Managing Encounters With the Mentally Ill Presented by
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 • • Family problems Interpersonal conflicts Economic/financial difficulties Role conflicts, role ambiguity, role overload http: //cop. spcollege. edu
And Other Significant Life Events: • • 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: – – 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 – – 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 • 5 th 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 • • • 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 • • 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 • • 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 – – 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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