thinkscotty

I uploaded this slide from one of my my powerpoints specifically regarding the phrase "calm down" just for you! In my opinion it's the most useless phrase anyone could ever use. Everything it communicates is wrong. 1) It tells the person that they aren't worth listening to, 2) It stops the individual from venting emotions and thereby de-escalating their symptoms, and 3) It tells the person that their concerns aren't valid. In roll play scenarios I run with the police, I specifically make them replace that phrase.

The average police officer knows a lot more than they used to. In fact, younger officers can often be highly knowledgable about mental illness because it's basically a requirement that officers have college degrees these days and a large number of them study psychology. Still, many times they quickly forget what they've learned and become cynical. Where the "older" cops have the advantage is in knowing that being the loudest person in the room doesn't always mean you're the most in control. So while they may have less "head knowledge" about mental illness they are usually calmer and less "ancy" than their younger colleagues.

EDIT: "Antsy". I never said I could spell.

This is a great question. I am very upfront about making sure officers know that they're not expected to be clinicians. In fact, I always tell them I don't care if they can tell the difference between bipolar disorder and schizoaffective disorder, etc. my wife's a mental health therapist (in training) and if can take her months before she's willing to make a form diagnosis.

All I care about is that the officers can say, "okay this guy isn't just being a jackass or trying to lie to me -- he has a mental illness". At that point we give them a set of small changes to their response that will improve their interaction no matter the diagnosis. But it is surprising how little some officers know about mental illness so we try to cover the most important signs and symptoms of the more common disorders.

Aside from preventing an interaction from going downhill, officers can also decide to take someone to the hospital for emergency evaluation, either instead of arresting them, before arresting them. Or instead of doing nothing. They don't decide if the person needs to be committed, just that the person needs to be evaluated. By being able to recognize the illness, they can also provide extra resources to families and recommend that an individual go into a Mental Illness Court Alternative Program after they're arrested so that they get help and have a better chance of getting better.

EDIT: My wife says I am wrong and that it doesn't take "months" to get a diagnosis. It's just not a simple matter and that it requires nuance. : )

Personality disorders, by far. This is true of the general public as well. Individuals with Antisocial Personality Disorder, Borderline Personality Disorder, and Histrionic Personality Disorder are otherwise entirely rational and healthy but engage in behaviors that can be very damaging to their friends and family.

While it can be fairly easy to have empathy for someone with schizophrenia or a suicidal person with depression, personality disorders are far more difficult to understand and therefore treat. We do know that while less than 1% of individuals experience Antisocial Personality Disorder, up to 16% of prison inmates have the disorder -- and they almost never get the help they need.

This isn't always easy. Cops have been trained over-and-over-and-over again about being on the look out for any little sign of aggression, so they tend to see aggression even in places it doesn't exist. There's a lot to be said for less-lethal alternatives like Tasers, but these don't always work either. Last week I actually worked first-hand with an officer who had shot and killed a man with mental illness when his partner's taser failed.

But more than anything else we try to make sure officers know how to keep a situation from becoming confrontational in the first place. I bring in speakers who have mental illness and who've been arrested to try and humanize the disorders. That's always helpful. Some of the symptoms of mental illness can seem bizarre and make officers feel on-edge so it's always good if they've been exposed to the human side of illnesses like bipolar disorder and schizophrenia. Research shows -- and my experience confirms -- than an officer's personality and emotional response is far more important than their "head knowledge" of techniques, so the biggest impact I can have is shifting their thinking toward empathy. Again, that's not always easy.

Regarding techniques, however, I try hard to make sure officers understand that 99% of the mentally ill individuals they encounter aren't trying to misbehave or commit crimes. Usually they're confused. Their brain is lying to them, telling them to do or say things that don't correspond to reality. Professionals call this delusions.

Because people with mental illness aren't out to commit crimes, their motivations are very different than the average criminal for which cops have been trained. For example, the common criminal is likely to see the advantages of backing down and giving in when a cop looks "big and bad". So cops are trained to increase their forcefulness in order to influence a criminal.

Unfortunately, people with mental illness often respond in the exact opposite way. We know that mental illness is correlated with extreme levels of stress hormones that cause flight-or-flight reactions. This being the case, an officer who appears MORE threatening is more likely to cause the mentally ill person to run or try to resist. So we train officers to be an non-threatening as they can by talking quietly, not arguing, and making themselves physically small.

When the mind isn't functioning correctly it also takes much longer for the individual to take-in what the officer is saying. In many cases, the mentally ill person may have no idea what the police officer wants and needs a lot of time to understand it. We train officers to give the person far more time than they normally would before moving in, otherwise they risk making the individual resist simply because they don't understand. Moreover, one of the explicit symptoms of many mental illnesses is that they don't read body language and social cues well and they don't have as much control over their communication. When a person with mental illness is yelling, there's a very good chance they aren't as angry as they look. But cops interpret them as aggressive even though they really just are frustrated.

Finally, teach verbal interaction skills such as reflective listening and mindfulness techniques that draw individuals out of their own deluded reality and into the "real world".

In terms of the biggest obstacle -- let me list two.

1. Officers are recruited with little-to-no attention paid to their empathy. Most officers tend to be "action men" by attitude -- they didn't sign up to be social workers. Unfortunately, the reality of the situation is that they'll spend 75% of their jobs working with at-risk populations like those with mental illness. So the personalities of many officers get in the way. Now, there are a LOT of very good, empathetic cops out there. But there should be more.

2. Perhaps more importantly, our legal and medical system means a disproportionate burden in working with the mentally ill falls on the police. In many other developed countries we have proactive social work programs that can make home visits, etc. to make sure people are taking their medication and seeing their therapist. In the US we don't, which costs us a lot of time and money in the long run. So while I can sometimes be frustrated by police attitudes, in reality the fault lies more with our society's failure to give people with mental illness the services they need to stop them from entering and re-entering crisis situations over-and-over. Mental illness is extremely treatable. If we had a system to help people maintain treatment, cops wouldn't be put in these difficult situations as often.

This is EXACTLY right. As I wrote in one of my comments above, one of the major problems is that we as a society haven't provided services that make sure people with mental illness maintain treatment. Our legal system makes it difficult to get confused/resistant people into treatment and we haven't adopted proactive models that have been proven to work in other countries - weekly social worker home visits, housing, etc. This ends up leaving cops very frustrated that beyond calming people down they don't have much to offer.

The best alternative IMO would be a system that saves both saves money and prevents crime by hiring social workers and therapists to go make sure people are maintaining treatment. Mental illness is highly treatable in todays day-and-age. The problem is that people don't have the capacity or resources to maintain their treatment. With a little extra help and oversight, individuals would be more likely to maintain treatment.

The homelessness and mental health epidemic is caused by a) A lack of public resources to help people with mental illness, b) US cultural attitudes (namely individualism) that expect everyone to make it on their own, even when their illness clearly prevents them from doing so, and c) A legal system that errs very far on the side of individual rights, preventing us from legally requiring individuals to take medications or treatment unless they commit crimes. Regarding the legal issues that "force" treatment, I won't comment personally as to whether it's good or bad. It's just a fact of life in the US, one that makes cops' jobs a lot harder and makes our mental health treatment more expensive than in other countries. But on the other hand it certainly prevents individual rights violations that could occur with a less lenient system.