To describe the problem of mentalillness in the context of the criminaljustice mission.Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes12.1
12.1 The Problem of Mental IllnessOVERVIEWHandling cases involving the mentally ill can be dangerous, both for thepolice and the mentally ill individuals with whom they come in contact.During the period 1997-2006 there were 1058 officers assaulted inAmerica, and 13 feloniously killed while responding to calls involvingmentally ill people.Many, if not most people suffering a mental illness will react negatively tothe police, and this reaction tends to cause the police to resort to theirtraining and take a defensive posture, many times resorting to the use offorce to de-escalate the situation.
12.1 The Problem of Mental IllnessOVERVIEW• In the first nine months of 2006, the LAPD had 46,129 contacts with peoplesuspected of being mentally ill. Of those, 709 had attempted suicide and4,686 were taken into custody for an involuntary commitment andpsychiatric evaluation.• The Lincoln, Nebraska Police Dept. reported that in 2002 it handled over1,500 cases involving mentally ill persons, and that it has spent more timeon these cases than on burglaries, felony assaults, or traffic accidentsinvolving injuries.• In 2000, officers in Florida transported more than 40,000 people for aninvoluntary 72-hour psychiatric evaluation. This number exceeded burglaries(26,087) and aggravated assaults (39,120) handled during the same year.
To summarize the traditional policeand corrections response to mentalillness.Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes12.2
12.2 The Police ResponseTHE POLICE RESPONSETraditionally, the police have had two major problems effecting theirresponse to cases involving the mentally ill:• A lack of training on how to effectively respond to, contain, and de-escalate such a crisis without the need for heightened or deadly force.• The perception among police officers that mentally ill people arealways more violent than non-mentally people, a perception that is notnecessarily supported by available research.
12.2 The Police ResponseTHE POLICE RESPONSEThe problems with police training and perceptions come together to causean officer to immediately enter a situation in a more heightened state ofreadiness and with an expectation that some level of force will benecessary. The combination of these two reactions only increases thepotential for a violent outcome if a confrontation occurs.
To list and define some of the morecommon types of mental illnessfaced by crisis responders.Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes12.3
12.3 Types of Mental IllnessThought DisordersCharacterized by a person’s disordered thinking and a disconnect fromreality. Most common type is schizophrenia.• Paranoid SchizophreniaThese individuals can be extremely dangerous. Typically fixated on the false belief that someone is out to getthem, or that they are being persecuted in some manner.• Disorganized SchizophreniaTypically incoherent. Disorganized speech and behavior are almost always present. Delusions andhallucinations are common. There is typically no consistent theme to their thinking.• Catatonic SchizophreniaTypically withdrawn and unresponsive. They may show very little movement, and may curl up in a fetalposition. They pose essentially no danger to responders.• Residual SchizophreniaThe after effects of a schizophrenic episode. Individuals typically experience depression anda loss of interest in life. Their ability to communicate is greatly diminished.
12.3 Types of Mental IllnessThought DisordersAccording to the Diagnostic and Statistical Manual of the APA (DSM-IV-TR), in order to be diagnosed with schizophrenia, a person mustdemonstrate at least two of the following:• DelusionsDelusions of control, Nihilistic delusions, Delusional jealousy, Delusion of guilt or sin, Delusion of mindbeing read, Delusion of reference, Erotomania, Grandiose delusion, Persecutory delusion, Religiousdelusion, Somatic delusion• HallucinationsAuditory or visual/ positive or negative• Disorganized Speech• Grossly disorganized or catatonic behavior
12.3 Types of Mental IllnessMood DisordersSymptoms include extremes in how the person feels, either extremeagitation, excitement, or depression.Depression-Depressed most of the day, and almost everyday-Diminished interest in almost all activities-Significant weight change-Insomnia-Feelings of worthlessness-Recurrent thoughts of death-Inability to think rationallyPeople who are severely depressed can be dangerous if they are havingthoughts of suicide. They may force the police to use deadly force againstthem…”suicide by cop.”
12.3 Types of Mental IllnessMood DisordersSymptoms include extremes in how the person feels, either extremeagitation, excitement, or depression.Bipolar DisorderA second type of mood disorder, and one that can be extremely dangerousfor those who confront people suffering from this disorder, is bipolardisorder, also called manic-depressive disorder.People diagnosed with this disorder will experience periods of elevatedmood, energy, and cognition (mania), as well as periods of depression.Typically the two extremes are separated by periods of relatively normalfunctioning, and psychotic-like features, such as delusions andhallucinations, are sometimes experienced at the extremes.
12.3 Types of Mental IllnessAnxiety DisordersThese disorders are marked by abnormal amounts of fear, worry, oruneasiness. At their extreme, these disorders can include physical symptomssuch as chest pains and shortness of breath. A person suffering from asevere anxiety disorder may be entirely unable to function normally withoutsome type of therapeutic intervention, to include medication.If they are in the midst of an anxiety episode, whichmany of them areduring a personal crisis, then they have the capacity to behave inunpredictable and erratic ways, and can be dangerous.- Generalized anxiety disorder- Panic disorder- Obsessive-compulsive disorder- Post-traumatic stress disorder (PTSD)- Separation anxiety
To summarize the accepted bestpractices for responding to mentallyill offenders, victims, suspects, andinmates.Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes12.4
12.4 Best PracticesThe Memphis Model (CIT)Developed in 1988 to reduce violent encounters between mentally illindividuals and the police.Included the formation of a specially trained crisis intervention team (CIT) torespond to cases involving mentally ill individuals. Team members receivedtraining from mental health professionals and family advocates.Goals of the program:• To de-escalate a situation involving a mentally ill individual without the use offorce.• To avoid arrest where possible, and divert the individual to needed services.• To work in partnership with community mental health centers and drug-alcoholtreatment centers.
12.4 Best PracticesThe Memphis Model (CIT)Benefits that have been seen in Memphis…- Crisis response is immediate- Arrests and use of force have decreased- Underserved consumers are identified and provided services- Patient violence in the ER has decreased- Officers are better trained in de-escalation techniques- Officer injuries have decreased- Officer appreciation in the community has increased- Less “victimless” crime arrests- Decrease in health care liability in jail- Cost savings
12.4 Best PracticesDe-escalation Techniques• ENGAGEMENT- Non-threatening approach- Be cognizant of the person’s boundaries- Identify self in a calm and professional voice- A simple purpose statement, “I’m only here to help you.”• ESTABLISH RAPPORT- Ask their name- Look for a point of connection (i.e., tattoos, sports logo, military, etc.)- Establish trust through honest disclosure• ACTIVE LISTENING- Minimal encouragements- Paraphrasing- Emotion-labeling- Open-ended questions- “I” messages- Effective pauses
12.4 Best PracticesCommunity ResourcesIt is important that all officers have a knowledge of the available resourceswithin their communities. They may include…- Primary care facilities- Counseling centers- Support groups- Advocacy groups- Faith-based providers- Shelters