Police use of TASER devices in mental health emergencies: A review☆
Anthony J. O'Brien a,
⁎, Katey Thom b,1
a
Centre for Mental Health Research, University of Auckland, Private Bag 92019, Auckland, New Zealand
b
Centre for Mental Health Research, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
a b s t r a c ta r t i c l e i n f o
Available online 20 March 2014
Keywords:
Police
TASER devices
Mental health
Crisis
Research
The proliferation of TASER devices among police forces internationally has been accompanied by concerns about
injuries and health effects, and about the use of TASER devices on vulnerable populations such as people with
mental illness. TASER devices have generated a ﬂood of research studies, although there remain unanswered
questions about some of the key issues. This paper outlines the introduction of TASER devices to policing and
their subsequent widespread adoption. The paper considers the role of police in mental health emergencies
with a particular focus on use of TASER devices. Some factors contribute to the special vulnerability of people
with mental illness to the effects of TASER devices. The paper also reviews research into use of TASER devices
and raises issues about conﬂict of interest in research into TASER devices. We conclude that TASER devices
look set to play a signiﬁcant role in policing in the future. We make suggestions for a future research programme,
and suggest guidelines for publication of papers in which there may be a conﬂict of interest.
© 2014 Elsevier Ltd. All rights reserved.
1. Introduction
Police exercise a unique role in the community in responding to a
range of emergency situations, including behavioural emergencies.
Many behavioural emergencies involve people with either newly
presenting mental illness or a history of mental illness, and are frequently
complicated by alcohol or other substances. Over the past two
decades many police departments internationally have deployed
TASER devices as part of their range of options in responding to emergencies.
The available literature suggests that people with mental illness
are prominent among the groups on whom TASER devices are deployed.
Use of TASER devices is a concern to mental health professionals for two
reasons. Firstly, police perceptions of people with mental illness as dangerous
may contribute to an increased likelihood of use of TASER devices
in mental health emergencies compared to criminal arrests.
Secondly, the known health risks of TASER devices are heightened in
the case of people in mental health crisis who may show central nervous
system arousal as a result of high levels of anxiety. People with mental
illness also have a high incidence of comorbid physical illness and use
of illicit substances, and may be prescribed psychotropic medications
that further heighten their risk.
In this paper we review the nature of police involvement in mental
health emergencies in community settings, with a particular focus on
police use of TASER devices. In addition to addressing the concerns
noted above, we also discuss the state of current literature on police
use of TASER devices in mental health emergencies, and make suggestions
for a research agenda in this area. The current literature on use
of TASER devices pays scant attention to their use on people with mental
illness. Questionable claims are made about prevention of suicide,
many studies do not present data on people with mental illness, and
overall there is a lack of robust research on the incidence of use of
TASER devices on people with mental illness. The research literature
on TASER devices safety is plagued by selection bias and lack of generalizability
to real world circumstances. Concerns about conﬂict of interest
have been reported, most frequently in relation to researchers with ﬁnancial
ties to the manufacturer, TASER International Inc. There is a
need for more independent research and more research into the implications
of TASER devices use on people with mental illness.
2. TASER devices
TASER devices2
, alternatively referred to as conducted electrical
weapons (CEWs) or conducted electrical devices (CEDs) are handheld
devices designed to deliver short high-voltage, low current energy
pulses by means of twin barbs attached to ﬁne wires with the aim of
temporarily paralyzing a person by causing painful muscular contraction
(Kunz, Grove, & Fischer, 2012). First introduced to police in 1974
(Koscove, 1985), use of TASER devices in engagements with individuals
with behavioural disturbances has increased markedly in the past two
decades (Crow & Adrion, 2011). Information from the manufacturer of
International Journal of Law and Psychiatry 37 (2014) 420–426
☆ TASER is the registered trademark of TASER International, Inc.
⁎ Corresponding author. Tel.: +64 9 3737599x85693.
E-mail address: a.obrien@auckland.ac.nz (A.J. O'Brien).
1
Tel.: +64 9 9239579.
2
In this paper we use the proprietary term ‘TASER’ to refer to all currently used electrical
behaviour control devices as that is the term most commonly used in the literature.
