Mental health professionals and police work

[cara susanna]

Hi everyone,

I'm sure that you've all heard about the proposals going around for "defund the police" or "community policing," which to my understanding would involve shifting some of the traditional responsibilities of police to mental health workers. I am wondering how we all feel about that. Although I think that this is a very good idea in many ways, I am concerned about the implications it could have for our profession as I feel like we already expected to be a panacea for violent behavior. What do you guys think?

I'm also aware that most people seem to be mentioning social workers specifically, not psychologists, although I have seen therapists mentioned. So I'm not sure to what extent it would impact psychologists specifically.

(Btw, to limit the likelihood of this thread turning into a dumpster fire, please keep your thoughts focused as much as possible on how this would impact mental health workers and not thoughts on these proposals in general.)

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[WisNeuro]

Some jurisdictions have been already doing a sort of hybrid model, pairing MH with PD

St. Paul police expanding new mental health unit

The St. Paul Police Department deals with thousands of expensive calls related to mental health problems. They're expanding its mental health unit to help deal with calls that are not crisis level.

www.mprnews.org

 

[cara susanna]

Some jurisdictions have been already doing a sort of hybrid model, pairing MH with PD

St. Paul police expanding new mental health unit

The St. Paul Police Department deals with thousands of expensive calls related to mental health problems. They're expanding its mental health unit to help deal with calls that are not crisis level.

www.mprnews.org

Yes, I recently learned about MH units at a conference and they seem like a really good idea. So maybe just expanding those is the key.

 

[WisNeuro]

Yes, I recently learned about MH units at a conference and they seem like a really good idea. So maybe just expanding those is the key.

Yeah, they made a big deal about it when they first started up, but besides hiring a few more MH people last year, I haven't heard much more about it in the news.

 

[futureapppsy2]

I have an acquaintance who is a masters-level clinician who works as first-responder with the police (she's paired with a LEO for crisis and MH calls). Personally, I think getting the police involved in things like safety checks and suicide prevention was an incredibly poor move as a society, as the behaviors selected for with police officers (suspicion, aggression, hostility) are the exact opposite of behaviors you need when working with someone who is suicidal and will much more likely make the situation worse rather than better (I also don't think we should criminalize suicidality, though).

 

[Sanman]

I have an acquaintance who is a masters-level clinician who works as first-responder with the police (she's paired with a LEO for crisis and MH calls). Personally, I think getting the police involved in things like safety checks and suicide prevention was an incredibly poor move as a society, as the behaviors selected for with police officers (suspicion, aggression, hostility) are the exact opposite of behaviors you need when working with someone who is suicidal and will much more likely make the situation worse rather than better (I also don't think we should criminalize suicidality, though).

Agreed. I do think that this is a bit of a band-aid though. What you need is psychologists in the training arena and shift in focus of all the workers. From a population stand point, you want as many people trained as possible with as little cost as possible to address needs that are non-violent and community focused. In the same way I have trained nursing assistants as a psychologist, there needs to be better training and first responder teams that include engagement specialists (just like they have hostage negotiators). You don't need a doctorate to problem-solve and not shoot someone or hold them down. Watching George Floyd's death, not one cop asked him why he was upset and tried to de-escalate the situation like any mental health worker might be trained to do.

 

[beginner2011]

This is an excellent summary of the evidence regarding police reform (up to 10/2019, when this was originally posted):


White Bird Clinic in OR (mentioned in tweet #8) is also a great example of integration of mental health unit into emergency response:

 

[WisNeuro]

Agreed. I do think that this is a bit of a band-aid though. What you need is psychologists in the training arena and shift in focus of all the workers. From a population stand point, you want as many people trained as possible with as little cost as possible to address needs that are non-violent and community focused. In the same way I have trained nursing assistants as a psychologist, there needs to be better training and first responder teams that include engagement specialists (just like they have hostage negotiators). You don't need a doctorate to problem-solve and not shoot someone or hold them down. Watching George Floyd's death, not one cop asked him why he was upset and tried to de-escalate the situation like any mental health worker might be trained to do.

Totally agree with additional, but effective training. But, this also goes beyond that simple training. In this example, MPD has a particularly strong union. Our police chief has tried to remove a number of officers over the years fora variety of misconduct, but a shocking percentage of those are fuly reinstated after a grievance by the union. Some of the instances Chauvin has been involved in have been chilling to say the least. Extra training doesn't go very far when you can't remove bad apples and they have free rein to do what they want without consequence a good deal of the time.

