Police & Mental Health; how to get it right locally

"As the National Policing lead for Mental Health and Disability, I really welcome this guide which offers practical advice to officers and staff when interacting with people with mental health problems, and provides examples of some of the innovative police practice from around the country. The findings and recommendations contained in the report 'At risk', yet dismissed highlight where police practice could be improved to better support and encourage victims with mental health problems to report crime; this guide is an excellent resource that can be used to support forces and partner agencies in developing their policies and practices to achieve this".

Chief Constable Simon Cole, National Policing Lead for Mental Health and Disability

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Police & Mental Health; how to get it right locally

"Excellent good practice covering local initiatives, liaison and diversion, training and support schemes which can be emulated to ensure good practice towards mental health is rooted and routine in all areas of policing. I cannot recommend the guide highly enough."​

Kevin Huish, Custody & Mental Health Lead,  Police Federation of England and Wales

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Definition: 

Fetal alcohol spectrum disorder (FASD) is a highly prevalent neurodevelopmental disorder that has significant implications for the criminal justice system. Caused by prenatal exposure to alcohol, FASD is characterised by behavioural, emotional, and physical health problems that can have catastrophic consequences across the affected individual’s lifespan.

 

FASD drastically increases a person’s risk of contact with the criminal justice system as a victim, witness, or suspect of a crime. The latest prevalence rates of FASD in the general population 1–8 percent worldwide, but these prevalence rates are estimated to be significantly higher in criminal justice and forensic settings.1

 

Studies have suggested that the rate of criminal justice contact for persons with FASD has been approximately 60 percent for adults and adolescents.2

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Understanding the extent of the prevalence of this condition among criminal justice populations is limited due to difficulties with attaining an accurate diagnosis. However, studies are beginning to demonstrate the pervasiveness of this disorder within legally involved populations. Youthful offenders involved in the criminal justice system who meet criteria for an FASD are estimated to range from 23–36 percent.3

 

A study by public health researcher Dr. Svetlana Popova and her colleagues indicated individuals with an FASD were 19 to 40 times more likely to have involvement in the criminal justice system compared to individuals without the disorder.4

 

A more recent study by clinical psychologist Dr. Katherine McLachlan and her co-researchers found that 30 percent of individuals with prenatal alcohol exposure had been involved in the criminal justice system, compared to less than 1 percent of the general population.5

 

Overall, the research that has been completed on this population indicates individuals with an FASD are at very high risk of criminal justice involvement at some point in their lives.

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Invisible Deficits

The impairments associated with FASD can range across a spectrum of needs.6 

 

Some physical, behavioural, or medical indicators of FASD may be as follows:

• • Abnormal facial features such as smooth ridge between the nose and upper lip

  • Smaller head circumference or head size

  • Medical problems such as with the bones, heart, and kidneys

  • Shorter-than-average height

  • Problems with vision and/or hearing

  • History of sleep problems that started during infancy

  • Low IQ or intellectual disability

  • Language and speech delays

  • Poor judgement and reasoning

  • Problems in school and difficulties in certain subjects, namely math

  • Learning disabilities

  • Poor attention

  • Poor memory

  • Lower body weight

  • Poor coordination

  • Hyperactivity

However, in spite of these deficits, individuals with FASD frequently appear capable, informed, and competent upon initial encounter.

 

One reason for this is the fact that the overwhelming majority of persons exposed to alcohol prenatally show no outward signs of impairment; this is misleading due to the brains damage. 

 

Additionally, one feature often present in those with FASD is what is referred to as “superficial talkativeness.” In other words, on a superficial level, they can engage in conversation and sound like they understand and are knowledgeable; however, when asked more in-depth or abstract questions, it becomes obvious that they do not really understand.

 

Nonetheless, individuals with FASD often deal with an array of invisible deficits that place them at a great disadvantage within the criminal justice system.7 

 

A portion of Table 2 below illustrates various impairments that are often invisible until the individual is stressed or overwhelmed. Such a lack of obvious symptoms can even result in law enforcement professionals misconstruing individuals with FASD as lazy, manipulative, or noncompliant.

 

For example, persons with FASD may acknowledge that they understand their rights, but not actually comprehend what their rights truly entail or the consequences associated with waiving these rights.

 

Therefore, law enforcement professionals should take extra precautions when advising someone of their rights and questioning them when the individual may have FASD.

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Secondary Disabilities and Conditions

Law enforcement professionals should also consider the likelihood that individuals with FASD suffer from secondary disabilities or conditions.

 

When individuals with FASD go undiagnosed and untreated, secondary conditions and disabilities become quite common. Individuals with FASD are prone to making poor choices, struggle with adapting to challenges, and have difficulty conforming with societal norms.8 

 

As a result, individuals with FASD are disproportionately likely to develop secondary disabilities and conditions like mental illness, substance use problems, economic instability, and other issues (see Table 1).

 

If law enforcement officers become familiar with the secondary disabilities common among individuals with FASD, these professionals could help improve detection of FASD and help ensure appropriate adjustments are made during criminal justice processes.

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Common Environmental Risks

Knowledge of common background risk factors for FASD could also benefit law enforcement professionals and the communities that they serve. Individuals with FASD often unfairly experience one or more historical adversities in addition to prenatal exposure to alcohol.

