities have this already but are understaffed.

I've had enough patients try to assault me even after they've been (temporarily) restrained, sedated, and placed in a less stimulating environment. I have absolutely no interest in being on scene with undifferentiated agitated citizens.

It's EMS who get the real crap end of this stick, with PD not wanting to help subdue/transport these folks.

 

[wolfvgang22]

Shy of serving subpoenas exactly what calls that cops go out to all the time would be more appropriate for a social worker?

Are you serious? A large portion of calls to police from hospitals are regarding people who need help. Our social workers call police for "well checks" daily on our vulnerable patients.

Most of our patients who are admitted to the psychiatric hospital involuntarily are not trying to harm anyone other than themselves, but sometimes may have firearms or be intoxicated. Having trained people who know how to speak with patients with mental illness rather than escalate situations would be great. I think my local police do a great job most of the time but often they have told me they would love some more help in this area rather than just winging it and hope being a good person is enough.

 

[calvnandhobbs68]

Shy of serving subpoenas exactly what calls that cops go out to all the time would be more appropriate for a social worker?

I agree with this though, social workers shouldn't be out on their own on undifferentiated 911 calls. As noted above, what happens when they run into truly violent situations, especially when a large proportion of the American population has access to firearms? They have no authority to physically respond in force and this opens them up to a huge risk of violence. A much safer model is for a social worker to be going along with police so that when they've assessed the situation, they're able to intervene if able and needed.

For instance, the reason social workers have police involved for "well checks" is that social workers alone have limited means and no authority to forcibly enter a residence. Police do have the authority to enter a residence without a warrant or permission if they have reasonable grounds to believe they need to enter to prevent someone inside from being seriously injured or killed (thus, the "well check" aspect of this) and have the means to do this.

 

[deleted480308]

Are you serious? A large portion of calls to police from hospitals are regarding people who need help. Our social workers call police for "well checks" daily on our vulnerable patients.

Most of our patients who are admitted to the psychiatric hospital involuntarily are not trying to harm anyone other than themselves, but sometimes may have firearms or be intoxicated. Having trained people who know how to speak with patients with mental illness rather than escalate situations would be great. I think my local police do a great job most of the time but often they have told me they would love some more help in this area rather than just winging it and hope being a good person is enough.

I’m very serious for the reasons @calvnandhobbs68 mentioned sending sws alone is not a good idea so the notion to just send home half the police and sws can do their jobs is not well thought out

 

[wolfvgang22]

I’m very serious for the reasons @calvnandhobbs68 mentioned sending sws alone is not a good idea so the notion to just send home half the police and sws can do their jobs is not well thought out

I had not heard anyone actually wanting to send social workers alone, I agree that would be a bad idea.

 

[Dalemane]

maybe we should approach the problem from another angle and do a more thorough screening as well as education of police officers

 

[WisNeuro]

maybe we should approach the problem from another angle and do a more thorough screening as well as education of police officers

Good luck getting most unions to agree to this.

 

[NickNaylor]

I think there's a role for MH professionals accompanying police on calls that seem like they're MH-related, but I don't think they should be doing so alone for the reasons mentioned above in addition to the very real safety concerns, and I don't think that a psychiatrist is the best person to be involved in these encounters.

 

[PikminOC]

Do Republicans either? Let's not talk about the deficit under the current administration, even prior to COVID.

The military had been defunded by alot under obama, this had to be built back up again. M4a and green new deal will cost much more than that.

 

[WisNeuro]

The military had been defunded by alot under obama, this had to be built back up again. M4a and green new deal will cost much more than that.

In general. his numbers were on par with Bush. Many of the sequestration cuts were provisions of the Budget Control Act, not an act of the WH. This talking point doesn't really stand up to muster when you look at the real numbers and causes for things.

 

[Stagg737]

I had not heard anyone actually wanting to send social workers alone, I agree that would be a bad idea.

I believe this was proposed at one point in Minneapolis by their city council after they passed the motion to dismantle city's PD. I've also heard it suggested through other sources (some local SWs), but have not heard of it being heavily pushed. Although our VA system already does this with regular well-checks on many of our SPMI patients.

 

[PikminOC]

In general. his numbers were on par with Bush. Many of the sequestration cuts were provisions of the Budget Control Act, not an act of the WH. This talking point doesn't really stand up to muster when you look at the real numbers and causes for things.

Citation please. And bush's number pre or post 9 11? We have more threats then back then.

Congress and Obama Depleted the Military

The Trump budget would increase spending only 3%. With today’s threats, that’s not nearly enough.

www.google.com

 

[WisNeuro]

Citation please. And bush's number pre or post 9 11? We have more threats then back then.

Congress and Obama Depleted the Military

The Trump budget would increase spending only 3%. With today’s threats, that’s not nearly enough.

www.google.com

Fact-checking GOP candidate claims on Obama's military spending

Trashing Obama and arguing that he has failed to spend enough on defense has become a staple for Republican presidential hopefuls. What's lost in the din: Money spent on weapons modernization is on par with the George W. Bush administration.

www.pbs.org

And we didn't have more threats back then, merely more business interests to protect for wealthy donors and party members.