 

[Sanman]

Totally agree with additional, but effective training. But, this also goes beyond that simple training. In this example, MPD has a particularly strong union. Our police chief has tried to remove a number of officers over the years fora variety of misconduct, but a shocking percentage of those are fuly reinstated after a grievance by the union. Some of the instances Chauvin has been involved in have been chilling to say the least. Extra training doesn't go very far when you can't remove bad apples and they have free rein to do what they want without consequence a good deal of the time.

Oh, I don't disagree at all. You would likely need to do what Camden NJ did and basically create a new police structure.

 

[cara susanna]

I definitely think that MH needs to be more involved in welfare checks and suicidality situations. I think I'm wondering more about homicidal behavior or physical violence towards others. In our clinic, we always have security or police on standby when we have patients with behavioral flags.

I also agree that accountability is a big part of this. My husband was expressing surprise that body cams haven't fixed more of these issues, and I responded that it's because even with video they still aren't facing consequences. Heck, George Floyd was captured entirely on video and even with that the consequences have been lackluster.

 

[WisNeuro]

Oh, I don't disagree at all. You would likely need to do what Camden NJ did and basically create a new police structure.

Indeed, seems to have worked in some ways. I am not for a disband type of response to PDs, more of a reallocate funds for certain services to professionals who are better suited to those issues. However, if the police unions refuse to budge on reforms regarding transparency and immunity issues, I will indeed support and vote for officials who want to disband them in the future.

 

[cara susanna]

The Twitter thread beginner linked led me to this website, which has an excellent discussion of evidence-based solutions and how mental health would be involved. I feel like I have a better understanding now!

Campaign Zero

www.joincampaignzero.org

 

[JennXeno]

I plan on working as a police officer while in my last two years of school, we will see what happens now. What about having to expand the foster care systems because more social workers will be involved? The broken foster care systems are also in need of reform. Causality should be considered imo.

 

[BuckeyeLove]

What about having to expand the foster care systems because more social workers will be involved? The broken foster care systems are also in need of reform.

I think we could have an entire thread on this one.

 

[PsyDr]

I want a badge and a gun. And some old guy who demands I turn those in because I don’t play by the rules.

 

[MAClinician]

I think we could have an entire thread on this one.

Or the school to prison pipeline.

My agency has the emergency services contract in our area. A masters level clinician will complete an evaluation and determine if they need higher LOC or divert to community services, and if HLOC is determined it needs to be agreed by an MD before requesting auth from insurance. Last year the agency partnered with the city’s PD to have a clinician ride along with police for mental health intervention. I don’t have specific numbers but have heard there have been positive outcomes from this. There are other departments across the state that have hired social workers to support officers in the community with MH related calls. So it’s certainly promising.

 

[AbnormalPsych]

I want a badge and a gun. And some old guy who demands I turn those in because I don’t play by the rules.

@PsyDr, you knew the rules, but you couldn't help yourself! Turn in your MMPI-2-RFs and WAIS-IV Blocks.

 

[mojetter]

As soon as society stops patting police officers on the back, blindly thanking them for their service and stop buying into the "bad apple" exception the sooner the problem will right itself. We have a societal "good guys vs bad guys" culture and guess who gets to be the good guy...im so, so angry this is still happening...the use of force as an endpoint if you dont comply in any situation has to stop in American police culture

 

[beginner2011]

I saw a recent estimate that CAHOOTS (Crisis Assistance Helping Out On The Streets) costs taxpayers about $150 per dispatch, whereas the local PD response costs about $400 per dispatch.

 

[WisNeuro]

I saw a recent estimate that CAHOOTS (Crisis Assistance Helping Out On The Streets) costs taxpayers about $150 per dispatch, whereas the local PD response costs about $400 per dispatch.

And that's just per dispatch, just imagine the savings if we started decreasing the number of multimillion dollar settlements that are paid out regularly due to misconduct.

 

[BuckeyeLove]

Follow the money (as with most things). I got bored one day and looked up my city's CBA. The overtime pay...oh. my god. There have to be officers making 3-400k.

 

[WisNeuro]

Follow the money (as with most things). I got bored one day and looked up my city's CBA. The overtime pay...oh. my god. There have to be officers making 3-400k.

