If one topic exists that law enforcement leaders can all agree on, policing today has evolved significantly during the last two decades. Not only have crime and technology changed, but so have social opinion and arguments regarding incarceration and penalties for crimes. One such change surrounds the legalization (or decriminalization) of marijuana, which has garnered substantial support in recent years.

As sworn guardians of the law and of those who cannot protect themselves, law enforcement must consider a question that arises in this evolution of changing laws and social perception—has one of the most vulnerable segments of our society, those with mental illnesses, been overlooked in these debates? It must be considered how the increased accessibility of marijuana in many areas might affect the well-being of people with mental illness and how that should influence law enforcement’s response to this population when the police are first on the scene during a mental health crisis.

Health of the Mental Health Care System in America

It is clear that public support to divert persons with mental illness who commit crimes from the criminal justice system to mental health services is strong. At the conclusion of a successfully de-escalated mental health crisis intervention, officers face limited resources provided by the mental health system. Stories of officers responding to a person who was potentially suicidal and successfully taken into custody, but who was released only a few short hours later are common. In one example, a California Highway Patrol officer took a female into custody after she threatened suicide on the freeway; she was released four hours later, only to jump out of the moving taxi that was called for her by the mental health facility. Following existing law and policy, she was deemed “not a threat” to herself or others; tragically, she successfully committed suicide.¹

Mental Health America, a U.S. community-based nonprofit dedicated to addressing the needs of those with mental illness, estimates in its 2015 annual report, The State of Mental Health in America, that “1 in 5 adults, equivalent to 40 million Americans, have a mental condition.” The report avers “Rates of youth with severe depression increased from 5.9 percent in 2012 to 8.2 percent in 2015. Even with severe depression, 76 percent of youth left have no or insufficient treatment.” Of the 40 million adults with mental illness, “56 percent do not receive treatment.” Significantly, “Nearly half have a co-occurring substance abuse disorder.” The report also conveys the extreme shortage of mental health professionals, including psychiatrists, psychologists, social workers, counselors, and psychiatric nurses.² In a 2018 interview with the author, licensed marriage and family therapist Joni Dickson-Garcia said,

The cost of graduate school, unpaid practicums, low or unpaid internships, and low insurance reimbursement rates create severe financial barriers to those who would otherwise pursue a career in the mental health field. Specifically, drug counselors, although not required to obtain graduate-level study, are one of the lowest paid mental health professionals. If we want to increase services, we must decrease these barriers and increase financial incentives for this field.³

The solutions to these issues are as complex as the issue of mental health itself. What is known is that collaborative, creative critical thinking must occur among law enforcement leadership, the mental health community, and elected officials to find a path to provide the highest level of service to those with mental illness. Complicating the breadth of this issue is the rapid move to legalize drugs across the United States and other countries, especially the widespread legislation intended to allow recreational marijuana.

Mental Health Crisis Response Training and Social Acceptance of Marijuana

Police commanders send their officers into harm’s way every day, knowing that a call involving a mental health crisis incident is among one of the most dangerous situations an officer can face. As law enforcement leaders, it is imperative to ensure that officers are equipped to handle many types of situations, including calls involving mental health crises. In the article, “Improving Police Response to Persons with Mental Illness: A Multi-level Conceptualization of CIT,” the authors write,

These encounters can be dangerous for police officers and persons with mental illness. The majority of individuals that assault police officers are under the influence of drugs or alcohol and/or have a psychiatric disorder.⁴

A 2017 Gallup poll revealed that approximately 64 percent of people in the United States support the legalization of marijuana. This is up from 12 percent in 1969, when Gallup first asked this question.⁵ This social support, combined with influential advocates and economic arguments, set the stage for increased legalization of marijuana across the United States, as well as in other countries.

Although correlations have been made between cannabis use and psychotic events, brain development, and long-term health risks, little to no attention has been paid by the mainstream media to these links.

