Emotionally Disturbed Persons

8/12/2019 Emotionally Disturbed Persons

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This course is a general overview ofEmotionally Disturbed Persons

It is recommended that prior to starting

the course that you expand the AdobePresenter window in order assist youwith reading the text on each individualslide.

Emotionally Disturbed Persons


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Introduction to this course:

Law enforcement officers are often confronted with people suffering from

mental disorders, sometimes on a daily basis. Many homeless, or street,

people are afflicted with varying types of mental disorders that interfere with

their ability to function within social, familial, and vocational/educational

frameworks. Others are not quite so visible to the untrained eye; they come

and go in everyday society, virtually unnoticed. Some, like John Hinckley, Mark

David Chapman, and Ted Kaczynski, burst into the headlines with acts of

violence.Mental illnesses are generally thought of as disorders of the brain. Like

diabetes is a disease of the pancreas, mental illnesses are diseases of the brain,

which often result in an inability to cope with everyday life. Characterized by

alteration in thinking, mood, or behavior, mental illnesses affect more than 5

percent of adults in the United States. One in twenty people you will contact inyour career have what is considered to be a serious mental illness (SMI). The

cause of many forms of mental illness remain unknown, as they involve the

most complex aspects of the human brain.

Continued


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Mental illnesses can affect personas of any age, race, religion, and

socioeconomic level. Social position, intelligence, or physical health cannot

predict immunity from mental illness. Serous mental illness comprises four of

ten leading causes of disability in the United States: schizophrenia, bipolar

disorder, major depression, and obsessive-compulsive disorder. Research

indicates many persons suffering from mental illness will recover, although a

majority will not. The complex business of law enforcement is further

complicated by decreased funding for mental illness programs and outpatient

treatment centers: a condition that forces the mentally ill onto the street and

brings them in conflict with members of the public and, inevitably, lawenforcement.

The purpose of this course is to distinguish mental illness from mental

retardation, provide a description of the various types of mental illnesses, and

discuss some legal issues affecting the mentally disturbed. The concept of

deinstitutionalizing those with serious mental illnesses, which began in the1960s, continues unabated, forcing law enforcement officers to confront and

mitigate situations involving potentially violent subjects.


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Developmental disability, once known as mental retardation, is the failure of a subject to

adapt normally and grow intellectually at the same rate as his or her peers. In other words, a

person fails to achieve age-appropriate adaptive behaviors, or milestones, during his

development from infancy to adulthood. While there are many medical causes for

developmental disability, the diagnosis of the exact reason is only made in about one-quarter ofthe cases. Research indicates persons with developmental disabilities are seven times ore likely

to be contact by law enforcement officers than persons without the disability.

The primary difference between mental illness and developmental disability is mental

illness can strike anyone at any time, regardless of intellectual capabilities, and may consist of

delusions or hallucinations affecting a persons sight, hearing, and touch. Conversely,

developmental disabilities usually manifest sometime prior to age eighteen and include below

average intellectual functioning, social adaptation, and life skills.


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Those causes for developmental disability that have been identified can be broken down

into several categories:

Unexplained, the largest category, a catch-all for a developmental disability that defiesdiagnosis.

Trauma, either before or shortly after birth. This category would include inadequate

blood supply to the brain or a severe head injury.

Diseases, such as meningitis, rubella, or HIV infection.

Genetic abnormalities.

Pre-birth exposure to poisons, such as alcohol, drugs, mercury, or lead. Malnutrition from birth.

Environmental factors, such as poverty, low socioeconomic status, and deprivation

syndrome, which includes the lack of handling and nurturing.


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While law enforcement officers cannot positively identify persons afflicted by a developmental

disability, the can identify factors that may indicate a disability. Those factors are as follows:

Wearing clothing inappropriate for the season. Poor physical coordination, leading to awkward movement.

An extremely limited vocabulary, evidence by the person using only simple words and terms

in his conversation.

A tendency to parrot or repeat questions.

Residence in a group home.

Attendance of special education classes. Employment or residence in a center for people with developmental disabilities.


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Law enforcement contacts with persons suspected of having a

developmental disability should be conducted in a typically

professional manner, with a few exceptions. If the person is

suspected of a crime, great care must be exercised to ensure the

person understand Miranda warnings and provides a knowing andintelligent waiver of his rights.

Persons with a developmental disability often try to please

those in authority, and may confess to crimes not out of guilty, but

out of a desire to please the officer conducting the interview.

Investigators should exercise special care when interviewing

persons suspected of having a developmental disability to unsurethey do not suggest or lead the persons to give inappropriate or

untrue answers.

If such a person is taken into custody and booked, the jail staff

must be notified before or during the booking process to ensure

the person is not placed with the general jail population, where

the subject may be victimized by other inmates.


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Officers interviewing a person with a

developmental disability who is suspected of criminal

acts should determine as early as possible whether

the person possessed criminal intent, knew thedifference between right and wrong, knew he was

committing crime, and whether he could have

resisted the impulse to commit the act.

Some psychologist use the police officer as the

elbow test to asses a persons knowledge of the

wrongfulness of an act. The suspected offender isasked if she would have committed a certain act if

she were in the presence of a law enforcement

officer. If the answer is no, it is a good indication

the individual knew her act was wrong and possessed

the ability to control her actions.


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In this article, Handle with Care: Dealing with Offenders Who are

Mentally Retarded, published in the FBI Law Enforcement Bulletin,

Arthur Bowker suggests a few street tests that officers may use to

recognize developmental disability. Bowkers list includes the following:

Can the person easily button or unbutton a shirt or coat?

Can the person give coherent directions from one location to

another?

Can the person paraphrase or restate a question, using his own

words?

