Vaughan, A.D., & Andresen, M.A. (2018). The cost of mental health related calls on police service: Evidence from British Columbia. In R. Mitchell & L. Huey (Eds.), Evidence-based policing: An introduction (pp. 173 – 185). Bristol: Policy Press, University of Bristol.
Mental illness is a condition that imposes costs on many aspects of our society, including policing. Often on the front line helping people in mental health crisis, because of their nature and the regulations involved, mental health related calls for police service impose a significant cost on policing. However, because of the relatively new identification of this concern, there is a relative lack of evidence-base for its presence, patterns, and costs on policing. In this chapter, we consider the time costs for dealing with mental health related calls for police service in a number of urban, suburban, and rural areas of British Columbia. We show that despite being a relatively small proportion of police calls for service, mental health related calls for police service are overrepresented in the amount of time they consume. We discuss the importance of this issue and the implications for resourcing, training, and public health.
According to Statistics Canada (Mazowita, Greenland 2016), in the 2014/2015 fiscal year, the expenditures for police services in Canada were $13.9 billion. These expenditures are comprised of salaries and wages (66%) for the roughly 69,000 police officers and 28,000 civilian employees across Canada’s ten provinces and three territories followed by benefits (e.g., the employer’s contribution to group medical plans, pension plans) (15%) and operating expenditures (e.g., equipment maintenance, office supplies) (19%). Canada’s population is primarily policed by independent municipal police services, followed by the RCMP which proves both municipal and provincial police service, and provincial police services in three provinces. Understanding where resources are allocated in various jurisdictions can be useful in developing an understanding of the local policing cost and trends over time may that may assist in projected budgeting and future resource deployment. Moreover, knowing the costs of specific aspects of policing, such as mental health, can be used to inform policy decisions regarding the costs and benefits of various policing programs, supporting evidence-based policing practices (Sherman 1998).
Generally speaking, police budgets are managed at the local level, with a local community police board as well as other support staff working together to develop and amend a police department’s budget. The amount of resources in these budgets is generated using a variety of factors, but at its most basic level, it can be reduced to revenue streams (e.g., taxation, traffic and other fines) and expenses (e.g., salaries, equipment). With police services falling under the broad umbrella of public safety, local police budgets are likely to be associated in some manner to the local crime rates. These rates may be generated at the local level, but federally generated Uniform Crime Report (UCR) data may be used as a barometer for the crime trends in a given jurisdiction or more broadly in a province. Though these are not the only factors in police budgets, they can act as a measure of the demand for a portion of police resources. The relationship between crime rates/statistics and policing costs has also been included in these discussions with some noting the differences in trends over the past 20 years. For example, in Canada policing costs increased by 45.5% between 1986-2012 while Criminal Code of Canada incidents per police officer declined by 36.8% (Di Matteo 2014). Other scholars also note the increase in police budgets over this time frame but highlight that other state services—health and education—have per capita rates that are six and four times higher than police services and are increasing at similar rates (Institute for Canadian Urban Research Studies 2014).
To say that police budgeting has become a topic of public debate in the early twenty-first century is an understatement. Debates often encompass greater political pressure for fiscal and operational accountability, increasing costs of policing, declining police growth and shrinking or stagnant police budgets (Griffiths, Pollard et al. 2015). The expanding demands of police services, are of particular concern because in some jurisdictions, like rural and remote locations, the police are the only state-funded option to respond to social issues. Milne’s (2013) concept of ‘wide policing’, or the addition of more and more police duties to cover social problems that are not being addressed by other service providers, is important to consider in any discussion regarding police expenditures. In addition, Leuprecht (2014: 5) highlights that front-line uniformed officers in Canada spend a copious amount of time “waiting to give testimony in court, transcribing interviews, teaching CPR, transporting prisoners, or a hundred other duties that take them off the street.” Additional costs for policing are likely to be found in rural and remote locations where, generally speaking, the costs associated with these locations are much higher than in urban settings and much higher than the national average cost for policing (Ruddell, Lithopoulos et al. 2014).
