TRAININGBULLETIN
“Department Training Bulletins shall be used to advise members of current police techniques and procedures and shall constitute official policy.”
Index Number: III-N Alpha Index: Mentally Ill Persons Effectiv Date: 29 Sep e
06
POLICE CONTACT WITH MENTALLY ILL PERSONS Definition and Prevalence
A mental disorder is defined as “a behavioral or psychological syndrome or pattern associated with distress, or disability, or associated with increased risk of suffering death, pain, disability, or loss of freedom. The behavior or syndrome must be considered a manifestation of a psychological or biological dysfunction in the individual”.
The number of persons affected with mental illness or disorders is large. As many as one family in five is estimated to be affected by mental illness.
Law Enforcement Contact
Mentally ill persons have special needs; they may require assistance or become victims of crimes. They frequently come to the attention of the police. A California Little Hoover Commission report
suggests that law enforcement frequently handles mentally ill persons like it handles other special needs that lack adequate community resources. There are special challenges associated with mentally ill persons. They may not understand or follow instruction, and they may appear to misbehave. Some mental illnesses are associated with antisocial or criminal behaviors. For each of these reasons police have frequent contact with mentally ill persons. It is helpful to recognize when a person is suffering from a mental illness. Although it can be difficult for mental health professionals to agree on diagnoses, officers can learn to recognize the common or more disruptive signs of mental illness. Many mentally ill persons suffer breaks from reality in which they experience auditory, visual, or other hallucinations. They may hear “command voices” that give them commands or directions to do dangerous or destructive things. Other behaviors the officers may look for are:
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Confused thinking and speech where the subject has trouble in communicating in coherent sentences.
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Emotional flatness or lack of expression, where their speech is brief and lacks content.
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The subject displays a sense of heightened energy, euphoria, racing thoughts, inflated feelings of power, and /or reckless behavior.
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Profound sadness and irritability, feelings of guilt, hopelessness, changes in their sleep patterns, and a decrease in appetite.
1
American Psychiatric Association, 2000
Diagnostic and statistical manual disorders(4
th
edition, text revised),
Washington, DC
2
Being There: Making a Commitment to Mental Health
(Report #157, November 2000)
2 Police Contact with Mentally Ill Persons, Index Number III-N
Prevalence of Violence
It is a common belief that mentally ill persons are violent and threatening. A national study supported by the McArthur Foundation
found that, in general, even seriously mentally ill persons who take their prescribed medications are not more likely to be involved in violence than the general public. There are exceptions to this finding. Mental illness together with alcohol or substance abuse is known to lead to confrontations and violence. Particular diagnoses or illness (e.g., paranoid schizophrenia) may produce delusions that make a person fearful. Their beliefs that someone or something intends to injure them may lead to suicidal or violent behavior.
Safety Concerns
Approach persons known or suspected of suffering from mental illness with the same safety concerns as any other call for service: safety of the subject, safety of the uninvolved persons, and officer safety remain important. Mentally ill persons may suffer from delusions or breaks from reality, they may be frightened by responding officers or may not comply with the officers’ directions. Emergency psychiatric detentions are inherently dangerous. They require officers to evaluate persons believed to be dangerous to themselves or others, and take them into custody. The only Oakland Police Department call for service to result in the deaths of more than one responding officer involved a mentally ill person. Calls regarding persons suspected of suffering of mental illness shall not be taken without a cover officer. When information from OPD Communications indicates that a person suffering from mental illness is violent (radio code 5150B), a supervisor shall also respond to the incident. Recently, there have been a number of cases resulting in the use of lethal force against the person who was being evaluated or detained. Case studies of detentions in California and nationwide reveal a number of calls in which officers attempted detentions or put themselves in positions that aggravated the mentally ill subjects and escalated the confrontation.
The officers in the case studies often lacked adequate tactical plans or the manpower to accomplish the detention. Due to poor planning, the officers had to resort to lethal force when the subject became combative to protect themselves.
