Law Enforcement and The Mentally Ill

ROCIC Special Research Report
By Publications Specialist Jennifer Adkins

2013 Regional Organized Crime Information Center
Introduction ..........................................................................2
Describing the Problem ......................................................2
Impact on Police Resources .............................................4
Effective Response Strategies ..........................................7
Managing Risks ...................................................................9
Common Situations ..........................................................11
Psychotic Disorders .........................................................12
Mood Disorders .................................................................14
Anxiety Disorders ..............................................................15
Related Problems ..............................................................17
Police Homeless Outreach Programs ............................19
Altered Mental Status from Medical Illnesses ...............21
Conclusion .........................................................................23
Sources of Information .....................................................24
ROCIC - A RISS Center
www.riss.net
A Proven Resource For Law Enforcement
Law Enforcement
and the Mentally Ill
Effective Policing Techniques
for Persons in Crisis
ROCIC Special Research Report Law Enforcement and the Mentally Ill
2
P
roblems associated with people with mental illness
pose a signifcant challenge for modern policing.
Given the false stereotype that all mentally disordered
people are dangerous, citzens ofen call upon the police
to do something in situatons involving mentally ill
individuals, partcularly when they exhibit the more
frightening and disturbing signs of a mental disorder.
Police ofcers are not mental health experts, but
they are ofen the frst on the scene to deal with the
mentally ill, such as those with psychotc disorders,
mood disorders, and anxiety disorders. It is important
to recognize at the outset that mental illness is not, in
and of itself, a police problem. However, a number of
the issues associated with people with mental illness
ofen do become police maters. These include crimes,
suicides, disorder, and a variety of calls for service.
As with all law enforcement decisions, the responding
ofcer must exercise discreton in choosing the most
appropriate acton when encountering a person
exhibitng signs of mental illness or altered mental
status. The more knowledge and training that the
ofcer receives, the more it will impact this response,
and heighten ofcer safety and the safety of the subject.
Describing the Problem
Police involvement with mentally ill persons is based
on two principles of common law: (1) The power and
responsibility of the police to protect the safety and
welfare of the public, and (2) The protecton of the
disabled, such as mentally ill persons.
Safety is the primary concern both safety for the
ofcer and for the (person in crisis), said Lieutenant Jon
Garlick, Mental Health Ofcer with the Calhoun County,
Ala. Sherifs Ofce. People in crisis are emotonal, and
reason takes a back door. The goal in any contact is to
reduce the emotonal level and therefore reduce the
danger.
Approximately 22 percent of U.S. residents have a
serious mental illness. An estmated 7 percent of police
contacts in jurisdictons with 100,000 or more people
involve the mentally ill.
Mental illness is a signifcant factor in the injury or
death of on-duty law enforcement ofcers. Early
studies (1998-2001) found that people with mental
Defnition of Mental Disorders
Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV)
A clinically signifcant behavioral or
psychological syndrome or pattern
that occurs in an individual and that
is associated with present distress
(i.e., a painful symptom) or disabil-
ity (i.e., an impairment in one or
more important areas of function-
ing) or with a signifcantly increased
risk of suffering death, pain, disabil-
ity, or an important loss of freedom.
The syndrome or pattern must not
be merely an expectable and cul-
turally sanctioned response to a
particular event. It must currently
be considered a manifestation of
a behavioral, psychological, or bio-
logical dysfunction in the individual.
No defnition adequately specifes
precise boundaries for the concept
of mental disorder. Also known as
mental health, mental impairment,
mental illness, brain illness, and se-
rious brain disorder.
Source: The Liberty Crier
3
illnesses killed ofcers at a
rate fve tmes greater than
the rest of the populaton. And
the mentally ill populaton
contnues to grow.
Encounters with police are
also dangerous for mentally
ill persons. It is estmated
that people with mental
illnesses are killed by police in
justfable homicides at a rate
nearly four tmes greater than
the general public. State and
local statstcs are inconsistent,
but it is estmated that 375 to
500 people shot and killed by
police each year in this country
have mental health problems.
Police ofcers are frequently
not amenable to being told theres a beter way of doing things than what
theyre doing, said Ron Honberg, the Natonal Director for Policy and Legal
Afairs at the Natonal Alliance on Mental Illness, in a news account. Its an
entrenched culture that doesnt change easily.
There are also many cases where individuals with mental illnesses provoke
police into killing them, commonly known as suicide by cop. In some cases,
the ofcers knew the subjects were disturbed but lacked the training and
resources that might have prevented them from taking lethal acton. Of typical
situatons involving mentally ill persons, ofcers have rated the threat of suicide
as the most difcult to handle. Reducton of injuries and deaths of persons with
mental illness should be a high-priority objectve for police agencies.
Factors Contributing to the Problem
De-insttutonalizaton: Afer 1960, societys preference shifed away from
insttutonalizing people with mental illness. Mental health practces were
changed, and many hospitals were closed. However, community-based services
were not adequately developed to fll the void in treatment. For instance, as of
2011, only 10 percent of the natons approximately 15,000 police departments
ofered crisis interventon programs.
Criminalizaton: Afer de-insttutonalizaton, calls to police about crimes and
disorder involving people with mental illness increased. Because of an apparent
lack of choices, police turned to arrest as the only available soluton to the
immediate problem. This had the efect of criminalizing mental illness and re-
insttutonalizing people with mental illness. An estmated 10 to 15 percent of
jailed people have severe mental illnesses.
4
Medicalizaton: An important aspect
of community-based mental health
care is getng non-insttutonalized
people with mental illness to take
their medicaton as prescribed.
Factors interfering with the regular
use of prescribed medicatons include
negatve side-efects associated with
some drugs, the high cost of medicaton,
the tendency to self-medicate, the
abuse of illegal drugs and alcohol, and
the lack of follow-up by the mental
health system.