Where researchers have used other terms we follow the terminology used by those
researchers.
http://dx.doi.org/10.1016/j.ijlp.2014.02.014
0160-2527/© 2014 Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect
International Journal of Law and Psychiatry
TASER devices states that the devices are used by more than 16,000
agencies in 40 countries (http://investor.taser.com/).
Two major reasons have been offered in the literature for the introduction
of TASER devices into policing. Most prominently, TASER devices
are considered to offer a “less lethal” police response when
compared to ﬁrearms because they allow police to effectively contain
situations of high risk without resort to lethal force (Vilke & Chan,
2007; White & Ready, 2007). TASER devices also offer the potential
that they allow police to effectively contain situations of high risk
while reducing the rate of ofﬁcer injuries.
A before and after study across 12 police departments found a 25%
reduction in ofﬁcer injuries following the introduction of TASER devices
(McDonald, Kaminski, & Smith, 2009). The main reason for injury
reduction is the reduced need to physically intervene with a resistant
person. Further evidence of injury reductions comes from a four year
quasi-experimental study which compared ofﬁcer and suspect injury
in police departments with and without TASER devices (Taylor &
Woods, 2010). The researchers reported that compared to departments
that deployed TASER devices, those without the devices had higher
rates of ofﬁcer and suspect injuries, and higher rates of injuries requiring
medical attention. A potentially confounding factor in Taylor and
Woods' study was the quite large unexplained increases in all four injury
measures in the non-TASER device sites in the post period compared
to the preperiod. Beneﬁts of injury reductions are not realised in all situations
and under some circumstances, notably those involving multiple
forms of police response, use of TASER devices has been associated
with a higher rate of ofﬁcer injuries (Paoline, Terrill, & Ingram, 2011;
Terrill & Paoline, 2012). A limitation of the latter studies is that data included
dart injuries, which had the effect of inﬂating the number of injuries
recorded (Kaminski, Engel, Rojek, Smith, & Alpert, 2013).
While police use of TASER devices seems to enjoy a high level of public
acceptance, this development is not without controversy. With the
increased use of TASER devices has come growing concern and public
debate about safety of those subject to this technology. In the United
States, Amnesty International (2008) has documented 334 deaths following
use of TASER devices between 2001 and 2008. The much
publicised death of Robert Dziekanski at Vancouver airport (Rolfsen,
2007) has also contributed to public concerns about safety of TASER devices.
These concerns are reinforced by news reports of individual
deaths following use of TASER devices in Australia (Merhab, 2008) the
United States (Hall, 2009) and England (Smith, 2013).
The Amnesty International report and the media attention to the
case of Robert Dziekanski and others represent the public face of the debate
about the safety of TASER devices, but medical literature also reports
a number of adverse effects (Denham & Mallon, 1999; Lim &
Seet, 2007; Sanford, Jacobs, Roe, & Terndrup, 2011; Strote & Hutson,
2006). Although TASER devices are reported to be safe in healthy individuals
(Bleetman, Steyn, & Lee, 2004), other researchers have concluded
that “While less lethal weapons are signiﬁcantly safer than
traditional ﬁrearms, no weapon can be entirely non-lethal and no weapon
can be made entirely safe.” (Bozeman & Winslow, 2005). The medical
literature on TASER devices contains many case reports of injuries
from TASER devices and these are discussed later in this paper (for a review,
see Pasquier, Carron, Valotton, & Yersin, 2011).
Safety concerns are acknowledged by the manufacturer of TASER
devices, whose product information sheet states that use of TASER
devices “causes physiologic and/or metabolic effects that may increase
the risk of death or serious injury” (Taser International, 2013). The information
sheet goes on to note that some individuals, particularly
those with “profound agitation”, drug intoxication or chronic drug
abuse, may be particularly vulnerable. The warning includes “excited
delirium”, a diagnostic category not found in either of the commonly
used diagnostic taxonomies, the American Psychiatric Association's Diagnostic
and Statistical Manual of Mental Disorders (DSM IVTR) or the
World Health Organization's International Classiﬁcation of Diseases
(ICD-9) (Takeuchi, Ahern, & Henderson, 2011), but which is used to
describe a syndrome in which people experience severe agitation with
lethal consequences (Vilke, Bozeman, Dawes, Demers, & Wilson,
2012). Excited delirium is commonly cited as contributing to deaths
when individuals have been subject to TASER device discharge
(Jauchem, 2010; Strote & Hutson, 2006).