Civilian Mobile Crisis Team
Civilian Mobile Crisis Teams (CMCT, Radio Call Sign 37C51) have resources that are not available to law enforcement. Communications Division shall dispatch a CMCT, if available, to calls involving persons with mental illness. If mobile crisis personnel are available to respond, they may have knowledge of the subject’s history, medication and usual complaints from mental health records, or from their personal experience with the subject. The CMCT can arrange appropriate referrals, aftercare, or follow up for the mentally ill subjects and their families. A history of mental health treatment or even the fact that a person had been treated for a mental illness is protected information under the federal Health Insurance Portability and Accountability Act (HIPAA). Mental health personnel may be prohibited from sharing these facts with responding officers. Officers shall defer to the mental health expertise of the CMCT and allow them to contact and evaluate the subject if it is safe to do so. Officers retain the responsibility of monitoring the contact and taking police action, if necessary. Officers that on-view an incident involving a mentally ill person shall check with the Communications Division to ascertain if a CMCT is on duty and available to respond to assist with the call.
3
Steadman, H. J., Mulvey, E.P., Monahan, J., et al. (1998) Violence by people discharged from acute psychiatric inpatient facilities and by other in the same neighborhoods,
Archives of General Psychiatry
55: 393-401
4
Protection and Advocacy, Inc. (2000) Report of an investigation into the Deaths of Charles Vaughn, Sr., on May 19, 1998 and Marvin Noble on July 16, 1998
3 29 Sep 06
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Oakland Police Department
Useful Techniques for Approaching Mentally Ill Persons
The CMCT has limited duty hours, so officers are responsible for a large portion of contacts without their assistance. Approaching in a cautious and patient way can be less disturbing and less confrontational to a potentially mentally ill person. A number of techniques can slow the course of events and calm the subject down:
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Identify and contact family, friends or the reporting party to obtain updated details since initial call to the dispatcher and, if known, historical information.
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Move slowly and assure the person that you are there to help them.
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Turn down the volume on your radio when possible to lower the amount of outside stimuli which could add to the subject’s confusion. If outside, turn off emergency lights and sirens.
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Ask the subject to turn off stereos, televisions, or other distractions under their control.
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Avoid giving the commands or orders traditionally used to control a crime scene or dispute. Permit one officer to communicate with the subject; and avoid multiple conversations.
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Simplify directions and conversations. Recognize that an anxious or confused subject may only understand a few words.
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Attempt to determine what the immediate problem is and relate concerns for their feelings.
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Be truthful with the subject and try to develop a rapport.
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Allowing extra distance between the officer(s) and a mentally ill subject affords more time for the officer(s) to react and may be less likely to disturb the subject.
Emergency Psychiatric Detentions
Police officers may be called to execute emergency psychiatric detentions or to serve legal process on individuals believed to be incapacitated by mental illness. Refer to Department General Order (DGO) O-1, Mentally Disordered Persons, for the procedures to be followed during these detentions. Officers have historically been limited to behavior they actually observe in making the decision to detain a person for psychiatric evaluation. Recent legislation added section 5150.05 Welfare & Institution Code (W/I). This section requires police officers to
consider
the experience and advice of family members or others in evaluating the subject’s potential dangerousness to himself or others. Family members or associates may be a valuable source of advice on the subject’s fears and supply helpful hints on how to approach. Officers should be aware that an emergency psychiatric detention is the most invasive police action against a person not suspected of a crime. A supervisor shall be advised, and respond if available, on all involuntary psychiatric detentions.
5150.05 W/I Code
In January 2002, AB 1424 modified the Lanterman-Petris-Short (LPS) Act which governs involuntary treatment of individuals with mental illness in California. The bill was due to the efforts of the families of these individuals who found it difficult to access the system and that the system was not supportive of the family’s interaction with enforcement and treatment. Section 5150.05 W/I was added to the LPS Act which states: