Police and psychiatric disorders: vulnerable individuals are in danger
Among the victims of fatal police violence are many individuals with psychiatric disorders. A culture of aggressive intervention and lenient rules on the use of firearms lead to police actions that are particularly inappropriate, disproportionate, and violent.
An article by Marion Durand for Index.
After a lengthy legal process and a first dismissal, on September 20, 2022, three police officers were sentenced by the Paris Judicial Court to fifteen months of suspended prison time for involuntary manslaughter, for causing the death of Amadou Koumé, 33, in 2015.
The officers’ intervention was marked by extreme chaos, with “failures at every level of the intervention,” as noted by the Défenseur des Droits [the French independent administrative ombudsman, ed.] in a report published on May 29, 2018. The case began on the evening of March 5, 2015, when Amadou entered a Paris bar and ordered a pint of beer. He quickly became agitated and began speaking incoherently. The bartender called the police, telling the dispatcher that Amadou was shouting and refusing to leave the bar, describing the situation as “very bizarre” and mentioning “some psychiatric problems,” according to recordings released by the Defender of Rights. Around midnight, the first police unit arrived, followed by four more. Amadou was apprehended and handcuffed, then transported in a police van to the 10th arrondissement police station in Paris, where he was pronounced dead at 2:30 a.m.
People with psychiatric disorders are disproportionately represented among the victims of police violence. In 2017, the French media outlet StreetPress published a list documenting deaths linked to police violence over the previous ten years. Out of 47 people who died, at least 21 had shown signs of psychiatric disorders. There are no official statistics on the number of mentally ill individuals who have died or been injured following police interventions.
According to the French National Authority for Health, people with mental disorders are more often victims than perpetrators of violence. Yet instead of being seen as vulnerable, psychological disorders or crises are often interpreted as aggression, provoking mistrust and communication breakdowns on the part of the police—resulting in a heightened risk of force being used. The killing of Amadou Koumé, along with other cases reviewed by Index, reveals that police responses tend to be inappropriate and rely on disproportionate use of force by officers.
Back to March 2015: when the police entered the bar, they immediately realized that Amadou was not in a normal state. He was likely experiencing one of the anxiety attacks he periodically suffered from, “often when he was under stress after a failure,” explained his partner, Jessica Lefèvre. “He seemed delirious, close to madness […] he may have genuinely believed in his delirium that we were fake police officers,” said one of the officers, as quoted in a report by the Défenseur des Droits. The intervention was swift and brutal: although Amadou was neither armed nor threatening, only one minute and forty-five seconds passed before the officers began to subdue him. “There wasn’t even a conversation, they didn’t try to understand his condition,” noted Jessica, who has viewed the bar’s surveillance footage. “He [the officer] grabbed him by the throat, put him in a chokehold, forced him down, and immediately pinned him face-down for 6 minutes and 30 seconds.” Amadou was then taken to the police station, where he was declared dead from “slow mechanical asphyxiation.”
Two years after the death of Amadou Koumé, another incident led to the death of Luis Bico, a 48-year-old man with schizophrenia. The police intervention was marked by an escalation of violence that ultimately proved fatal. On August 19, 2017, in Châlette-sur-Loing (Loiret), Luis was experiencing a crisis: he had locked himself inside a vehicle with a knife. The six police officers dispatched to the scene were informed that he was not in full possession of his mental faculties. They surrounded the vehicle, pointed their weapons at Luis Bico, shouted at him, struck the vehicle with a baton, and discharged two canisters of tear gas into the car’s interior.
“Everything that should not have been done in response to Luis Bico and his psychiatric condition was done,” said Lucie Simon, the lawyer representing Luis’s family, in a documentary by Index examining the circumstances of his death. “The vulnerability linked to his mental illness was seen as an additional threat and was treated as such,” she added, convinced that if medical personnel had been present during Luis’s crisis, the outcome would have been very different.
After seven minutes of chaotic intervention, when Luis Bico attempted to flee in his vehicle, the police fired at him 18 times, fatally wounding him. In this case, the charges against the officers were dismissed, a decision upheld on appeal and by the Cour de Cassation, under Article L. 435-1 of the French Code de la sécurité intérieure. Introduced by a law passed on February 28, 2017, this article relaxed the conditions under which law enforcement can use firearms, allowing police to shoot in cases of noncompliance if the vehicle’s occupants are “likely to commit, during their flight, acts that could endanger their own life or physical integrity, or that of others.” The hypothetical nature of such threats gives police a broad margin for interpretation; since 2017, fatal police shootings at moving vehicles have increased.
For the judges of the Orléans Court of Appeal, the use of firearms by the police was justified “by the clear danger posed by Luis Bico and the demonstrated likelihood, based on his prior behavior, that he might harm others.” Luis Bico’s relatives and their lawyer have filed a complaint at the European Court of Human Rights (ECHR).
The ECHR has already ruled on similar cases involving individuals with psychiatric disorders who were killed by French police. For example, in 2017, the Court condemned France for “violating human dignity” in the case of Mohamed Boukrourou, a 41-year-old man suffering from delusional psychosis. His heart stopped after he was violently apprehended in front of a pharmacy on November 12, 2009, in Valentigney (Doubs). According to the ECHR judges, the officers had used “violent, repeated, and ineffective” force.