Use of TASER devices in mental health emergencies has also been
subject of debate, with rights groups such as Amnesty International
criticising use of TASER devices on people with mental illness. Rates of
use of TASER devices in mental health emergencies appear to be high
(Ho, Dawes, Johnson, Lundin, & Miner, 2007; O'Brien, McKenna, Thom,
Diesfeld, & Simpson, 2011) and use of TASER devices has extended
from community to hospital settings (Erwin & Philibert, 2006; Little,
Hogbin, & Burt, 2013; O'Brien et al., 2011), including on psychiatric patients
in emergency departments (Choudhary, Sabri, & Sabri, 2012). It is
clear that the TASER device has appeal to staff in a range of emergency
and health settings, and with the potential for proliferation into some
unanticipated contexts, especially mental health settings.
3. Police and mental health emergencies
Police involvement in mental health emergencies is not a new
phenomenon (for an early review, see Bittner, 1967). In every western
country police have traditionally held a role of intervention with
people with mental illness in community settings. However concerns
about police interaction with individuals with mental illness,
often expressed by police themselves, rose markedly during the period
of deinstitutionalisation, when large numbers of formerly
hospitalised patients were discharged to community living (Lamb,
Weinberger, & De Cuir, 2002). At the same time, as hospitals began
to downsize, police disposition to hospital became more difﬁcult.
Services to people with mental illness were not always available at
the point of arrest, leading police to refer to themselves as “street
corner psychiatrists” (Teplin & Pruett, 1992). In many western countries
mental health services are now predominantly community focussed.
Police interaction with people with mental illness is relatively common,
and is the focus of a considerable proportion of police time (Godfredson,
Thomas, Ogloff, & Luebbers, 2010; Short, MacDonald, Luebbers, Ogloff,
& Thomas, 2012; van den Brink et al., 2012; Wells & Schafer, 2006),
with use of alcohol and other substances further complicating these
encounters.
Frequently, when mental health crises arise in community settings,
neither police nor mental health services alone can respond effectively.
Mental health teams are not empowered or trained to effect detention
and police, while they may recognise features of mental illness, are
often not trained in psychiatric assessment. There is a need for police
and mental health services to work together in such situations (Laing,
Halsey, Donohue, Newman, & Cashin, 2009; Patch & Arrigo, 1999). A
large number of jurisdictions have initiated combined police and mental
health teams, with a view to identify mental health issues at the point of
arrest and diverting detainees from the criminal justice system towards
mental health services. While the most well-known and well researched
example of such an innovation is the Crisis Intervention Team (CIT) or
Memphis Model (Borum, 1998; Compton, Bahora, Watson, & Oliva,
2008; Ogloff et al., 2012; Watson & Fulambarker, 2012; Watson,
Morabito, Draine, & Ottati, 2008), a range of different models have been
developed in different contexts (see Cotton and Coleman (2010));
Herrington and Pope (2013); Steadman, Deane, Borum, and Morrissey
(2000). Evaluations of collaborations between police and mental
health have generally been positive, with beneﬁts noted in ofﬁcer
attitudes and knowledge, timeliness of mental health service response,
and diversion to mental health services. However police
contacts with people with mental illness still contain the potential
for aggression and violence, and for the need for force in the police
response (Johnson, 2011).
Recently, police have explored the use of a range of strategic options
aimed at reducing reliance on ﬁrearms in situations where a person
421A.J. O'Brien, K. Thom / International Journal of Law and Psychiatry 37 (2014) 420–426
subject to arrest is perceived as presenting a danger to themselves, to
others or to arresting ofﬁcers. TASER devices are one such strategic option,
and have been promoted as a “less lethal” alternative to ﬁrearms
(Bleetman et al., 2004; Vilke & Chan, 2007; White & Ready, 2007). Because
presentations to police may be undifferentiated at the time of
an event, police will consider the full range of tactical options, including
TASER devices, as part of their response. It is unsurprising, therefore,
that among the groups subject to use of TASER devices are people
with mental illness (Ho et al., 2007; Munetz, Fitzgerald, & Woody,
2006; O'Brien et al., 2011). The next section of this paper discusses
how ofﬁcer perception of the dangerousness of people with mental illness
may inﬂuence the decision to deploy a TASER device when
responding to a mental health emergency.