Can the person write his or her name clearly and without

difficulty?

Is the person able to read and understand a newspaper or

other printed document?

Is the person able to recognize coins or make change?

Can the person tell time from a standard-type clock?

Is the person able to use a telephone?


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Intoxication and drug abuse is included in this course because of its

symptomatic relationship with mental illness, meaning a substance abuse may

resemble mental illness. Although not a physiological disorder of the brain, the

various forms of substance abuse and dependence present problems for law

enforcement that are similar in nature to mental illness. The physiological effects

of substance on the brain, whether they are stimulants or depressants, create

disordered thinking and mood alterations, and, in severe cases, can impactsocialization and employment.

According to the Alcohol, Drug Abuse, and Mental Health Administration

(ADAMHA), at least half of the nearly two millions Americans suffering a severe

mental illness abuse illicit drugs or alcohol, compared to 15 percent of the general

population. The problem of the severely mentally ill having substance abuse

difficulties is so pervasive that mental health professionals have coined the term

dual diagnoses, although this term has been replaced in recent years by

mentally ill chemical abusers (MICA).

The problem confronting law enforcement officers is some symptoms of

substance abuse resemble mental illness or developmental disability. The

converse is also true: persons suffering mental illness or developmental disability

act similar to those under the influence of drugs and/or alcohol. Look again at the

street tests of Arthur Bowker: do these remind you of an alcohol-intoxicated

subject? A person under the influence of an opioid, such as heroin, or

phencyclidine (PCP) will also display symptoms similar to Bowkers list.


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What is meant by the term:dual diagnosis?


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Several subtypes of schizophrenia exist,

with the paranoid type being most common.

Paranoid schizophrenia is characterized

primarily by delusions or auditory

hallucinations, in the context of otherwise

normal functioning and appearance. In other

words, the paranoid schizophrenic does notstand out in a crowd. Compared to other forms

of schizophrenia, the thoughts of paranoid

schizophrenic are coherent, and his delusions

generally revolved around an organized theme.

For example, Ted Kaczynski, the Unibomber,

believed the power of society to control theindividual was expanding rapidly, and if not

stopped, would lead to the end of individual

liberty. Kaczynski also felt entitled to embark

upon his bombing spree in service of his anti-

technology beliefs. The fact that a typical

paranoid schizophrenics thinking is coherent

but is accompanied by delusions makes him, as

in the case of Kaczynski, potentially lethal.

Another, more recent example is Russell

Weston, the man who shot two U.S. Capitol

police officers to death on July 24, 1998.Weston murdered Officers Jacob Chestnut and

John Gibson inside the Capital building. His

motivation for going to the Capitol was a

delusion that a government satellite was spying

on him, and the control for the satellite system

was located on the first floor of the Capitolbuilding. Weston survived three bullet wounds

and is awaiting trial on two counts of murdered.


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Systems of paranoid schizophrenia are

delusional thoughts of a grandiose nature-suchas Westons surveillance satellite suspicions-

anxiety, anger, violent tendencies, and an

argumentative posture. Close relatives, such as

siblings or children, are likely to develop

schizophrenia, as evidence of genetic links to

the disease exists.

Although medication to treat

schizophrenia is available, many afflicted with

schizophrenia have no insight into their illness

and, therefore, refuse to acknowledge their

need for regular doses of medication. Those

who have taken anti-psychotic medicationshave experienced undesirable side effects, and

refuse to continue taking them. Coupled with

the fact that schizophrenic is usually unable to

maintain meaningful employment, his resultant

lifestyle is not conducive to obtaining adequate

medical care. Physical illnesses and substance

abuse are prevalent amount those suffering

from schizophrenia.


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Woman pushed in front of train, dies

New York- A young man approached Kendra Webdale as she waited for the N train in a

New York subway station and asker for the time. When she replied, the man pushed her

onto the tracks as the train pulled into the station. Webdale, 32, was killed instantly.

Andre Goldstein made no attempt to flee, but sat down against a wall in the station.

When officers arrived, he told them, it was her turn. He admitted to officers that he

had stopped taking medication to control his schizophrenia. The drugs curb the voices,

irrational behavior, and delusions that mark the mental disorder.

This incident is similar to one involving Goldstein that occurred six months earlier. In an

event unreported to police, Goldstein tried to push another woman in front of a subway

train at a station in Brooklyn, but the woman was able to fight him off and escape.

Over a 10-year period, Goldstein has spent time as an in-patient at four New York

psychiatric hospitals. Court records indicate Goldstein committed more than a dozen

assaults, many against psychiatric staff, during 1997 and 1998 alone.

Goldstein was charged with second-degree murder and is being held without bail

pending trail.

January 3, 1999

By The Backup news staff


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Mood disorder is a term describing a variety of mental

illnesses, which may be classified as psychotic in that they areserious mental illnesses, or neurotic in that they are minor in

nature and usually short-lived. Mood disorders include bi-

polar disorder- formerly manic-depression- major depression,

and dysthymic disorder, which is a prolonged minor

depressive episode.

Bi-polar Disorder

Bi-polar disorder is the most distinct and dramatic of the

depressive disorders. Unlike major depression, which occurs

at any age, the onset of bi-polar disorder is usually before age

thirty. Almost two million Americans suffer from bi-polar

disorder.


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Bi-polar disorder results in mood swings from mania-

exaggerated feelings of well-being- to depression, generallywith periods of normal moods in between. Some subjects

cycle back and forth between extremes without periods of

normalcy. People with this condition are called rapid cyclers.