 

[psydoc80]

I agree that there are designated crisis intervention teams that are part of the emergency calls. These teams are deployed when there is a mental health crisis. If there are not enough of them then open more jobs. For criminal related calls or/and drugs intoxicated calls ie George Floyd, the guy that the gf called for DV and had a knife in the car, then NO. No mental health professionals are able to de-escalate a criminal or someone who is intoxicated. It will be costly, not effective, and open up lots of liability if those people get hurt. As a psychiatrist I don't want to be involved in crisis intervention on the street (even with police present). You don't need a psychiatrist for that. Unless it is my patient that is in a crisis, I'm not interested.

 

[birchswing]

The military had been defunded by alot under obama, this had to be built back up again. M4a and green new deal will cost much more than that.

Built back up to do what?

Maybe the military could do something like build a high-speed railroad. You know infrastructure building, like our military does in other countries after we've helped destroy them.

 

[PikminOC]

Fact-checking GOP candidate claims on Obama's military spending

Trashing Obama and arguing that he has failed to spend enough on defense has become a staple for Republican presidential hopefuls. What's lost in the din: Money spent on weapons modernization is on par with the George W. Bush administration.

www.pbs.org

And we didn't have more threats back then, merely more business interests to protect for wealthy donors and party members.

We will have to agree to disagree

 

[WisNeuro]

We will have to agree to disagree

Being presented with facts has a tendency to do that.

 

[PikminOC]

Being presented with facts has a tendency to do that.

My article didn't have facts?

 

[Mass Effect]

You could not pay me enough money to do a job where I'd ride along with police. If that were my only career option after residency, I would legitimately consider leaving right now.

I'm the opposite. I would do it for the right salary (and life/disability insurance). I worked in homeless outreach with police and love it. I think there are probably a lot of psychiatrists/psychologists who would be interested in something like this, but definitely not enough.

 

[Mass Effect]

And this is where the true problem lies imo. The places that would benefit from this the most are the same places that struggle to attract psychiatrists to normal outpatient or inpatient positions. What psychiatrist, psychologist, or even SW is going to move to BFE for an embedded position at rural police stations?

Offer full loan reimbursement and a healthy salary and you'd be impressed at who would move out to BFE Montana to do this job.

 

[Osminog]

Police vehicles should be used as interprofessional clowns cars, packed to the brim with psychiatrists, social workers, career counselors, plumbers, insurance salesmen... and heck, maybe even a police officer or two. That way, no matter what the nature of the encounter is, the right person will be on the scene.

 

[Stagg737]

I'm the opposite. I would do it for the right salary (and life/disability insurance). I worked in homeless outreach with police and love it. I think there are probably a lot of psychiatrists/psychologists who would be interested in something like this, but definitely not enough.

I worked as a EMT for several years before med school. While I did enjoy it, there were several times that I wish I’d had a firearm to defend myself and I had a few coworkers end up in the hospital with serious injuries because calls suddenly took unexpected turns. Now that I have a family, you could not pay me enough to put myself in those situations again.

Offer full loan reimbursement and a healthy salary and you'd be impressed at who would move out to BFE Montana to do this job.

Doubtful. I’ve seen plenty of these positions and actually recently talked to a few of the recruiters for these positions at virtual fairs. One or two of them ~1-2 hours outside my current city have literally been open for years (one was where I did my rural IM rotation in med school and still hasn’t filled 5 years later).

I’m sure you could get someone to do locums there short-term with the right offer, I just don’t believe you’re going to fill many of these positions unless you offer unrealistic reimbursement.

 

[calvnandhobbs68]

Police vehicles should be used as interprofessional clowns cars, packed to the brim with psychiatrists, social workers, career counselors, plumbers, insurance salesmen... and heck, maybe even a police officer or two. That way, no matter what the nature of the encounter is, the right person will be on the scene.

You're hilarious med student. Police departments were somehow able to handle whole camera crews when they wanted to flash their badges on COPS or whatever local spinoff they'd have...I feel like they'd be able to handle a social worker in a car.

 

[whopper]

While we're at it why not good looking dancers in skimpy outfits go along with the police so if they see a domestic dispute the dancers could do their thing and lift the spirits of the people in the dispute?


Years back in residency the local police wanted the PES I worked in to have a nurse they can rely upon to go up to acute dangerous people they suspected of having a psych problem. The police would have no idea if the person was armed, how dangerous the person was, and in instance asked the nurse to show up (she naively did) and the person was armed with a gun and the police wanted her to go in by herself to diffuse the situation. Well she got there and refused to go in. The police thought cause she was a psych nurse she had some type of Jedi Mind Trick to make the guy with a gun want to put it down and give up.

Psych's come a long way since back in the day when I was a resident. Now no cop (or anyone) would think this but back in the day idiots thought psychiatrists could look at them and read their soul, wave their finger and make that person calm down. Some idiot psychiatrists today still pull BS like that.