4. Perceptions of dangerousness and police interactions with people
with mental illness
While many of those who come to the attention of police do so for
reasons of criminality, in a substantial minority of cases police contacts
involve people in various states of mental health crisis (Kesic, Thomas, &
Ogloff, 2013; Lipson, Turner, & Kasper, 2010). To further complicate the
nature of police response, the two groups are not distinct (Cummins,
2012). People in mental health crisis may behave in ways that would
otherwise be considered criminal, for example by threatening others,
damaging property, or trespassing on private property (Johnson,
2011). While calls might involve individuals with a known history of
mental illness, or may even be initiated by mental health services, in
other cases it may not be clear, at the time police are contacted, that
mental illness is a contributing reason to a call to police.
While perceptions of people with mental illness as dangerous or potentially
violent are frequently exaggerated (Markowitz, 2011) a significant
subgroup presents an increased risk of violence (Choe, Teplin, &
Abram, 2008). This subgroup includes people who are experiencing
acute psychosis and who have consumed alcohol or other substances
(Van Dorn, Volavka, & Johnson, 2012). A police perception of potential
for violence may complicate these interactions, especially if police
have had little training in response to mental illness (Ruiz & Miller,
2004; Watson, Corrigan, & Ottati, 2004). Police may also misinterpret
the behaviour and demeanour of people with mental illness, contributing
to greater likelihood of adverse outcomes from police encounters
(Kerr, Morabito, & Watson, 2010). When police response to people
with mental illness is driven by perceptions of dangerousness and potential
for violence, police are likely to draw more deeply on their use
of force options. A study in Victoria Australia, reported that more than
50% of 48 victims of police shootings between 1982 and 2007 had recorded
histories of Axis I mental disorders (Kesic, Thomas, & Ogloff,
2010). Even after a programme to improve police response, people
with mental illness remained at higher risk of fatal outcome following
a police encounter. These ﬁndings have implications for deployment
of TASER devices, especially as TASER devices are promoted as a safe alternative
to lethal weapons. A perception of people with mental illness
as dangerous, together with the availability of an apparently safe technology
of intervention, may combine to create a low threshold for use
of TASER devices in mental health emergencies.
Running counter to suggestions that police may perceive people
with mental illness as dangerous and therefore act more coercively towards
them, is a body of research that suggests the opposite: that people
with mental illness are not more likely to experience police use of
force, and that police use of force may even be less likely with this
group. Engel and Silver (2001) reported comparable arrest rates between
criminal suspects with and without a mental illness, once level
of offence, intoxication and resistance were controlled for. A similar
ﬁnding was reported by Terrill and Mastrofski (2002) whose measure
of “mental impairment” was not correlated with police use of force
after controlling for relevant confounders. In a study that contradicted
the “criminalisation hypothesis” (that police act coercively towards
people with mental illness) Novak and Engel (2005) found that rather
than acting more coercively towards people with mental illness, such
people were less likely than their criminal counterparts to face arrest,
despite being more likely to have committed a serious offence, to be
intoxicated or to resist arrest.
Where high rates of police use of force with people with mental
illness have been reported, several explanations for this apparent
disparity have been offered. These include the relationship between
psychosis and hostile or violent behaviour, non-adherence with
treatment of people with a diagnosis of psychosis, use of drugs and
alcohol, and experiencing stressful events such as homelessness or
interpersonal conﬂict (Johnson, 2011). “Mental illness” as a category,
especially if it is identiﬁed by police reports, may be too broad to advance
understanding of police response without considering subgroups
within that category, and the factors that may exacerbate
resistive or aggressive behaviour. One group in particular who present
problems for police are those with personality disorder. In a recent
qualitative study of police ofﬁcers' views of interactions with
people with personality disorder, such people were described as
“behaving badly” but also as not being rational (Martin & Thomas,
in press). Police experienced difﬁculty in achieving their desired disposition
to mental health services, with the result that police, rather
than mental health services, are seen as the social agency with most
responsibility for this group, at least in terms of any response to disturbed
behaviour in the community (Martin & Thomas, in press). The
researchers noted that personality disorder is not covered by mental
health legislation, even although it is a diagnosis associated with a
signiﬁcant level of disturbed behaviour.