Privatzaton: Many mental health
facilites are operated by private
partes. Privately run facilites have
an inherent incentve to cut expenses,
ofen resultng in minimum and low-
paid staf. This results in a facility that
relies on police to help manage patents/clients. As a result, police resources
are wasted and people with mental illness do not get the quality of care that
they deserve.
Impact on Police Resources
Law enforcement ofcers are the frst responders to people with mental
illnesses who are in crisis. These encounters have increased as the number of
mentally ill persons in the general populaton, in jail, and among the homeless
has grown.
Law enforcement has always confronted more mentally ill people in crisis than
any other profession, stated Lt. Garlick. Typically, law enforcement ofcers
are not mental health professionals and the training they receive is minimal
compared to other professions. An encounter with an EDP (emotonally
disturbed person) will take longer and ofen requires more ofcers than non-
EDPs.
Ofcers who encounter an EDP creatng a disturbance have three choices:
1. Transport that person to a mental hospital
2. Arrest the person
3. Resolve the mater informally
Studies found that police resolved situatons informally in 72 percent of the
cases, made an arrest in 16 percent of the cases, and initated emergency
hospitalizaton in 13 percent of the cases.
Most state laws permit ofcers to take these individuals into custody and
transport them to hospitals if they meet the legal criteria for psychiatric
5
evaluaton. However, transportaton and hospital security demands associated
with mentally ill persons are perceived as a major consumer of law enforcement
resources natonally; increasing amount of tme and manpower.
In additon, police use of hospitals is limited by the number of psychiatric
beds available in the community and by the criteria for admission. Persons
categorized as dangerous may not be admited to some hospitals, nor may
persons with pending criminal charges.
The trend has been to reduce bed space for the mentally ill throughout the
country, said Lt. Garlick. We are at the lowest per capita for mental health
beds since 1880. This forces people back to the community for outpatent
treatment.
In Alabama, we have approximately 100,000 people being treated by community
mental-health centers. Approximately 1 percent of those require some form of
permanent hospitalizaton. These 1,000 people circle through the system from
hospital commitment to outpatent treatment untl they either experience
decompensaton that results in an ER visit or a crisis that lands them in jail.
If the person is considered too dangerous (or in some cases their behavior is not
considered severe enough) to qualify for hospital admitance, arrest is the only
alternatve for ofcers. The person exhibitng signs of mental illness may be
arrested when considered deviant, disorderly, and it is thought that the person
would contnue to cause a problem if acton was not taken.
Unfortunately, the criminal justce system is not designed to be a major point of
entry into the mental health system. An arrest labels the person as a criminal
and will most likely result in future arrests due to disorderliness. The arrest
rates for persons exhibitng signs of mental illness are greater than that of other
6
citzens involved in similar types
of incidents. And the arrest rate
contnues to grow for mentally ill
persons.
In jail, the impact is greater.
Jails are not hospitals and dont
have the resources available for
medicatons or therapy or even
suitable bed space, Lt. Garlick
said.
In general, police make a formal
dispositon hospitalizaton or
arrest when the situaton, if
unchecked, would escalate and
require further police assistance.
Informal optons are based on
how the person is perceived. Disturbed people who are likely to be
handled by informal means are ofen categorized as neighborhood
characters, troublemakers, and quiet, unobtrusive mentals. Ofcers
familiarity with these types enables them to soothe them without
taking more formal acton.
Police know the parameters of the behavior of their neighborhood
characters, such as Batman or Mailbox Molly. Ofcers familiarity
with their idiosyncrasies and symptoms enable them to placate them.
Troublemakers are not usually hospitalized or arrested. Interventon
in such cases may not be worth the trouble. These persons may have
such a long history of disturbance that ofcers fnd it a hassle to
contnue to arrest him or her.
Quiet, unobtrusive mentals, ofend neither the populaton nor the
police with obvious manifestatons of their illness, and their symptoms
are not considered serious enough to warrant hospitalizaton.
The police problem of people with mental illness is closely connected
to three other problems: homelessness, drug abuse, and alcohol
abuse. Addressing people with mental illness in your jurisdicton
may require that you take on these problems as well. This guide will
address these difcultes associated with the mentally ill populaton.
In general, a small
subset of people
with mental illness,
those who are
actively experiencing
serious psychotic
symptoms, are more
violent than the
general population.
Violent and criminal
acts that are directly
attributable to mental
illness accounts for
a small proportion
of all such acts in
the United States.
The vast majority
of persons with
mental illness are
not criminals, and of
those who are, most
are not violent.
Threat of
Violence
7
Recommendations for an Effective Response Strategy
The public mental health system and the criminal justce system must
collaborate so that police ofcers have several alternatves, other than arrest
or hospitalizaton, when handling mentally ill persons in the community. Police
ofcers must also receive adequate training in recognizing and handling
mentally ill citzens so that individuals who are more disordered than disorderly
are referred to the appropriate system.
1. Working with the mental health community. Give careful consideraton
to who else in your community shares responsibility for the problem and
can help your department beter respond to it. Mental health professionals
and advocates for mental-health-system reform can be viable partners with
police ofcers. Be the leader in helping these organizatons collaborate and
share informaton.
2. Working with emergency hospitals. Negotate no-refusal agreements with
hospitals. Several jurisdictons, including Memphis, Tenn., have established
crisis response sites where police can transport people in mental health
crisis as an alternatve to an emergency room or jail. These sites are usually
located in hospitals as a drop-of point and have a no-refusal policy with
police. These agreements establish a successful liaison between the police
department and the mental health system. At the least, police agencies
should meet with staf of local hospitals periodically to develop protocols
and address problems. For example, it should be clear how long an ofcer
must remain at the hospital and when security can take over. It should be
clear whether the police or an ambulance is responsible for transportng a
patent to another facility.
3. Training police ofcers. Ofcers should receive training about mental
disabilites and their symptoms, available community resources, and basic
crisis communicaton skills. Proper training typically integrates lecture,
discussion, tours of mental health facilites, and role-playing that does
not exaggerate the danger involved in police encounters with people with
mental illness. The most popular response to incidents involving persons
with mental illness has been deploying specialized police ofcers who are
given extra training. Agencies could also deploy a specialized non-police
responder, such as a social worker or mental health clinician. Models of
this type have been successful in Birmingham, Ala. and Knoxville, Tenn.