Yeah, *surprising* that when all of the union busting went down a while back in the guise of "fixing budgets" most legislatures wouldn't touch the unions that constituted the majority of the budget (police, fire). Of course, it didn't have anything to do with who they support politically...

 

[FlameHeart]

Personally, I'm all for integrating Trained Professionals to deal with Mental Health issues ride along with Police Officers dispatched to such suspected situations and also to train Police Officers to with a basic understanding of Phsychology as well.

It was bad what happened to George Floyd, that entire department needs heavy Internal Affairs and reform even criminal charges after removing thsoe responsible from the force.

But it is bad to go too much in the extreme and say that get rid of Police Officers altogether.

Crime isn't always a mental health issue, we have to acknowledge and accept that there are plenty of people who know full well what they are doing and choose to do break the law and do evil.

No amount of talking is going to save you when you got a gun pointed to your face.

On the other hand, how can we except criminals to come back on the streets as better people if we don't reach out to them in prison to get to know them and offer to help them reform their lives for the ones they love?

Disband the police, create your own society. Guess what? You will still struggle against corruption, selfishness, and abuse of power. Why? Because we are all tempted by that and some of us give in to that. That's reality.

The real solutions are to 1: give Internal Affairs (Police for the Police) real teeth and keep the bad apples out and prosecute them, make it stick. No Police Officer is above the law.

And 2: give better training to the Officers from actual Psychiatrists and Psychologists (both are important for the different perspectives) and even have actual Psychiatrists and Psychologists on the force for these situations.

You need both, The Police are there for when the criminals don't want to do any talking and the Psychiatrists and Psychologists are there to prevent a bad situation getting worse and maybe even work with this criminal while they serve their sentence to actually get them reformed.

 

[BuckeyeLove]

Crime isn't always a mental health issue, we have to acknowledge and accept that there are plenty of people who know full well what they are doing and choose to do break the law and do evil.

This. so. much. this. There's this trend I've seen the last 5ish years to attribute everything and all to complicated trauma that can somehow be "cured" through unpacking everyone's stuff in a haphazard fashion. Sometimes, just sometimes, people are bad for bad's sake.

 

[WisNeuro]

This. so. much. this. There's this trend I've seen the last 5ish years to attribute everything and all to complicated trauma that can somehow be "cured" through unpacking everyone's stuff in a haphazard fashion. Sometimes, just sometimes, people are bad for bad's sake.

But...but....we need the "mental illness" to explain away all of our mass killing gun violence...

 

[Sanman]

This. so. much. this. There's this trend I've seen the last 5ish years to attribute everything and all to complicated trauma that can somehow be "cured" through unpacking everyone's stuff in a haphazard fashion. Sometimes, just sometimes, people are bad for bad's sake.

And sometimes complicated trauma can't be cured or the person does not want the help. You can't fix all the bad things and sometimes it is society that needs to be fixed, not the individual.

 

[beginner2011]

But it is bad to go too much in the extreme and say that get rid of Police Officers altogether.

I think you'll find there are very few who are advocating for no peace officers of any kind ever again. Even people who are vehemently requesting police forces be "abolished," are stating that this is a necessary step in the process toward a new kind of police:

"Why on earth would we think the same reforms would work now? We need to change our demands. The surest way of reducing police violence is to reduce the power of the police, by cutting budgets and the number of officers."

source: Opinion | Yes, We Mean Literally Abolish the Police

The assumption that "Defund the Police" means "let all the aggressive and violent sociopaths run wild looting and pillaging the suburbs" is just a convenient straw-man.

 

[FlameHeart]

I think you'll find there are very few who are advocating for no peace officers of any kind ever again. Even people who are vehemently requesting police forces be "abolished," are stating that this is a necessary step in the process toward a new kind of police:

"Why on earth would we think the same reforms would work now? We need to change our demands. The surest way of reducing police violence is to reduce the power of the police, by cutting budgets and the number of officers."

source: Opinion | Yes, We Mean Literally Abolish the Police

The assumption that "Defund the Police" means "let all the aggressive and violent sociopaths run wild looting and pillaging the suburbs" is just a convenient straw-man.

Except there are people who have burned down Police Stations and taken over certain areas creating a chaotic Zone where might makes right.

We don't need less Police Officers, we need better Internal Affairs.

 

[WisNeuro]

Fewer, not less.

