You may have arrived here via a direct link to a specific post. To see the most recent posts, click HERE.

Monday, June 30, 2008

The CMHA weighs in on tasers

June 2008

Canadian Mental Health Association, Ontario is concerned about the use and safety of Tasers, as well as the propensity of law enforcement officials to deploy Tasers on people experiencing a mental health crisis or demonstrating signs of emotional distress.

Conducted energy weapons (CEWs), commonly referred to as Tasers, were introduced to Canadian law enforcement agencies starting in 2001. Tasers are hand-held weapons that send a jolt of electricity intended to stun and temporarily incapacitate an individual's motor nervous system. The charge is delivered through a pair of wires, weighted with barbed hooks, that can be fired from up to 10.6 metres away and will penetrate clothing up to five centimetres thick.1

The Taser is one of several use-of-force weapons that police officers may use to subdue or restrain an individual, to reduce the risk of injury or death to both the individual and the responding officer. The Taser is often represented as an alternative to the use of lethal force by police.

According to a recent backgrounder by the CBC, Tasers are being used by 73 law enforcement agencies across Canada. Most mid-size police forces use these stun guns between 50 to 60 times a year on average, reports the CBC, based on figures compiled by the Canadian Police Research Centre.1 The RCMP has 2,840 Tasers and has trained 9,132 officers to use them. They have been deployed more than 3,000 times since December 2001, in either drive stun mode (when electrodes on the Taser transmit electrical energy on contact with a subject's body) or in full deployment (when darts are fired at a subject).2 Following a pilot study by the Toronto Police Service, Ontario's Ministry of Community Safety and Correctional Services approved the Taser for use by Ontario police services in January 2005. In 2007, Tasers were used 264 times in Toronto, in either drive stun mode or full deployment,3 up from 97 times in 2006.4 The Taser was used an additional 140 times in 2007 as a "demonstrated force presence," a deterrent measure where a spark is generated or the laser sighting system activated without any contact to the subject.

It is estimated that there have been 270 deaths worldwide, including 17 Canadian deaths, proximal to Taser use since 1999.5 It is not possible to accurately count deaths, as there is no independent central registry in existence to monitor incidents and adverse events, and there remains controversy, as there is no conclusive proof that Tasers directly cause death. Many police services, coroners and researchers are suggesting Taser-associated deaths may be related to a condition referred to as "excited delirium," but no conclusive evidence has yet been established. The Canadian Police Research Centre describes excited delirium as a potentially fatal state of extreme mental and physiological excitement that is characterized by extreme agitation, hyperthermia, hostility, exceptional strength, and endurance without apparent fatigue.6 This condition was first described as early as 1982, when investigators were examining unexplained deaths due to physical restraint by police.7 It has been hypothesized that excited delirium generates an extreme state of physiological arousal that places individuals at greater risk of death.

The symptoms associated with excited delirium, while not a true mental health condition included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), appear to be similar to some of the behavioural symptoms exhibited by individuals experiencing a mental health crisis.

Ontario's Use of Force Continuum
All police officers in Ontario must have basic training in use of force. The Ontario Use of Force Model (2004) directs that officers shall continuously assess each encounter and select the most reasonable option for action, relative to the circumstance.8 The use of force continuum provides guidelines to incremental increases in use of force. The five stages of the continuum are: officer presence, verbal communication, physical control, intermediate weapons (using non-lethal chemical, electronic or impact weapons on an individual) and lethal force (using any force likely to cause permanent injury or death).

Ontario's Use of Force Model does not make allowance or offer guidance to police officers when encountering individuals who may be experiencing a mental health crisis and by virtue of their condition may not appear cooperative, due to hallucinations, delusions or other symptoms. However, other options are available, and mental health crisis intervention is the preferred approach for police to de-escalate such encounters.

Excessive Use of Force
Complaints have been issued against the RCMP and other police services claiming deployment of Tasers to subdue or gain compliance. The Commissioner for Public Complaints Against the RCMP has identified that Tasers are being used to subdue resistant subjects who do not pose a threat, and has referred to this expanded and less restrictive use as "usage creep."9

In January 2007, the South Coast British Columbia Transportation Authority Police Service announced that it would arm police patrolling Vancouver's TransLink public transit system with Tasers.10 After reviewing ten cases of Taser deployment on the transit system, accessed under freedom of information legislation, the British Columbia Civil Liberties Association identified four cases where there appeared to be no significant threat to individual or public safety. One case involved the use of a Taser when the suspect attempted to flee for fare evasion.11 This practice is concerning and may set a precedent in other provinces.