Sergeant Keith Simonds with the Oklahoma City, Okla. P.D. teaches a
fve-day crisis interventon course. On the frst day of class, Sgt. Simonds
strikes a typical police ofcer pose: feet planted frmly, hand on gun.

Doesnt exactly say, Im here to help you, does it? Sgt. Simonds said in
a news account. More like, Im here for target practce. Sgt. Simonds
explains that when a crisis interventon ofcer encounters someone in
psychiatric crisis, he should approach with cauton and patent talk: How
are you doing today, sir? Looks like maybe youre having a bad day. Are you
taking any medicaton?
Watch for
opportunities to
attend specialized
ROCIC Training
events at
www.rocic.com.
8
4. Informing patrol ofcers. Agencies should provide two
types of informaton to patrol ofcers: (1) informaton
about clinics, shelters, and mental health services
available in the community, and (2) informaton on
community members with a history of mental illness
and repeat ofenses. Patrol ofcers must also have
alternatves to deadly force, including pepper spray and
stun guns.
5. Targetng chronic disturbers and repeat calls for service.
If a person is merely being loud, annoying, or actng
strangely, involuntary commitment is not usually an opton.
In response, ofcers may atempt to soothe the victm,
look for a guardian, command the person to leave or cease,
or make an arrest for disorderly conduct. If the person
engages in the same behavior repeatedly, police may run
out of optons quickly and may have to empower the
community to apply more supervision over the disturber.

Theres a lot of individuals standing on a street corner
who may be cursing and may be yelling and may be
going in and out of trafc, said Major Sam Cochran, the
crisis interventon program coordinator for Memphis,
Tenn. P.D., in a news account. Each of those would
be an infracton disorderly conduct, disturbing the
peace, or something of that nature. But who really
cares if the individual goes into the criminal justce
system? The public wants that person of the street.

In additon to chronic disturbances, some individuals
may call police repeatedly for police service. This might
involve a large number of false, imaginary, or trivial
calls. If police can identfy the caller, they can take
further acton, such as seeking assistance from social
workers or mental health professionals. In Ithaca, N.Y.,
calls from emotonally disturbed people were the police
departments most common non-crime calls. A new
system was adopted in which calls from or about people
with mental illness were handled as they were received,
but also referred to community-based ofcers and
mental health providers for next-day follow-up. Chronic
calls were all but eliminated.
6. Targetng hot spots. Crime, disorder, and calls for service
relatng to mentally ill persons tend to be concentrated
in a subset of locatons in any jurisdicton. Once hot spots
are identfed, it is important to analyze the situaton
to determine the nature of the calls and why they are
occurring, before tailoring a response.
Offcer James Smith takes a break from patrolling
the streets of Memphis, Tenn. to check on Joseph,
a man he has dealt with in the past. Team members
often establish a rapport with some of the mentally ill
people in their precincts. Members of the Memphis
police crisis intervention team get 40 hours of
training on mental health and confict resolution, then
regularly handle calls involving disturbed people.
They work closely with a hospital that accepts people
for psychiatric assessments around the clock. In
Memphis, fewer than 1 percent of calls handled by
the police crisis intervention team result in arrest,
compared with an estimated national average of 20
percent on similar calls. Source: hamptonroads.com.
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Managing Risks
Innovatve programs designed to
manage the risk of encounters
with people with untreated mental
illnesses have been implemented
in some communites, and free up
law enforcement tme, money, and
other valuable resources.
Law enforcement agencies can
be proactve by working with the
probate court to create a mental
health ofcer who can order 72-
hour holds, suggested Lt. Garlick.
A crisis negotaton team is also an
asset to working with EDP events,
and, of course, training street-level
cops beyond the basics learned in
the academy.
1. Crisis interventon training. Calhoun County, Ala., Memphis, and Houston, are
among the agencies which have developed Crisis Interventon Teams (CIT).
CIT members are specialized law enforcement ofcers who have 40 hours of
training and experience in a special-duty assignment, such as responding to
emotonal disturbance crisis calls, in additon to making regular police service
calls. CIT ofcers learn to interact with people with mental illness who are in
crisis. Week-long basic CIT training consists of 15 training modules of varying
lengths. These courses, usually given in order, include:
Introducton to Clinical Issues Relatng to Mental Illness
Introducton to Psychotropic Medicatons
Substance Abuse and Co-Occurring Disorders
Post-Traumatc Stress Disorder (PTSD)
Cultural Awareness
Suicide Preventon
Rights and Civil Commitment Law
Family and Consumer Perspectve
Traumatc Brain Injury (TBI)
Developmental and Disruptve Disorders of Childhood and Adolescents
Introducton to Verbal Techniques
Borderline and Other Personality Disorders
Basic Strategies of De-Escalaton
Advanced Verbal Techniques and Practcum
Community Resources
Houston police began a mental health unit in 1999. Since then, they have
increased CIT training to more than 2,100 ofcers. In 2012, the Houston Police
Department responded to more than 28,000 mental health calls, resultng in
only 55 arrests.
Houston, Texas Police Departments Homeless Outreach Team (HOT) Mental Health
Unit Offcer Jaime Giraldo speaks with a homeless man about to be transported to a
local hospital. Offcer Giraldo drives the HOT Mercedes Benz van, painted in classic
black and white police colors and equipped with a powerful wheelchair lift in the rear.
HPD offcers assigned to HOT will use the roomy vehicle as a mobile offce, as well as
a safe transport for homeless people. Source: Houston Chronicle
10
2. Mental health ofcers. On a smaller scale, many agencies, including
Florence, Ala., are employing a mental health ofcer. A mental health
ofcer is called to the scene whenever a suspect is believed to have
a mental illness. The ofcer is trained to assess whether the person is
mentally ill, if the person is dangerous, whether the person can make a
reasonable decision about treatment, and if the person is undergoing
treatment. The ofcer may take the person to a hospital to be evaluated.
