The Drug War Uniquely Harms People with Mental Health Issues. But it Doesn’t Have to be that Way.

Drug Policy Alliance
10 min readMay 27, 2021

By Alex Klaus

At the end of March, new details were released in the killing of Marvin Scott III by Texas corrections officers, revealing just how easy it is for people with mental health issues to get caught in the crosshairs of the drug war, how these interactions with law enforcement can quickly escalate into too often dangerous and even fatal encounters, and how inadequate the criminal justice system is at providing necessary care and support services.

It’s important to recognize the prevalence to which mental health issues and substance disorders coexist. With about half of the population of those who suffer from some kind of mental health issue also having a substance use disorder and vice versa, it is difficult to disentangle the conditions from each other. And yet, as we have seen time and time again, police response — especially when drugs are involved — is almost entirely void of any kind of mental health considerations, resources or training. And unfortunately, the outcome too often ends in serious trauma, injury or death.

In fact, Marvin Scott’s killing was eerily similar to that of Daniel Prude’s in March 2020, and even Carlos Ingram Lopez in June 2020, down to the physical restraint, spit hood and all. We may ask ourselves — why? The answer is two-fold: 1) the drug war, and 2) we don’t have the right people responding to issues of substance use and mental health. In all three instances, the police did what they have been trained to do — find out what the person did that was illegal (drugs) and then subdue and punish them by any means necessary. What we need is a more appropriate response from a trained mental health or substance use/harm reduction professionals to support and stabilize the individual.

In all three of these instances, it all started when someone called 911 — thinking that would result in the person getting the support they needed. They were wrong.

When Marvin Scott, Daniel Prude, and Carlos Ingram-Lopez found themselves experiencing a mental health crisis, 911- often the only known option- was called for help. Police — not medical or other health professionals — were sent, bringing deadly consequences each time. In Prude’s case, officers quickly blamed his death on a drug overdose when they learned about his PCP use. In Ingram-Lopez’s case, officers pointed fingers at excited delirium, a controversial and widely-debunked term used to characterize sudden aggressive and distressful behavior by a person who has typically consumed drugs, that is most-commonly used to justify police killings. And with Scott, officers immediately assumed him to be on drugs, using the less than two ounces of marijuana he had on him as a means to arrest him in the middle of a crisis. The stories of these three men are painfully similar and far too common; people that struggle with mental health issues are 16 times more likely to die at the hands of police, and account for one-third to one-half of all victims of police brutality.

These deaths should’ve sparked a conversation about our needless dependence on police in times of mental health crises. Instead, police officers and media outlets stigmatized the victims’ drug use and disregarded their mental health issues so that it could better fit the pro-police narrative of “drugs” being to blame. It’s rare that police are actually needed in times of mental health-related crises, yet only 4% of calls about mental health emergencies result in EMS responding without police. Far too often, we see police appear at scenes where a health responder was urgently needed, as law enforcement continues to take on a job they aren’t trained for: mental health crisis intervention.

In Scott’s case, when police were called to the mall because of him experiencing a mental health crisis, stabilizing him should have been the first priority, but because that falls outside of law enforcement’s purview, they responded with their best known tactic — criminalization, in this case arresting him for the less than two ounces of marijuana in his possession.

Scott, like many others who are living with mental health issues or other disabilities, was using the marijuana in his possession to self-medicate, because of the inadequacies of the health services he was provided for his condition. For many, cost as well as punitive drug scheduling under the Controlled Substances Act and the stigmatization of scheduled medication, especially those used to treat mental health issues, makes it increasingly difficult to get treatment. These policies often scare doctors out of prescribing controlled substances designed to treat specific conditions, pushing some to use illicit (and often unregulated) drugs like heroin or methamphetamine to replace prescribed opioids and amphetamines.

And as with Scott, that criminalization can often quickly escalate to use of violent force, traumatizing and dehumanizing people with mental health issues.

Law Enforcement Interactions with People with Disabilities Can be Especially Harmful — and Too Often, Fatal.