We probably do need fewer officers. They should not be answering most MH type calls. They are not trained for it, and they botch it a good deal of the time, or they just agitate the hell out of someone in a MH crisis and then dump them off in our ER. Trained MH pros can undoubtedly decrease deaths by police in this population, as well as reduce ER visits. Some cities that have already done this have seen pretty good results.

 

[Sanman]

Fewer, not less.

We probably do need fewer officers. They should not be answering most MH type calls. They are not trained for it, and they botch it a good deal of the time, or they just agitate the hell out of someone in a MH crisis and then dump them off in our ER. Trained MH pros can undoubtedly decrease deaths by police in this population, as well as reduce ER visits. Some cities that have already done this have seen pretty good results.

Agreed. The problem is not really police officers as much as it is a lack of alternative services when there is a problem. At the end of the day, we need to "right size" law enforcement budgets and offer other services to help address societal needs. The question is what is the right size and correct response. For example, in the Rayshard Brooks shooting, would an unarmed social worker be comfortable approaching a drunk man alone or would an officer need to be on the scene in case of violence? These are tough questions that need answering.

 

[WisNeuro]

Agreed. The problem is not really police officers as much as it is a lack of alternative services when there is a problem. At the end of the day, we need to "right size" law enforcement budgets and offer other services to help address societal needs. The question is what is the right size and correct response. For example, in the Rayshard Brooks shooting, would an unarmed social worker be comfortable approaching a drunk man alone or would an officer need to be on the scene in case of violence? These are tough questions that need answering.

This doesn't need to be an either or situation. Some jurisdictions pair MH workers with a police officer to respond to MH situations.

 

[Sanman]

This doesn't need to be an either or situation. Some jurisdictions pair MH workers with a police officer to respond to MH situations.

I'm aware, hence my question about what a budget realistically needs to be for a police department. In some instances you are not reducing costs, but adding to them. Society needs to decide how much they want to spend on these concerns and in what manner.

 

[WisNeuro]

I'm aware, hence my question about what a budget realistically needs to be for a police department. In some instances you are not reducing costs, but adding to them. Society needs to decide how much they want to spend on these concerns and in what manner.

Well a good first step would be to actually allow audits of PDs finances (in many jurisdictions, they are only required to audit themselves), scale back the bloated pension system, and stop spending billions of dollars to buy military equipment usually only used in war zones. I feel like that might go a LONG way in reducing budgets.

 

[thebalmofhurtminds]

I'm aware, hence my question about what a budget realistically needs to be for a police department. In some instances you are not reducing costs, but adding to them. Society needs to decide how much they want to spend on these concerns and in what manner.

Isn't there an insane amount of the budget spent on police misconduct settlements? I would hazard a guess that the low cost of a MH professional partner might decrease that substantially...

 

[Sanman]

Isn't there an insane amount of the budget spent on police misconduct settlements? I would hazard a guess that the low cost of a MH professional partner might decrease that substantially...

I think that will depend on implementation and training. Who is in charge on the scene, the MH pro or the officer? If it is the officer, would the Rayshard Brooks scenario have ended in exactly the same way, but with a SW also standing there?

 

[WisNeuro]

Isn't there an insane amount of the budget spent on police misconduct settlements? I would hazard a guess that the low cost of a MH professional partner might decrease that substantially...

I mean, if you consider 20 million for one single settlement a high amount...

 

[thebalmofhurtminds]

I mean, if you consider 20 million for one single settlement a high amount...

Tis but a flesh wound.

 

[BuckeyeLove]

I had an interesting experience yesterday at the grocery store. There was a man right outside the door, and he appeared to be evidencing active symptoms of psychosis (disorganized/tangential speech, slight indications of grandiosity, etc.) and likely hypomanic. He did not appear to be a danger to himself or others, or in any way shape or form pink slipable [sic]. I didn't get the feeling he was high on meth either. Anyway, the workers were discussing calling the police on my way out, as he was pacing and appearing to amp up. As I walked out, he approached me and began to rant in a way that very much solidified my initial hypothesis about what he was experiencing. Now...I'm not here to say how great I am, let me say that out the gate, merely to describe my interaction with him and result. I very simply validated some of his concerns, asked a few clarifying questions, and then bam, he left and went on his way. The workers then came out and were like "Oh man, we were so scared to say anything to him, we were just about to call the cops."