3. Mental health courts. Specialized mental health courts could be
developed, in which one or a few judges hear all cases involving persons
with mental illness and have ready access to mental health professionals.
These types of courts are in a beter positon than a general criminal court
to make adjudicaton and sentencing decisions that are tailored to the
specifc needs of each defendant, while stll protectng the community.
4. Assisted outpatent treatment. Studies and data from states using
assisted outpatent treatment (AOT) prove that AOT is efectve in
reducing incidents of hospitalizaton, homelessness, arrests and
incarceratons, victmizaton, and violent episodes. AOT also increases
treatment compliance and promotes long-term voluntary compliance for
people with mental illnesses. These outcomes reduce law enforcement
contact with people with severe mental illnesses.
Participants in the Norfolk, Va. mental health court wait to discuss their progress. Source: hamptonroads.com
11
Common Situations
Police ofcers encounter people with mental illness in many diferent types of
situatons, in roles that include criminal ofenders, disorderly persons, missing
persons, complainants, victms, and persons in need of care (see table).
There are many scenarios from a suicidal person, to a barricaded suicide, a
psychotc person on the street, homeless populatons, domestc violence you
name it, said Lt. Garlick.
The fve most frequent scenarios are as follows:
1. A family member, friend, or other concerned person calls the police for help
during a psychiatric emergency.
2. A person with mental illness feels suicidal and calls the police as a cry for help.
3. Police ofcers encounter a person with mental illness behaving inappropriately
in public.
4. Citzens call the police because they feel threatened by the unusual behavior or
the mere presence of a person with mental illness.
5. A person with mental illness calls the police for help because of imagined threats.
Roles of People with Mental Illness and Examples
Role Examples
Offender A person with mental illness commits a personal or property crime.
A person with mental illness commits a drug crime.
A person with mental illness threatens to commit suicide.
A person with mental illness threatens to injure someone else in the delusional belief that the person
poses a threat to him or her.
A person with mental illness threatens to injure police as a means of forcing police to kill him (commonly
called suicide by cop).
Disorderly
person
A family or community member reports annoying or disruptive behavior by a person with mental illness.
A hospital, group home, or mental health facility calls for police assistance in controlling a person with
mental illness.
A police offcer on patrol encounters a person with mental illness behaving in a disorderly manner.
Missing person A family member reports that a person with mental illness is missing.
A group home or mental health institution reports that a person with mental illness walked away and/or is
missing.
Complainant A person with mental illness calls the police to report real or imagined conditions or phenomena.
A person with mental illness calls the police to complain about care received from family members or
caretakers.
Victim A person with mental illness is the victim of a personal or property crime.
A family member, caretaker, or service provider neglects or abuses a person with mental illness.
Person in need
of care
Police are asked to transport a person with mental illness to or from a hospital or mental health facility.
Police encounter a person with mental illness who is neglecting his or her own basic needs (food, cloth-
ing, shelter, medication, etc.).
12
These are the most common situatons in which police encounter people with
mental illness. However, ofcers do not always realize that mental illness is
involved and may try to handle the situaton as usual (by giving directons,
issuing commands, or making an arrest) but not get the cooperaton or
compliance expected, which may lead to an escalaton in tension. Therefore, it
is important for law enforcement ofcers to learn the signs and symptoms of
serious disorders.
The main examples of serious mental illness are:
1. Psychotc Disorders
2. Mood Disorders
3. Anxiety Disorders
4. Childhood Disorders
5. Eatng Disorders
The following sectons go into more detail on psychotc, mood, and anxiety
disorders.
Psychotic Disorders
The most obvious symptoms of psychotc disorders include paranoia,
hallucinatons, and delusions. Other signs include disorganized thinking, speech
or language that doesnt make sense, unusual behavior and dress, problems
with memory, disorientaton, changes in eatng or sleeping habits, energy level,
or weight, and the inability to make decisions.
All cases of schizophrenia are considered serious psychotc disorders. While 95
percent of violent acts are commited by people with no mental illness, those
with schizophrenia are two to four tmes more likely to commit violence than
the average person.
Vincent van Gogh suffered from recurrent psychotic episodes, and committed suicide at age 37. While some psychiatrists
point to lobe epilepsy as the diagnosis for his illness, others contemplate whether or not the artist was schizophrenic.
13
Suggestons for encountering a person with acute psychosis, who is actng out:
Remain calm.
Remember that you cannot reason with acute psychosis.
Do not express irritaton or anger.
Dont threaten. This may be interpreted as a power play and increase assaultve
behavior by the person.
Dont shout. If the psychotc person seems not to be listening, it isnt because he or
she is hard of hearing. Voices or deluded thoughts are interfering.
Dont critcize. It will only make maters worse.
Dont bait the person into actng out wild threats; the consequences could be tragic.
Dont stand over the person if he or she is seated. Instead, seat yourself.
Avoid direct, contnuous eye contact or touching the person.
Comply with requests that are neither endangering nor beyond reason. This provides
the person with an opportunity to feel somewhat in control.
Decrease other distractons immediately turn of the TV and radio.
Express understanding for what the person is experiencing.
Speak quietly, frmly and simply.
Worst Case Scenario: Schizophrenic amputee fatally shot by Houston ofcer
A 45-year-old amputee was fatally shot by a Houston, Texas police ofcer. The man had lost
his lef arm and leg because he believed that the devil was in the lef side of his body, so he
had decided to lay down on railroad tracks and wait for a train to come and dismember him.
(People with paranoid schizophrenia ofen see and hear things that arent there.) In 2012,
police responded to reports that the man was actng out at a residental care facility. The man
cornered a responding ofcer with his wheelchair and atempted to stab him with a shiny
object. Another responding ofcer, fearing for his partners life and his own safety, shot the
man in the head. The shiny object turned out to be a ballpoint pen. Criminal charges were
not made against the police ofcer; however, the department was natonally critcized for
the incident.
