Structural determinants of police responses to psychotic crises: a narrative review with implications for Brazil
DOI:
https://doi.org/10.25118/2763-9037.2026.v16.1630Keywords:
Psychotic Disorders, Mental Health Services, Police, Violence, Crisis Intervention, Risk Assessment.Abstract
Introduction: Police interventions involving individuals experiencing psychotic crises have raised increasing concern due to the risk of escalation and fatal outcomes. These events highlight structural gaps in the coordination between public security and mental health systems, particularly in contexts where police act as first responders to clinical emergencies. Objective: To synthesize evidence on police responses to psychotic crises, with emphasis on structural determinants, stigma, co-response models, and prevention strategies. Methods: This narrative review was prepared according to the SANRA (Scale for the Assessment of Narrative Review Articles) recommendations to improve methodological transparency and reporting. It was included studies published between 2005 and 2025, identified through searches in PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, and SciELO, complemented by Google Scholar and institutional reports. Eligible publications addressed police interactions in psychotic crises and included empirical studies, reviews, and guidelines. A structured selection process was applied, and findings were analyzed using thematic synthesis. Results: A total of 25 publications were included. Four main themes emerged: (A) lack of police preparedness; (B) failures in risk management; (C) symptomatic aggression is not a crime; and (D) state responsibility and prevention strategies. Evidence indicates that inadequate training, absence of structured risk-assessment protocols, and stigmatizing perceptions contribute to escalation and inappropriate use of force. In contrast, co-response models, continuous training, and integration with community mental health services are associated with improved outcomes. Conclusion: Police-related deaths during psychotic crises are influenced by structural factors rather than isolated decisions. Strengthening integrated crisis-response systems, including collaboration between public security and healthcare services, may contribute to safer and more effective management of psychiatric emergencies.
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