Because police are not trained as mental health professionals, they can easily misunderstand various cues and react in ways that further agitate the situation. For Marvin Scott, this was him “acting strange,” for Daniel Prude and Carlos Ingram Lopez, this was them “acting erratically.” And in all instances, instead of addressing the mental health crises, the responding officers immediately blamed drugs and reacted as the drug war has conditioned them to do — with complete disregard for human life.

Much of this comes from a police culture that is informed by racist tropes and mythological narratives — such as those that claim drugs give people superhuman strength. These myths have been perpetuated throughout history, as a way to villainize — and sow reason to fear — people of color, and especially people of color they suspect to be using drugs. Many of these blatantly false depictions of people who use drugs, such as the sudden onset of “excited delirium,” continue to be regarded as serious threats — and therefore reason to act with force — by law enforcement and are even used in police training to this day.

Because of this, law enforcement and others within the criminal legal system often misinterpret normal behaviors of people with mental health or other neurological conditions, like avoiding eye contact, fidgeting, difficulty reading social cues, and uncontrolled facial movements and speech as suspicious.

Coercive and predatory interrogations and trials are a unique burden. People with mental health issues and other cognitive disabilities often process and respond to information differently, making the process of interrogation and trial exceedingly complicated. Officers failed to identify three-quarters of intellectually disabled suspects as such at the time of arrest, meaning they were never offered accommodations in the first place. They account for 43 percent of false confessors, further heightening the risk of unjust sentencing, sometimes with outcomes as vile as the death penalty. Similar disparities extend past interrogation rooms and into courthouses, with fewer than 30 percent of court systems listing mental health issues on their websites as a basis for providing needed accommodations.

Criminalization Doesn’t Just Begin at the Time of Legal System Involvement; It Begins Early in The Public School System.

Students with mental health issues or other disabilities, especially students of color, often find themselves tangled in the school-to-prison pipeline because of punitive zero-tolerance policies, policing, and neglection of students’ support needs. Nationally, schools reported more than 27,000 sworn law enforcement officers compared to 23,000 social workers. Rather than utilizing social workers and accessibility specialists to support students with behavioral symptoms of mental health issues or developmental disabilities, schools suspend disabled students twice as often as their non-disabled peers, despite suspension correlating to higher rates of school dropouts, psychological distress, and criminal legal system involvement later on. Young people with mental health issues and learning disabilities account for 85% of the youth in jails and prisons, and studies predict 31% of young people with learning disabilities will enter the criminal legal system within three to five years of leaving high school. It costs millions of dollars to criminalize students with mental health issues and other developmental disabilities, money that could be much better spent on health and social programs to support them.

Correctional and Treatment Facilities aren’t Equipped to Treat People With Mental Health Issues and Other Cognitive Disabilities

Poor access to quality education, employment, housing, and services makes it easy to understand why people with mental health issues and cognitive disabilities may find themselves in a cycle of painful circumstances. And rather than devoting resources to improving their lives, we continue to see them essentially being warehoused in jails, prisons and other kinds of forced-commitment facilities.

In fact, people in jails and prisons are three times as likely to report a disability, and in total, there are more than 750,000 people behind bars with a disclosed disability, two-thirds of which reported a mental health or cognitive disability. And despite this, prisons and jails routinely ignore Americans with Disabilities Act (ADA) requirements, thus creating an unlivable environment and subjecting them to further harm.

Because so many correctional facilities fail to properly screen for mental health and developmental disabilities, much less provide treatment, the support they need is often non-existent or wholly inadequate. In fact, out of 38 state corrections agencies that responded to a survey, 25 reported screening protocols failing to meet professional standards, and five states didn’t report screening for developmental disabilities at all. And despite the extremely high prevalence of mental health issues among jail and prison populations, the latest federal data reveals that nearly half of those in prison and two-thirds in jails never receive treatment.