Beter Case Scenario: 22-year-old schizophrenic calmed by Baltmore ofcer
In July 2013, a 22-year-old man with schizophrenia called 911 to report a gunshot to his head.
Earlier in the day, he thought hed heard a group leader at his psychiatric rehab program ask
who wanted directons to his house. The delusion frightened him and by the end of the day,
he thought hed been shot in the head. The ofcer met him on the sidewalk and shook his
hand. She asked him what was wrong, and he responded that he wanted to report being
shot in the head. The ofcer asked where he was shot and he pointed to both temples. The
ofcer acknowledged that she saw what he was talking about. She asked him if he possessed
anything sharp that could hurt her and asked to check his pockets, to which he consented.
For the beneft of the man, the ofcer pretended to check her databases to ensure that
no one could acquire his address. She asked him how she could make him feel beter, and
repeatedly assured him that no one knew his address and that his gunshot wound would
be okay in 4-5 days. She gave his mother a phone number to an emergency hot-line to call
in the event of a crisis. The ofcer validated the mans concerns, addressed his worries, and
de-escalated the situaton.
14
Mood Disorders
Severe cases of major depression
and bipolar disorder are considered
serious mental illnesses that could
put the victms and others safety
in jeopardy. Bipolar disorder is a
persistent illness with recurring
episodes of mania and depression
that can last from one day to
months. Severe symptoms can
include recurring thoughts of
death or suicide, reckless behavior,
impulsiveness, delusions, and
hallucinatons.
In bipolar disorder, suicide is a
signifcant risk, occurring in 10 to 15 percent of people with Type I or II. Suicidal
thoughts and atempts are more likely to happen when the individual is in a
depressed state. Other forms of self-harm, such as cutng and self-mutlaton, is
also common in people with bipolar disorder I or II.
Bad decision-making can happen with severe bipolar disorder. There can be extreme
irritability. They may start yelling at strangers on the street or get in fghts in public
places. Reckless behaviors could also include binge drinking and drug use.
Atemptng suicide, assaultng another person, stealing, speeding, creatng a public
disturbance, and lewd conduct are among the more common ways that someone
might break the law during a bipolar episode.
Worst Case Scenario: Knife-wielding bipolar man commited suicide-by-cop in New York
In May 2013, a 39-year-old man diagnosed with bipolar disorder bore down on New York ofcers
while screaming Im going to get you; Im going to f---ing kill you. He charged an ofcer with a
13-inch knife, ignoring commands to drop his weapon. The man came within three feet of the
ofcer before he was killed by a single shot. The man and his girlfriend had been drinking that
night when they fought and his girlfriend lef their apartment. Realizing she needed clothes, she
fagged down a police car. The police ofcers accompanied her back to the apartment, where,
without warning, the door few open and the man rushed out with a knife in hand. The man
had two months prior atempted to overdose on his ant-anxiety and ant-psychotc medicaton.
Previous domestc incident reports had also been taken.
Beter Case Scenario: Georgia elementary school shooter surrenders to police
The August 2013 suspect in a Georgia elementary school shootng surrendered to police
afer fring six rounds in a front ofce. He had nearly 500 rounds of ammuniton with him. He
surrendered to police afer exchanging gunfre with them. It is believed that he took the AK-47
from an acquaintances house. The shooter had bipolar disorder and sufered from Atenton
Defcit Disorder (ADD). He indicated to the schools bookkeeper, who he held captve during the
incident, he had stopped taking his medicine. The bookkeeper allegedly convinced him to put
down his gun afer explaining to him that she loved him and told him about her own troubles
occurring in her life, saying, Its going to be okay. If she could recover, he could too. Afer they
talked, she asked him to put his weapon down. He complied and was taken into custody.
Michael Hall, 20, diagnosed with bipolar disorder, entered an
Atlanta, Ga. elementary school with an AK-47. He surrendered
to police after his feelings were justifed by the school book-
keeper, who he held captive during the ordeal.
15
Anxiety Disorders
Serious anxiety disorders include severe cases of panic disorder, obsessive-
compulsive disorder, and post-traumatc stress disorder.
Panic atacks typically begin without warning and at any tme driving a car,
at the mall, sound asleep, or in the middle of a business meetng. Symptoms
include:
Sense of impending doom or danger
Fear of loss of control or death
Rapid heart rate
Sweatng
Trembling
Shortness of breath
Hyperventlaton
Chills
Hot fashes
Nausea
Abdominal cramping
Chest pain
Headache
Dizziness
Faintness
Tightness in throat
Trouble swallowing
Complicatons from panic disorders could include depression, increased
risk of suicide or suicidal thoughts, and alcohol or substance abuse. People
experiencing them may fear they are dying, sufocatng, having a stroke or heart
atack, or simply going crazy. In severe cases, victms may develop agoraphobia,
an intense and irratonal fear of being in public places and may never leave
home.
Obsession symptoms ofen have themes to them, such as fear of contaminaton
or dirt, having things orderly and symmetrical, aggressive or horrifc impulses,
and sexual images or thoughts. Signs include:
Fear of being contaminated by shaking hands or by touching objects
others have touched
Doubts that theyve locked the door or turned of the stove
Thoughts that theyve hurt someone in a trafc accident
Intense stress when objects arent orderly or facing the right way
Images of hurtng their child
Impulses to shout obscenites in inappropriate situatons
Avoidance of situatons that can trigger obsessions, such as shaking
hands
Replaying pornographic images in their mind
Dermatts or raw skin because of frequent hand washing
Skin lesions because of picking at their skin
Hair loss or bald spots because of hair pulling
Compulsions include repeatedly washing, cleaning, countng, checking,
demanding reassurances, and orderliness.