5. Health effects of TASER devices
The health effects of TASER devices have been the subject of considerable
controversy. Health concerns can be classiﬁed into three broad
streams: sudden deaths, injuries and adverse effects, and the potential
for the electrical energy of a discharge to cause disruption to cardiac
functioning. The overall conclusion of this research is that TASER devices
are generally safe with healthy, sober subjects, and when used in accordance
with the manufacturer's and police departments' guidelines, but
there are several important provisos to this conclusion. In their review
of morbidity and mortality associated with use of TASER devices
Pasquier et al. (2011, p. 185) concluded that “the potential association
between use of TASER devices in the ﬁeld and death is of great concern”.
This concern is heightened by the limitations of existing studies, an
issue addressed below. TASER devices also have the potential to cause
severe injuries and other adverse effects, resulting from the unique penetrating
action of the prongs of TASER devices, from muscular contractions,
or from falls. The three areas of health concerns related to use of
TASER devices are discussed below.
5.1. Sudden deaths
As noted above, a number of newspaper and police reports have recorded
sudden unexpected deaths following use of TASER devices. In
many cases these deaths have occurred following use of multiple
means of restraints, and in individuals affected by stimulant drugs
(Jauchem, 2011; Morrison & Sadler, 2001). There is as yet no widely accepted
empirical evidence or theoretical account that identiﬁes a causative
role for use of TASER devices and sudden death. Zipes (2012) has
proposed such a role based on a series of case reports, but that account
has been disputed (Ho & Dawes, 2013; Nanthakumar & Waxman,
2013). Where deaths have been reported they are often associated
with “excited delirium”, a syndrome whose provenance has been
questioned (Paquette, 2003; Truscott, 2008) but which is used to describe
sudden deaths in custody associated with severe agitation,
and autonomic arousal. Such states are not uncommon in police encounters,
and are frequently seen in people with acute mental
422 A.J. O'Brien, K. Thom / International Journal of Law and Psychiatry 37 (2014) 420–426
illness, creating heightened risk when TASER devices are used with
this group. In this regard it should be noted that sudden deaths in
custody are not a new phenomenon. Such deaths have been reported
long before the advent of TASER devices (Grant et al., 2007), with associated
factors including resistance, agitation, restraint, being held
in prone position, use of pepper spray, use of prescribed psychotropic
medication and use of non-prescribed stimulant drugs (Robison, 2005).
While it might be expected that the deployment of a less lethal device
such as TASER devices would impact the rate of sudden deaths in
custody and deaths from police use of ﬁrearms, at least one epidemiological
study has shown a trend in the opposite direction. Lee et al.
(2009) reviewed data from 126 sheriff departments in California and
found that in the ﬁrst year following deployment of TASER devices, incustody
deaths increased six fold. In addition, deaths from ﬁre arms
doubled, while the rate of ofﬁcer injuries was unchanged.
A range of factors combine to create a unique risk proﬁle for people
with mental illness. These factors include high blood pressure,
obesity, cardiac and respiratory disease, and metabolic syndrome
(Usher, Foster, & Park, 2006). People with severe mental illness
have a range of physical comorbidities (De Hert & Leucht, 2011),
are more likely than the general population to use alcohol or other
substances (Chwastiak et al., 2006), and may be prescribed drugs
with the potential to alter cardiac functioning (Zemrak & Kenna,
2008), heightening the known risks of adverse outcomes. The latter
authors also noted that mental health patients may be prescribed
multiple drugs and at high doses, and may also be consuming illicit
drugs and alcohol, factors that further increase their risk from the
use of TASER devices. In a recent review of police department policies
for use of conducted energy devices (CEDs) such as TASER devices,
Thomas, Collins and Lovrich (2012, p. 421) commented that
“the individuals who are most likely to experience adverse health effects
post-CED deployment (e.g., mentally ill, intoxicated) are the
same individuals who are most likely to be exposed to CEDs”. In summary,
the debate over a causative role of TASER devices in sudden
deaths remains unresolved and will persist as long as sudden deaths
continue to be reported. It is possible that use of TASER devices acts
as an indicator of overall level of force in police response rather
than a causative factor in its own right. Such a hypothesis is amenable
to empirical investigation that may advance the debate over the
role of TASER devices in sudden deaths.