Each police service in Ontario is currently governed by different protocols and policies concerning the number of times a Taser may be deployed. However, the Canadian Police Research Centre noted in their 2005 study that "...police officers need to be aware of the adverse effects of multiple, consecutive cycles of CEDs [Tasers] on a subject..."12

Taser Use Is Not Publicly Reported
There are no comprehensive national or provincial records regarding how many police officers are carrying Tasers. Most police services are not publicly reporting incidents involving Taser use and outcomes.

Amnesty International indicates that international standards and codes of conduct for law enforcement officials prescribe that the deployment of non-lethal weapons require standard evaluation and control of use protocols.13

Research on Tasers Suggests Caution
Research on the safety of Tasers has primarily been conducted on animals, rather than humans. When research has been conducted on humans, they have been deemed medically healthy. While Tasers may be used without injury on some individuals, there are vulnerable populations on whom Tasers should be used with caution. A 2004 review of Taser technology by British Columbia's police complaint commissioner indicated that risk factors for death by Taser include drug-induced toxic states (cocaine, alcohol, etc.) and "acute psychiatric decompensation."14

In reviewing the available literature, the Commission for Public Complaints Against the RCMP examining RCMP use of Tasers determined:

...that there is a distinct lack of research nationally and internationally that thoroughly examines the connection between CEW use, excited delirium and the likelihood of death. Medical research is still in the early stages of reviewing this condition. What little is known of this condition suggest the need for a more conservative course of action with respect to the deployment of CEWs against vulnerable populations (people experiencing mental health crises, those suffering from drug toxicity and those exhibiting symptoms of excited delirium). The research suggests that these populations have a higher likelihood of death, not necessarily as a result of the use of force or restraint employed, but because of the mental or medical condition of the person at the time of police intervention.15
A May 2008 review published by the Canadian Medical Association Journal contradicts previous assertions that "stun guns" manufactured by Taser International and others are unlikely to impact with deadly force. The authors reference three independent investigations that have found that stun guns may, in some circumstances, stimulate the heart and potentially result in adverse consequences.16 They recommend that additional research with human subjects is required.

This finding is especially significant given increased cardiovascular vulnerability among people with serious mental illness. People with a mental illness appear to be at greater risk of developing irregular heartbeats (arrhythmia)17 and coronary heart disease.18 In addition, people taking antipsychotic medication have been found to have a 2.4 times greater risk of sudden cardiac arrest and death.19

Crisis Intervention Approaches for People with a Mental Illness
Some people with a mental illness who are in crisis will come in contact with police officers. Section 17 of Ontario's Mental Health Act, R.S.O. 1990, gives police officers the authority to bring someone to a medical facility for assessment if the officer has "reasonable and probable grounds" to believe a person has acted in a "disorderly manner" if the person is believed to have a mental disorder, has threatened or attempted to harm themselves, has behaved violently or caused someone to fear bodily harm, or has shown an inability to care for themselves.20

A number of barriers have been identified that pose challenges to police dealing with people who have a mental illness.21 These include not having advance information from dispatch that the person may have a mental illness, or what they might expect upon arrival at the scene. More fundamentally, lack of adequate education about mental illness is a reality that impacts police officers' ability to carry out their work with this vulnerable population. Police require customized training regarding how to identify situations involving mental illness, as well as how to communicate and intervene so as to minimize the use of force and maximize the likelihood that individuals with a mental illness are able to access the services they require. Evidence suggests that identifying a specific group of police officers to receive training and respond to mental health crisis is most beneficial, as these individuals will then have the mandate to utilize and update their skills on a regular basis.22

Some police services in Ontario have received training and participate in mental health crisis intervention teams. These teams consist of police officers and mental health workers acting together to respond to individuals experiencing a mental health crisis. This partnering offers the expertise of both professions.

There are a variety of ways in which the police and the mental health system can work together to manage first-response situations, in which the police are called to deal with an incident involving a person who appears to be mentally ill:

Comprehensive advanced response model: all police officers receive training related to working with individuals with mental illness and are expected to be able to handle most situations.

Mental health professionals co-response model: mental health professionals from another agency with whom the police have some kind of working agreement would respond to a police call at the request of the police, generally after the police have responded and assessed the situation.

Mobile crisis team co-response model: the police and the mental health workers are co-employed, sometimes by having mental health workers employed by police services and sometimes by having police officers seconded to community mental health agencies.

Crisis intervention team (CIT): specially trained officers respond to problematic situations. These officers are assigned to other duties (such as traffic patrol) from which they may be pulled as needed.