16
Post-traumatc stress disorder develops afer a terrifying
ordeal that involved physical harm or the threat of
physical harm. It was frst brought to public atenton
in relaton to war veterans, but can also result
from incidents such as a mugging, rape, torture,
kidnapping, child abuse, car accidents, bombings,
or natural disasters. External signs and symptoms
include sweatng, depression, easily startled,
and angry outbursts. Common side efects of
antdepressant medicine include headache,
nausea, agitaton, sleeplessness, and sexual
problems.
It takes a lot of mental energy for people
diagnosed with an anxiety disorder to hold
a conversaton because their brains are
overwhelmed with anxiety, causing distracted
thinking, over-thinking from nervousness, tongue
stumbling, lightheadedness, loss of reality, and
trouble listening.
Worst Case Scenario: DC gunman sufering from
PTSD killed 12 at Navy building
In September 2013, a Navy veteran killed 12 people in
Washington, D.C. afer sufering a host of serious mental issues,
including paranoia and a sleep disorder, as well as Post Traumatc
Stress disorder afer his involvement in the rescue of Sept. 11, 2001 victms. Armed
with a shotgun and two handguns, he sprayed bullets from the fourth foor down
to the cafeteria area of the Naval Sea Systems Command headquarters. He died
later during an exchange of gunfre with police. Navy personnel had previously been
warned that the gunman heard voices, and that people were sending microwave
vibratons into his body to deprive him of sleep. He visited two hospitals in the weeks
prior to his rampage.
Beter Case Scenario: OCD teen arrested before bombing Oregon high school
In May 2013, an Oregon teenager was arrested afer police got a tp that he was
making a bomb to blow up his high school. He was charged as an adult with one count
of atempted aggravated murder and six counts of manufacturing and possessing a
destructve device. The suspect allegedly struggles with a rare form of obsessive-
compulsive disorder. Investgators found six bombs under the foorboards of the
suspects bedroom, along with writen plans modeled afer the 1999 Columbine
atack.
17
Related Problems
Problems related to mental
illness include homelessness,
drug abuse, and alcohol
abuse. Approximately one-
third of the adult homeless
populaton sufers from severe
and persistent mental illness.
They havent been in
treatment because they are
on the streets, and they dont
want to take their medicaton
because it makes them sleepy,
disoriented or confused and
they are afraid theyll get
beaten up and robbed, said
Deirdre Kimble-Charles, a
caseworker with the Harris
County, Texas Mental Health-
Mental Retardaton Authority,
in a news account.
Mental disorders prevent people from carrying out essental aspects of daily life,
such as self-care, hygiene, household management, and personal relatonships.
Some mentally ill homeless persons live in abandoned houses and burn them down.
Homeless people with mental disorders remain homeless for longer periods of
tme and have less contact with family and friends. They encounter more barriers
to employment, tend to be in poorer physical health, and have more contact with
the legal system than homeless people who do not sufer from mental disorders.
There is a strong relatonship between residency in homeless encampments and
dual diagnoses of addicton and mental illness. Efectve strategies to get people of
the streets include long-term integrated treatment programs and comprehensive
case management. Many communites have groups actvely working to increase
state and local government funding of these services.
Negatve interactons between police ofcers and homeless people can be
avoided through educatonal eforts to change police culture and attudes toward
homelessness. Invitng homeless advocacy groups to help design and teach the
curriculum can be very useful in building positve inter-agency relatonships.
Police involvement in planning community-wide strategies to end homelessness
is also benefcial. Community meetngs are a good way to express what resources
your department can bring to the table as well as any limits on your involvement.
Why do we need police ofcers doing this? Because a lot of tmes police ofcers are
the frst ones called, said Houston, Texas Mayor Annise Parker in a news account.
Up to 30 percent of daily service calls to the San Luis Obispo, Calif. Police Department are for
homeless-related activity. The department has applied for the Justice and Mental Health Program
Grant, which would allow for Transitions Mental Health Association, SLO County Behavioral Health
Services, and the Police Department to work together. It helps you look for and understand their
mindset because they may be schizophrenic or have some other kind of mental disorder, said
Offcer John Villanti. With the grant, a mental health professional would patrol with the CAT Team on
an ongoing basis. Source: Central Coast News
18
Theres an angry property owner downtown, who says, Somebody is sleeping
on my front steps. Do something! or Someone is urinatng on my building. Do
something! These people dont belong in jail, they need assistance.
Approximately 25 percent of sherifs ofces and local police departments
have writen policies for contacts with homeless people. These policies should
be developed to include training on handling homeless people with mental
illnesses, including CIT training. Policies should also include procedures for
casual contacts and arrests, as well as details about how to give notce to illegal
campers and deal with the property of homeless people. Appropriate record
keeping can later help assess the efectveness of the policy.
Some police departments have specialized units to deal specifcally with
homeless people. Other agencies allow outreach workers to accompany them
on patrol through areas frequented by homeless people. In Fort Lauderdale, Fla.,
police ofcers on the Homeless Outreach Team learned that wearing a uniform
and driving a marked patrol car made it easier to contact homeless people
being approached by someone in plain clothes and an unmarked patrol car
made them fearful. Ofcers in San Diego partner with mental health clinicians
in a Psychiatric Emergency Response Team. Ofcers in Santa Monica, Calif.,
created a specialized unit known as the Homeless Liaison Program to reach out
to transients and refer them to housing providers, job placement services, and
treatment programs for mental illness and substance abuse disorders.
Frequently, police offcers encounter mentally ill people who have not committed a crime, or the crime was of a petty,
non-violent nature. Offcers attend Crisis Intervention Training to learn alternative methods (other than arrest) to
dealing with persons with mental illness. To become a CIT offcer, offcers participate in an intensive 40-hour training
class, which revolves heavily around role-playing exercises where professional actors and actresses are used to
play the part of the mentally ill subjects. The training is also comprised of site visits to local mental health centers and
treatment facilities, meetings with mental health professionals, family members of mentally ill people, and consum-
ers of mental health services.