 

As presented in Table 1 above, these forms of adversity can include maltreatment, exploitation, victimisation, and poverty.9 These adversities typically exacerbate FASD impairments, secondary conditions (e.g., neurodevelopmental disorders and psychopathology), problematic behaviours, and broader life course trajectories. Further, the experience of these different adversities are typically also significant predictors of criminality. Therefore, law enforcement professionals should be aware of common background risk factors for individuals with FASD.

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Interviewing Approaches

In light of the cognitive, social, and adaptive functioning impairments of FASD, law enforcement professionals are encouraged to learn practical approaches for communicating with individuals that may have FASD.

 

One such approach is the D.E.A.R. method (see Table 3). This method involves the use of direct language, engagement of support systems, ensuring the accommodation of needs, and always remaining calm.

 

The D.E.A.R. approach is based in empirical evidence and can help law enforcement officers minimise the likelihood of miscarriages of justice such as false confessions and convictions.

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Strategies for Law Enforcement Professionals

The challenges, needs, and abilities of individuals with FASD differ vastly from many other people who come into contact with the criminal justice system. Individuals with FASD are at increased risk of contact with criminal justice professionals as witnesses, victims, and offenders.

 

In light of this, law enforcement professionals should carefully consider how they approach, communicate, and interact with individuals with FASD. Table 4 provides tips on how law enforcement officers can better understand the perspectives of people with FASD.

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Summary

FASD is a serious mental and physical health condition that impacts families and broader communities and contributes to situations that necessitate the intervention of law enforcement professionals. Although it is uncertain how frequently police officers encounter individuals with FASD, given the prevalence of FASD, it remains incredibly likely that such encounters occur on a regular basis.

 

In these situations, there are multiple considerations that law enforcement professionals should weigh when interacting with a person who may have FASD.

 

Many of these are highlighted in Table 5, which provides several important take-aways. Despite the serious need for increased knowledge in this area, there are very few formal FASD-based training programs tailored to law enforcement officers.

 

As a result, FASD continues to be under-recognised and misunderstood by law enforcement professionals. Improved recognition pertaining to the signs, symptoms, and consequences of FASD are critical in preventing miscarriages of justice.

 

Officers who are knowledgeable about FASD will be in a better position to assist these highly vulnerable individuals. To this end, law enforcement professionals are strongly encouraged to seek out continuing education opportunities and place themselves in a better position to assist these highly vulnerable individuals.

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Reference source: 

1. Michael Widder et al., “Evaluation of the German Biographic Screening Interview for Fetal Alcohol Spectrum Disorder (BSI-FASD),” Scientific Reports 11, March 4, 2021.

2. Najat Khalifa et al., “The Neurocognitive Profiles of Justice Involved People with Foetal Alcohol Spectrum Disorder: A Systematic Review,” Behavioral Sciences & the Law 40, no. 1 (January/February 2022): 87–111.

3. Carol Bower et al., “Fetal Alcohol Spectrum Disorder and Youth Justice: A Prevalence Study among Young People Sentenced to Detention in Western Australia,” BMJ 8, no. 2 (April 2018); Diane K. Fast, Julianne Conry, and Christine A. Loock, “Identifying Fetal Alcohol Syndrome among Youth in the Criminal Justice System,” Developmental and Behavioral Pediatrics 20, no. 5 (October 1999).

4. Svetlana Popova et al., “Fetal Alcohol Spectrum Disorder Prevalence Estimates in Correctional Systems: A Systematic Literature Review,” Canadian Journal of Public Health 102, no. 5 (September–October 2011): 336–340; Svetlana Popova et al., “Cost Attributable to Fetal Alcohol Spectrum Disorder in the Canadian Correctional System,” International journal of Law and Psychiatry 41 (July–August 2015): 76–81.

5. Kaitlyn McLachlan, “Difficulties in Daily Living Experienced by Adolescents, Transition-Aged Youth, and Adults with Fetal Alcohol Spectrum Disorder,” Alcoholism, Clinical and Experimental Research 44, no. 8 (August 2020): 1609–1624.

6. Centers for Disease Control and Prevention, “Basics about FASDS,” January 11, 2022.

7. Natalie Novick Brown and Stephen Greenspan, “Diminished Culpability in Fetal Alcohol Spectrum Disorders (FASD),” Behavioral Sciences & the Law 40, no. 1 (January/February 2022): 1–13.

8. Rebecca Pedruzzi, “Navigating Complexity to Support Justice-Involved Youth with FASD and Other Neurodevelopmental Disabilities: Needs and Challenges of a Regional Workforce,” Health & Justice 9, February 27, 2021.

9. Katherine Flannigan et al., “Characterizing Adverse Childhood Experiences among Children and Adolescents with Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder,” Child Abuse & Neglect 112 (February 2021): 104888.

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With kind permission: Jerrod Brown, Amy Jozan, and Megan Carter, “Interview Considerations – Fetal Alcohol Spectrum Disorder: A Beginner’s Guide for Criminal Justice Interviewers,” Police Chief Online, July 6, 2022.

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