5.2. Potential to disrupt cardiac functioning
Many studies have explored the cardiac effects of TASER devices following
the results of animal studies that indicated myocardium capture
(Nanthakumar et al., 2006). Studies have used electrocardiogram to
measure cardiovascular effects of TASER device exposure on healthy individuals.
No clinically signiﬁcant effects or damages to the myocardium
were reported in studies by Bozeman et al. (2009), VanMeenen et al.
(2010) or Vilke et al. (2008). Increased heart rate and systolic blood
pressure have been observed (Vilke et al., 2008), however these were
considered to be due to the TASER device creating a pain stimulus
(Bozeman et al., 2009). Decreases in PR interval have also been noted
but were deemed clinically irrelevant (Vilke et al., 2008). Following a report
of a TASER device causing myocardium capture (Cao, Shinbane,
Gillberg, & Saxon, 2007), Dawes, Ho, Reardon, and Miner (2010)
attempted to repeat this observation experimentally, but
echocardiograph data showed no adverse cardiac outcomes. One case
of atrial ﬁbrillation has been reported in an otherwise healthy adolescent
male (Multerer, Berkenbosch, Das, & Johnsrude, 2009). A recent report
on excited delirium syndrome (Bozeman, Ali, & Winslow, 2013)
noted prolonged QT interval, a clinical ﬁnding common in people prescribed
antidepressant and antipsychotic medication (Zemrak &
Kenna, 2008).
Overall, the literature on health effects of TASER devices on people
with mental illness suggests that the risks are small but not negligible.
Authors are consistent in concluding that TASER devices are not free
from risk, a conclusion also reﬂected in TASER International's product
information. In their review of the literature on pathophysiological effects,
Kunz et al. (2012) concluded that while the majority of recent scientiﬁc
publications classify the health risks as minor, there is still
uncertainty about some effects. People in mental health crisis should
be considered a group with a unique combination of factors that place
them at high risk. High levels of autonomic arousal, antipsychotic medication
with the potential to cause disturbances of cardiac rhythm, physical
health comorbidities, and consumption of illicit drugs are all more
likely to occur, and in combination, in people in mental health crisis.
5.3. Injuries
The medical literature contains numerous case reports describing
speciﬁc injuries such as ocular perforation (Chen, Richard, Murthy, &
Lauer, 2006; Li & Hamill, 2013; Ng & Chehade, 2005); retinal detachment
(Sayegh, Madsen, Adler, Johnson, & Mathews, 2011); intracranial
penetration (Kaloostian & Tran, 2012; Le Blanc-Louvry, Gricourt, Touré,
Papin, & Proust, 2012); pneumothorax (Hinchey & Subramaniam,
2009); pharyngeal perforation (Al-Jarabah, Coulston, & Hewin, 2008);
and compression fracture of the spine (Sloane, Chan, & Vilke, 2008).
One case report described a tonic–clonic seizure after a TASER device
barb made contact with the subject's head (Bui, Sourkes, & Wennberg,
2009), although this effect has not been observed in others who have
been shot in the head with TASER devices (Kunz et al., 2012).
Despite their reported low risk, TASER devices can have unintended
consequences. In addition to the case reports described above, Sharma,
Theivacumar, and Souka (2009) reported the case of a 42 year old man
who sustained a 7-cm wide and 10-cm deep stab injury to the upper abdomen
when the TASER device was deployed to disable him as he held a
knife to his chest. In this case use of a TASER device resulted in contraction
of the skeletal muscles and as a consequence a potentially lethal injury.
Such incidents are rare, and it might be argued that the level of risk
in this case was already high, but incidents such as these underscore the
frequently made point that like other forms of intervention, TASER devices
are not without risks.
6. Research on TASER devices and mental health
A notable gap in the literature on use of TASER devices is in relation
to people with mental illness. As noted above, database studies of police
use of TASER devices shows that they are frequently used in mental
health emergencies in community contexts, but their use also extends
to hospital settings. New Zealand research showed that when comparing
criminal arrests with mental health emergencies, TASER devices
were more than twice as likely to be discharged in response to mental
health emergencies as in criminal arrests (O'Brien et al., 2011). The police
database also identiﬁed cases in which TASER devices were used as
part of police response to inpatient mental health services, something
that had been reported previously (Erwin & Philibert, 2006) but was unanticipated
in the New Zealand context. A limitation of the New Zealand
study is that it did not control for other factors contributing to police use
of force, such as intoxication, resistance and severity of offence.