Although correlations have been made between cannabis use and psychotic events, brain development, and long-term health risks, little to no attention has been paid by the mainstream media to these links. In her article, “Public Perceptions of Arguments Supporting and Opposing Recreational Marijuana Legalization,” Johns Hopkins Associate Professor Emma McGinty and her colleagues wrote, “The best available research suggests that legalization could lead to increased rates of marijuana use and, in turn, adversely affect brain development, educational attainment and long-term health; increase rates of cannabis use disorder; and increase injury and mortality due to marijuana-impaired driving.”⁶

Most revealing is the article’s point that “public health risk messages were viewed as less compelling than pro-legalization economic and criminal justice-oriented arguments.”⁷

Similar to the cigarette marketing in the 1950s and 1960s on billboards, television commercials, shows, and movies, marijuana advocates have effectively utilized social media geared toward youth and young adults to sensationalize the use of marijuana while failing to mention any adverse effects of its use. Governance experts William A. Galston and E. J. Dionne Jr. provide statistical and demographic data showing support for the legalization of marijuana, stating,

[D]emographic change and widespread public experience using marijuana imply that opposition to legalization will never again return to the levels seen in the 1980s. The strong consensus that formed the foundation for many of today’s stringent marijuana laws has crumbled.⁸

Trends such as these suggest that public support for marijuana legalization will continue and law enforcement will have little effect on the social perception of marijuana. Two of the most effective tools law enforcement has to sway opinion, though, are knowledge and experience. The ability to communicate the dangers of marijuana, especially on people with mental illness, centers on law enforcement’s ability to understand the drug’s psychoactive ingredients and their effects on human cognition and to link those dangers to the reality of mental health crises that come to the attention of the police.

Physiological Effects of Cannabis on the Human Brain

The main psychoactive (mind-altering) chemical in marijuana, responsible for most of the intoxicating effects marijuana users seek, is delta-9-tetrahydrocannabinol (THC). Many people who smoke marijuana experience a euphoric state of mind, a sense of relaxation, a heightened sensory perception, an altered sense of time, and an increase in appetite. Conversely, there are also users who experience anxiety, fear, and panic.⁹ There is a growing body of research noting the adverse effects of marijuana to inform policy makers:

• According to the National Institute on Drug Abuse,

These effects are more common when a person takes too much, the marijuana has an unexpectedly high potency, or the person is inexperienced. People who have taken large doses of marijuana may experience an acute psychosis, which includes hallucinations, delusions, and a loss of the sense of personal identity. These unpleasant but temporary reactions are distinct from longer-lasting psychotic disorders, such as schizophrenia, that may be associated with the use of marijuana in vulnerable individuals.¹⁰

• In a position statement in the Canadian Psychiatric Association (CPA), “Implications of Cannabis Legalization on Youth and Young Adults,” Dr. Phil Tibbo, states,

Early and regular use increases the risk of developing a primary psychotic illness in those individuals who are vulnerable. … In those young adults who have developed psychosis, continued cannabis use worsens long-term symptom and functional outcomes.¹¹

• In 2012, Colorado voters approved legislation to legalize marijuana for recreational use. Dr. Andrew Monte, an associate professor of emergency medicine at the University of Colorado, brings to light some of the lessons learned and the health system effects from the passing of legalized medical marijuana in 2000, noting

Exacerbation of chronic health conditions was expected. Tetrahydrocannabinol (THC) is associated with psychosis, anxiety, and depression symptoms, making exacerbation of underlying psychiatric disorders inevitable.¹²

• Finally, a 2017 study that assessed the association between cannabis use disorder (CUD) and self-injury among veterans revealed,

As expected, after adjusting for sex, age, sexual orientation, combat exposure, traumatic life events, traumatic brain injury, posttraumatic stress disorder, depression, alcohol use disorder, and non-cannabis drug use disorder, CUD was significantly associated with both suicidal and non-suicidal self-injury.

