Managing Encounters With the Mentally Ill

Managing Encounters With the Mentally Ill Presented by Florida Regional Community Policing Institute at St. Petersburg College

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

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

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.

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

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).

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).

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

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

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

And Other Significant Life Events: • Loss of a loved one • Physical illness • Sexual Dysfunction • Loss of employment • Marriage • Birth of a child • Divorce • Retirement

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).

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

Mental illnesses identified in childhood • Mental Retardation • Autism • Oppositional Defiant Disorder • Conduct Disorder

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

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

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

A Visual Representation…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 Florida’s population has increased 17% over the same period.

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%!

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

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

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

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…

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?

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

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

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%

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

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?

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?

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

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

Managing Encounters With the Mentally Ill