Telephone consultation model: police have a toll-free number to a mental health unit or hospital psychiatry floor which is staffed 24/7, which they may call for advice and direction whenever there is an incident.23

The Canadian Association of Chiefs of Police has prepared guidelines for police programs and services for people with mental illness and the mental health system, that include, but are not limited to, developing effective and compassionate crisis response.24

Recommendations from the Canadian Mental Health Association, Ontario Regarding Conducted Energy Weapons (Tasers)

June 2008

A group of specially selected officers in every police service in Ontario be trained in mental health crisis intervention and other appropriate de-escalation techniques.
Police services in Ontario co-develop and participate in mental health crisis intervention teams to serve the needs of their community.

Police services in Ontario limit their use of Tasers to situations where the alternative would be use of deadly force. Tasers are only used as a last resort and after all other de-escalation techniques have proven unsuccessful.

Police services monitor and publicly report the incidence and outcomes of Taser use.
Independent research is conducted into the safety of Taser use, including the effects on persons experiencing a mental health crisis.

Canadian Broadcasting Corporation, "Taser FAQs," CBC News Online, May 13, 2008, www.cbc.ca.

Canada, "RCMP Use of the Conducted Energy Weapon (CEW): Interim Report," Commission for Public Complaints Against the Royal Canadian Mounted Police, December 11, 2007, www.cpc-cpp.gc.ca.

Toronto Police Services Board, Minutes of the Public Meeting, March 27, 2008, www.tpsb.ca.

Toronto Police Services Board. Minutes of the Public Meeting, April 26, 2007, www.tpsb.ca.

Bruce Stuart and Chris Lawrence, "Report on Conducted Energy Weapons and Excited Delirium Syndrome," Royal Canadian Mounted Police, October 29, 2007, www.rcmp-grc.gc.ca.

Drazen Manojovic et al., "Review of Conducted Energy Devices," Canadian Police Research Centre, Technical Report TR-01-2006, August 22, 2005, www.cprc.org.

M. Pollanen, D. Chiasson, J. Cairns and J. Young, "Unexpected Death Related to Restraint for Excited Delirium: A Retrospective Study of Deaths in Police Custody and in the Community," Canadian Medical Association Journal 158, no. 12 (1998): 1603-7.

Ottawa Police Service, "Use of Force Annual Report - 2007," February 19, 2008, www.ottawa.ca.

Canada, "RCMP Use of the Conducted Energy Weapon (CEW)."

Canadian Broadcasting Corporation, "SkyTrain Transit Police to Get Tasers," CBC News Online, January 22, 2007, www.cbc.ca.

British Columbia Civil Liberties Association, "Letter to the Office of the Police Complaint Commissioner for British Columbia, Re: TransLink Police Use of Tasers," April 17, 2008, www.bccla.org.

Manojovic et al., "Review of Conducted Energy Devices."

Amnesty International, "Canada: Inappropriate and Excessive Use of Tasers," International Secretariat, May 2007, www.amnestyusa.org.

British Columbia, "Taser Technology Review and Interim Recommendations," Office of the Police Complaint Commissioner, September 2004, www.opcc.bc.ca.

Canada, "RCMP Use of the Conducted Energy Weapon (CEW)."

K. Nanthakumar et al., "Cardiac Stimulation with High Voltage Discharge from Stun Guns," Canadian Medical Association Journal 178, no. 11 (2008): 1451-57.

J.G. Reilly et al., "QTc-Interval Abnormalities and Psychotropic Drug Therapy in Psychiatric Patients," The Lancet 355, no. 9209 (2000): 1048-52.

D.L. Evans et al., "Mood Disorders in the Medically Ill: Scientific Review and Recommendations," Biological Psychiatry 58, no. 3 (2005): 175-89; D.C. Goff et al., "A Comparison of Ten-Year Cardiac Risk Estimates in Schizophrenia Patients from the CATIE Study and Matched Controls," Schizophrenia Research 80, no. 1 (2005): 45-53.

W.A. Ray et al., "Antipsychotics and the Risk of Sudden Cardiac Death," Archives of General Psychiatry 58, no. 12 (2001): 1161-67.

Ontario, Mental Health Act, RSO 1990, c. M.7.

Canadian Mental Health Association, British Columbia, "Study in Blue and Grey. Police Interventions with People with Mental Illness: A Review of Challenges and Responses," December 2003, www.cmha.bc.ca.

R. Dupont and S. Cochran, "Police Response to Mental Health Emergencies: Barriers to Change," Journal of the American Academy of Psychiatry and the Law 28, no. 3 (2000): 338-44.

Canadian Association of Chiefs of Police, "Working Together - How?" Canadian National Committee for Police/Mental Health Liaison (no date), www.pmhl.ca.

Canadian Association of Chiefs of Police, "Contemporary Policing Guidelines for Working with the Mental Health System," Police-Mental Health Subcommittee, July 2006, www.pmhl.ca.

No comments: