Dealing with the non-violent mentally ill

[BehindBlueI's]

I started to put this in Roll Call stories, but thought about it and would like this to be a "best practices" thread and open for discussion. LE and non-LE with subject matter expertise are strongly encouraged to relate anecdotes that demonstrate both the "how to" and the "how not to" aspects. This is not for the violent, combative, officer safety type issues. Just the non-violent and how to help them help themselves, both for their sake and for the reduced demand on first responders/jails/courts.

I dealt with a homeless woman who was delusional and knew she was delusional, but couldn't sort what was real and what was delusion. She would talk to me, but she would also talk to "C" and to "Emily" who were only in her head. I spent quite a bit of time trying to talk her into a new voluntary commitment program that's being piloted and she bit on it for awhile, but "C" talked her out of it because she wouldn't be allowed to keep her phone during her stay.

I know first responders and ER staff get tired of dealing with these people and that "compassion fatigue" is a very real thing. I've been that guy myself plenty of times. I'm trying to not be, and since I had a 6 year break from the street maybe I'm seeing things with new eyes again. I really tried to get her some help and was completely honest with her the entire time. My pitch to her was basically this:

"The truth is that you are delusional. If you believe me or not, your reality is not the reality that everyone around you interacts with. You've tried to deal with it on your own, and this is where it's gotten you. If you don't like where it's gotten you, what's the harm of trying something new? It's not a forced commitment. You can leave at any time. It just gives you an option. If it works, take it and turn your life around. If it doesn't, you've lost nothing. I can't promise you it will work. I can only tell you it's possible it could help you."

She admitted to knowing she was delusional and scared, but she trusted me. We talked it out for awhile and she initially agreed to try it, but as I said ultimately backed out. I left her the phone number to call if she changed her mind. She won't, though. Not without some intervention. The door opened just a little but slammed shut too fast to take advantage of it, and the moment has now passed. I'm only working her district for 3 more days, as this is just a 6 day training rotation and not my permanent district.

Now I know for a fact she's been screamed and cursed at by other first responders. Here's the point of where I'm going with this. It's not her fault. Some chemical or wiring in your brain could have come out a little wrong and you'd be the same as her. Don't forget that there but by the Grace of God go you. Being an asshole isn't going to help, and you're making it harder for the next cop/EMT/fireman who deals with her...and you know they are going to.

[TSH]

Being an asshole isn't going to help, and you're making it harder for the next cop/EMT/fireman who deals with her...and you know they are going to.

100%.

Went to a class where the instructor specifically told us not to play along with their delusions. Easy to say in a classroom, but hard to do in a situation where you are trying to keep a non-violent situation from turning into a violent confrontation because you chose the wrong set of words. Went to a call one day and decided I wasn't going to play along (despite my reservations), and found out it really does work to tell it to them straight. I work in a part of the country that feels like its been basically overrun with homeless people, many of which are mentally ill, so I have been getting plenty of practice.

A big hurdle can be time constraints. I work in a busy city with low staffing, so when I am spending an inordinate amount of time dealing with one individual, it can be frustrating listening to other units getting dispatched to calls in my area. I think you just have to shut off that part of your brain and remain in the moment.

[BehindBlueI's]

100%.

Went to a class where the instructor specifically told us not to play along with their delusions. Easy to say in a classroom, but hard to do in a situation where you are trying to keep a non-violent situation from turning into a violent confrontation because you chose the wrong set of words.

I don't remember where I learned the phrase, maybe CIT, but the "I can't see/hear the xxxx, let's concentrate on things we can both see/hear" type lead-in is supposed to work pretty well at treading that ground between not playing along and not out right calling them on it. After all, if I see a bird and you can't see the bird, there could be something blocking your view so just saying you don't see it isn't calling me a liar/challenging me.

[peterb]

I was told something similar — don’t pretend you’re experiencing the same thing, but do acknowledge that their problem is valid, as in “Seeing things other people don’t see must be scary/confusing/frustrating for you.” Then, as you said, try to find a plane of reality that you can both work from.

[03RN]

I'll post this weekend with some info.

I'm a psych nurse in a locked unit.

[45dotACP]

I don't remember where I learned the phrase, maybe CIT, but the "I can't see/hear the xxxx, let's concentrate on things we can both see/hear" type lead-in is supposed to work pretty well at treading that ground between not playing along and not out right calling them on it. After all, if I see a bird and you can't see the bird, there could be something blocking your view so just saying you don't see it isn't calling me a liar/challenging me.

This is pretty much what they train you to say as a nurse.

Usually you avoid a direct challenge, but you do explain that you believe that they see/hear the things they see and hear, but you do not.

Sent from my XT1585 using Tapatalk

[BehindBlueI's]

I'll post this weekend with some info.

I'm a psych nurse in a locked unit.

Please do.

[willie]

Once I worked for a mental health center and dealt with these folks and then at a later date worked with emotionally disturbed juvenile offenders. A caveat is that these folks read body language and are also sensitive to sarcasm. This comment applies to mentally challenged persons too. If the responsible adult in the equation becomes impatient and irritated, then the others trip out. Of course cops know this. My opinion is that time constraints and nut fatigue(not used disrespectfully)are inhibiting factors. In my town when policeman work traffic, the other guys have to take up the slack in answering calls. They become displeased. Perhaps it's the same way with mental health calls that take a lot of time.

[UNM1136]

I have had a lot of success with discussing their diagnosis, and history, and many will admit that when they are compliant with their meds they don"t have many of those issues. They may hate the meds, and think their providers or family members or the govenment or whatever are trying control their thoughts, but when you discuss their diagnosis/history matter of factly and directly without entering their delusions you can almost see the light dawn.

It is not foolproof, but it works better than I expected. A frequent tract is to talk to them, and listen to what the client says "they"(the docs) say about them, or what drugs the client is supposed to be taking, and then point out that the delusions are greatly reduced when they are med compliant you can start to get them to realize that going in and getting checked out is a good thing. It requres honesty and directness while letting them self label. I have found that many times there is a small part of their mind that realizes from past experience that "yeah, I've been here before, this is familiar, and something might be wrong".

Not sure if this is best practice now; my initial CIT training was in 2000, and my update was in '15.

pat

[FNFAN]

I've had some experience working at a correctional facility for offenders with acute mental health issues. Many of the folks were at best marginally functional to the point that they were not even accountable for behavior normally addressed through the code of penal discipline (conduct rules and sanctions for misbehavior) for the incarcerated.

One of the startling things you see, if you pay attention, is how people cycle through symptoms and behaviors. It's very dramatic even for those who were on highly regulated chemical therapy. Once those folks get to the street they often drop or have less access to the med's that allow them to function "best." When that happens their behavior cycles exponentially more rapidly.

The best advice I've got (due to time constraints) is to ensure that you're providing clear step by step instructions or question rather than what I'd poorly term, "conjuctive" or complex instuctions. Ask simple questions and break things down into small manageable concepts -without condescending, and then validate their understanding of what you said.

One tool that's a big help is Motivational Interviewing, a technique which differs widely from forensic interviewing. It's worth a study for anyone dealing with the public in difficult situations or when you're attempting to modify behavior.