How to Handle the Mentally Ill
Bruce A. Rodgers, PhD
Police officers not only must be able to recognize abnormal behavior and mentally ill persons, but also must be prepared to guard, restrain, or take into custody people whose behavior suggests the presence of a mental illness. The following are suggestions for handling these difficult situations.
1. Calls involving known emotionally disturbed individuals should be answered by more than one officer. If it is not known that the call involves a disturbed person, the officer who arrives first on the scene should immediately ask for backup. Do not try to handle the case alone. Handling it alone does not prove you are a better officer than if you ask for help.
Psychiatric attendants, doctors, and nurses who have worked with very disturbed people, including both homicidal and suicidal patients, suffer very few injuries. Even prior to tranquilizers, mental health professionals have been able to work on a ward housing forty to fifty such patients without difficulty. One reason for this is their ability to use the show-of-force principle effectively. For example, an attendant might approach Mr. Brown and tell him that he has to go to X ray. He should, of course, try to convince Mr. Brown to go. If Mr. Brown shows signs of resistance and refuses, the attendant would not argue or try to force him. Instead, he should withdraw and reappear with three or four more attendants and again tell Mr. Brown that, for his own welfare, the doctor had ordered X rays and that he has to go to X ray. He should be told, without anger or threats, that he can walk to X ray under his own power or be carried by attendants. He should also be told that more attendants can be called if needed. Faced with this show of force, most patients usually elect to proceed under their own power. This show of force does two things for disturbed individuals: It gives them a face-saving out if they have been bragging how tough they are or that no one can force them to do anything they do not want; and it shows them that many people are interested in them and that they care enough to ensure that treatment orders are carried out.
This process can work the same way on the street. If a disturbed person has been boasting that no cop is going to take him anywhere, he may feel required to put up a battle against one policeman. With two or three officers present as backup, he has a face-saving out. The officers also can use their numbers to assure the person that they are able to offer him protection against any threat. As with the hospital patient, their numbers also give him a sense of importance and show him that somebody does care about him. An acutely disturbed subject should be taken to a hospital emergency room for evaluation and assistance ( Leff and Simon 1984 ).
2. Stay with disturbed persons until additional help arrives. If necessary, ask someone else to phone for assistance rather than leaving the person.
3. Move slowly. Resist the impulse to act hastily. This may be difficult since most police training teaches the importance of quick decisions. With the emotionally disturbed, it is better to take time and carefully assess the situation. Immediate action is necessary only when handling an immediate danger.
4. Reassurance is important. Acutely disturbed individuals are generally very frightened.
5. As a matter of policy, it is usually a good idea to send uniformed officers. Avoid emergency lights and sirens since they tend to attract unwanted crowds. Keep spectators away if possible.
6. Solicit help from friends, relatives, and others known to the emotionally disturbed individuals. The time spent in obtaining this help may prevent violence and harm from coming to the individual, yourself, or others. Be cautious, however, in allowing these people to talk to the disturbed person. Their presence may further upset him or her.
7. Don’t lie or try to deceive emotionally disturbed persons. If they are aware of deception, dealing with them will become more difficult. If you lie, you also create a barrier to their acceptance of future help.
8. Do not rely on your weapons. The threat of a gun is quite meaningless to people who are acutely disturbed. They may grab it and use it, or you may be tempted to use it. A weapon should be used only in the very rare situation when it is necessary to save a life.
9. Don’t be fooled by the individual’s size. For the same reasons that some people are impervious to intense pain during periods of emotional stress, others may have unusual physical strength at these times. Experienced police officers are familiar with this phenomenon and can cite cases where several officers have found it difficult to subdue a 125-pound senior citizen.
10. Don’t meet hostility with hostility. This is often a natural reaction since hostile people tend to elicit hostility in others. It is important to maintain a professional attitude. Meet hostility and anger by being calm, objective, and accepting. Ask why they are angry or afraid. If they will tell you, they may begin to calm down.
11. Don’t argue with delusions, but don’t agree either. Rather, try to steer people away from whatever subject is exciting them. If they demonstrate by actions, facial expression, increased agitation, or bizarre behavior that the subject discussed is making them upset, switch to another subject. Try to bring them back to reality by asking concrete questions, such as: “How long have you lived here?” “Who is in your family?” and “Where do you work?” By maintaining control of the discussion, you will reassure them. Sensing that you are in control of the situation will help them to gain control.
12. Don’t be fooled by a sudden return to reality. Emotionally disturbed individuals can return to their delusions just as quickly. Consider them potentially dangerous because their behavior is unpredictable, and remain alert even if they calm down. You can remove any restraints that have been applied if, in your judgment, behavior warrants it; but be ready to reapply them if behavior makes it necessary. If available, leather cuffs similar to those used in mental hospitals are best. Agitated people have been known to pull tendons and cut wrists while in handcuffs. If handcuffs have to be used, check frequently to see that circulation has not been cut off. When restraints are unavailable, safety devices can be made on the spot using pillows, mattresses, and belts or by reversing an ordinary coat or jacket.
13. Take all suicidal behavior seriously. Ten to 20 percent of all crisis calls are likely to involve suicidal persons (France 1982). People making threats, gestures, and suicidal attempts should be referred for professional psychiatric help. Do not excuse or gloss over a person’s behavior just to reassure anxious relatives.
14. Make sure individuals are not physically ill or injured. Diabetic coma, fever delirium, brain tumors, convulsive disorders, and other physical illnesses could be mistaken for drunkenness or combativeness. Head injuries often go unnoticed, especially if there is an odor of alcohol on the breath. If any doubts exist, get medical attention
15. Keep a record of a person’s complaints regarding plots against him or her. If the complaints change from a vague “they” to a particular person or small group of people, the safety of those named may be at risk. Officers or mental health professionals may have a legal obligation to warn anyone who is threatened. Try to persuade someone who knows the person to take him or her to the family doctor, clergy, or local psychiatric facility.
16. Learn what community facilities are available. These exist to help the mentally ill and their families, especially in an emergency.
17. Remember that most disturbed people are afraid. They experience extreme fear because they do not understand their feelings and because they are not certain how others will treat them. When emotionally disturbed persons become aggressive, it is almost always because of fear. Therefore, officers should attempt to handle them in a calm, understanding, and humane way. This will often reassure the people that officers are there to help.
18. Don’t make fun of other people’s troubles. It is easy to become callous, especially in dealing with disturbed persons.
19. Maintain your sense of humor. This is important, especially in stress situations. Many a day has been saved because someone did.
This article is an excerpt from Psychological Aspects of Police Work: An Officer’s Guide to Street Psychologyby former police officer and federal agent, Bruce A. Rodgers, PhD.