19
Police Homeless
Outreach Programs
in the ROCIC Region:
Homeless Outreach Team
Fort Lauderdale, FL
The Police Homeless
Outreach Team is
composed of a police ofcer
and a volunteer from the
Broward Coaliton for the
Homeless who seek to
build relatonships with
the homeless in hopes of
informing them of various
resources and assistance that can help them become self-sufcient. The volunteer
is a formerly homeless person who can identfy with the struggles many face but
also to ofer personal anecdotes. The police ofcer wears the uniform because
it conveys authority and safety once the relatonships are established. Also, the
homeless were more receptve of this approach as opposed to the ofcer and
volunteer working without any visible identfcaton.
In additon to this program, the police department hopes to break the cycle of
homelessness once individuals arrested for crimes are discharged so they are not
simply released to the streets again. When an individual is booked, police ask certain
questons. If the police believe that the person is homeless, then they require him
or her to fll out a homeless referral form which goes to the Broward County Social
Service Outreach Team. The homeless are contacted by social workers with the
goal of placement in appropriate social service upon release from jail.
Clearwater Homeless Interventon Project
Clearwater, FL
The CHIP program has a community policing substaton which is housed in the
shelter and which also serves as home to the Clearwater Police Departments
Downtown Bicycle Team. In line with Clearwaters traditon of proactve community
policing, ofcers on bicycles are patrolling the downtown area and getng to know
the residents, business owners, and also the homeless populaton. The Bike Team
is taking an actve role in referring clients to CHIP, as well as enforcing the rules of
conduct at the shelter. The shelter provides homeless citzens with opportunites to
become self-sufcient as well as a day service that serves individuals, giving them
somewhere to stay during the day hours.
Homeless Assistance Collaboratve
New Orleans, LA
This initatve began in the fall of 2004 to efectvely handle homeless persons and
to establish an alternatve to arrest for minor ofenses. Ofcers collaborate with
UNITY (nonproft that organizes 63 of the areas homelessness organizatons) to
move homeless people into permanent housing. Ofcers are trained to call for a
marked NOPD mobile assistance unit when approaching a homeless person. The
unit helps homeless people with their immediate concerns and provides referrals
and assistance to a shelter, hospital, or substance abuse program.
Volunteers with the Homeless Assistance Collaborative help homeless men into a waiting New Orleans
Police Department HAC van to be taken to Travelers Aid for assistance.
20
Homeless Outreach and
Proactve Enforcement
(HOPE Program)
Atlanta, GA
The program is targeted towards
the high levels of homeless
individuals at the Hartsfeld
Jackson Atlanta Internatonal
Airport. The ofcers assigned to
the airport precinct and selected to
be HOPE program liaisons receive
training in crisis interventon
from licensed psychologists. The
ofcers are equipped with ways
to assist homeless people and
are trained to become a referral
system to various local social
service agencies.
Rescue Mission Program
Nashville, TN
The Metro Police started this program to assist homeless people in getng bus
fares out of the city. Through the program, homeless people and others stranded
in the Nashville area are referred to the private sector, which purchases the
bus tckets. The goal of the program is not to rid Nashville of the homeless but
to provide help to those in need. The program works in conjuncton with the
Nashville Downtown Partnership.
Homeless Project Ofcer
Fayeteville, NC
This ofcer is responsible for the identfcaton and classifcaton of homeless
persons. The ofcer serves as a resource to homeless people in the area,
assistng them with identfcaton, meals, shelters, and other basic necessites.
In additon to these dutes, the ofcer also has to initate and maintain trespass
agreements for vacant homes, lots and businesses afer operatng hours to
reduce criminal actvites.
Homeless Outreach Partnership Enforcement (HOPE) Unit
Richmond, VA
The dutes of this unit include policing, serving, and protectng the homeless
populaton in the Richmond area. The unit consists of a sergeant, three ofcers,
and City Department of Social Services social work specialist dedicated to
homeless services. The unit patrols areas usually populated by homeless
individuals and assists people by providing them with referrals for homeless
services.
Street Outreach Program (STOP)
Birmingham, AL
This initatve is funded by HUD and provides two CDM social workers to work with
the City Acton Partnership, which is Birminghams Business Improvement District.
Fayetteville, N.C. Police Offcer Stacy Sanders offers a homeless man a donated jacket under-
neath the Person Street Bridge spanning the Cape Fear River. Im not surprised by the num-
bers. Im not surprised by the children and the families that are homeless but I am surprised by
the lack of resources, said Offcer Sanders, the departments homeless specialist. The thing
that bothers me the most is that my hands are limited. Source: newsobserver.com
21
Altered Mental Status
From Medical Illnesses
Law enforcement ofcers
ofen interact with people
who demonstrate erratc and
potentally violent behavior
persons who have an altered
mental awareness of their
surroundings. These types of
behaviors are ofen dismissed
as alcohol intoxicaton or pure
psychotc episodes; however,
the behavior may actually be
atributed to a medical illness
or an adverse reacton to a
traumatc event, such as with
Alzheimers disease, diabetc
emergencies, seizures, and
trauma victms. For instance:
In July 2013, the Santa Fe, N.M.
police came under heavy critcism afer deputes forced a woman who was
having a diabetc episode onto the road pavement, handcufed her, and lef
her in the back of a police unit where she almost went into diabetc coma. She
had been a minor trafc accident, and police thought she was drunk. She was
subsequently forced out of her car afer she was unresponsive to demands to
open her door. Police eventually phoned paramedics, who treated her for low
blood sugar.
The following are common medical illnesses that could be misconstrued as
alcohol or drug intoxicaton or as a mental disorder.
Alzheimers Disease
The challenges in dealing with a person with progressed Alzheimers disease
is that he or she may not be able to ask or recognize that they need help. They
could walk or drive for hours unaware of the passage of tme or their own
disorientaton. They even may atempt not to be found by searchers.
Signs and symptoms of Alzheimers disease include repetton, paranoia,
anxiety, loss of inhibiton, rummaging, hiding or hoarding objects, pacing and
fdgetng, and wandering.
