managing encounters with the mentally ill presented by florida regional community policing institute...
TRANSCRIPT
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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
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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
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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.
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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
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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).
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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).
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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
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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
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Social Stress and Mental Illness
• Family problems
• Interpersonal conflicts
• Economic/financial difficulties
• Role conflicts, role ambiguity, role overload
Some stress inducing conditions that can contribute to mental illness
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And Other Significant Life Events:
• Loss of a loved one• Physical illness• Sexual Dysfunction• Loss of employment• Marriage• Birth of a child• Divorce• Retirement
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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).
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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
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Mental illnesses identified in childhood
• Mental Retardation
• Autism
• Oppositional Defiant Disorder
• Conduct Disorder
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Disorders of the Elderly
• Dementia includes:– Memory impairment– Deterioration of language skills– Impairment of motor functioning– Inability to process information
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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
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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
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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
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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
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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
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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
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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
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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
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Bipolar
• Is a disorder that includes periods of mania and depression
• The cycles vary in duration– Months– Weeks– Days– Hours?
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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
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Anxiety Disorders
• Extreme sensations of nervousness, tension, apprehension, fear or anticipation of danger
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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
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Symptoms of Personality Disorders
• 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
Exhibits patterns of:
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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
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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
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Borderline Personality Disorder
• A pervasive pattern of instability in interpersonal relationships
• Very impulsive – self damaging
• Relationships may be love – hate
• Poor self image
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Borderlines are Dangerous
• Very common suicidal behavior
• Self-mutilation
• Intense anger, difficulty in controlling anger
• Recurrent physical fights
• Paranoid ideations
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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
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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
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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.
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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%!
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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
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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
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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
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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…
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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?
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Suicide Intervention
• Listen
• Be honest
• Share your feelings
• Ask the person very directly if they want to commit suicide – Be graphic and direct (DSP)
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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
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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%
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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
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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?
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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?
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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
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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
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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
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We Must
• Recognize that a mentally ill person in crisis may be overwhelmed by– Sensations– Thoughts– Frightening beliefs– hallucinations
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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