Bi-polar disorder has a tendency to recur and subside

spontaneously, with either the manic or depressive states

predominating.During manic episodes, a subject feels on top of the

world, and displays an abundance of energy. He seems to

talk and think faster, and may also think he is invincible,

leading to reckless behavior and acts that endanger his well-

being. During the manic phase, a subject sleeps less, is easily

distracted, and tends to be more irritable. The subject mayexhibit poor temper control and excessively irresponsible

behavior patterns. Delusions, or false beliefs, and

hallucinations may also be present in the manic phase.

During the depressive phase, a person may lose all

interest in daily activities and people close to him,


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and exhibit hopelessness. The subject will

demonstrate persistent daytime sleepiness,difficulty in concentration, loss of appetite,

diminished interest and pleasure in daily

activities, and memory loss- amnesia. A person

in the depressive phase is a suicide risk.

The causes of bi-polar disorder, or manic-

depression, are unknown. However, certainfactors have been identified that have a role in

persons suffering from the illness. Heredity

may contribute to bi-polar disorder, for it runs

within families and may be carried by a gene

inherited from one to both parents. Chemical

changes in the brains neurotransmitters havebeen identified as a possible contributing factor

to bi-polar disorder. Lower than normal levels

of two of these are neurotransmitters,

serotonin and norepinephrine, are thought to

play an especially important role in bi-polar

disorders. Stress, caused by physical illness,

death of a loved one, or financial problems may

trigger a bi-polar episode.Research indicates bi-polar disorders in the

most treatable of the serious mental illnesses.

A combination of psychotherapy and

medications enables many who suffer from bi-

polar disorder to enjoy happy lives. The most

common medication used in the treatment ofbi-polar disorder is lithium carbonate, which

works to help balance neurotransmitters in the

brain, reducing the swings from mania to

depression. Taking lithium without a physicians

supervision, however, is dangerous. Side effects

include delirium, confusion, seizures, coma, andeven death in rare instances.


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Bi-polar disorder consists of two phases, the depressed phase and the manic phase. During

the depressed phase, the subject will display persistent daytime sleepiness, difficulty in

concentration, loss of appetite, diminished interest and pleasure in daily activities, and memory

loss otherwise known as amnesia. A person in the depressed phase is a suicide risk and should

be monitored closely. During the manic episodes a person is usually elated and feels on top of

the world and displays an abundance of energy. He seems to talk and thinks faster, may think he

is invincible leading to reckless behavior and acts that endanger his well-being. During the

manic phase, the subject sleeps less, is easily distracted and tends to be more irritable. Thesubject may exhibit poor temper control and excessively irresponsible behavior patterns.

Delusions or false beliefs, and hallucinations may be present during the manic phase.


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Major Depression

Major depression is not a debilitating mental illness. If it was debilitating, Abraham Lincoln and

Theodore Roosevelt would not have been able to govern the United States, particularly in time of war.

Robert Schumann and Ludwig von Beethoven would not have been able to write the beautiful music they

composed. Edgar Allen Poe and Mark Twain could not have written their memorable novels. Each one of

these men suffered from major depression: I am now the most miserable man living. If what I feel were

equally distributed to the whole human family, there would not be one cheerful face on earth.

While it is common for people to say how depressed they feel, such depression is usually sadness

associated with lifes disappointments. True depression is very different from occasional sadness. Majordepression profoundly impairs the ability to function in everyday life by affecting moods, thoughts,

behaviors, and physical well-being. Major depression interferes with a persons ability to eat, sleep, or get

out of bed in the morning.

According to the National Institute of Mental Health, depression strikes about seventeen million

American adults each year- more than cancer, AIDS, or coronary heart disease. An estimated 15 percent of

chronic depression cases end in suicide. Research indicates women are twice as likely to suffer from major

depression.Clinical depression consists of two types: major and dysthymic. Major depression is severe and

episodic, likely to come and go repeatedly in a persons life. Dysthymic depression prevents a person from

functioning well or feeling good. Persons suffering from dysthymic depression are able to function in

everyday life, such as working, socializing, and attending to religious callings, but in a state of depression.

Symptoms of major depression include depressed mood, loss of interest or pleasure in almost all

activities, sharp changes in appetite and weight, disturbed sleep, fatigue or loss of energy, feelings of

worthlessness, and difficulty thinking, concentrating, and making decisions.


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Personality disorders are, perhaps, what makes the job of law enforcement so interesting, diverse, and

dangerous. According to the U.S. Census Bureau, there are approximately 5.9 billion people living in the

world today. That means there are 5.9 billion different personalities walking around on the plant, many

having exchanges with law enforcement personnel. Following is a brief description of some types of

personality disorders that may be of interest to law enforcement officers.

Antisocial Personality Disorder

This is the individual who will come to your attention as a violator, suspect, defendant, or inmate. He is

the person who does not function well in society. His antisocial personality has developed and is apparent

by the time he reaches fifteen years of age. A person is classified as having antisocial personality disorder if

three or more of the follow descriptions apply to him:

Continually committing unlawful acts

Deceitfulness, as indicated by repeated lying, using aliases, or conning other for personal gain Impulsively or failing to plan, the concept of the future is not acknowledged

Aggressively and irritability, as indicated by repeated physical fights or assaults against others

Reckless disregard for the safety and welfare others; others just do not matter to this person

Consistent irresponsibility, indicated by a repeated failure to sustain employment and honor

financial obligations

Lack of remorse, indicated by being indifferent to having hurt, mistreated, or stolen from another

person


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Persons suffering from antisocial personality disorder do not necessarily possess all of these attitudes and

behaviors, and the degree varies from subject to subject. For example, there is a wide gap between a person who

is a petty thief and a person who is a serial killer, but they share common antisocial personality disorders. The petty

thief is not concerned about the property of another. As far as he is concerned, everyone elses property is his; he

just has not gotten around to taking possession of it. The petty thief continually gives false names to law

enforcement, has not had meaningful employment during most of this life, fails to plan for future periods of morethan an hour, and jeopardizes others in his flight from the police. Yet, this person would not commit a robbery with

the intent of committing murder to facilitate his escape.

