Whether the setting is a community, one of our custody facilities, a County park or building, or the Metro system, engaging effectively with mentally ill (MI) individuals has perhaps never been as important (or potentially challenging) as it is now. On a national level, with roughly one-third of law enforcement resources being utilized to deal with MI persons, many law enforcement agencies are working diligently to put policy and training in place that better support their sworn personnel and service the community at large in a more effective manner. Civilian members of our Department are not exempted from these challenges. Whether it’s in the course and scope of work duties, social circles or family life, many have found encounters with MI individuals confusing and even stressful.
One of the reasons these encounters can be so challenging is the notion that MI individuals can respond with a level of volatility or unpredictability not consistently seen in other populations. For sworn personnel, using a more traditional “authoritative” or “command presence” approach that would be effective otherwise may serve to trigger an MI individual into a state of “fight or flight” where they escalate physically, cognitively and emotionally (this is called a paradoxical relation to the use of force). For civilian personnel, attempting to communicate with an MI individual without paying attention to things like body language and voice tempo (volume, tone and speed) can be met with similar results.
To address these issues, our Department is working to coordinate a version of Crisis Intervention Training, or CIT, for most of our deputies and some nonsworn personnel. CIT is a national model used mainly in the field, but has also been used in correctional settings because it is “evidence based,” meaning there has been research done on its utility and efficacy when dealing with MI populations. If you have not yet participated in a form of this training, you may in the near future.
In the versions of this training offered by our Department, there is an emphasis placed on officer safety and a concept called the “window of time” in which personnel are trained to recognize a short critical period (usually less than 60 seconds) at the beginning of an encounter where adjusting one’s interactional approach can potentially reduce the likelihood of having to “go hands on.” For civilian personnel, communicating effectively and safely with an individual who has symptoms of MI involves being able to “cue in” to behaviors to note signs of agitation, anger or aggression. A central part of this involves being able to recognize any indicators of mental illness that may be present so that the pace of the encounter can be slowed. While teaching how to diagnose MI is not part of training, being able to identify traits and signs of MI and interact effectively are important aspects covered. Here you’ll find a quick checklist you can use for identification. You’ll notice that the traits, signs and symptoms are divided into four main categories for easy reference.
Suicidal/self-harming:
• Making statements about wanting to harm self (i.e., having a plan, etc.)
• Verbalizing a desire to die
• Taking active steps to attempt death (i.e., running into traffic)
• Cutting or severely scratching skin
• Burning or scalding self
• Hitting self or banging head
• Throwing body against walls and hard objects
• Sticking objects into skin
• Swallowing poison or inappropriate objects
Making sense/not making sense:
• Bizarre, peculiar behavior or socially inappropriate behavior
• Not oriented (person, place, time, situation)
• Severe neglect of self-care; appearance
• Easily distracted
• Paranoia
• Delusions (fixed, false beliefs)
o Grand ideas of wealth, self-importance, etc.
o Thoughts of persecution (government, surveillance)
o Person, usually of higher status, is in love with them
o Inflated worth, power, knowledge, or relation
o Being mistreated in some way
o Have a physical defect or medical condition
• Hallucinations (sensory stimuli)
o Talking to self, laughing alone, crying without cause
o 1,000-yard stare
o Covering ears with hands, clothing or headphones
o May “duck” or fend off something
o Sitting/standing motionless or rocking motion
o Looking around/staring toward voices
o Screaming or yelling for no apparent reason
o Scratching skin
• Disorganized speech
o Incoherence
o Abrupt stop in the middle of a train of thought
o Inability to answer a question without giving unnecessary details
o Rhyming sounds together
o Echoing of another’s speech
o Pressured speech: Excessive, rapid speech without pauses involving unrelated ideas
o Incoherent: “word salad,” stringing of words together that do not make sense
o Perseveration: Repeatedly giving same response to different questions
Elevated/anxious/depressed:
• Elevated
o Elated mood/extreme happiness, euphoria
o Irritability
o Increased physical activity
o Disoriented about self (visions of grandeur)
o Highly talkative, pressure to keep talking (pressured speech)
o Flight of ideas/racing thoughts
o Extreme impulsivity (risk-taking behavior, speeding)
o Hypersexual
• Anxiety/Panic
o Hyperarousal
o Paranoia
o Fear of dying
o Fear they are going crazy or losing control
o Verbalizing excessive worry
o Difficulty breathing/chest pain or discomfort
o Dizziness or faintness
o Trembling or shaking
o Abdominal distress
o Hot flashes or cold chills
• Depressed
o Sad, down
o Reduced energy level
o Poor hygiene
o Tearful, sobbing
o Physical slowing
Miscellaneous:
• Rapid emotional changes (laughing, crying, sadness, anger, panic)
• Easily distracted (cannot track communication or follow commands)
• Aggressive toward inanimate objects (glass, mirrors, shiny objects and materials)
• Stripping off clothing
• Reduced facial expressions, gestures
• Rigid, does not move, does not talk, does not respond
While this list does not represent all of the indicators of MI, it does represent the broad spectrum of behaviors that may be observed as a result of MI. Perhaps the most important concept when interacting with someone who may be MI involves recognizing that the individual is not their illness, nor did they choose to be MI. Rather, they are someone’s family member or friend, and a human being. Sometimes this awareness can go a long way.
If you would like to obtain further assistance regarding Department training on mental illness or indicators of mental illness, you can contact Psychological Services Bureau at (213) 738-3500. You can also obtain additional information by visiting our intranet site at http://intranet/intranet/ESS/Index.htm. Stay safe.