Taken together, the findings from the literature reviewed above suggest that cannabis use is likely to be associated with increased risk for both suicidal and non-suicidal self-injury in civilians.¹³

It is incumbent on the police to link the issue of marijuana legalization to that of mental health to create more effective public policy.

Equipped with this information on the risks of marijuana use on mental health, law enforcement leaders can develop strategies to ensure their officers are thoroughly trained and prepared to engage with persons in crisis due to (or exacerbated by) the adverse effects of legalized marijuana. Leaders can also speak intelligently on the subject to the communities they serve. Since the medical and research community’s insights have seemingly not been considered in past legislative efforts, it is incumbent on the police to link the issue of marijuana legalization to that of mental health to create more effective public policy.

The Future Depends on Today’s Actions

There are efforts underway to improve police response to mental health crises in light of the research discussed herein and other similar findings. For example, in California, where marijuana has been legalized for both medicinal and recreational use, a panel of community members and experts was convened in September 2017 to study and discuss the issue and develop recommendations, among them were the following, many of which, while conceived with California in mind, could also benefit agencies in other regions.

Recommendation 1: Reevaluate the type of mental health crisis response training provided to beat-line officers and supervisors.

It is imperative that the old-school mind-set of “this is just how we’ve always done it” is in the past. Not only are law enforcement agencies dealing with increased public demands, they are also employing an ever-more diverse workforce to which each member brings his or her morals and values. Ensuring that departmental policies, protocols, and training are the most contemporaneous, leadership can set a solid example and clear expectations regarding mental health crisis response. This training should incorporate drug-influenced psychosis examples to provide officers with firsthand experience of what they might encounter in the field.

Recommendation 2: Begin teaching mental health crisis response at the academy level.

Law enforcement leaders would agree that newly hired cadets are motivated; eager to learn; and, at the earliest stage of their law enforcement careers, moldable. A significant component of academy training should include mental health crisis response. Scenario-based training should encourage a compassionate approach before elevating to a more traditional force option. This type of training would provide cadets with knowledge and build confidence as they transition from cadet to officer. Service expectations should be emphasized through all elements of academy training. New recruits should receive significant training on ethics, honor, and integrity. Additionally, it would be beneficial for a mental health services consumer to share with the cadets his or her story of law enforcement involvement, positive or negative. Instilling in new recruits the importance of service, compassion, and community trust at the earliest stages of their careers is the first step toward building and reinforcing trust within the community.

Recommendation 3: Invest in communities to build solid working relationships, trust, and confidence.

Most, law enforcement agencies desire to build trust and confidence within the communities they serve. Law enforcement leaders should engage in every opportunity to work with their communities and empower their officers and supervisors to do the same. These “deposits” of trust are essential when an unfortunate event occurs that requires immediate leadership attention, such as the use of force caught on camera or employee misconduct. Law enforcement should invest and welcome the community into “their” police department. For example, Barber Shop Talks, Coffee with a Cop, Citizen Advisory Boards, and opening the doors of their departments to the public for a meet and greet are great ways to invest for future goodwill.

Recommendation 4: Begin collecting data regarding public contacts that involve marijuana.

To state there is a problem is one thing, to prove the problem through empirical data is taking the issue to a whole new level. For example, the Golden Gate Division of the California Highway Patrol began collecting data on January 1, 2018, on marijuana-related incidents; collisions, arrests, citations, and even encounters with the mere odor of the drug. Officers, who for years have related that marijuana use is pervasive, can have a voice through data collection. Once gathered, it will be imperative to share this information with the community.

Recommendation 5: Connect with mental health professionals, key community members, and elected official stakeholders to find solutions and mitigate potential problems.

This recommendation requires adaptive leadership by executives in law enforcement. Recognizing that no one person has all the answers and that, essentially, two heads are better than one, law enforcement agencies would do well to make these connections. For example, the Golden Gate Division of the California Highway Patrol hosted a marijuana symposium in the fall of 2018. Community stakeholders and elected officials were invited to listen to experts from the medical and mental health professions, as well as law enforcement experts in the field of drug impairment. These types of community engagement opportunities are avenues to provide the public with proven data and information regarding cannabis and its use.