All murderers are not afflicted with antisocial personality disorders. The so-called mom and pop murders,

committed during the heat of a domestic violence incident, are evidence of this. However, those murderers who

have an antisocial personality disorder fall into a category of extreme psychopath; nothing and no one stands in

their way.

Bonnie Parker and Clyde Barrow, the robbery and murder due from the American Midwest of the 1930s, are classicexamples. The fictional character Hannibal Lecter, aka Cannibal, from the movie Silence of the Lambs, is another.

These are the people law enforcement officers prepare, through training and attitude, to deal with. Officers

seek out these people every day during their careers. TI sis when one is found, unexpectedly, that an officer is in

extreme jeopardy. When we speak of the bad guys, this is the group to whom we are referring: the really bad

guys. Take a look around your town; chances are you can name people who fit into this antisocial personality

disorder classification. You may know them so well you can recite their dates of birth and describe their tattoos.

When we speak of the bad guys,this is the group to whom we are

referring: the really bad guys.


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Borderline Personality Disorder

A person suffering from a borderline personality disorder (BPD) displays a pervasive pattern of

instability of interpersonal relationships, self-image, and impulsiveness beginning by early adulthood.

Everyone, especially adolescents, has all of these traits, but persons with BPD have them for long periods of

time-years-and they are intense.

While BPD comprises 10 percent of all mental health outpatients, 75 percent of those diagnosed with

BPD are women. Seventy-five percent of those suffering from BPD have a history of sexual or physical

abuse. The characteristics of a BPD subject include the following:

Frantic efforts to avoid real or imagined abandonment by a romantic partner;

A pattern of unstable and intense romantic relationships, characterized by extremes. The term

love/hate relationship describes a BPD subject; his or her relationships change from love to hate

and back again in a matter of seconds. The 1971 film Play Misty for Me and the 1987 film FatalAttraction contained chilling examples of this BPD tendency;

Remarkable and persistent instability of self-image, contributing to suicidal behavior, threats, or

self-mutilation;

Intense impulsivity in areas that are self-damaging, such as spending habits, substance abuse,

deviant sexual behavior, reckless driving, and binge eating; and

Inappropriate, intense anger or difficulty controlling anger; frequent displays of temper, constant

anger, or recurrent physical fights.


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Research indicates there is no such thing as a pure BPD; it coexists with other forms of

mental illness, such as posttraumatic stress disorder, mood disorders, panic/anxiety disorder,

substance abuse, gender identity disorder, and obsessive-compulsive disorder. It is important to

remember such characteristics naturally exist in every healthy persons personality. It is when

they are extreme and intense in nature that the person becomes a danger to you.

Obsessive-Compulsive Disorder

In order to discuss obsessive-compulsive disorder (CPD), it is necessary to define the terms.

An obsession traps a person in a myriad of recurrent and unwanted ideas or impulses, such as

when a person is obsessed with neatness. A compulsion is a strong, irresistible impulse to

perform a certain act, such as washing ones hands, checking the stove to ensure the gas isturned off, or counting the number of steps taken. Persons suffering from obsessive-compulsive

disorder have fears that a lack of order, neatness, or cleanliness will endanger their personal

safety or that of a loved one.


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A compulsion is a behavior based on an obsession. People perform compulsive behaviors

according to rules they make up for themselves that accompany obsessive thoughts. For

example, a person may have profound fear of germs and infection, and may spend hours

washing her hands after using a public restroom. The repeated hand washings temporarily

easies her fears, but the fears return and the routine is repeated all over again. Most peoplewith OCD are aware their obsessions are compulsions are ridiculous, but are unable to ignore

them. Some common obsessions include the following:

An unnatural fear of dirt, germs, or contamination;

An overriding concern with order, symmetry, and exactness; and

Worry that a task has been performed poorly, even when the person knows it is not

true.

OCD was at one time thought to be rare. However, the actual number of affected people

was hidden from public statistics because of embarrassment. Recent studies have found more

than 1 percent of the population, or more than two million people, suffer from OCD.


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The cause of OCD is thought to be similar to that of other forms of mental illnesses: an

imbalance of brain neurotransmitters, in this case, serotonin. Serotonin serves as a bridge in

sending nerve impulses from one nerve cell to the next, and in regulating repetitive behaviors.

Medications are available to help relieve the symptoms of OCD.

Persons suffering from OCD often experience other forms of anxiety, such as phobias (fearof snakes or fear of flying), panic attacks, and depression. Research indicates people with OCD

have an episode of major depression at some time in their lives. Alcohol and drug abuse

become a complicating factor when people with OCD turn to them for relief. Some common

compulsions include the following:

Frequently cleaning and grooming oneself, such as excessive hand washing, showering,

or tooth-brushing; Checking rituals involving drawers, doors, locks, and appliances, making sure they are

shut, locked, or off;

Repeating rituals, such as going in and out of a door, sitting down and getting up from a

chair, touching certain objects several times, and avoiding lines on the sidewalk;

Counting over and over to a certain number; and

Saving newspapers, mail, or containers when they are no longer needed.


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According to the

National Institute of

Mental Health, more

than nineteen million

Americans sufferfrom some type of

anxiety disorder.