In police officers’ training, handling people with psychiatric disorders is only covered in a single half-day course. A training manual from the police academy, consulted by Index, recommends “creating a helping relationship by maintaining dialogue, speaking calmly,” calling the person by their name, and avoiding physical contact. A memo issued by the Direction Générale de la Police Nationale (DGPN) on November 4, 2015, emphasizes that if officers or radio operators know in advance that a person may have conditions that complicate their restraint, they should “systematically notify a medical coordinator or the fire brigade’s dispatch center.” In practice, it is unclear whether these recommendations are taught or implemented. In none of the cases examined by Index were they followed.
There is also little information about how police and paramedics and EMS coordinate in the field. This issue is particularly apparent in the case of Babacar Gueye’s death. On December 3, 2015, in Rennes, the 27-year-old, suffering a psychotic episode, began cutting his own abdomen and wounded the friend who was hosting him for the night with a knife. His friend called EMS, who in turn alerted the police. The police and emergency medical services arrived at the scene at the same time, but the police went in first. Babacar was shot dead by a member of the Brigade Anti-Criminalité [BAC, a plain-clothes police branch, ed.], who fired five bullets. On May 9, 2023, the charges against this officer were dismissed. The family filed an appeal and a final court decision is expected on June 6, 2025.
“Could we imagine that a paramedic might have gone in first to try to talk to Babacar, while being accompanied by armed police?” asks Lucie Simon, who also represents Babacar Gueye’s sister. According to the French firefighters’ association [in France, firefighters also serve as paramedics, ed.], in cases involving agitation or psychiatric disorders, responders are always accompanied by police and a doctor. Coordination with police is handled on a case-by-case basis, depending on how the incident was described on the phone and based on an on-site “situation check,” explains Captain Brocardi, the firefighters’ communications director.
Like Amadou Koumé, Kouami Godefroid Djinekou died following a prone restraint—a particularly dangerous immobilization technique that has cost many lives, including those of Lamine Dieng and Cédric Chouviat. On September 22, 2016, in Béziers, Céna Cissokho Djinekou was awakened in the middle of the night by the screams of her 46-year-old brother Godefroid, who asked her to call the police. Officers responded to a call about “a man wearing only underwear and visibly agitated.” According to the dismissal order, he was pinned in a prone position for twelve minutes. He was pronounced dead at 5:30 a.m.
Godefroid had previously been admitted to the emergency room of the Toulouse University Hospital in July 2016 after jumping from a first-floor window during a paranoid episode. He also had heart problems. Medical experts concluded that the cause of death was multifactorial, involving his heart condition, exacerbated by stress, physical restraint, cocaine intoxication, and exposure to tear gas.
Among the medical reports produced in this case, one referenced the controversial concept of “excited delirium,” also cited in the death of George Floyd. This diagnosis, coined in the U.S. in the 1980s, is frequently used in forensic medicine to justify the deaths of Black and Latino men at the hands of police—particularly in cases involving asphyxiation—and suggests that death can result from drug use, even in small amounts. This notion, whose scientific basis is contested, is not recognized by international health authorities, nor by American ones. Godefroid Djinekou’s case was closed without charges on February 3, 2020, followed by a dismissal order on January 12, 2024, absolving the police officers involved of any criminal responsibility. In the dismissal order, the judge wrote that the prone restraint was due to “his extreme agitation, which needed to be contained, reduced or moderated, and this in the complete absence of any thoracic pressure.”
The DGPN memo from November 4, 2015, states that compression on the chest or abdomen “must be as brief as possible” and that a person in a state of overexcitement is “physically more fragile and therefore more prone to cardio-respiratory distress,” and that a medical exam should be performed as soon as possible. In 2007, France was again condemned by the ECHR for the death of Mohamed Saoud, a 26-year-old man with schizophrenia who died from “slow asphyxiation” after being subjected to a prone restraint for over 30 minutes by police. The prone restraint technique is strongly criticized by the Ligue des Droits de l’Homme [the French Human Rights League, ed.] and Amnesty International. Although now banned in several U.S. cities, it remains permitted in France.
In a study conducted by three psychiatrists from the Paris University Hospital Group (GHU) involving 191 Paris police officers, published in June 2023, nearly half of respondents said they intervene with people suffering from psychiatric disorders several times a month. According to Thomas Fovet, a psychiatry lecturer at the University of Lille, the frequency of such encounters is related to the crisis engulfing the public psychiatric system in France, overwhelmed by rising demand and shrinking resources. “We must remember that most people with psychiatric disorders do not have behavioral issues or pose any danger,” Fovet notes. “But there are some patients for whom that is the case. Psychiatry may currently be focusing a lot on general mental health with increasingly broad missions, and less on those with the most severe psychiatric conditions. These patients, not always receiving appropriate care, end up in situations where the police are the first responders.”
In the GHU study, while psychiatrists noted “generally caring, understanding, and non-stigmatizing attitudes,” they also emphasized that “police officers remain insufficiently trained in psychiatry; this lack of training can lead to communication difficulties, mistrust or fear, and therefore increase the risk of force being used.” Since the beginning of our investigation, the GHU—while declining interview requests—has published an article explaining that two of the study’s authors now offer a three-hour training course approved by the police academy, for those who request it. More than 150 officers have been trained since April 2024. Before that date, to our knowledge, no ongoing training on this topic was offered. The DGPN and the IGPN [the Inspectorate General of the French Police, ed.] did not respond to our questions for this article.