‘I was having an anxiety attack and they pepper sprayed me': police apprehension in mental health contexts in Australia

ABSTRACT

Police attendance in mental health contexts is often traumatic for the person in crisis, their family and first responders. Existing literature on police involvement in mental health responses tends to focus on police perspectives. Scholarship exploring lived experience perspectives is limited, yet is crucial for informing programmes, policies and reforms. We present findings from one of the first projects co-produced with people with lived experiences of being apprehended by police under mental health legislation. Interviews were conducted with twenty participants who had experience(s) of police apprehension across Australia. Findings highlight the social disadvantage experienced by participants prior to being apprehended and that use of force (such as tasering, pepper spraying and restraining in locked police vans) was common and over-used. Our study identified that police apprehension has lasting and wide-ranging impacts, leading to loss of employment, trauma, property damage, negative self-perceptions, discrimination, and fear of future police responses. Some participants were also apprehended by police while experiencing family violence and were misidentified as perpetrators. We argue police use of force mirrors the use of force within mental health services, with participants not experiencing a clear separation between police and mental health responses. The article shares participants’ ideas for change, including response models based on human rights, police non-attendance and peer-led initiatives. Our findings suggest the need for investment in alternatives to police responses and further research involving lived experience perspectives to inform out understanding of mental health crisis responses.

KEYWORDS:

• Mental health
• police use of force
• crisis intervention teams

Introduction

Transport of individuals in mental distress to mental health services is often undertaken by police without the assistance of paramedics, nurses, social workers or other allied health practitioners (Commonwealth of Australia 2006, Short 2014). In Victoria, Australia, mental health-related police callouts occur about every 12 minutes (State of Victoria, Royal Commission into Victoria’s Mental Health System 2018). Police involvement in mental health crises has been acknowledged as humiliating and traumatic for people in crisis, with traumatic impacts on families, supporters, and first responders also reported. The impacts of police involvement have precipitated calls for investing in alternative approaches (Kim 2021, Rowe 2022). Some police departments have sought to reduce their involvement (Victoria Police 2019) by exploring response models that aim to reduce unnecessary police involvement such as the ‘Right Care, Right Person’ (RCRP) approach (College of Policing 2024).

While there is a substantial body of international literature exploring perspectives of police (Morabito 2012, Desmarais 2014, Martin and Thomas 2014), research that engages with the perspectives of people who have been apprehended is limited (Desmarais 2014, Jones and Thomas 2018, Davey et al. 2021, Jones 2022). Our literature review did not locate research co-produced with people with lived experience. Lived experience is crucial for informing programmes, services, training, law and policy reform, and wider public and scholarly discussion. Whilst we recognise that family, supporters, mental health professionals and police hold their own perspectives, we sought to address this gap by presenting the findings from one of the first research projects co-produced with people with lived experiences of police apprehension. We begin by exploring the context for police involvement in mental health contexts in Australia, then provide an overview of how the research was co-produced, and articulate a theoretical approach informed by Fricker’s work on epistemic injustice (2007). We discuss the findings of the research, limitations, and present recommendations for change.

Language

The language in this paper is informed by both the project’s findings and the language preferred and endorsed by the project’s lived experience leadership group. ‘Mental distress’ indicates the broad range of feelings a person may have been experiencing when apprehended, including the severe emotional overwhelm that all people experience at some time. The terms ‘use of force’ and ‘excessive use of force’ are also used throughout this article. ‘Use of force’ refers to all coercive actions used to apprehend an individual. ‘Excessive use of force’ refers to all experiences that participants perceived as harmful and unnecessary.

Background

In Australia, state and territory mental health legislation authorises police to transport those deemed to be experiencing a mental illness to mental health facilities. A systematic review of international research, including numerous unique studies from the United States, United Kingdom and Australia, found that that about one in ten individuals encounter police in their pathway to the mental health system (Livingston 2016). Services and crisis support lines may also contact police if an individual is deemed to be at risk of harm to themself or others due to perceived mental distress, resulting in police apprehension and transport to mental health facilities. Upon the judgment of attending police, people are usually placed in the locked section of police vans (Al-Khafaji et al. 2014), physically and/or mechanically restrained, and/or sedated by paramedics (Ward 2022), and transported to hospital emergency departments (Roennfeldt 2021). People experiencing distress are over-represented in incidents of police use of force, and there have been numerous fatal shootings of people perceived to be mentally ill by police in Australia (McCulloch 2000, Thomas 2021). Those with diagnoses of schizophrenia are at heightened risk of being fatally shot (Kesic et al. 2012, 2013, Bowler et al. 2022). Literature exploring police perspectives reports that police officers are resistant to take up what they perceive as welfare-related work, that there is inadequately training in mental health (Miles-Johnson and Morgan 2022), and that officers often believe that people who appear mentally ill are unpredictable and irrational (Godfredson 2011, McTackett and Thomas 2017, Xanthopoulou et al. 2022). Conversely, literature suggests that people who are apprehended in a mental health context often fear and distrust police (Watson 2008). Prior studies in the US have established that procedural justice (perceptions of fairness and justness in decision making processes) is important to people who are apprehended (Lind and Tyler 1988, Greer et al. 1996).