One of the challenges for estimating the cost of “other duties” through crime statistics like the UCR is that they are not well-captured or identified at all. For example, previous research suggests that in police records management systems, roughly 20-30% of the police calls-for-service generated are reflected in some way in the UCR with almost 70-80% of other police files not being captured in the UCR (Institute for Canadian Urban Research Studies 2014). As a result, estimates of costs of all calls-for-service—criminal and non-criminal-- are virtually absent in the literature.
Police responses to persons with severe mental illness
Since the early 1980s, an area that has increased in the demand for police services is the response to persons with severe mental illness (PwSMI) (Cotton, Coleman 2010). Not surprisingly, this increase has also resulted in the use of more police resources with some studies suggesting that police interventions with PwSMI use 87% more resources compared to interventions with persons without mental illness (Charette, Crocker et al. 2014). The range of police contacts, the different ways in which PwSMI can be found within police data, and the varying police contacts within Canada results in some wide-ranging results on how much police work and subsequent labour cost is tied to this population (Livingston 2016). In Canada, UCR data will capture the criminal activity of PwSMI, but there are a sizable number of police interactions with this population that are for non-criminal reasons (e.g., victimization, general assistance) (Vaughan, Hewitt et al. 2016). More generally, it has been established for a number of years that a large number of police encounters with PwSMI do not often involve law enforcement and “involve people who are neither a danger to themselves or others” (Chappell 2010: 289). As a result, accounting for the amount of police work attributable to PwSMI is often anecdotal or based on a small subset of the available data. In the push for evidence-based policing, a natural next step is to estimate the amount of resources police use with this population longitudinally using empirical data.
Resource use has been operationalized as the use of police time and/or the financial cost of responding to PwSMI. Studies from Canada suggest that the duration of a call involving PwSMI is approximately 90 minutes in length, though this duration can increase substantially when the police incident involves a criminal event (Charette, Crocker et al. 2014). The Vancouver Police Department suggests that in 2012, their police officers were involved in 3043 events that fell under the BC Mental Health Act (herein referred to as the Act) which consumed 21,000 on-scene police hours (Szkopek-Szkopowski, Palmer et al. 2013). A recent study from the UK has taken an additional step and provides estimates of the costs for a variety of interventions through mental health and police services (Heslin, Callaghan et al. 2017). The authors suggest that in 2012, the cost per police incident with persons with enduring mental health needs was, on average, £522. The authors go on to model service enhancements to represent alternative care pathways for patients to test the impact of a change in decision making on the overall cost of response. Findings indicate that enhancing services may decrease per incident costs by 8% but in other cases, the costs may increase by 6%. Clearly, there can be cost and benefits to changing the way PwSMI are serviced by health and policing services but it is crucial that any new programing and/or policy not only reduces recidivism (e.g., admissions to the ED, police contacts) but that they are also cost-effective for taxpayers.
The goal of this chapter is to extend this recent work by providing various estimates of the use of police resources when they respond to PwSMI. Using a longitudinal dataset covering multiple policing jurisdictions, we estimate:
The amount of resources police use to respond to PwSMI who fall under the Act;
The amount of resources used when police services respond to all calls with PwSMI; and
The resources consumed when police respond to “heavy users” or persons who habitually cycle through police custody.
The Fraser Health Authority (FHA) is a large health region in the south-west section of the province of British Columbia, Canada. This area currently contains approximately 1.7 million of the province’s population. The majority of the population resides along a major east-west highway. To the east of this catchment area lies Vancouver. To the north and west of the Fraser Health Authority are less densely populated rural areas followed by Washington State that buttresses to the southern portion.
