Managing Encounters With the Mentally Ill

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Managing Encounters With the Mentally Ill

• Presented by
• Florida Regional Community Policing Institute
• at
• St. Petersburg College

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Your Instructor

• Tony Rolón
• Police Officer
• DOJ RCPI Subject Matter Expert

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Why This Training?

• The Memphis CIT approach specialized teams to
  deal with the mentally ill
• We believe that every one who deals with the
  public should have the skills to effectively deal
  with the mentally ill

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Mental Illness

• Mental Illness is a general term for a wide range
  of disorders involving the brain, where there are
  varying degrees of impaired mental functioning
  and where psychological, behavioral and emotional
  symptoms may be exhibited.

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Mental Illness

• Is simply behavior and ways of thinking that are
  not accepted by society
• It is incorrect to view the mentally ill as
  inferior
• The unhappiness often exhibited by the mentally
  ill results from their inability to relate to
  normals and the tendency for normals to view
  them negatively

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Some stats on mental illness

• More than 54 million Americans have a mental
  disorder in any given year, although fewer than 8
  million seek treatment (SGRMH, 1999).
• 5.4 of Americans have serious mental illness.
• Up to one-half of all visits to primary care
  physicians are due to conditions that are caused
  or exacerbated by mental or emotional problems
  (CFHC, 1998).

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More Stats

• Severe mental illnesses are more common than
  cancer, diabetes, or heart disease (National
  Alliance of the Mentally Ill).
• The 1 reason for hospital admissions nationwide
  is psychiatric disorder (National Alliance of the
  Mentally Ill).

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Even more stats

• The total cost of mental health services in the
  U.S. in 1990 was 150 Billion dollars
• 4 of the leading 10 causes of disability in the
  U.S. and other developed countries are mental
  disorders, major depression, bipolar,
  schizophrenia, and OCD

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Prison and the Mentally Ill

• 16 of jail and prison inmates or about 270,000
  people suffer from mental illness
• Nearly 550,000 probationers suffer from mental
  illness
• Mentally ill offenders have a higher rate of
  substance abuse, unemployment, and homelessness
  than other offenders

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Social Stress and Mental Illness
Some stress inducing conditions that can
contribute to mental illness

• Family problems
• Interpersonal conflicts
• Economic/financial difficulties
• Role conflicts, role ambiguity, role overload

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And Other Significant Life Events

• Loss of a loved one
• Physical illness
• Sexual Dysfunction
• Loss of employment
• Marriage
• Birth of a child
• Divorce
• Retirement

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Treatment Success

• The treatment success rate for schizophrenia is
  60, 80 for bipolar disorder, 65 for major
  depression whereas the treatment success rate for
  heart disease ranges from 41-52 (National
  Alliance of the Mentally Ill).

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Recognizing Mental Illness

• Mentally Ill individuals may be difficult to
  distinguish from any other person
• Can be quite intelligent, perceptive, and
  articulate
• Can be employed and maintain familial
  relationships

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Mental illnesses identified in childhood

• Mental Retardation
• Autism
• Oppositional Defiant Disorder
• Conduct Disorder

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Disorders of the Elderly

• Dementia includes
• Memory impairment
• Deterioration of language skills
• Impairment of motor functioning
• Inability to process information

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Dementia Features

• May underestimate risks driving
• May have severe mood swings
• Delusions and hallucinations are common
• The most common are delusions concerning
  persecution
• Violent behavior and suicide may occur

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Psychotic Disorders

• Disorganized thinking is the single most
  important feature of schizophrenia and other
  psychosis
• Answers to your questions may be somewhat related
  or completely unrelated
• Speech is usually disorganized as well
• Catatonia
• Rigid
• repetitive

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A Visual Representation
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Psychotic Disorders

• Delusions false belief that usually involve
  misinterpretation of perception or experience,
  despite contradictory evidence
• Delusions include
• Persecutory
• Referential- gestures, songs, books are
  specifically directed at them
• Religious
• Grandiose

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Psychotic Disorders

• Hallucinations may occur in any sense
• Auditory hallucinations are the most common
• Hallucinations shape, form and substance that is
  real to the perceiver
• Command hallucinations are the most dangerous

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Observable Symptoms

• Statements that someone is trying to harm them
• Wearing flamboyant clothing or no clothing at
  all
• Specific objects have special powers
• Conversing with someone or something others
  cannot see
• Someone is the head of the CIA and spying on them

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Symptoms of Depressed Mood

• Argumentative, easily irritated (especially in
  children)
• Talks negatively about self, hopelessness
• Sleeping excessively or not at all
• Withdrawn, down in the dumps feeling
• Fatigue or loss of energy nearly every day
• Diminished ability to think or concentrate

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Depression is Dangerous

• 15 of those experiencing a major depressive
  episode will die by suicide
• Those that are over 55 experience a 4 fold
  increase in death rates from suicide

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Symptoms of Elevated Mood

• Feelings of euphoria
• Not needing to sleep or eat for days
• Flight of ideas thoughts are racing
• Increased self esteem or grandiosity
• Excessive involvement in pleasurable activities
  that are risky financially, sexually,
  physically

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Bipolar

• Is a disorder that includes periods of mania and
  depression
• The cycles vary in duration
• Months
• Weeks
• Days
• Hours?