Ho et al. (2011) described use of a TASER device by security staff in a
general hospital. In Ho et al.'s report one deployment was with an individual
who was suicidal, but there is no other analysis of the role played
by mental illness in other uses of TASER devices in the hospital.
More recently Little et al. (2013) have reported the deployment of a
TASER device in a mental health facility in England. In research that
does report on use of TASER devices in mental health emergencies the
criteria for classiﬁcation of such cases is often unclear and some of the
claims made for the effectiveness of TASER devices do not stand close
scrutiny (see O'Brien, 2008 in response to Ho, Miner, Dawes, Lundin, &
Johnson, 2008). Given the extent of police involvement with mental
health services and their role in responding to mental health emergencies
423A.J. O'Brien, K. Thom / International Journal of Law and Psychiatry 37 (2014) 420–426
in the community, the dearth of research into use of TASER devices in
mental health emergencies is surprising to say the least.
7. Conﬂict of interest in research
Research evidence about the safety of TASER devices is dominated
by studies whose authors have ﬁnancial interests in the commercial
production, sale, and promotion of TASER devices by police. This issue
has been the subject of commentary for several years (Azadani, Tseng,
Ermakov, Marcus, & Lee, 2011; O'Brien, 2008; Pasquier et al., 2011;
Stanbrook, 2008; Terrill & Paoline, 2012), but over that time nothing
has changed substantially. It is notable, too, that researchers afﬁliated
to TASER International are quick to respond to publications reporting
risks associated with Tasers, or critiquing the claims of Taser afﬁliates.
While there is nothing improper about Taser-afﬁliated scientists
responding to published reports, overall there appears to be signiﬁcant
commercial interests in the Taser literature, and this has the potential to
inﬂuence the volume and content of publications. To manage this
problem, some journals provide statements of authors' professional afﬁliations,
research interests and afﬁliations with commercial organisations.
For example, a recent publication in Police Quarterly (White et al., 2013)
included a declaration of conﬂict of interest in which three authors declared
their professional and ﬁnancial relationships with TASER International.
In view of persistent reports of such conﬂicts of interest the Police
Quarterly example provides a model which could be emulated by other
journals. Unlike pharmaceutical research where numerous corporations
fund studies of their products, the issue of conﬂict of interest in research
into TASER devices can be traced to a single proprietary manufacturer,
TASER International Inc. A large proportion of studies of use of TASER devices
have been conducted by researchers with ﬁnancial links to the
manufacturer (Azadani et al., 2011). Many of these studies have signiﬁcant
methodological problems, such as small and selective samples, exclusion
criteria that rule out participants with known risk factors, lack
of control groups, and the controlled conditions of the studies which
are very different to the real world conditions in which TASER devices
are actually used. The caution urged by Pasquier et al. (2011), based on
the funding sources and methodological inadequacies of current studies,
still applies, and will do until robust, independent studies are available.
8. Discussion
Use of force by police is a relatively rare event in the context of the
overall functioning of police (Kesic et al., 2013; White & Ready, 2007)
and police encounters with people with mental illness constitute a
small proportion of the overall work of police (Kerr et al., 2010). Nevertheless,
both are important issues, the more so when police ﬁnd it necessary
to use force with people who are mentally ill. In the context of
mental illness, and especially in crisis situations, use of force my lead
to increased, rather than reduced resistance (Kerr et al., 2010).
When use of force is proportionate, and in line with the social mandate
extended to police, it is seen as legitimate and necessary (Terrill &
Paoline, 2012). Given that police interactions with people in mental
health crisis at times contain the potential for violence, it is intuitively
reasonable that police would seek to use tactical approaches such as
TASER devices that seem to reduce the extent of aggressive behaviour.