According to the National

Institute of Mental Health,

more than nineteen million

Americans suffer from some

type of anxiety disorder,including panic disorder,

posttraumatic stress disorder,

phobias, and generalized

anxiety disorder. Tormented by

panic attacks, irrational

thoughts and fears, flashbacks,nightmares, or innumerable

frightening physical symptoms,

people suffering from anxiety

disorders are frequent users of

emergency room and other

medical services.

Many people having

anxiety disorders are likely to

experience depression, alcohol

and/or drug abuse, or other

mental disorders. Because ofwidespread lack of

understanding and the stigma

associated with these disorders,

many victims suffer privately, as

they are not diagnosed properly

or are not receiving treatmentproven successful through

research.


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Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a persons reaction to witnessing or otherwise

experiencing a major traumatic event is in his life. Once thought to be an illness suffered by

military, law enforcement, firefighting, and emergency medical services personnel, PTSD is

estimated to afflict 5 percent of the general, civilian population. Women are twice as likely toexperience PTSD as men.

Typically, PTSD results from extreme stressors, such as serious accidents or natural

disasters, rape or criminal assault, combat exposure, child sexual or physical abuse, hostage

situations, or the sudden, unexpected death of a loved one.

A person experiencing PTSD has three types of symptoms: re-experiencing the traumatic

event, avoidance and emotional numbing, and increased arousal. Re-experiencing of the eventconsists of flashbacks, during which the person feels as if the event is recurring while he is

awake; nightmares; exaggerated emotional and physical reactions to events similar to the

subject event; and overpowering recollections of the event itself.


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Avoidance and emotional numbing is indicated by avoidance of activities, locations, and

conversations related to the traumatic event, loss of interest in general, feelings of detachment,

and restricted emotions.

The PTSD symptom of increase arousal is demonstrated by difficulty in sleeping, having

outbursts of anger when inappropriate, hyper vigilance, and an exaggerated startle response.There are three levels of PTSD severity: acute, chronic, and delayed. Acute PTSD lasts from

one to three months. Chronic PTSD symptoms continue for longer than three months, and will

continue without medical and/or psychological intervention. Delayed PTSD symptoms appear

weeks, months, or even years after the traumatic event, and are likely to occur on the

anniversary of the event or when a similar traumatic incident occurs.

The closer a person is to a traumatic event the more likely he is to suffer from one of thethree levels of PTSD. A person who is shot at and see the muzzle flash is more likely to

experience PTSD than a person who heard the gunshots and later leaned the shots barely

missed him. A rape victim who reasonably believed her life was in danger is more likely to

experience PTSD than a rape victim who did not believe she was going to be killed. Victims of

violent crime are more likely to experience PTSD than people who experience life threatening

natural disasters, such as hurricanes and earthquakes.


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The severity of the trauma symptoms displayed by a person

suffering from PTSD depends on several factors; the severity of

the incident, the length of time it lasted, the closeness of a

person to the incident, the perception of danger exposure, the

frequency of the event, and negative reactions from friends andfamily members.

Research reveals a link between PTSD and substance abuse.

First, persons with PTSD are more likely to report to drug and

alcohol abuse as a means of easing and symptoms associated

with PTSD. Second, substance abusers, of both drugs and alcohol,

are more likely to experience PTSD than non-abusers. Finally,PTSD is found to be more prevalent in subjects with a history of

cannabis (marijuana) dependence but not alcohol dependence.

Mild forms of PTSD are normally treated with psychotherapy.

More severe forms are usually treated with psychotherapy and

medication. Statistics indicate women are more likely to suffer

chronic and acute PTSD.


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Panic Disorder

Panic disorder, or panic attacks, is a serious condition that affects slightly more than 1

percent of the United States population. Usually appearing in late adolescence or early

adulthood, the causes of panic disorder are unclear, although there seems to be a link between

the attacks and major live transitions, such as graduating from college, getting married, andmoving far away from ones childhood home. Research has shown a genetic predisposition;

persons with panic disorder are likely to have family members who have also suffered it.

A panic attack is a sudden urge or overwhelming fear that comes without warning and

without any obvious reason. A true panic attack is far more intense than the feeling of being

stressed out them any people experience. The symptoms of a panic attack include a racing

heartbeat, difficulty breathing, paralyzing terror, dizziness, trembling, sweating, tingling in thefingers and toes (pins and needles), and a feeling that death or insanity is imminent.

Many people would recognize the symptoms of panic disorder as similar to those of fight

or flight syndrome, which humans experience when confronted with dangerous situations. The

major difference between the two is panic attacks occur when there is no basis for the attack;

they seem to come out of nowhere. They can even occur when a person is asleep.


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Panic attacks occur without any warning or way to stop them. Luckily for those persons

experiencing panic attacks, they are usually short in duration, passing within minutes.

Unfortunately, repeated attacks can continue to recur for hours at a time.

Panic disorders are not physically dangerous to its victims, but it can be terrifying, mainly

because the person feels out of control. Panic disorder may also lead to other complications,such as phobias-irrational fears- depression, substance abuse, medical complications, and

suicide. The effects of panic disorder range from mild social impairment to a total inability to

face the word.

Many people have experienced panic attacks, but do not suffer from panic disorder. That

is, they have suffered one or two panic attacks, usually based on a life transition. The key

symptom to panic disorder, however, is the persistent fear of future attacks, which lead tophobias, depression, and other medical complications. The cause of panic disorder has yet to be

identified but, as indicated, there is evidence of a genetic predisposition and life transitional

causes.


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Phobias

Phobias are marked and present fears that are excessive or unreasonable, often brought

on by the presence of anticipation of a specific object or situation. Most are familiar with

phobias of flying in airplanes, heights, animals, or receiving medical injections, but there are

many more phobias. Literally numbering in the hundreds, phobias range from fear of

stepmothers, fog, gold, clutter, and men, to being alone, certain colors, and gravity.