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Bipolar is Dangerous

• 15 of those that are Bipolar will die by suicide
• There is a high probability of violence and
  psychosis in manic episodes
• Child abuse, domestic violence, and substance
  abuse are common

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Anxiety Disorders

• Extreme sensations of nervousness, tension,
  apprehension, fear or anticipation of danger

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Posttraumatic Stress Disorder

• Is the development of symptoms following exposure
  to a traumatic event
• Soldiers, EMS, children victims, LEO
• Symptoms include
• Avoidance of things that remind of the event
• Increased arousal hypervigilance, anger
  outbursts, startle response
• Reexperiencing the event hallucinations,
  dissociative flashbacks

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Symptoms of Personality Disorders
Exhibits patterns of

• Self harm or risky behavior
• Violating the rights of others
• Difficulty with interpersonal relationships
• Work or daily living is sometimes limited
• Displays self-defeating behaviors
• Has distorted view of the world

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Antisocial Personality Disorder

• A pervasive pattern of disregard and violation of
  the rights of others
• Deceit and manipulation are central features
• Impulsive and irresponsible
• Lack of remorse

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Antisocial is Dangerous

• They are reckless with their and others safety
• They are irritable and aggressive
• They are much more likely to die by violent means
  suicide, accident, homicide

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Borderline Personality Disorder

• A pervasive pattern of instability in
  interpersonal relationships
• Very impulsive self damaging
• Relationships may be love hate
• Poor self image

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Borderlines are Dangerous

• Very common suicidal behavior
• Self-mutilation
• Intense anger, difficulty in controlling anger
• Recurrent physical fights
• Paranoid ideations

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Psychiatric Medications

• Medications help a person manage the symptoms of
  their illness
• They are not a cure or magic bullet
• Newer meds seem more effective in treating
  psychosis and depression

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Side Effects of Psychotropic Medications

• All medications carry the potential of a person
  developing side effects
• Side effects are the undesired effects of taking
  a medication and are different for different
  types of medication
• Can be uncomfortable, dehumanizing, and difficult
  to tolerate
• Some side effects are irreversible

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Some Baker Act stats

• The number of initiations has increased each
  year, from 69,235 in 1997 to 109,682 in 2003.
  This is an increase of 58 for this period.
  Census data indicates that Floridas population
  has increased 17 over the same period.

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Law Enforcement and the Baker Act

• Law enforcement officers initiated 45 of Baker
  Acts in 2003 (FMHI).
• The most common evidence type indicated was
  harm, 72!

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Medical Cases

• When a person has suffered an injury they may
  refuse medical treatment
• Only if the person meets all of the criteria of
  the Baker Act can they be taken into custody
  under the Baker Act
• Medical personnel can also commit

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Suicide

• One of the most common circumstances where law
  enforcement encounters the mentally ill or others
  in crisis
• 80-90 suicides occur daily in the U.S.
• 31,655 suicide deaths in 2002 (NCHS)
• 438,000 emergency room visits (NCHS)
• Suicidal persons pose a substantial risk to
  everyone involved in the crisis

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Suicide 101

• Suicide is one of the 10 leading causes of death
• One every 3 minutes
• 5th try is usually successful
• 3 times as many men as women actually commit
  suicide

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Suicide is

• A form of behavior designed to deal with or solve
  a problem, a goal oriented coping method
• Sigmund Freud called it murder turned inward
• Or, the ultimate revenge

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Assessing Danger to Self

• Are they talking about suicide?
• Is there a suicide note?
• Are there signs of hopelessness?
• Is there a specific suicide plan?
• Are there means at hand to harm self?
• Has there been a previous attempt?
• Is there evidence of self injury?

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Suicide Intervention

• Listen
• Be honest
• Share your feelings
• Ask the person very directly if they want to
  commit suicide Be graphic and direct (DSP)

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Suicide By Cop

• An incident in which an individual bent on
  self-destruction, engages in life threatening and
  criminal behavior in order to force law
  enforcement officers to kill them
• Also called Victim Precipitated Homicide

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LE Shootings and Suicide

• 10-15 of LE shootings are reported by the police
  as being SBC
• The FBI and other researchers suggest the rate is
  as high as 50

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Your Safety First!

• You must have as your first and foremost concern
  the idea that you are going to protect YOURSELF
  and the others involved from injury at all times

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Assessing the Probability of Violence

• What has been done or said that was threatening?
• What happened to precipitate this incident?
• What has been done in the past and how?

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Assessing the Probability of Violence

• Is there ongoing violence?
• Is there a weapon at the scene?
• Is the subject barricaded in a room or house?
• Is the subject holding a hostage?

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You Must

• Be aware of the environment
• Note the locations of entrances and exits and the
  swing of doors
• Determine the position of all involved persons
• Survey site damage

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Approaching the Subject

• Use a triangular approach
• Watch body language
• Take charge
• Move dangerous objects
• Separate persons in conflict
• Introduce yourself
• Tell them why you are there

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Remember to

• Keep the subjects hands in view
• Remove influences that upset the subject
• Do not violate personal space
• Maneuver the person into a safe area
• Avoid one-on-one physical contact
• Maintain control

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We Must

• Recognize that a mentally ill person in crisis
  may be overwhelmed by
• Sensations
• Thoughts
• Frightening beliefs
• hallucinations

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Operational Safety Issues

• We must maintain our safety at all times
• Maintain a position of safety COVER
• Always request back-up, never go it alone
• Develop an initial intervention plan
• Once back-up units arrive they must maintain
  constant vigilance silently
• Confine and isolate the situation

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Always Remember to

• Be an active listener
• Use your authority in a positive manner