Here's the thing, I work on an acute inpatient unit at a state hospital. I know how to talk to individuals evidencing psychosis and mania in ways that usually don't lead to escalation and often can deescalate with the best of them. But I have years of education, training, and experience. Had they called the cops, I honestly don't know what would have happened, but I know they likely aren't taught those skills during training, so why would we expect them to be able to do that? There has to be a better way though. Anyway, rambling done.

 

[beginner2011]

I had an interesting experience yesterday at the grocery store. There was a man right outside the door, and he appeared to be evidencing active symptoms of psychosis (disorganized/tangential speech, slight indications of grandiosity, etc.) and likely hypomanic. He did not appear to be a danger to himself or others, or in any way shape or form pink slipable [sic]. I didn't get the feeling he was high on meth either. Anyway, the workers were discussing calling the police on my way out, as he was pacing and appearing to amp up. As I walked out, he approached me and began to rant in a way that very much solidified my initial hypothesis about what he was experiencing. Now...I'm not hear to say how great I am, let me say that out the gate, merely to describe my interaction with him and result. I very simply validated some of his concerns, asked a few clarifying questions, and then bam, he left and went on his way. The workers then came out and were like "Oh man, we were so scared to say anything to him, we were just about to call the cops."

Here's the thing, I work on an acute inpatient unit at a state hospital. I know how to talk to individuals evidencing psychosis and mania in ways that usually don't lead to escalation and often can deescalate with the best of them. But I have years of education, training, and experience. Had they called the cops, I honestly don't know what would have happened, but I know they likely aren't taught those skills during training, so why would we expect them to be able to do that? There has to be a better way though. Anyway, rambling done.

I remember several years ago when I was in a coffee shop with a non-MH friend and a naked woman who looked fairly disheveled came through the front doors and sat at a booth by herself. She appeared to be having a psychotic/manic/drug-induced episode of some sort, although I didn't get close enough to really make much of a determination. Two police officers followed hot on her heels and when she didn't follow their orders to leave the store things escalated quickly to a fairly aggressive shouting match before the officers ultimately wrestled her to the ground and held her down while they handcuffed her. I remember her shouting "somebody help me!" repeatedly when they began to be physically violent with her. I was only in my third year of training, but was working on an inpatient unit at the time and felt regret that I didn't do something to help her. I'm not sure what I could have done, given the circumstances, but I do think that validation and deescalation from the authorities could have reduced harm and difficulty in the interaction.

I appreciate you sharing a more encouraging outcome.

 

[msc545]

I had an interesting experience yesterday at the grocery store. There was a man right outside the door, and he appeared to be evidencing active symptoms of psychosis (disorganized/tangential speech, slight indications of grandiosity, etc.) and likely hypomanic. He did not appear to be a danger to himself or others, or in any way shape or form pink slipable [sic]. I didn't get the feeling he was high on meth either. Anyway, the workers were discussing calling the police on my way out, as he was pacing and appearing to amp up. As I walked out, he approached me and began to rant in a way that very much solidified my initial hypothesis about what he was experiencing. Now...I'm not here to say how great I am, let me say that out the gate, merely to describe my interaction with him and result. I very simply validated some of his concerns, asked a few clarifying questions, and then bam, he left and went on his way. The workers then came out and were like "Oh man, we were so scared to say anything to him, we were just about to call the cops."

Here's the thing, I work on an acute inpatient unit at a state hospital. I know how to talk to individuals evidencing psychosis and mania in ways that usually don't lead to escalation and often can deescalate with the best of them. But I have years of education, training, and experience. Had they called the cops, I honestly don't know what would have happened, but I know they likely aren't taught those skills during training, so why would we expect them to be able to do that? There has to be a better way though. Anyway, rambling done.

Well done! However, you cannot train police officers to be mental health workers, or even train them to reliably de-escalate tense situations. The kind of people that are selected to be police officers are generally of average to low average intelligence, rigid, hostile, and suspicious by nature, and tend to resolve situations with violence. The training they receive in police academies only reinforces these characteristics. No amount of subsequent training will mitigate these traits to the point that they are no longer a problem. Sending MH workers with them may help to some degree, particularly if the MH worker is in charge, but this presents a whole raft of new problems.

Revising selection criteria for police officers, and revising their initial training are the only things I can think of that would reduce their chronic violence.