Persons suffering from chronic cases of specific phobias are likely to experience an

immediate anxiety response, which may resemble a panic attack. Pointing out the irrationality

of a persons phobia is of little to no value, as people suffering from phobias recognize the fear

is excessive or unreasonable.


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Posttraumatic Stress Disorder is often identified by the following characteristics. A person

experiencing posttraumatic stress disorder has three types of symptoms:

1. Re-experiencing the traumatic event;

2. Avoidance and emotional numbing;

3. Increased arousal;4. Nightmares;

5. Exaggerated emotional and physical reactions to events which may be similar to the original

traumatic event; are often common;

People suffering from posttraumatic stress disorder have:

1. Overpowering recollections of the event itself;

2. Difficulty in sleeping;

3. Outbursts of anger when inappropriate;

4. Hyper vigilance; and

5. Exaggerated startle response


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Panic Disorder is marked by the following. The symptoms of a panic attack include:

1. Racing heartbeat

2. Difficulty breathing

3. Paralyzing terror

4. Dizziness5. Trembling

6. Sweating

7. Tingling in the fingers and toes

8. A feeling that death or insanity is imminent


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Many people recognize the symptoms of panic disorder as similar to those of the fight or

flight syndrome. Panic disorder may also lead to other symptoms, such as phobias or un-

rational fears, depression, substance abuse, medical complications, and even suicide.

Phobias are common to many people. Literally numbering in the hundreds, phobias range

from fear of stepmothers, fog, gold, clutter, and men to being alone, certain colors and gravity.

Persons suffering from chronic cases of specific phobias are likely to experience an immediate

anxiety response which may resemble a panic attack. Pointing out the irrationality of a persons

phobias is of little or no value as those suffering from phobias recognize their fears as excessive

or unreasonable but are unable to control the emotion evoked by the stimulant or fear.


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Organic disorders, for the purpose of this course, are

medical conditions of the brain causing abnormalities of

emotions, thought, and behavior. The causes of brain

disorders are numerous, but can be grouped into two

categories: environmental factors, such as a head injuryresulting from a vehicle collision, or the intentional misuse

of a drug resulting in brain damage; and internal factors,

such as aging or disease, that lead to the disruption of

blood flow to the brain. The two most common groups of

symptoms, known as syndromes, are delirium and

dementia.Delirium refers to a sudden change in mental

functioning caused by an injury or other challenge to the

brain caused by a medical condition. It is typically intense

and, if the medical cause is threated promptly, short-lived.

Delirium can be a serious conditions requiring immediate

medical attention to prevent permanent brain damage.

Some of the symptoms of delirium

are a quick onset of symptoms,

disorganized thinking,

disorientation as to time and place,

reduced level of attention, andincreased agitation.


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Delirium can be caused my many medical conditions, such as urinary tract infections, low

blood pressure, dehydration, and alcohol withdrawal. The delirium associated with alcohol is

called delirium tremens (DT), which is a disturbance of the brain occurring during the late states

of severe alcohol dependence or withdrawal. They symptoms of DT are confusion,

hallucinations, tremors, irrational over-activity, and profuse sweating. Like other forms of

delirium, DT is a medical emergency; research indicates a mortality rate of 15 percent if the

symptoms are left untreated.

Delirium tremens usually begins three to several days after removal of alcohol, but as

indicated above, may also affect a person in the late stages of severe dependence. When

treated medically, DT usually runs its course within three to five days.

The other organic disorder is known as dementia. Where delirium occurs suddenly,dementia is a gradual loss of intellectual functioning occurring over a long period of time.

Memory, as a highly integrated brain function, is particularly sensitive to developing dementia:

memory loss, especially recent, is often the first symptom noted. The causes of dementia

include Alzheimers disease, strokes, long-term alcohol abuse, a reaction to medication, Vitamin

B12 deficiency, thyroid disease, and depression.


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The most common type of dementia is dementia of the Alzheimers type (DAT). This brain

disorder results in several years of progressive loss of cognitive abilities and eventually death.

DAT is caused by an irreversible and incurable deterioration of brain cells. As brain cells die off,

the brain shrinks in size.

DAT is not confined solely to the aged: it may appear early in a persons life, earliest

indicators appearing prior to age 60. Known as presenile, it is thought to b related to genetic

factors, but this is as yet not understood. Persons suffering DAT are likely to wander away from

their homes and have no recollection of the way back, or even the location where their journey

began.

The speech of a person suffering from

dementia usually remains normal but many

people experiencing dementia have difficulty

finding the correct words to use in

conversation. Dementia also is likely to includea general loss of cognitive abilities, such as

reasoning, attention, concentration, and

behavioral control.


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Delirium and dementia are both classified as organic disorders. Delirium is marked by the

following symptoms: There is usually a quick onset of symptoms such as 1) disorganized

thinking, 2) disorientation as to time and place, 3) reduced level of attention, and 4) increased

agitation.

The delirium associated with alcohol is called Delirium Tremens or DT, which is a

disturbance of the brain occurring during the late stages of severe alcohol dependency or

withdrawal. The symptoms of DT are: 1) confusion, 2) hallucinations, 3) tremors, 4) irrational

over-activity, and 5) profuse sweating.

Where delirium occurs suddenly, dementia is a gradual loss of intellectual functioningoccurring over an extended period of time. Memory is a highly integrated brain function and is

particularly sensitive to developing dementia. Memory loss, especially recent, is often the first

symptom noted. Causes of dementia include Alzheimers disease, strokes, long-term alcohol

abuse, reaction to medication, a vitamin B12 deficiency, thyroid disease, and depression.


