How First Responders Interact with Subjects Suffering from Depression in the Field

1. How First Responders Interact with Subjects Suffering from Depression in the Field 6.9% of adults in the United States – 16 million – have suffered from at least one major depressive episode in the past year. Chances are most of us know someone with depression, and with a staggering statistic like this, it is even more likely law enforcement officers have encountered subjects suffering from depression. A person with depression can function normally in society or have their daily life severely impacted. However likely it is an officer will interact with a person suffering from depression, it is not their job to diagnose. This information, as well as lessons provided in the V-VICTA “Mental Illness for Contact Professionals” course, is meant to provide law enforcement with additional tools and insight in encounters where a person appears to be suffering from mental illness. Signs of Depression Depression is more than feeling sad or depressed for a fleeting moment. Instead, people diagnosed with depression are often undergoing a daily struggle with controlling negative emotions. While it is difficult to pinpoint the cause of depression, some triggers may include: a chemical imbalance in the brain, severe stress or living in an unstable environment. The following list of signs and symptoms is not all-inclusive. Rather, it provides a general look at what first responders may notice or learn about when interacting with a subject who suffers from depression: Subject feels sad, empty, hopeless and/or pessimistic. Loss of self-esteem and self-worth. Loss of interest in hobbies and fun activities. Abnormal sleep patterns, such as oversleeping or not getting enough sleep. Decreased energy and fatigue. Difficulty concentrating and sitting still. Changes in weight and appetite. In rare cases, depression can cause psychotic symptoms such as hallucinations. Crisis Behaviors Unfortunately, depression can lead to extreme behaviors not seen in otherwise mentally well persons. For those unaware of the crisis behaviors, they may come as a shock and leave officers feeling unprepared. It is recommended that when a crisis occurs, medical staff should be staged nearby so the subject can receive immediate medical attention if necessary. With severe depression, people may consider suicide or attempt it. In situations where a subject is deemed suicidal, it is imperative to talk to them and find out more information. Ask them if they are considering suicide, if they have a plan and what the plan might be. This allows the officer to determine the level of suicidality to determine next steps. Remember, saying the words “suicide” or “killing yourself” will not put the idea into the person’s head. A person discussing suicide may be desperately asking for help.

2. Depression can cause people to intentionally cause physical injury to themselves, which is known as Non-Suicidal Self Injury (NSSI). Typically, this manifests as cutting, bruising, inserting objects into the skin, etc. This becomes more than a mental health crisis, often a physical one, depending on the severity of the injuries. How to Help & Communicate Officers can help subjects suffering from depression by speaking to the subject calmly, directly and openly. Allow the person to express their feelings without interruption or expressing your own thoughts or feelings—do not make them feel judged. It is important to make them feel their feelings are accepted and active listening plays a significant role in helping a person feel understood. Most importantly, encourage the depressed subject to seek help. Just because a person is not actively suicidal or engaging in NSSI does not mean behavior health intervention is not needed. For more information on depression and other mental illnesses, visit the V-VICTA “Mental Illness for Contact Professionals” lesson plan. Instructors can learn more about V-VICTA and how to incorporate it into training here. References: National Alliance on Mental Health. (n.d). Mental Health by the Numbers. Retrieved from https://www.nami.org/Learn-More/ Mental-Health-By-the-Numbers1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders fifth edition (DSM-5). American Psychiatric Association; 2013 National Alliance on Mental Illness. (n.d.) Depression. Retrieved from https://www.nami.org/Learn- More/Mental-Health- Conditions/Depression Nock MK, Favazza AR. (2009). Nonsuicidal self-injury: definition and classification. Understanding Non- Suicidal Self-Injury: Origins, Assessment, and Treatment. Washington, DC: American Psychological Association; 2009:9–18