Data for analysis
Data for this project were provided by all police services contained within the FHA. Within this catchment area, there are five independent-municipal police agencies, a regional transit police agency, and various contracted police forces by the Royal Canadian Mounted Police (RCMP). All police services in BC use the same records management systems for storing and maintaining their call-for-service data. Various datasets were created for analysis using the same initial number of PwSMI subjects (n = 37K). For research question 1, we looked only at Act-events and for research questions 2 and 3 we considered all police contacts that a participant may have had. All data used in this study were for a seven-year period from January 1, 2009 to December 31, 2015.
For this chapter, resource usage is operationalized using multiple perspectives. We use costing estimates in terms of dollars spent on a call, the full-time equivalent (FTE) of the number of full-time police officer works in a year, and per capita cost estimates. Given the fact that pay scales can vary dramatically both within and between police services in Canada and that the data for analysis covers data from six regional or municipal police departments and 13 RCMP departments, the costing and FTE rates were standardized. However, the formulas used for calculating resources can be re-used in other jurisdictions with proportional adjustments.
The recent Statistics Canada report on policing services as a guide to produce costing estimates for police-involved calls-for-service with PwSMI (Mazowita, Greenland 2016: 11) suggest that policing expenditures are comprised of “salaries and wages (66%), benefits (15%), and other operating expenditures (19%).” Here benefits refer to all payments made to employees which is not a component of their salary or wages. For example, a police department’s contribution to employment insurance, health insurance, and severance pay. Examples of operating expenditures includes, office furniture and vehicle purchases. Using these expenditure proportions, we extended this model, C, or an inflation adjusted estimate for the total cost for police services responding to PwSMI-related calls:
C = (X + Y + Z)T,
where X represents the cost of one officer with benefits and operating expenses. In 2015, the total hourly cost with benefits and operating expenses for a 1st class constable (3-years of experience) in one of the municipalities in this study was $67.13/hour. Y and Z represent the cost for support and supervision (e.g., supervisors, dispatchers, clerical staff, and overtime) of Act and non-Act events respectively. Because Act calls are known to be laborious (Szkopek-Szkopowski, Palmer et al. 2013), we estimate Y to be 50% of X (i.e., $33.57/hour) and Z to be 25% of X (i.e., $16.78/hour). T represents the duration of a call-for-service measured in hours as recorded in the computer-aided dispatch (CAD).
To estimate the number of full time police officers required to respond to Act-related calls for police service, we consider one full time equivalent (FTE) officer to work 1720 hours per year. This count accounts for annual holidays, sick leave and statutory holidays and is based on a shift rotation of four days on and four days off.1 And the per capita estimate is simply the cost divided by the population. The population in the FHA in 2015 was approximately 1.7 million. Population estimates for the FHA were obtained from BC Statistics.2
Of the sample of PwSMI (n = 36,893), they were involved in 76,310 Act calls. The yearly increase was about 9.70% per year. As a consequence, the number of policing hours associated with these calls has also increased but at a slightly higher rate (11.84% per year). The resulting cost to police service and per capita costs are highlighted in Figure 1. Using C, the most expensive year for policing was 2015 where we estimate the cost to be $4.79 million across all police agencies with an average annual increase of roughly 13.56% (range 3.75-20.43%). In 2009, the per capita cost was $1.37 per person who resided in the FHA. In 2015 that amount doubles to $2.74 per person. In comparison to the national per capita costs for policing in Canada of $320 per person (Mazowita, Greenland 2016: 11), these amounts are relatively small. However, the fact that the per capita costs for policing PwSMI in Canada have doubled over a 7-year period is concerning considering that since “2009/2010, operating expenditures have generally been declining, including a 0.9% decrease in 2014/2015” (Mazowita, Greenland 2016: 11). Furthermore, though these calls-for-service do occur, the strict guidelines as written in the Act ensure that police officers only use the legislation when a patient is in danger of harming themselves or others.