Withholding needed treatment can worsen the conditions of people behind bars. Having this basic need neglected can be extremely harmful, and living in an incarceration environment — where they could be subject to emotional and physical distress — can lead to extreme trauma. Corrections officers, like police, are not properly trained to deal with people experiencing mental health issues and can many times resort to use of force as a means of control. And people with mental health issues and cognitive disabilities are disproportionately prone to violent force at the hands of prison guards, even leaving those who are properly screened for disabilities at risk of becoming a victim of violent force or sexual assault. While there’s a limited number of studies to demonstrate the frequency of violent force, multiple states have made these disparities clear. In South Carolina, people with diagnosed mental illness were subjected to use of force two-and-a-half times that of other people in prison, and in Los Angeles County jails, a third of all use of force cases were against people with mental illnesses despite constituting only 15 percent of the jail population.

People with mental health issues in drug treatment programs face similar neglect. Out of concern for eroding valuable funds, many facilities refuse to use integrated treatment styles, which combine mental health and drug treatment and are regarded as having the highest success rate for people who are struggling with both substance use and mental health problems. For this reason, most drug treatment programs are rarely adaptable to people with mental health issues.

Even transitioning from prison or drug treatment facilities to freedom can be a huge challenge as re-entry programs often lack necessary accommodations and connections to community services for participants with disabilities.

But This Isn’t the Only Way.

Various organizations have paved the way for safer alternatives across the country, proving we can reduce this overreliance on police and provide people with the appropriate level of care, without use of force or violence. CAHOOTS, a crisis aid program in Eugene, Oregon serves as an alternative to police presence in non-violent situations. They respond to about 65 calls a day, when specifically requested or dispatchers feel they are the more appropriate option. Of the estimated 24,000 calls CAHOOTS responded to in 2019, only 311 required police backup. Similarly, in Sacramento, community organizers agreed that, in order to interrupt and eliminate police dependency in times of mental health crisis, they would prioritize community resources instead of the police. As a result, a community-led response program called MH First was born. People can call a hotline Friday to Sunday from 7 PM to 7 AM, connecting callers to a volunteer from their community that readily offers solutions that don’t involve police. Within a few months of the program launching, MH first expanded to serve Oakland, CA as well.

Other cities have likewise implemented mental health crisis intervention, outreach, and community-first response programs, albeit with continued police involvement. On the surface, this may still seem promising, but it unfortunately fails to recognize the root of the problem: people need trained and certified health professionals, not police who’ve primarily been trained in enforcement practices, many of which are violent by nature. It also continues to allocate funding towards law enforcement, which could be better spent on more appropriate response programs.

The UK has also started acknowledging this need for better responders, putting pressure on the National Health Service (NHS) to respond to crisis calls. People experiencing a mental health crisis can call 111, the emergency line, and operators are trained to connect callers to a variety of interventions and resources rather than sending police. £679 million has been invested into advancing mental health services in an attempt to reduce police reliance. This investment into mental health services allows for early intervention to prevent crises from occurring and escalating in the first place, and those experiencing a mental health crisis can promptly get assistance without the fear of criminalization or violence at the hands of the police. This system has improved the timeliness of referrals, improved mental health outcomes, and reduced arrests and offenses.

The war on drugs and overly punitive policing has disproportionately harmed people with mental health issues and cognitive disabilities for far too long. Instead of neglecting treatment and accessibility needs, unjustly incarcerating, and using violent — and sometimes lethal — force against people with mental health issues, it’s time we begin providing them with the support they need.

We can start by investing in equitable healthcare, evidence-based treatment for people with dual-diagnoses, accessible housing, and better community response for people in crisis. Having unarmed non-police responders, trained in mental health and harm reduction, can help de-escalate these situations and ensure the person involved is given the appropriate level of care. Had resources and programs like these been more widely available, Marvin Scott, Daniel Prude, and Carlos Ingram Lopez would have been treated with the dignity they deserved and the health services they needed. Most importantly, they would be alive today.

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Drug Policy Alliance

DPA is the nation’s leading organization promoting drug policies that are grounded in science, compassion, health & human rights.