Conclusion

The human brain weighs approximately 3.3 pounds and contains billions of nerve endings connected by synapses; arguably, the brain is one of the most complex parts of the human body. When a person has a mental illness, and foreign chemicals are introduced into an already complex system, things can go very wrong, and law enforcement can be called to assist.

Unregulated access to legalized marijuana in many states and countries will influence law enforcement’s response to those in mental health crises. The full extent of the impact of the drug is unknown; however, mental health is an ever-growing challenge with no end in sight. When individuals with mental illness introduce marijuana into their systems, potential psychotic episodes can occur more frequently. As resources to assist in their recovery continue to dwindle, many individuals will go untreated, creating an even higher demand on law enforcement.

When individuals with mental illness introduce marijuana into their systems, potential psychotic episodes can occur more frequently.

The key to a successful outcome is having law enforcement leaders recognize that officers are on the front line of defense for these types of calls for service and provide them with the knowledge, skills, and abilities needed to respond effectively. Leaders must also work hard to build working relationships with mental health professionals, as solutions will require a team effort.

In order to provide the highest level of service to the public, law enforcement leaders must be fully committed and engaged with their communities and their rank-and-file officers. To choose otherwise, is akin to burying one’s head in the sand, hoping the problem disappears. Collaboratively, with an adaptive leadership mind-set, law enforcement can continue to provide the highest level of service to those they are sworn to protect.

Notes:

¹ Would the following work? Is it the correct incident?
Nate Gartrell, “Woman Jumps to Death from Taxi when Hospital Sends Her Back to Scene of Domestic Violence Call,” Mercury News, updated August 12, 2016

² Mental Health America, “The State of Mental Health in America,” November 01, 2018.

³ Joni Dickson-Garcia (Marriage & Family Therapist, MA, LMFT), interview by author, May 26, 2018.

⁴ Amy C Watson et al., “Improving Police Response to Persons with Mental Illness: A Multi-Level Conceptualization of CIT,” International Journal of Law and Psychiatry 31, no.4 (2008): 359-68.

⁵ Justin McCarthy, “Record-High Support for Legalizing Marijuana Use in U.S.,” Gallup, October 25, 2017.

⁶ Emma E. McGinty et al., “Public Perceptions of Arguments Supporting and Opposing Recreational Marijuana Legalization,” Preventative Medicine 99 (June 2017): 80–86.

⁷ McGinty et al., “Public Perceptions of Arguments Supporting and Opposing Recreational Marijuana Legalization.”

⁸ William A Galston and E.J. Dionne Jr., “The New Politics of Marijuana Legalization: Why Opinion Is Changing,” The Brookings Institute: Governance Studies, May 2013.

⁹ AddictionResource, “Marijuana High – The Dangers of the Recreational Use of Marijuana.”

¹⁰ National Institute on Drug Abuse, “What Are Marijuana Effects?” updated June 2018.

¹¹ Phil Tibbo et al., “Implications of Cannabis Legalization on Youth and Young Adults,” Position Statement of the Canadian Psychiatric Association (approved February 17, 2017).

¹² Andrew A. Monte, Richard D. Zane, and Kennon J. Heard, “The Implications of Marijuana Legalization in Colorado,” JAMA 313, no. 3 (2015): 241–242.

¹³ Nathan Kimbrel et al., “ The Impact of Cannabis Use Disorder on Suicidal and Non-suicidal Self –Injury in Iraq/Afghanistan-Era Veterans with and without Mental Health Disorders,” Suicide and Life-Threatening Behavior 48, no.2 (April 2018):140–148.

Please cite as:

Stephen D. Perea, “Marijuana, Law Enforcement, Mental Health: A Dangerous Social Experiment,” Police Chief (March 2019), online.