[Insert Figure 1 here]
The number of FTE police officers (Figure 2), needed to enforce the Act over the seven-year period ranges from as low as 13.73 in 2009 to as high as 26.53 in 2015. Much like the per capita estimates, we see a doubling of the required police resources in seven years of data. Though 26.53 police officers may not sound like a lot (Surrey alone, the largest municipality in the FHA, has an authorized strength of over 600 police officers), this is still a sizeable number of police officers; for example, this is one-half of the authorized strength of Port Moody, a small municipality in the FHA region and part of Metro Vancouver.
Knowing that police work related to PwSMI involves a wide array of calls for service, we considered all of the police interactions for the PwSMI sample. This sample was involved in approximately 564,691 event files which is roughly 15.5% of all PRIME-BC event files within FHA. This rate is slightly higher to previous research that suggests 12% of all calls for police service involve the patient’s mental health care pathway (Livingston 2016). With each patient having roughly 6-7 additional police contacts on top of their Act event, the cost for police services also increases. Using C, we estimate that at its lowest level in 2009, cost to policing services to respond to all calls-for-service with PwSMI across the FHA was roughly $14.8 million. Much like the other upward trends in the data, in 2015 the estimated cost increased to $24.6 million.
Given the large number of police hours associated with all calls-for-service, FTE estimates suggest that in 2009 and 2015, it would have taken roughly 113 and 170.5 police officers across all of the police services within the FHA, working fulltime, to respond to all calls associated with PwSMI. This is a large number of police officers who are “dedicated” to responding to a relatively small portion of the population. In order to provide some context, the City of Port Moody has a population that is approximately the same size as the PwSMI sample in our analysis. The Port Moody Police Department has an authorized strength of 51 sworn police officers. The number of officers in the FHA region as of 2015 to respond to this population is 3.33 times the authorized strength of the Port Moody Police Department. This is very clearly an expensive sub-population to serve.
[Insert Figure 2 here]
With many programs and policies placing heavy emphasis on reducing recidivism and improving the well-being of PwSMI who are ‘frequent fliers’ or ‘heavy users’ of police service (Akins, Burkhardt et al. 2016), we selected the top ten most frequent users in the dataset to estimate their police resource usage and to explore some of the basic trends in this group in terms of the types of police services they are accessing. Table 1 provides a general overview of the demographics of this group, the total number of police interactions, their mobility patterns (i.e., the number of different police services they were serviced by), the resources used, and the nature of their police interaction. It is important to note that all heavy users had continual contact with the police over the data collection period and, along with the high number of police contacts, we can predict that these individuals were not incarcerated or hospitalized for any prolonged period.
[Insert Table 1 here]
Though the patterns of the heavy users should not be interpreted as the trends for the population, there are some early indicators that there are differences of police contact in this group. For example, participant 29485, a middle-aged man with slightly fewer than 100 contacts per year, has had many encounters with the police for substance use such as public intoxication and other liquor related problems. Participant 36330 is a middle-aged female with roughly the same total number of contacts with the police. However, the roughly 2/3 of her police contacts are non-criminal in nature or the police were not enforcing or using criminal law. With all participants, the number of Act events was relatively modest. Over the 10 participants, we found only about 2.25% of their contacts were associated with the Act.
Notwithstanding the high volume of calls-for-service all heavy users have, the longitudinal pattern of participant 30414 is particularly concerning given his first contact with police occurred age 8. Comparable to other life-course research in criminology (Moffitt, Caspi et al. 2002), previous research on the developmental etiology of criminality among persons with mental disorders results in three typologies: early starters, adolescent-limited offenders, and late or adult-start offenders. (Hodgins, Janson 2002). At a quick glance, one may suggest that participant 30414 is an ‘early starter’ as his patterns of criminal behaviour have been stable in childhood to early adolescence. However, if we only include his criminal events, we overlook that roughly 49% of his other interactions with the police were calls for assistance and/or missing persons reports. In other words, his spectrum of CJS involvement is multifaceted, goes beyond crime and the direct application of the Act, and like most of the other heavy users in this study, he interacted with multiple (seven) police departments.
