MENTAL ILLNESS: WHAT YOU SHOULD KNOW

Nowheresville, Texas—Late 2002

I was walking an inmate in the jail from the clinic to his cell in another section.  He was tall, clean cut, soft spoken, and cooperative.  He was also diagnosed with paranoid schizophrenia.

“Hey, guy,” I looked at him with curiosity.  “Just so I understand better—what’s it like?  When you experience your hallucinations.  Can you tell that something’s wrong?”

“Mr. Deuce,” he replied calmly, “when it happens—it’s crystal clear and is as real and vivid as you are, standing here, talking to me right now.”

Anyone in law enforcement deals with mentally ill persons frequently, and a successful career requires an understanding of some practical truths about mental illness.  Here are some realities that everyone needs to understand because…

– There are a lot of people with mental illness out there. 

Many Americans have a range of conditions that are hereditary or induced by drug or health problems, or by their personal development, socialization, or experiences, that cause them to act or think in a manner considered abnormal.

Your co-worker with mood swings, your relative who is “a bit off,” the kid at school who can’t get along with people and is severely withdrawn, or who melts down at McDonald’s… all of them are dealing with some form of mental illness.

The young have less ability to regulate themselves.  Adults do better and often mask the condition.

Most of the time it isn’t severe.  Perhaps you have worked with some guy or woman for ten years and have no idea they have a mental illness.  This is likely.

– The majority manage their condition.

They often have coping behaviors and measures, like medication and therapy, that they have taken to regulate it. They usually know they have a problem in the more severe cases, and are good people and try to get along.

For example, the veteran who had just had a combat flashback—and asked that I handcuff him to protect me and the others around us.  He was a good American whom the system didn’t do enough to help.

– They usually lead successful lives. 

They may be doctors and scientists.  Some of them are police officers and first responders.  I know cops that are veterans with PTSD and, despite their challenges, do great work.  Many other veterans struggle with this while doing great things.

– Some don’t know they have mental illnesses. 

They don’t think they have a problem and have never been diagnosed with any conditions, or if they have—they weren’t so severe that someone had to intervene with them.  Ultimately, they didn’t need professional help.

– Morally and legally, they are persons with problems—not monsters.

Most people with mental illness are not severely impaired—defined here as being a danger to themselves or others.  That is the legal standard in most states for a mental health arrest—and understand, this is to protect that person and others; not because they have committed a crime.

Many people this bad off know they have a problem and have been trying to cope with it—and have been unsuccessful.

Or, they may have tried to “self-medicate” with illicit drugs, which almost always tears them up even worse. Or perhaps they have fallen on hard times and cannot afford the medication that they need.

Persons in this state can’t sense their surroundings properly, can’t react appropriately as a consequence, and have severe delusions.  They are rare.

A person in this state needs to be evaluated and given care.  You may be able to take your child or someone you are a guardian over for treatment depending on your state laws.

But safety first—for you and them!  Keep reading.

Now I need to talk about this last group.  They would be the even rarer ones that are criminally insane.

These are the people in the horror movies and they do exist.  Like the armed robber I knew who turned into The Incredible Hulk if he didn’t get his medications, and liked to stab people.  He’s doing life in prison now.

An insanity defense to criminal responsibility is, in Texas, an affirmative defense to prosecution—you have to prove you are impaired enough to be legally insane.  That tells you how rare this is.

If you encounter this sort, you need to protect yourself.  Get away and call the cops.  Your state self-defense laws apply.

Let’s talk about interacting with someone in a mental crisis.

Relatively rarely, a person with mental illness will have a breakdown in which they cannot regulate their emotions, or lose their situational awareness of what is going on around them.

They can be violent and aggressive.  It is not a given that this will happen.  If it does, it is probably because they perceive a threat to them. They may just withdraw and try to isolate, or otherwise assume the state of someone in distress.

But for some reason here, you are thinking about contacting them.  Maybe you got cornered; maybe they’re a friend or relative, or are inside your business.

– Rule one of being a first responder:  Do not become part of the incident.

Should you be doing this?   Is there an immediate danger?  Do you have legal responsibility here?  Are you able to do this?

Not every monkey belongs in your circus.  Be honest; if “no,” the responsible choice is to call for help.  Law enforcement needs to respond for evaluation.

Law enforcement mental health resources have gotten good.  Oftentimes they have crisis-trained officers and clinicians with them in the unit.  They are able to handle this.  You aren’t doing anyone a favor by not calling 911.

Legally, if you initiate an encounter with them and/or assume a duty towards them, you may be liable civilly (or criminally) for the outcome.

The cops may be called anyway; after your effort goes sideways and you need help. Now they have two problems to fix.

I ask you again—should you be doing this?

– Be respectful. 

They don’t give up their civil rights just because they have mental problems.

Yelling at them, crowding them, trying to push them around, or trying to force assistance on them is not only stupid and illegal, but liable to provoke the violent reactions you don’t want.

Don’t move around a lot and wave your arms, or assume some martial arts stance.

– You don’t know what they are going through. 

So don’t say you do.  A shocking number of people have dysfunctional family members and have been abused, raped, and have suffered in life.

They may have had a horrible experience in combat and are flashing back.

Someone you know is wounded like this—and is masking it from you really well.

– Be calm. 

I rarely have had any situation where yelling helped me.  Now, sometimes it did.  But never when I was trying to establish a rapport with someone!

You don’t start off at a high level of energy/aggressiveness with your fists up and reading them their pedigree, and then try to go down to a calmer state.  That usually falls flat!

Once a person’s heart beats a certain number of times per minute, they begin thinking with their midbrain—and that’s your survival brain with all the discernment of an angry wolverine.  Watch two dogs barking at each other.  That’s what you have here.

Also, slowing the situation down will give them more time to think and regulate.  Don’t fear them irrationally—but do be aware if they start to react to you or others in a dangerous manner.

– Be honest and sincere.

They may say they see extra people around them or some other phenomena, but you should not try to “play along.”

If you need to interact with this person, you need to be credible; and that means no lying to them—about anything.  Tell them, “I understand you see (whatever), but I do not.”

If you wish to give them your name, do so—but again, be honest.

Do not promise to give them help or assistance that you cannot or will not give them.

Treat them with the empathy and seriousness you would for a friend or loved one in this state.

– Keep the “why” in mind.

Why are you having this interaction?  Are you a business owner, asking a customer to calm down or to leave?

Are you concerned about someone lying on the sidewalk?  Are you a teacher with a difficult student (or parent)?  A boss with a problem employee?

Your encounter with them should have a definable purpose, beginning, and desired end state.

Other than this, just speak with them and deal with them as you would anyone else.

Again, this is a human with a problem—not a person who has ceased to be human.

And know your limits—for their sake, and your own.

Mark Deuce has had a life-long career in community law enforcement. He is the author of Deuces Wild for TTP.