Managing Encounters With the
Mentally Ill
Presented by
Florida Regional Community Policing
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
Mental Illness
• Is simply behavior and ways of
thinking that are not accepted by
• 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
• 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,
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
And Other Significant Life
Loss of a loved one
Physical illness
Sexual Dysfunction
Loss of employment
Birth of a child
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
Mental Retardation
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
– The most common are delusions concerning
• Violent behavior and suicide may
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
• 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
• Delusions include
– Persecutory
– Referential- gestures, songs, books are specifically
directed at them
– Religious
– Grandiose
Psychotic Disorders
• Hallucinations may occur in any
• Auditory hallucinations are the
most common
• Hallucinations shape, form and
substance that is real to the
• 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,
• Sleeping excessively or not at all
• Withdrawn, “down in the dumps” feeling
• Fatigue or loss of energy nearly every
• Diminished ability to think or
Depression is Dangerous
• 15% of those experiencing a major
depressive episode will die by
• Those that are over 55 experience a
4 fold increase in death rates from
Symptoms of Elevated Mood
• Feelings of euphoria
• Not needing to sleep or eat for days
• Flight of ideas – thoughts are
• Increased self esteem or
• Excessive involvement in
pleasurable activities that are risky
– financially, sexually, physically
• Is a disorder that includes periods
of mania and depression
• The cycles vary in duration
Bipolar is Dangerous
• 15% of those that are Bipolar will
die by suicide
• There is a high probability of
violence and psychosis in manic
• 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
Symptoms of Personality
Exhibits patterns of:
• Self harm or risky behavior
• Violating the rights of others
• Difficulty with interpersonal
• Work or daily living is sometimes
• 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
• 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,
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
• 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
• Can be uncomfortable,
dehumanizing, and difficult to
• 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
• 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
• Only if the person meets all of the
criteria of the Baker Act can they be
taken into custody under the Baker
• Medical personnel can also commit
• 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
• Has there been a previous attempt?
• Is there evidence of self injury?
Suicide Intervention
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
LE Shootings and Suicide
• 10-15% of LE shootings are
reported by the police as being
• 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
• What has been done or said that
was threatening?
• What happened to precipitate this
• What has been done in the past and
Assessing the Probability of
• 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
Remember to
• Keep the subject’s hands in view
• Remove influences that upset the
• Do not violate personal space
• Maneuver the person into a “safe
• Avoid one-on-one physical contact
• Maintain control
We Must
• Recognize that a mentally ill person
in crisis may be overwhelmed by
Frightening beliefs
Operational Safety Issues
• We must maintain our safety at all times
• Maintain a position of safety – COVER
• Always request back-up, never go it
• Develop an initial intervention plan
• Once back-up units arrive they must
maintain constant vigilance silently
• Confine and isolate the situation
Always Remember to
• Be an active listener
• Use your authority in a
positive manner

Managing Encounters With the Mentally Ill