Of particular concern with this group is that, on average, each one of them requires their own full-time police officer to respond to their calls for police service, broadly speaking. The range is 0.6 to 2.5, so even having to require one-half of a full-time police officer is a huge economic cost. This points to the importance of considering increased, and more cost-effective, social services for this population aside from policing.
It should be clear that the PwSMI population places a significant cost on our police services. Moreover, this population is involved with a disproportionate number of calls for police service and a corresponding number of police officers to respond to their calls for police service. Regardless of how the budgets change, crime rates decrease, the counts, costs, and proportion of budgets that go towards responding the Act has been going up over time. The slopes of the cost per year of the trend line for Figures 1 and 2 are always increasing. Heavy users consume and enormous amount of resources and implementing problem-solving/collaborative programs are crucial for reducing recidivism and getting them into a treatment plan that works for them. The 10 heavy users had many similar features but many more features that differed. As such, having different programs available, especially ones that do not require that a patient be already involved in the court/correction system, would likely work more effectively. Of course, there is also an ethical issue here given that the provision of mental health services should not only come after someone has been involved in the criminal justice system.
Though instructive, our analyses are not without limitations. First, we used truncated data (calls were capped at 12 hours/call). This was done to limit the time spent by a police officer to be an entire shift. Though this may be considered a long time for any given event, there will also be calls for police service that require continued attention by the police. Second, our cost estimates only include direct policing costs. We do not include any other costs (dollar costs or hours spent/FTE equivalents) associated with the services of other emergency personnel: hospitals, paramedics, fire department, and so on. We also do not consider the influence of substance use. Finally, we estimate the values of C as 1.5 for Act calls and 1.25 for all other calls based on the number of officers necessary to address each of these types of calls for police service. Future research should investigate exactly how many members responded to a call for service and how much time each call consumes as cases where a patient barricades themselves into a house or threatens to commit suicide will likely take up more than 1.5 or 1.25 members.
Despite these limitations, our estimates of costs and FTE police officers for the population of PwSMI in the FHA has shown to be instructive. Our estimates are at the lower bound because they only consider direct policing costs and assume only one member/event responds. Moreover, despite the relatively low percentage of police calls for service that are direct responses to mental health (2 percent), all of their interactions with the police comprise approximately 15 percent of their calls for service. Based purely on the population of the FHA, the mental health related calls for police service from this population is proportional to the number of calls to the police (both are approximately 2 percent). However, we must remember that a fraction of the population actually consumes any police services and that 2 percent of the FHA population accounts for 15 percent of the police calls for service when all of their police interactions are considered. This is a significant overrepresentation in police workload that deserves future considerations.
The importance of these calculations in the context of evidence-based policing relates to the costs and benefits, or cost-effectiveness, of any programs that the police implement to better serve this population. Evidence-based policing is, in part, the application of research to find out which police practices at the agency, unit, and officer levels work best to better serve the public, but costs are a critical component of that research (Sherman 1998; Lum and Koper 2017). Presented with multiple options to address a policing (societal, in this case) issue, the relative costs of these options are important for the optimal allocation of scarce resources.
Knowing the costs to policing for police interactions with the PwSMI population, even what is likely an underestimate, provides an evidence-base for comparing various options in police practice: officer training, specialized units, and so on. These different options will have different costs and different outcomes. Though a more expensive option may initially be discarded because of the high up front costs, for example, knowing that the outcomes from that option outweigh the costs can provide for making better longer term decisions. In the case of the PwSMI population, such an evidence-base may be used to compare options outside of policing as well to support their social service needs. In short, an evidence-based approach to policing the PwSMI population will not only lead to this population being better served, but done so in the most cost-effective manner possible based on research.