Since colonisation, police have been responsible in Australia for transporting those in distress to asylums, mental hospitals and into police custody (Coleborne 2003, Office of Police Integrity 2012, Miles-Johnson and Morgan 2022). In the late twentieth century, Australian states and territories began a transition from state-run psychiatric institutions towards community-based services (Gooding 2016). Since this period, community-based mental health services have suffered from under-resourcing, resulting in the increased involvement of police. Police have therefore been described as playing a ‘gatekeeping’ role, determining whether those who have come to their attention should enter the criminal justice system or mental health system (Office of Police Integrity 2012). Police are implicated in the systematic criminalisation and over-representation of people with diagnoses of mental health conditions in the criminal justice system, as they are subjected to excessive police contacts, stops, searches, fines, and criminal charges (Police Accountability Project 2019). Aboriginal and Torres Strait Islander people experience heightened prevalence of disability and health conditions (Avery 2022) and are systematically criminalised as one of the most incarcerated groups in the world, accounting for around 33 percent of Australia’s prison population (Cunneen 2013, Australian Bureau of Statistics 2024). After the death of Yorta Yorta woman, Tanya Day in police custody in 2017, public drunkenness has been decriminalised in Victoria. With the exception of the removal of these offences in Victoria, the vast majority of recommendations of the Royal Commission into Aboriginal Deaths in Custody (1987–1991) remain unimplemented. As such, many policing practices continue to contribute to the preventable deaths of Aboriginal and Torres Strait Islander people in custody (Office of the Aboriginal and Torres Strait Islander Social Justice Commissioner 1996, Cubillo 2021).

Methodology

Lived experience involvement is required in policy, research, and the design, delivery and evaluation of services (Roper et al. 2018, Commonwealth of Australia 2019, Daya et al. 2020). Co-production is a recognised approach to the involvement of people with lived experience. Co-production involves people with lived experience from the outset in collaborative conception, design and analysis (Orr and Bennett 2012), requires longer-term engagement (Spencer et al. 2013), and is increasingly applied in criminal justice research and practice contexts (Johns 2022). Importantly, co-production re-positions those whose perspectives and knowledge have previously been excluded from research as active participants in the research process (Fricker 2007, Williams 2020). Co-production has documented benefits, as the involvement of impacted populations in data collection and analysis enhances the validity and relevance of research findings (Minkler and Wallerstein 2003, MacLean et al. 2008).

Co-production unsettles the dominant epistemological assumptions of positivist research methodologies that see ‘everything from nowhere’ (Foucault 1980, Lather 1986, Haraway 1988). Informed by the contributions of feminist theory (Haraway 1988, Harding 1990, 2004, Hartsock 1998) and decolonising approaches (Nakata 2007, Denzin et al. 2008, Smith 2013), we proceeded from the understanding that all knowledge is situated, relational and informed by the subjectivities of all members of the research team. Lived experience researchers participated in framing the research questions in conversation with the non-lived experience members of the research team, and terminology used was decided and endorsed by the lived experience leadership group. Grounded in the ethics of co-production, we aimed to challenge traditional research dynamics by being reflexive, identifying and addressing issues of power, building relationships and identifying the conditions for trust and collaboration (Doherty 2021).

Theoretical framework

Enacting co-production was viewed as a way of promoting epistemic justice. Fricker’s conception of ‘epistemic injustice’ theorises how those denied credibility as legitimate ‘knowers’ cannot be heard (Fricker 2007). Epistemic injustice describes a process in which the dominant tools of social interpretation puts those from marginalised social groups at a disadvantage when it comes to making sense of their social experiences and leads to the ‘deflated credibility’ of their testimony (Fricker 2007, p. 1). Fricker’s concept of epistemic injustice has been applied in the context of mental distress, including involuntary treatment and coercion (LeBlanc and Kinsella 2016, Scrutton 2017, Smyth 2021). For centuries, those considered ‘mad’ were socially viewed as incapable of reasoning and knowing (Foucault 1961). As such, the firsthand knowledge of those deemed mentally ill is routinely excluded in official discourse and knowledge production (Brosnan 2018, Rose 2023). We attempted to address issues of epistemic injustice through an approach sensitive to silencing practices in academia, by recognising those with lived experience as holding valuable knowledge.

Project design

The project conception was led by two lived experience academics who identified the issue of police involvement in mental health contexts as an important priority for co-produced research. After partnering with non-lived experience perspective academics to develop an ethics application, the ‘Been Apprehended Leadership Group’ (BALG) was formed to embed the involvement of lived experience in decision-making. The BALG comprised seven people with lived experience of police apprehension who resided across metropolitan and regional New South Wales, Queensland, and Victoria. The BALG met regularly online over the course of the project, facilitated by the lived experience project lead. The intimacy of BALG meetings enabled mutual learning, analysis, reflection, and deeper involvement of those with lived experiences. Occasionally, non-lived-experience researchers were invited to BALG meetings to provide training in interviewing skills and share ideas, however, these meeting were used primarily for lived-experience academics and BALG members to mediate power imbalances. Remuneration for the BALG members was in line with the National Mental Health Commission Paid Participation Policy (2019) and administered by the Victorian Mental Illness and Awareness Council (VMIAC), the peak body in Victoria for people with lived experience of mental health issues.

Participants

The project ran over a 10-month period in 2021–2022, with interviews conducted over four months. Ethics approval was provided by the Human Research Ethics Committee of RMIT University (24726). Individuals were eligible for participation if they were over 18, had experienced police apprehension in a mental health context in Australia, had no current legal disputes regarding police, and were not currently in a psychiatric or forensic setting. Participants and BALG members were recruited through project information disseminated by VMIAC.

Semi-structured interviews were conducted with 20 participants who ranged in age from 27-69, with a mean age of 45 years, and a median age of 50. One participant declined to answer demographic questions and is not included in the age data. Twenty-seven instances of apprehension were discussed within interviews, however, the total number of apprehensions experienced by participants over their lifetime was significantly higher. The age distribution at the time of apprehension was 16–69, with a mean age at the time of apprehension of 36.6 years and a median age of 37 years. Experiences occurred across five different locations within Australia: 16 events in Victoria, seven in NSW, two in Queensland, one in the Australian Capital Territory (ACT) and one in Tasmania. While most participant experiences of apprehension occurred in Victoria, the proceeding discussion reflects on experiences reported by participants across all locations (see Table 1). Twelve participants identified their gender as female, four as male, and four self-described their gender as either trans, non-binary, or gender diverse. Most participants identified their cultural identity as ‘white Australian’ (n = 10), three identified as Aboriginal or Torres Strait Islander (see Table 2). Fourteen participants reported having a psychosocial disability, five identified as having other disabilities, while eight reported chronic physical health conditions. While most participants spoke of having experienced mental health issues, others were apprehended by police due to the pathologisation of their behaviours in public space (for example, walking along a highway road, or sitting in a public phone box). Some participants reported having a psychosocial disability caused by the disabling social barriers stemming from diagnoses of psychiatric conditions (Puras 2022). Most participants categorised their socio-economic status as working class. Four participants were employed and also receiving social security payments, one was studying and receiving social security, and one participant was neither employed, nor supported by social security.

Table 1. Location of police apprehension experiences.

Location of apprehension events	Inner Melbourne, Victoria (n = 12)
	Regional Victoria (n = 4)
	Inner Sydney, NSW (n = 5)
	Regional NSW (n = 2)
	Regional Queensland (n = 2)
	Canberra, Australian Capital Territory (ACT) (n = 1)
	Hobart, Tasmania (n = 1)

Table 2. Ethic and cultural background of participants.

Ethnic or cultural background	Caucasian/white Australian (n = 10)
	Greek-Australian (n = 1)
	European (n = 2)
	Aboriginal or Torres Strait Islander (n = 2)
	Chinese (n = 1)
	Aboriginal and Irish (n = 1)
	‘Australian with French, British and Chinese heritage’ (n = 1)
	‘Irish, Scottish, Welsh, Spanish and Jewish’ (n = 1)

Research process

Consent processes were developed using an approach informed by the Convention on the Rights of Persons with Disabilities (CRPD), starting with the presumption of capacity to consent. Interviews were carried out in person or online due to COVID-19 safety measures. Participants were invited to bring support persons to the interview and were provided the option of being interviewed by lived experience researchers, non-lived experience researchers, or both. Participants were prompted to recall, to the best of their ability, events related to police apprehension and to reflect on the meaning and impact of events in their life, acknowledging that for some, memories could be distressing and/or may be challenging to recall. Check-ins were carried out for each participant one to two weeks post-interview. Interview recordings were professionally transcribed. Data were analysed based on an adaption of Flicker and Nixon’s (2015) ‘DEPICT’ approach, involving a six-step process for conducting collaborative qualitative analysis with individuals with lived experience. The various stages of the approach include dynamic reading, engaged coding development, participatory coding, inclusive reviewing and summarising of categories, collaborative analysing, and translating. The DEPICT approach has been refined over a decade in health and HIV research partnerships and provided a model adaptable to the research context. Reflective of the approach, the project lead allocated a sample of transcripts to groups of BALG members and non-lived experience academics. These groups then met and discussed themes identified while reading and coding the data. Preliminary categories and themes were developed and the project lead collated the group’s ideas into one cohesive codebook, which was circulated and trialed by small groups on other transcripts. Team members were provided with transcripts for coding using NVivo software. Several sessions for collaborative analysis involving the BALG and non-lived experience academics were then convened by the project lead. Additions were made by the small groups, which were incorporated into the final codebook used by the project lead for coding the remaining transcripts.

Findings

The findings cover all phases of police responses, starting with the context prior to apprehension, such as experiences of social and economic disadvantage, family violence, sexual abuse, homelessness and housing precarity, and discrimination. The experience of apprehension highlighted that police involvement exacerbated distress, that use of force was common, and the overall experience mirrored coercion within mental health systems. The ripple effects of being apprehended played out in participants’ lives for some time and ranged from material vulnerability (such as loss of employment or housing), through to changes in self-worth and identity. Participants shared ideas for alternatives to police apprehension, including peer-led responses and focus on human rights and dignity. For most participants, the experience of apprehension was harmful and created a series of events that undermined wellbeing. The experiences recalled by participants were diverse: some participants reflected on their experiences of apprehension by police and detention in state-run institutions, while others reflected on events that occurred just months prior to the interview. All participants below are referred to using pseudonyms.

The pre-apprehension context

Disadvantage prior to police contact

I had an extremely abusive partner. I’d had two children very close together, about a year apart from each other and it led to both postnatal depression and severe stress (Kate).

Prior to experiencing police apprehension, participants almost universally experienced social and economic disadvantage. This included family violence, sexual abuse, homelessness, housing precarity, discrimination based on psychiatric diagnoses, and lack of access to support:

My quality of life was so low from being homeless that I was like, if I don’t find stable housing in the long-term, suicide was the only way I could claim any sense of agency over that (Ash).

A lack of safe and affordable housing, experiencing family violence, the ongoing impacts of childhood trauma and abuse, and a lack of access to culturally safe supports were the most commonly reported factors.

Service systems interact together in unhelpful ways

Participants were generally failed by a lack of accessible, culturally safe supports and the crisis-driven nature of the mental health system. Participants identified the absence of voluntarily adopted supports that could have helped prevent crisis, often experiencing long waiting lists, receiving limited responses within the primary health care system, or being required to self-present at hospital emergency departments for support:

It all started with me trying to go to a GP and saying “I’m losing weight, I’ve moved to a new job, new area, getting a bit stressed, I need to nip this in the bud now” and they kept saying “Nah, we’re busy, we’re busy, we’re busy” and then, that escalated. From there, it just snowballed (Maz).

During police apprehension

Police escalated the situation and mental distress

Police apprehension intensified experiences of mental distress and Zulee’s quote highlights her fear of police and the actions she took to protect herself from them:

I had the knife for protection. In my head, it was: ‘This knife is going to protect me’ [from the police]. It wasn’t even about killing myself anymore … I was shocked, just seeing a sea of cops and just two paramedics, and I started saying, the first things that came out of my mouth was “Police, you go over there. You intimidate me.” (Zulee).

Participants described the experience of being observed by police officers during the apprehension process as intimidating, being ‘on public display’ and having their experience of distress used as a ‘training opportunity’ for police officers. When situations de-escalated, this was often not attributed to police tactics, but rather to participants’ own decisions to be co-operative or compliant, believing that not adapting one’s presentation would result in injury or death:

I can just sit there and go, “You know what? We can have a big punch on, and I’ll end up in the nuthouse, or you can just take me to the nuthouse”. I would, even when I was psychotic, I’d just go, “Well, let’s go. Just take me.” So, it was my change, not theirs, if that makes sense (Frank).

When a calmer approach was adopted, this mediated and deescalated the experience:

I think if you approach things as if they are inevitably dangerous, you’re more likely to get dangerous, whereas if you approach things in a mild and deescalating way, you’re much more likely to get a milder situation (Kate).

Emily had a positive experience when individual police officers took a supportive approach by spending time engaging in conversation and communicating options in a supportive way. Emily suggested this this response hinged on her presentation as a young, white woman, who was perceived by police as ‘vulnerable’, ‘non-threatening’, and deserving of a supportive approach.

[The police] sat with me for ages and gave me their jacket to keep me warm and talked to me about a lot of helpful things and kind of talked me through what I was going through, and even gave me their card afterwards to talk to them if I needed to (Emily).

Family violence and police responses

Several participants spoke of experiencing police apprehension in the context of family violence. Participants reported being apprehended and later discharged from services back into unsafe situations, as well as inappropriate responses from police when they were experiencing distress because of family violence. Kate described how her partner weaponised her psychiatric diagnosis by seeking police intervention as part of a coercive control and systems’ abuse dynamic:

I was in a domestically violent relationship. However, he tried to make out that I was responsible for the violence in the relationship. In order to make himself appear innocent, he would call the police and use it as a mental health call out. [He] was using the police to try and retain custody of the children (Kate).

One participant contacted police to report family violence, but when police arrived, she experienced a panic attack, which lead to her being pepper sprayed and tasered by police. Zulee reported that after being apprehended and transported to a mental health facility by police while experiencing suicidal ideation, the incident was later categorised as family violence, leading to her being made subject to family violence intervention orders:

We were served with a family violence intervention order on a Friday night at 11:00pm. [Police] came back, four weeks later, knocking at our door. I was absolutely shocked. What family violence? What do you mean, a suicide attempt is family violence? The police asked for full exclusion, 200 meters away from the home. I nearly fainted in the police station (Zulee).

Police use of force is common, over-used and distressing

Participants frequently experienced intimidation, threats, force, and restraint. Most participants had one, or multiple, experiences of being handcuffed and transported in police vans. Several had been sprayed with pepper spray, hit with batons, or tasered.

I was having an anxiety attack, and they pepper sprayed me. I had bruises all over my hands from the handcuffs they put on really roughly, even though I wasn’t under arrest. Then they took me to hospital (Alex).

Participants described feelings of shame, humiliation, and fear that they would be injured or killed by police. Aaron, an Aboriginal participant, feared being fatally injured by police:

I’m cowering on the nature strip, because I had a lot to do with the deaths in custody stuff, and I’m curled up on the nature strip going “Please don’t kill me”, because I thought they were going to take me back to the police station and bash me … My birth father was Aboriginal, so the idea of going to a police station at all was scary (Aaron).

Participants described the intimidating nature of witnessing large numbers of police in attendance, with several participants reporting physical restraint by multiple police. One participant was cornered in her kitchen by ten to twelve officers. Being transported in locked police vans replicated existing trauma, as communicated by Zulee:

I’d had an experience in between the other times where I’d been locked up by somebody. So being in the [divisional] van was quite scary for me because I was aware when I was in there … it looked like there was just one vent in the van where air came in, and I was just scared that they, the police, had total control (Zulee).

Participants sustained injuries from being transported while handcuffed in a police van without a seatbelt, and another reported being pepper sprayed while restrained in the back of a police van:

I accidentally had my foot in the wrong spot, it turns out there’s a camera in there. I was covering it, [but I] didn’t know. They told me to stop covering the cameras. [I said] “I don’t know what the hell you’re talking about”, so they just immediately opened this little thing on the side of the [divisional] van, this hole, and just sprayed straight in (Elliott).

Some participants had positive interactions with police; usually involving individual officers responding practically and compassionately (for example, a police officer providing their jacket, as Emily experienced, or being referring to community sport club). These experiences were generally outside of standard police processes. These positive interactions were categorised in contrast to previous experiences, or the harmful responses anticipated or feared by participants. Women who had been apprehended recounted distressing gendered experiences, for example, of being restrained by multiple male officers:

I was thrown into a stretcher, undressed forcefully, and exposed because they were trying to remove my top in front of the house. Paramedics kept pulling at my clothes, exposing me and I said, ‘Could you not undress me’ and the policeman didn’t even remove his eyes (Zulee).

Male participants sometimes recalled receiving aggressive comments from police officers, mocking, or challenging their masculinity:

I said something like, “Oh really, great response for someone who’s mentally ill”. Then the [police officer] was like “Get a girlfriend, you virgin” or something like that, and then they left (Sam).

Police use of force mirrors coercion in mental health services

Participants linked police responses to stereotypical associations between mental illness, violence, unpredictability, and dangerousness.

[Police assume] you’re a mental health patient, therefore you’re going to attack, so [they’re] just going to grab you straightaway and start dragging you towards the [divisional] van and not really bother to have a conversation … They just assume that you’re going to do the wrong thing (Elliott).

After apprehension, participants often reported involuntary admissions to hospital and further distress as a result of being subjected to coercive practices in mental health services (such as involuntary assessment and treatment, seclusion, physical and mechanical restraint by hospital staff or security guards). The impacts of apprehension were universally expressed as significant and shaped participants’ attitudes towards police and mental health services:

On that first night in, I was in isolation, but that first night there was a bed provided in a room, and I was lying on the bed, and then all of a sudden, the light goes on, in bursts six doctors and nurses, they physically held me down and then chemically restrained me after that. That was my introduction to the public mental health system (Frank).

Emma was apprehended by police and recalled being mechanically restrained at the hospital upon arrival by both police and hospital security guards:

I collapsed on the ground and said, “Can you help me?” No-one was helping me. Then they got police or security guards, I think it was both, dragged me and shackled me to the bed. For about three quarters of an hour, I was crying and yelling “Can you let me go?” (Emma).

Police apprehension impacted trust in police and services more broadly. Some participants described experiences of being apprehended by police as their first or only means of contact with the mental health system.

After apprehension

Participants were exposed to material vulnerability

Participants experienced significant material consequences as a result of the response from police and mental health services. This included loss of employment, property damage, and strained relationships with family, supporters, neighbors and community members. One participant was apprehended by police near their workplace and in full view of their co-workers. As a consequence of being apprehended and detained in hospital without access to their mobile phone, one participant lost their employment:

They sacked me because I wasn’t at work. I wasn’t allowed to contact them to say where I was, anything like that. [The hospital] didn’t care (Maz).

Kath detailed the impacts of damage and a robbery of her home, as a result of police forcing entry and leaving her property unsecured afterwards:

I was in [hospital] for a while, and [when I] came back to my home, the whole place was ransacked (Kath).

Others talked about anticipatory stigma from neighbors, community members, or co-workers:

Everyone would have imagined that I’m out there to harm someone. Now, I have pretty much agoraphobia. I’m not even going out in the driveway. Now, I only get in the car and go out, and I couldn’t take a walk anymore in the suburb (Zulee).

Changes in identity and distrust of services

I don’t call them. I don’t have anything to do with them. I avoid them. I see a police officer on the street, I turn my head, I try and walk around them (Jim).

Participants expressed how feelings of shame and humiliation led to changes in self-perception and identity:

Just this profound shock and disbelief, and I felt like, that’s it, I’m out of society. That’s it, I’m a bad person now. I just felt so debased, like I wasn’t a person, like I didn’t belong to society anymore (Zulee).

Participants spoke of developing an enduring fear and mistrust of police. Some reflected that they now avoid contact with the police because of their experiences:

I’m always terrified it would happen again because of what happened. I didn’t want [the police] bashing my place in, or threatening me, or dragging me around (Aaron).

Connection with others and community experienced as helpful

When participants had meaningful and supportive interactions, this was usually associated with instances where connection was fostered between the individual and wider community. Participants reported occasions where police officers exercised ‘common sense’, or where police officers engaged in conversation with them. Kai, a participant who was apprehended while living in a regional area, spoke of how a police officer referred them to a community sport club.

The policeman, even though he knew I wasn’t mentally well, he still didn’t hesitate to try and get me connected to the cricket club. He was trying to help me out, so he could identify that it would be a benefit for me to be linked in with the cricket club (Kai).

Alternatives to police responses

Preference for police non-attendance

Overwhelmingly, participants reported preferring alternatives to police attendance:

Well, I don’t think police should respond full stop (Emma).

I wouldn’t want to interact with the police at all (Alex).

Some participants expressed the view that only those police officers with substantial training in mental health should be permitted to respond. Participants valued police training involving people with lived experience and spoke of the need for training to provide skills in trauma response and de-escalation.

I’d like to see police have more mental health training than they [do] currently. I don’t know why, if there’s such a large proportion of people in society with a mental health condition, police aren’t given better training (Ash).

Peer-led responses

Almost universally, participants emphasised the desire for peer-led responses prior to, during and post crisis or discharge, and genuine alternatives to hospital emergency departments:

Peer representatives who make assessments related to the need for hospitalisation, a team who provide the transport in a nurturing way and then a separate team supporting people when they leave hospital or at home if they do not need to go. There should be a facility that offers peer support as an alternative to hospital (Zoe).

The values underpinning peer support, such as mutuality and connection were valued by participants. Mental health peer workers were considered to possess the values, skills, and training to communicate effectively in crisis and provide trauma-informed responses:

I think it would have been more helpful to have gone in to talk to a peer worker, like someone else who actually understands trauma and mental health issues (Samira).

In some circumstances, co-response models could be helpful

I don’t think police should be accompanying paramedics, unless a criminal act is about to occur, not a suicide (Zulee).

Participants often stated that police involvement in mental health crises would only be appropriate as part of a co-response model. Sometimes referred to as a ‘Police and Clinician Emergency Response’ model, co-responder schemes are varied and operate internationally and in parts of Australia. Co-responder models focus on improving police responses through collaborations between police officers and mental health professionals responding jointly in a mental health crisis.

In an ideal situation, there would be someone like a mental health worker with the police to talk to the person needing treatment and to talk them around and to be calm and considerate and how you’d want to be treated (Ash).

Human rights

Some kind of follow-up to let you know “We care about you”, because the entire process, I never felt cared about (Monica).

Participants frequently spoke of the need for human rights informed responses, such as those outlined in the CRPD, and empathetic and caring approaches.

I think human rights need to be first and foremost, the CRPD needs to be recognised in all legislation and embedded from the ground up (Kate).

I do acknowledge that sometimes people aren’t in the frame of mind to be hearing about their rights if they’re in the middle of a crisis, but that’s got to come into it somewhere (Monica).

Participants valued responses that afforded people in distress dignity, empathy, and respect. Simple acts such as engaging in conversation and presenting options had a profound impact, and could de-escalate situations.

[Police have] a really interesting kind of exterior of toughness and unyieldingness. They’re not your mate. They’re not your friend and I think that in those situations, you really probably need a friend. You probably really need someone who’s going to be compassionate, look after you a bit (Frank).

Discussion

Our research explored the experiences of people apprehended by police in a mental health context in Australia. Coproduction provided participants with the opportunity to reflect on their experiences in a mutually connected way, something not always evident in, or valued by, traditional research approaches. Our approach to the research and use of coproduction was grounded in the notion of epistemic injustice, which involved co-creating space for the sharing of difficult experiences.

Participants often had multiple experiences of police apprehension over their lifetime, involving the avoidable and disproportionate use of force, which led to worsened mental health and long-lasting personal consequences. Participants reported experiences of large numbers of police in attendance, the use of pepper spray and tasering at close range, being locked in divisional vans, injuries from police dogs, being hit with batons, handcuffing, being mechanically restrained in divisional vans or on stretchers. These experiences are consistent with existing literature that suggests police responses to mental distress are often inappropriate, traumatic and escalatory (Miles-Johnson and Morgan 2022, Xanthopoulou et al. 2022), and that police perceptions of mental illness increases the likelihood of coercive force (Kesic et al. 2010, 2012, p. 2013, Miller 2015). While there is some evidence that police perceptions of intoxication during an encounter increase the likelihood of sustaining injuries (Morabito and Socia 2015), substance use did not emerge in our findings.

A persistent theme across interviews was fear, with participants reporting that they anticipated significant injuries or being killed by police. For First Nations participants, this fear was directly linked to deaths in custody, and the role of police in settler colonial relations. Fear resulted in participants avoiding future contact with police and emergency and/or mental health services, confirming recent findings from Australian research that prior police contact impacts the help-seeking behaviours of people experiencing mental distress (Groot 2020, Randone and Thomas 2023). Experiences that were neither injurious nor lethal were frequently characterised by participants as ‘lucky’. These themes reflect the generally low expectations of, and distrust held by communities that anticipate harassment, discrimination or brutality from police (Watson 2008). No participant reported only positive experiences with police or ambulance services. The stigmatised and fear-based perceptions held by police officers of people presumed to be mentally ill (including presumptions of irrationality, unpredictability, irritability and violence) have deep implications for informing police behavior, training and practice. Fears of police held by those in distress and the police’s fear of those experiencing mental health crises, influence how apprehensions occur in practice.

While interview questions were centered around police responses, participants also spoke about how police responses influenced their engagement with mental health services upon arrival. As such, participants did not tend to categorise police responses as entirely distinct or separate from their encounters with mental health services. It became apparent that for many participants, police involvement was seen as an inherent part of their experience of the mental health system, and that the role and remit of police in connection with the mental health service system was unclear. Some participants framed police apprehension as the beginning of experiences of force, which extended into mental health services, through use of coercive practices such as involuntary treatment, seclusion and restraint.

