Managing Encounters With the
Mentally Ill
Presented by
Florida Regional Community Policing
Institute
at
St. Petersburg College
http://cop.spcollege.edu
Your Instructor
• Tony Rolón
– Police Officer
– DOJ RCPI Subject Matter Expert
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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.
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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).
http://cop.spcollege.edu
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).
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
Social Stress and Mental Illness
Some stress inducing conditions that can
contribute to mental illness
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•
•
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Family problems
Interpersonal conflicts
Economic/financial difficulties
Role conflicts, role ambiguity, role
overload
http://cop.spcollege.edu
And Other Significant Life
Events:
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•
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•
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Loss of a loved one
Physical illness
Sexual Dysfunction
Loss of employment
Marriage
Birth of a child
Divorce
Retirement
http://cop.spcollege.edu
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).
http://cop.spcollege.edu
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
http://cop.spcollege.edu
Mental illnesses identified in
childhood
•
•
•
•
Mental Retardation
Autism
Oppositional Defiant Disorder
Conduct Disorder
http://cop.spcollege.edu
Disorders of the Elderly
• Dementia includes:
–
–
–
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Memory impairment
Deterioration of language skills
Impairment of motor functioning
Inability to process information
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
A Visual Representation…
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
Bipolar
• Is a disorder that includes periods
of mania and depression
• The cycles vary in duration
–
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–
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Months
Weeks
Days
Hours?
http://cop.spcollege.edu
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
http://cop.spcollege.edu
Anxiety Disorders
• Extreme sensations of
nervousness, tension,
apprehension, fear or anticipation
of danger
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
Borderline Personality Disorder
• A pervasive pattern of instability in
interpersonal relationships
• Very impulsive – self damaging
• Relationships may be love – hate
• Poor self image
http://cop.spcollege.edu
Borderlines are Dangerous
• Very common suicidal behavior
• Self-mutilation
• Intense anger, difficulty in
controlling anger
• Recurrent physical fights
• Paranoid ideations
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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.
http://cop.spcollege.edu
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%!
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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…
http://cop.spcollege.edu
Assessing Danger to Self
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•
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•
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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?
http://cop.spcollege.edu
Suicide Intervention
•
•
•
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Listen
Be honest
Share your feelings
Ask the person very directly if they
want to commit suicide – Be
graphic and direct (DSP)
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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%
http://cop.spcollege.edu
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
http://cop.spcollege.edu
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?
http://cop.spcollege.edu
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?
http://cop.spcollege.edu
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
http://cop.spcollege.edu
Approaching the Subject
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Use a triangular approach
Watch body language
Take charge
Move dangerous objects
Separate persons in conflict
Introduce yourself
Tell them why you are there
http://cop.spcollege.edu
Remember to
• Keep the subject’s 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
http://cop.spcollege.edu
We Must
• Recognize that a mentally ill person
in crisis may be overwhelmed by
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Sensations
Thoughts
Frightening beliefs
hallucinations
http://cop.spcollege.edu
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
http://cop.spcollege.edu
Always Remember to
• Be an active listener
• Use your authority in a
positive manner
http://cop.spcollege.edu
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Managing Encounters With the Mentally Ill