43/95

Diabetes and epilepsy are not conditions

of an emotionally or mentally disturbed

person. However, much like someone

suffering from schizophrenia or a phobia,

his potential for mistreatment is very

real. For that reason, the these topics

will be discussed in this section of the

course.


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As a patrol officer, consider

the following scenario:

You are working a one-man car

in a town that might be in Maine or

California. It is late at night. You get

a call from dispatch saying a citizen

has called on his cell phone to

report a suspected DUI offender.

Since you are on the same road and nearwhere the suspected driver is traveling, you take the

call and spot the late-model vehicle described by

dispatch. Similar to the numerous DUI offenses you

have handled, the driver weaves within his lane. He

also crosses the fog line a couple of times, and his

speed is erratic- sometimes too fast and then

sometimes too slow. You think to yourself it is a

good thing traffic is light at this time of night.

You pull in behind the diver and activate your

overhead lights. There is no doubt in your mind the

driver has to be aware of your marked unit, but he

fails to slow down quickly.

Several blocks down the roadway the driver clumsilypulls over, buy only after your sirens have been

wailing. You then clear your situation with dispatch.

Walking up to the vehicle you notice the drivers

head snap down and if he is tired and then come

back up slowly. Deuce, for sure, you think.


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When you ask the driver for

proof of insurance and his drivers

license, he greets you with a comicalsmile, as if you have just told a funny

joke. He does not respond at all to

your request for identification, and

you get the feeling this drunken

driver will require just a little moreeffort than the usual DUI. Sure enough, when the

driver gets out of his vehicle after several repeatedrequests, he stumbles against the car door and

almost falls down. You immediately notice his face is

pale and clammy. His speech is severely slurred, and

he looks shocky. As you speak to him about the

reason for the stop, you can easily tell he is confused

and uncooperative to the point of annoyance.Several times, the driver shows real flashed of

irritability and anger.

Sure enough, he fails your field sobriety tests.

In fact, you decide he is so drunk that the roadside

tests do not need to be finished. Instead, you place

the driver in handcuffs and inform him he is under

arrest for suspected DUI.

As you drive to the county jail, youcongratulate yourself on taking another drunk driver

off the public roads. You do not know it yet, but you

are in for an unpleasant surprise when you get to the

jail with your arrestee.

Why? Well, your deuce is not drunk; he does

not drink alcohol at all. As a matter of fact, he has

not touched alcohol since he was diagnosed withdiabetes seven years ago. But YOU arrested him and

hauled him in for an alcohol-related crime, rather

than calling for medical assistance for a flare-up of

his disease.

Sound far fetched? Not according to the

American Diabetes Foundation and Lt. Chuck Hayesof the Oregon State Police.


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Hypoglycemia and Law Enforcement Officers ...

What do they have in Common?

Lieutenant Chuck HayesOregon State Police

A routine DWI, the kind that happens everyday. Get them off the road before another innocent victim

suffers. It's a common scene, but it isn't always as it seems. In Albany, Oregon, a man was involved in an

incident that has unfortunately happened once too often to law enforcement officers throughout the

country. After some very poor driving his vehicle was stopped and he was arrested on suspicion of DWI. The

driver, however, was actually diabetic and suffering from low blood sugar, known as hypoglycemia. The

driver later sued the law enforcement agency and was awarded $13,000 in damages.

Recent lawsuits by people with diabetes and their family members emphasize the importance of taking

precautions before a DWI arrest. Juries are sympathetic toward people who are falsely arrested based on a

medical condition, even if that condition is not obvious to the arresting officers. Unfortunately, this type of

situation has affected police departments and law enforcement officers too many times. Everyday, law

enforcement officers stop drivers under the influence of alcohol and other drugs who are DWI. Many ofthese drivers exhibit some of the same actions as a diabetic suffering from hypoglycemia.

Hypoglycemia is defined as an abnormal decrease of sugar in the blood. Individuals suffering from

hypoglycemia can feel cold and clammy. They can appear nervous, shaky, and very weak. Often, their face is

a pale color. They may experience headaches and have blurred vision.


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They become dizzy, demonstrate irritable behavior, and may exhibit personality changes. They may

seem confused, uncooperative, and may have slurred speech. In severe stages, they may even have seizures

or become unconscious, which can result in death. Most diabetics properly monitor and regulate their sugarintake to ensure they do not have adverse reactions. This condition can, and will, at times, happen suddenly

and dramatically while the individual is driving a vehicle. The result can often mirror the responses of a

suspected DWI driver. (Editors Note: this is where training in distinguishing between DUI and hypoglycemia

becomes invaluable.)

Soon after the Oregon incident, a support group from Albany General Hospital developed a means to

assist law enforcement officers in identifying vehicles operated by diabetics. The result was the "DM Med-

Aware" sticker. This light-reflective, all-weather sticker, is placed on the automobile to the left of the rear

license plate. This sticker is very visible and can communicate to a police officer, emergency response

personnel, and others, the driver may be diabetic.

Law enforcement officers cannot totally depend on diabetics to wear medical tags or jewelry. In

addition, officers often cannot search a wallet or purse in a critical situation. The "DM Med-Aware" sticker

can be a positive addition in assisting in the identification of diabetics in emergency situations.

The use of the sticker is voluntary. It is currently in use and recognized by many law enforcementofficers in the state of Oregon. The Albany General Hospital Foundation received a $20,000 grant from the

Oregon affiliate of the American Diabetes Association to produce an educational video of the "DM Med-

Aware" sticker program. The 8-minute video, primarily aimed at law enforcement, educates police officers

on how to observe and detect the signs and symptoms of hypoglycemia and provide proper treatment in

emergencies. The Oregon State Police is a sponsor of the program and has added the video to Medical First

Responder and DWI training.