Participants expressed an awareness of the inadequate nature of police culture and training for responding to distress and the demands and pressures on police, and to this end, some expressed the desire for improved police training on mental health. While some participants spoke of the need for training, we caution that for any training to be ‘successful’, this requires longer training periods, a focus on practical skills, experiential learning, partnership with people with lived experience (Davey et al. 2021) and independent evaluation (Saligari and Evans 2015, Thomas and Watson 2017). In discussions surrounding improved training and awareness for police on understanding mental health presentations, some participants spoke of improved awareness and practices in the context of co-response models. This confirms existing Australian literature that suggests these schemes are generally valued by people with lived experience (Evangelista 2016), however co-responder schemes are often under-funded and do not operate after usual business hours (Furness 2017). Evidence arising from international research regarding outcomes from the use of co-response models is also often mixed (Puntis 2018, Seo et al. 2021, Marcus and Stergiopoulos 2022).

Overwhelmingly, participants preferred that, where possible, police are not involved in responding in mental health contexts. The desires expressed by participants for non-clinical, peer-led responses requires the resourcing, development, piloting, and co-designed evaluation of such alternatives (Roennfeldt 2021, Banfield 2022, Brasier 2022). There are a range of examples of peer-led alternatives, such as the Gerstein Crisis Centre in Canada, which provides a voluntary crisis service, and the ‘Just Listening’ model developed by Humane Clinic in Adelaide, South Australia, which provides a drop-in service alternative to emergency departments (Ball et al. 2022). Peer support workers were generally thought to be best placed to understand presentations of distress and trauma. It is important to acknowledge that while peer-based responses will be appropriate and feasible to respond in some situations, they may not be so well suited to others. Further consideration of the applicability and scope of peer support responses needs to be explored in collaboration between people with lived experience and first responders.

For many participants, police were contacted in the context of family violence and as part of legal systems’ abuse (Reeves 2023) and in more than one case, a participant experiencing family violence reported being misidentified as a perpetrator. These accounts reflect the significant issues of police ‘misidentification’ (Hirschel et al. 2021) and the failures of law and order responses to family violence generally (Nancarrow 2019), particularly for marginalised communities (Douglas and Fitzgerald 2018, Ulbrick and Jago 2018).

Recognising that men (Knott 2007, Al-Khafaji et al. 2014) and migrant and culturally diverse communities experience higher rates of involuntary treatment in Australia’s mental health system (Kisely and Xiao 2018, Corderoy 2024) both groups appear to be under-represented in this study. Recruiting participants from culturally diverse backgrounds is likely to have been limited by disseminating study information in English. Because police target and surveil First Nations peoples and racialised communities (Cunneen 2001, Hopkins 2020, Porter et al. 2022), their behaviours when apprehended are more likely to lead to criminalisation (Joseph 2019). Because our study inclusion criteria focused on experiences of police apprehension in the transport to mental health facilities and required that participants have no unresolved legal issues in connection with the events, it is likely that we did not capture the experiences of those who received fines, criminal charges, or arrests in connection with mental health-related police contact. Their experiences therefore also remain an area for further exploration.

Limitations

As recruitment relied on advocacy groups and peer support networks, it is possible that our sample was overrepresented with people active (either in paid or advocacy roles) in the mental health system. Some participants described experiences from over a decade ago, which may not reflect current policing practices. Participants predominately reflected on experiences across urban Australian cities, meaning that findings may not be easily generalisable for rural and regional areas, or international jurisdictions. Future areas for research should examine the intersection between mental health-related police apprehension, family violence and systems abuse, experiences in regional locations and trans and gender diverse communities on experiences of police apprehension.

Conclusion

This research represents one of the first co-produced investigations of mental health-related police apprehension. Our project was led by a lived experience academic and engaged a lived experience leadership group, who were involved in all stages of the project. The emancipatory values of co-production underpinned the co-authoring of this paper by people with lived experience and lived experience researchers. Our approach was guided by a commitment to epistemic justice and a desire to provide testimonial justice for those who have experienced police apprehension. The findings demonstrate that police apprehension is a significant, traumatic event, with wide-ranging and long-lasting impacts in all domains of a person’s life, which can lead to a general distrust and fear of police and mental health services. Prior to being apprehended and transported to hospital, participants experienced mutually reinforcing forms of disadvantage and police apprehension intensified this. The qualitative data collected on the direct, first-hand experience of participants suggests that mental distress is escalated by police responses and that the use of force is common. Apprehension by police was experienced as part of coercive responses to distress that are also replicated and reinforced within mental health services, through practices of restraint, seclusion, involuntary assessment and treatment. Our findings suggest the need for alternatives to police involvement in mental health-related events. The strong preference expressed by participants for ambulance and peer-led responses requires further investigation and support for piloting programs led by those with lived experience.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Disability Research Partnership funding, awarded in 2021.