HOLY $HIT. This is what pisses me off about liberals and I consider myself a social liberal. They think they know how the system works and without knowing jack tell everyone how the problem needs to be fixed often times by dumping money into it without even considering the existing data showing the approach doesn't work. (The Right is ticking me off too thinking they know science when it's obvious their knowledge is pretty much nothing). Oh boy I'll stop myself now before I go on my rant about "defund the police by doing everything that increases a police budget but let's call it defund even though it makes no sense!"

Offer full loan reimbursement and a healthy salary and you'd be impressed at who would move out to BFE Montana to do this job.

What kind of salary? Like over 500K a year? Cause that's what a psychiatrist could make in Montana without doing this type of work.

I saw the Biden video above and yes he did say he wanted a psychologist or psychiatrist in the squad car but to be fair his bigger point was a "national committee to figure this out" made of police and mental health professionals.

 

[calvnandhobbs68]

While we're at it why not good looking dancers in skimpy outfits go along with the police so if they see a domestic dispute the dancers could do their thing and lift the spirits of the people in the dispute?


Years back in residency the local police wanted the PES I worked in to have a nurse they can rely upon to go up to acute dangerous people they suspected of having a psych problem. The police would have no idea if the person was armed, how dangerous the person was, and in instance asked the nurse to show up (she naively did) and the person was armed with a gun and the police wanted her to go in by herself to diffuse the situation. Well she got there and refused to go in. The police thought cause she was a psych nurse she had some type of Jedi Mind Trick to make the guy with a gun want to put it down and give up.

Psych's come a long way since back in the day when I was a resident. Now no cop (or anyone) would think this but back in the day idiots thought psychiatrists could look at them and read their soul, wave their finger and make that person calm down. Some idiot psychiatrists today still pull BS like that.

HOLY $HIT. This is what pisses me off about liberals and I consider myself a social liberal. They think they know how the system works and without knowing jack tell everyone how the problem needs to be fixed often times by dumping money into it without even considering the existing data showing the approach doesn't work. (The Right is ticking me off too thinking they know science when it's obvious their knowledge is pretty much nothing). Oh boy I'll stop myself now before I go on my rant about "defund the police by doing everything that increases a police budget but let's call it defund even though it makes no sense!"

What kind of salary? Like over 500K a year? Cause that's what a psychiatrist could make in Montana without doing this type of work.

I saw the Biden video above and yes he did say he wanted a psychologist or psychiatrist in the squad car but to be fair his bigger point was a "national committee to figure this out" made of police and mental health professionals.

Examples of police using resources inappropriately (availability of a crisis social worker/nurse/whatever) doesn’t negate the idea. This is like saying we should disarm all the police because of unjustified shootings.

Saying some stupid thing like “why don’t we send exotic dancers in so they can distract everyone har har har” is 1) obviously dumb and that’s why you said it and 2) has no basis in the actual problems people are trying to address with this approach. This is an approach utilized in cities with mobile crisis teams to good success as far as I can tell and avoids police + EMS being called for every nonviolent suicidal person or psychotic person acting weird at a bus stop.

Where is this data showing that this approach DOESNT work as youre stating above?

 

[whopper]

Examples of police using resources inappropriately (availability of a crisis social worker/nurse/whatever) doesn’t negate the idea. This is like saying we should disarm all the police because of unjustified shootings.

I agree. There is a lot of lack of knowledge among police when to use mental health providers, but simply adding a doctor or nurse is too simplistic an approach. A committee on hashing this out, however, does make sense.

h. This is an approach utilized in cities with mobile crisis teams to good success as far as I can tell and avoids police + EMS being called for every nonviolent suicidal person or psychotic person acting weird at a bus stop.

A problem being that police may be needed until the situation is considered non-violent. E.g. someone reports a homeless person out in the middle of the night. A lone social worker/nurse/doctor approaching said person could be in for an assault. That's the problem with flippantly just suggesting mental health provider without adding in that the situation has to be cleared as non-dangerous first. Another example is the nurse I brought up above. The police expected her to confront an armed and dangerous person all by herself.

IMHO what should happen is mental health provider sees the person once the police officer clears the person as non-violent, or mental health provider approaches the person with police protection after the police have done all they can to offer a situation report (e.g. "I saw this guy for 10 minutes, he appears confused because he's talking gibberish. Doesn't appear armed, no signs of hostile intent.") Also IMHO all ERs in urban settings need a PES.

What I've been hearing a lot of are people who don't know the situation (you do-you're a provider who's seen this thing happen) and say "yeah get rid of all police, instead we should have nurses do everything." Um no.

The data that "this doesn't work" comes from clinical experience. Also I'm not going to do a controlled experiment where I tell a 65 year old psych nurse who is by herself to go into a house where there's an armed person saying he's going to kill himself to obtain that data. So next best thing is clinical experience. We wouldn't do that to a nurse if on a psych unit.

 

[michaelrack]

Examples of police using resources inappropriately (availability of a crisis social worker/nurse/whatever) doesn’t negate the idea. This is like saying we should disarm all the police because of unjustified shootings.

I agree.... disarming the police would be almost as bad as the current Democrat plan to abolish the police

 

[asdf123g]

Just another politician saying what sounds nice to get elected even though its not realistic