Incidents involving Alzheimers patents include driving difcultes, false
reports to 911, domestc violence, homicide, suicide, indecent exposure,
shoplifing, abuse/neglect, poisoning, choking, overdoses, falling, cooking
accidents, trespassing, fres, and victmizaton.
In 2010, the Greenwich, Conn. Police Department began participating in Project Lifesaver,
a program that helps law enforcement locate people who wander away due to a medical
condition, such as autism, down syndrome, or dementia. People with those conditions wear
a radio transmitter attached to a bracelet, and police use a hand-held antenna to pick up
the signal from the device. The equipment was provided to the department free of charge.
Source: greenwichtime.com
22
Diabetc Emergencies
A diabetc person in insulin
shock ofen appears to be
drunk. He or she is slow to
respond to any stmuli, slurs
words, and is disoriented.
These persons need to raise
their blood glucose level with
orange juice or other high-
sugar foods.
Hyperglycemia or diabetc
coma is the opposite of
insulin shock. Symptoms
include disorientaton and
sweet-smelling breath that
is sometmes mistaken for
the by-products of alcohol
intoxicaton.
Diabetc emergencies may be more prevalent in the less privileged populatons
because of lesser access to medical care.
Seizures
Seizures may cloud awareness, block normal communicaton, produce a
variety of undirected, uncontrolled, unorganized movements, and may cause
loss of bladder or bowel control. The person will not comply with instructons
from the ofcer whether the person has had an absence seizure (a period of
unresponsiveness, but with eyes open) or the classic full-body shaking. The
actual seizing consumes a lot of energy resultng in a postctal (drowsy) state
afer the seizure, during which the patent is unresponsive to verbal stmuli
and appear to be under the efects of alcohol or drugs.
Trauma
Law enforcement ofcers observe the afer-efects of traumatc injury on
a daily basis, e.g., high-speed crash victms or an aggravated assault victm.
Injuries will alter a persons level of consciousness. Symptoms of a traumatc
brain injury include behaving inappropriately and disorientaton.
Elderly persons on blood thinning medicaton and chronic alcoholics are at
greater risk of cerebral hemorrhage from simple falls from a standing positon
and should be immediately referred to EMS.
Santa Fe, N.M. Police Department came under heavy criticism after mistaking a woman having
a diabetic attack for a drunk driver. Source: Police Magazine
23
Conclusion
The trick when dealing with people in crisis is to
calm the situaton and take your tme, advised
Lt. Garlick. A quick triage startng with medical
issues, then environment, diet, sleep, and fnally
trauma is most helpful in understanding what
may be happening.
The thing to remember is that states are reducing
beds and driving people into local treatment,
and 67 percent of mentally ill people dont seek
treatment because they do not have a supportve
family.
We need more places to permanently commit
people so that they have a clean place to live, get
food, and receive medicaton. Then they can live
a decent life. We also need to look at everyones
budget, not just a partcular agency, because we
are spending a lot of money in total dealing with this problem in a most inefcient
manner.
It is critcal that law enforcement ofcers tailor responses to local circumstances.
You should justfy each response based on reliable analysis of the situaton. In most
cases, an efectve strategy will involve implementng several diferent responses.
Agencies will also have to partner with their community, as law enforcement
responses alone are not enough to solve the problem.
Lt. Jon Garlick, Mental Health Offcer with
the Calhoun County, Ala. Sheriffs Offce
24
Lt. Jon Garlick, Calhoun County, Ala. Sheriffs Offce
Email correspondence
DSM-V Diagnostic and Statistical Manual of Mental
Disorders
www.dsm5.org
People with Mental Illness
http://www.popcenter.org/problems/mental_illness/print/
Law Enforcement Responder: Principles of Emergency
Medicine, Rescue, and Force Protection
http://books.google.com/
Keeping the Peace: Police Discretion and Mentally Ill Persons
https://www.ncjrs.gov/pdffles1/jr000244c.pdf
Mental Illness Impacts Law Enforcement Resources
http://www.nami.org/
Law Enforcement and People with Severe Mental Illness
http://www.treatmentadvocacycenter.org/storage/docu-
ments/bp_law_enforcement.pdf
How to Stop Suicide by Cop
http://www.psmag.com/health/how-to-stop-suicide-by-
cop-27758/
Across Nation, Unsettling Acceptance
When Mentally Ill in Crisis are Killed
http://www.pressherald.com/
Police Offcers Attitudes Toward and Decisions
About Persons with Mental Illness
http://psychiatryonline.org/data/Journals/PSS/3606/49.pdf
October 2011 FBI Law Enforcement Bulletin:
Responding to Persons with Mental Illness
http://www.fbi.gov/
Guest Post: A Successful Story -
A Police Offcer and a Person with Schizophrenia
http://bipolarbandit.wordpress.com/
Schizophrenia - Dealing with a Crisis
http://www.world-schizophrenia.org/publications/15-crisis.html
Adult Bipolar Disorder: When to Intervene
http://www.netplaces.com/adult-bipolar-disorder/
Knife Psycho Killed by Cops was Bipolar
http://www.nydailynews.com/news/crime/
Authorities: Georgia Shooting Suspect
had Nearly 500 Rounds of Ammunition
http://usnews.nbcnews.com/_news/
Obsessive-Compulsive Disorder
http://www.mayoclinic.com/health/
Panic Attacks
http://www.offcer.com/article/10249719/panic-attacks?page=3
What is Post-Traumatic Stress Disorder (PTSD)?
http://www.nimh.nih.gov/health/
As Mental Illness Permeates Streets, Police, Jail Struggle
http://www.houstonchronicle.com/news/
Police Homeless Outreach Programs
http://www.egovlink.com/
Homeless Encampments
http://cops.usdoj.gov/Publications/e011013251-Homeless-
Encampments.pdf
Police Experiment with Getting Mentally Ill
Help Instead of Handcuffs
http://hamptonroads.com/2004/11/police-experiment-get-
ting-mentally-ill-help-instead-handcuffs
Sources of Information

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