However enthusiasm for new technologies needs to be tempered with
awareness of their adverse effects and limitations (Crow & Adrion,
2011) especially where the opinions of police and the scientiﬁc community
are inﬂuenced by commercial interests. The success of programmes
of collaboration between police and mental health services shows that
response to people experiencing mental health crises in community settings
can effectively address safety and health concerns. Such collaborations
should also act as a check on use of TASER devices when
interpersonal methods of negotiation might bring about a resolution
to a crisis situation.
There is no speciﬁc literature examining how police training in use of
TASER devices should incorporate knowledge related to mental illness.
Given the vulnerability of people with mental illness, and their already
raised risk of sudden death in custody, Edinger and Boulter (2011)
have suggest that police training in use of TASER devices should specifically
address mental illness as a risk factor, and that their use with this
group should be limited to imminent likelihood of sustaining or causing
grievous bodily harm. The elements currently incorporated into police
training in mental health response would appear to be a necessary
prerequisite for training in use of TASER devices, with an emphasis
on communication problems arising from impaired cognition and
perceptions, and how that might impact on response to the presentation
of a TASER device. Information about the vulnerabilities of people with
mental illness, arising from intoxication, substance use, medical comorbidities,
and prescribed medication should also be included.
TASER devices look set to play a prominent place in police work in
the foreseeable future. One recommendation from this review is that
TASER devices are not deployed to ofﬁcers responding to mental health
crises unless those ofﬁcers have had speciﬁc mental health training, for
example those trained in CIT teams or other models of collaboration between
police and mental health services. Models such as CIT may not be
viable in small jurisdictions, but much of the training content is relevant,
especially that related to features of mental illness, de-escalation of agitated
individuals, and mental health disposition options. The collaborative
relationships central to CIT teams can be fostered even where the
full model cannot be implemented.
In their review of less lethal weapons Alpert et al. (2011) noted that
like other police interventions, technologies such as TASER devices have
the potential for over use. The view that TASER devices are a safe and effective
option for police may contribute to over use, especially as severe
adverse effects are rare, and the procedural justiﬁcation for use of a
TASER device relies heavily on subjective assessments by police ofﬁcers
on the presenting level of risk. These observations reinforce the need for
police training, not only in the procedural aspects of their work in mental
health emergencies, but also in knowledge, skills and attitudes related
to mental illness. The literature evidence is convincing in showing
that such training reduces the level of force in police response to people
with mental illness, and increases the likelihood of mental health
disposition.
There is a need for more research on the use of TASER devices in
mental health emergencies. In many jurisdictions, good records of
use of TASER devices are maintained, and can provide a rich source
of data for researchers. Database research can identify rates of use
of TASER devices with different groups in society, and can also monitor
trends over time. In large population settings, database studies
may provide sufﬁcient numbers to permit multivariate and regression
analyses such as those reported by Terrill and Paoline (2012),
leading to stronger conclusions about the patterns of use and effects
of TASER devices. Kaminski (2009) suggests case–control studies as
an alternative to the currently limited range of designs used. Case–
control studies have been used in criminology research and have
the advantage that they can be used to study relatively rare events
such as severe adverse effects of TASER devices. Research would
beneﬁt from more theoretically informed design, for example by
the focal concerns perspective used by Crow and Adrion (2011).
Such a theoretical perspective is conducive to exploring factors
that might inﬂuence ofﬁcers' decision-making when deploying
TASER devices. There is also a need for qualitative research to explore
police ofﬁcers' experiences of use of TASER devices, both in
general and in relation to mental health emergencies.
The issue of conﬂict of interest in research related to use of
TASER devices is a serious one and could in part be addressed by
journals adopting more rigorous and consistent standards relating
to declaration of conﬂicts of interest. However there is also a need
for more research that is independent of the inﬂuence of commercial
interests.
424 A.J. O'Brien, K. Thom / International Journal of Law and Psychiatry 37 (2014) 420–426
9. Conclusion
Use of TASER devices in police response to mental health emergencies
remains an underinvestigated phenomenon about which there
are many important questions, some signiﬁcant unresolved debates,
and legitimate concerns among mental health professionals. There are
as yet no studies of the views or experiences of people with mental illness,
meaning that practice is informed solely by the views of professionals,
and is subject to the commercial imperatives of the TASER
device manufacturer. Our paper has made several recommendations
for further research. It is to be hoped that in the near future a body of
empirical work will develop which will enable the use and effects of
TASER devices in mental health emergencies to be better understood.
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