 

[Therapist4Chnge]

If local/county/state LEO were held to the same screening standards as the FBI and related 3-letter agencies, there would likely be less violence. However, the reason why that would happen is because their standards are higher in regard to the interview process, background checks, education requirements, training standards, etc. They pay more too, so they can attract a higher caliber candidate. It could actually work if the funding for police were significantly altered to re-allocate resources towards more MH and support services and only a small group of hand-picked officers were needed to respond to violent crimes, etc.

 

[Mama Bear]

The other side of the coin is sending MH workers into situations that end up being law enforcement issues (e.g., violence occurs anyway, MH doesn’t end up being the primary issue). MH workers who take this role would need training to respond to violence. Also, do people who self-select this role share many characteristics of police officers?

 

[PsyDr]

If local/county/state LEO were held to the same screening standards as the FBI and related 3-letter agencies, there would likely be less violence. However, the reason why that would happen is because their standards are higher in regard to the interview process, background checks, education requirements, training standards, etc. They pay more too, so they can attract a higher caliber candidate. It could actually work if the funding for police were significantly altered to re-allocate resources towards more MH and support services and only a small group of hand-picked officers were needed to respond to violent crimes, etc.

Bro.... Some are raking in $300k or more... Plus pension.

Boston’s highest-paid worker: a cop accused of payroll abuse in 2007 - The Boston Globe

A Globe review of city payment records shows that the police payroll has jumped dramatically in the past decade, increasing by $125 million — or 43 percent — since 2011. Overtime growth has been even more significant, with an additional $35.5 million — 84 percent — spent over the same period.

www.bostonglobe.com

 

[Therapist4Chnge]

OT outliers will always exist. They had a NJ toll collector take in $125-$150k working OT a few years back. I was mostly talking about higher standards, but paying more in some Podunk town could help some circumstances.

The takeaway I wanted to make was using higher standards bc they won't need the volume of LEO if the majority of the police force is redistributed to other services.

 

[Spydra]

As a student nearly done with their program I am not overly concerned about this because it likely won't be figured out until I'm in the process of getting licensed. If this creates more assessment opportunities for psychologists to be involved in officer recruitment and such, then I am very interested in that. But me being the first responder for mental health crisis calls? If I wanted to do that I would have picked a different field.

 

[Action_Potential]

Don’t worry; Adler’s got this covered.

 

[AbnormalPsych]

What the heck is a MPA program?

 

[deleted480308]

If local/county/state LEO were held to the same screening standards as the FBI and related 3-letter agencies, there would likely be less violence. However, the reason why that would happen is because their standards are higher in regard to the interview process, background checks, education requirements, training standards, etc. They pay more too, so they can attract a higher caliber candidate. It could actually work if the funding for police were significantly altered to re-allocate resources towards more MH and support services and only a small group of hand-picked officers were needed to respond to violent crimes, etc.

Except no one knows which interactions can get violent, traffic stops are huge sources of violent interactions. It simply isn’t reasonable to pretend we can enforce current laws with a tiny fraction of the officers

 

[deleted480308]

I remember several years ago when I was in a coffee shop with a non-MH friend and a naked woman who looked fairly disheveled came through the front doors and sat at a booth by herself. She appeared to be having a psychotic/manic/drug-induced episode of some sort, although I didn't get close enough to really make much of a determination. Two police officers followed hot on her heels and when she didn't follow their orders to leave the store things escalated quickly to a fairly aggressive shouting match before the officers ultimately wrestled her to the ground and held her down while they handcuffed her. I remember her shouting "somebody help me!" repeatedly when they began to be physically violent with her. I was only in my third year of training, but was working on an inpatient unit at the time and felt regret that I didn't do something to help her. I'm not sure what I could have done, given the circumstances, but I do think that validation and deescalation from the authorities could have reduced harm and difficulty in the interaction.

I appreciate you sharing a more encouraging outcome.

I’m curious how you would have wanted that handled? In a hospital they get physically restrained and sedated too. How long does a store owner have to allow a naked person to hang out on their property before control is restored?

 

[WisNeuro]

I’m curious how you would have wanted that handled? In a hospital they get physically restrained and sedated too. How long does a store owner have to allow a naked person to hang out on their property before control is restored?

In the hospital you have many more interactions. I'd argue that the vast majority are handled very well, with no physical altercation, through de-escalation strategies. Which, is why we need more MH pros either responding to these types of situations, or embedded with police. Police, especially as they become militarized, treat most every situation as a hammer/nail issue. We need other tools in our response toolbox.