AKINS, S., BURKHARDT, B.C. and LANFEAR, C., 2016. Law enforcement response to “frequent fliers”: An examination of high-frequency contacts between police and justice-involved persons with mental illness. Criminal Justice Policy Review, 27(1), pp. 97-114.CHAPPELL, D., 2010. From sorcery to stun guns and suicide: The eclectic and global challenges of policing and the mentally ill. Police Practice and Research: An International Journal, 11(4), pp. 289-300.CHARETTE, Y., CROCKER, A.G. and BILLETTE, I., 2014. Police encounters involving citizens with mental illness: Use of resources and outcomes. Psychiatric services, 65(4), pp. 511-516.COTTON, D. and COLEMAN, T.G., 2010. Canadian police agencies and their interactions with persons with a mental illness: a systems approach. Police Practice and Research, 11(4), pp. 301-314.DI MATTEO, L., 2014. Police and Crime Rates in Canada: A Comparison of Resources and Outcomes. Vancouver, BC: Fraser Institute.GRIFFITHS, C., T., POLLARD, N. and STAMATAKIS, T., 2015. Assessing the effectiveness and efficiency of a police service: The analytics of operational reviews. Police Practice and Research, 16(2), pp. 175-187.HESLIN, M., CALLAGHAN, L., BARRETT, B., LEA, S., EICK, S., MORGAN, J., BOLT, M., THORNICROFT, G., ROSE, D., HEALEY, A. and PATEL, A., 2017. Costs of the police service and mental healthcare pathways experienced by individuals with enduring mental health needs. The British Journal of Psychiatry, 210(2), pp. 157-164.HODGINS, S. and JANSON, C., 2002. Criminality and violence among the mentally disordered: the Stockholm Metropolitan project. Cambridge, UK; New York: Cambridge University Press.INSTITUTE FOR CANADIAN URBAN RESEARCH STUDIES, 2014. Economics of Policing: Complexity and Costs in Canada, 2014. Burnaby, BC: Institute for Canadian Urban Research Studies.LEUPRECHT, C., 2014. The Blue Line or the Bottom Line of Police Services in Canada? Arresting Runaway Growth in Costs. Ottawa, ON: MacDonald Laurier Institute.LIVINGSTON, J.D., 2016. Contact between police and people with mental disorders: A review of rates. Psychiatric Services, 67(8), pp. 850-857.LUM, C., and KOPER, C.S., 2017. Evidence-Based Policing: Translating Research into Practice. Oxford, UK: Oxford University Press.MAZOWITA, B. and GREENLAND, J., 2016. Police Resources in Canada, 2015. 36(1). Ottawa, ON: Statistics Canada, Canadian Centre for Justice Statistics.MOFFITT, T., E., CASPI, A., HARRINGTON, H. and MILNE, B.J., 2002. Males on the life-course-persistent and adolescence-limited antisocial pathways: Follow-up at age 26 years. Development and psychopathology, 14(1), pp. 179-207.RUDDELL, R., LITHOPOULOS, S. and JONES, N.A., 2014. Crime, costs, and well being: policing Canadian Aboriginal communities. Policing: An International Journal of Police Strategies & Management, 37(4), pp. 779-793.SHERMAN, L.W., 1998. Evidence-based policing. Washington, DC: The Police Foundation.SZKOPEK-SZKOPOWSKI, T., PALMER, A., LEPARD, D., ROBINSON, D., PAUW, R. and TRAN, H., 2013. Vancouver's Mental Health Crisis: An Update Report. Vancouver, BC: Vancouver Police Department.VAUGHAN, A.D., HEWITT, A.N., ANDRESEN, M.A. and BRANTINGHAM, P.L., 2016. Exploring the role of the environmental context in the spatial distribution of calls-for-service associated with emotionally disturbed persons. Policing: A Journal of Policy and Practice, 10(2), pp. 121-133.
Figure 1: Policing and per capita cost to enforce the Act
Figure 2: Number of police officer hours and equivalent number of full-time police officers to respond to all calls-for-service with PwSMI
Table 1: Cost estimates for PwSMI who are heavy users of police services
# of police unique PD
#of events Act
# of events crime
# of events non-crime
# of missing persons/assist
# of substance use events
Total # of events
Total number of hours
FTE @ 1720 hr/yr