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The DM Med-Aware sticker is not a "free ticket" to drink and drive. It is designed to alert police officers

that the driver may be a diabetic and may be suffering from hypoglycemia. With this information, officers

can be better prepared to seek additional signs of medical impairment and ask questions that may or may

not support alcohol or drug impairment. Learning to recognize clues that identify a DWI suspect as

hypoglycemic can help officers avert further injury to the patient and possibly avoid an unnecessary costly

lawsuit.

For more information about the "DM Med-Aware" sticker or the training video, contact the Albany

General Hospital, 1046 Sixth Avenue S.W., Albany, Oregon 97321.

The underlined sentences in the article are considered important for understanding this medicalcondition, and its potential to affect law enforcement officers, especially those patrol officers who make

numerous DUI arrests. When ANY medical condition, including epilepsy, mimics a common Crime, it is

absolutely in your interest as an officer to distinguish between a crime committed and a medical emergency.

Too many officers do not and they and their agencies pay the price- either in employment or lawsuits.

To illustrate that this type of situation is not confined to American police, and is a widespread

phenomenon, read the following incident that occurred in Australia.

Officers in New South Wales arrested a woman suspect of shoplifting. The woman, Cherie Evans, hashad diabetes for 17 years and was totally aware of how to control the symptoms. When she felt the onset of

those symptoms, she paid for her groceries and went outside to her vehicle, where she sucked on lollipops

to quickly bring her blood sugar imbalance into normal ranges.


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Evans claims she as approached by security agents from within the store who then accused her of

shoplifting. Noticing her pale, confused, and shaking states they misinterpreted those symptoms as showing

guilt, and being indicative of intoxication in the bargain. Local officers were called who subsequently placedEvans in custody. Her slurred speech and mental confusion further convinced the officers they had a

arrested a criminal. She was told, A cup of coffee will sober you up.

Despite telling the store security guards and the arresting officers about her medical problem, she was

arrested, handcuffed, and taken to the local lockup.

Police officers thought I was drunk and my diabetes story was a cover for stealing. I was so

humiliated, Evans said later.

Her case was dismissed after authorities examined her blood glucose monitor, which showed a low

reading at the time of her arrest.

The CEO of Diabetes Australia, Liz Peers, summed up the incident accurately enough, saying, Police

these days should understand the difference between a medical condition and the effects of too much

alcohol.

Fair enough, you say. What are the differences and how can an officer readily distinguish between

them? Although appearing inebriated, a diabetic suffering from low blood sugar (hypoglycemia) will NOTshow Nystagmus. There will be NO odor of alcoholic beverages on the persons breath or clothing.

If your arrestee claims to be diabetic, do the right thing and dispel any doubt by calling for EMTs to take

a small drop of your suspects blood to get a quick, easy estimate of the blood sugar. If an IV is started and

the person immediately gets better, then you have solved the reason for the impairment.


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It is unfortunate, but many of the symptoms shown by diabetics with a low blood sugar

conditions closely mimic a person who is under the influence of alcohol. Nervousness,shakiness, paleness, and irritability overlap in both DUI offenders and hypoglycemia.

Other signs of hypoglycemia that are readily observable by an officer may include:

Sudden violent fear

Fainting

Inward trembling

Emotional disturbances

Hand tremors

Dilated pupils

Mental cloudiness

Complains of chilliness

Numbness

Pallor around the mouth

Complains of hunger

Apprehension


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As an officer whose duty it is to monitor thepublic for possible lawbreakers, you cannot depend

upon diabetics in public to wear medical alert

bracelets or even carry documents that identify them

as having this disease. Also, some diabetics drink and

drive. Some diabetics use illegal drugs as well. This

further middies the water from the standpoint of anofficer who feels he has a valid DUI arrest.

As hypoglycemia progresses, the followingsymptoms may appear. If they do, you can be

assured you do not have a DUI in custody but a

person suffering from the effects of low blood sugar:

Headaches

Double vision

Inability to walk

Muscle twitching

Disorientation

Coldness of the extremities

Unless these are treated, severe low blood

sugar can lead to convulsions and unconsciousness.

Do yourself a favor, and learn these symptoms and

what they mean. It will make you a better, moreinformed officer. It might also help you to help a

citizen who is undergoing a medical crisis, not

committing a crime.

Similar to diabetic symptoms being confused

with a possible DUI by officers another medical


52/95

with a possible DUI by officers, another medical

condition often confronts officers who work closely

with the public. Consider the following scenario you

might encounter as an officer. It is a situation that,

without the correct information, could lead to an

arrest which will come back to embarrass you.You get a call to respond to a street location in

the center of town. During a crowed street fair, a

man in a group of shoppers has uttered a strange cry

and is bothering people with his behavior.

Responding to the location you see the man acting

strongly. He is mentally unfocused and apparently

staring with intensity at a nearby wall. Passers-bywho have attempted to help him have found the

individual to be unresponsive and staring blankly. He

does not respond to their inquiries. While standing

there, you notice he has started to shake violently

and has defecated in his pats. Your first though is,

Great! another guy on PCD (or meth, or cocaine, or

alcohol)! Your inclination is to take the person intocustody, as he is obviously disturbing the peace and

obstructing your duties- both are certainly

misdemeanors. But you would be wrong to do so.

This person is experiencing the first stages of an

epileptic seizure. It is a medical condition you are

witnessing, NOT a crime. To arrest the individualwould be akin to putting out fire with gasoline.


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The following is a list of common symptoms of

epilepsy:

Episode may begin with a blank stare or cry

Unresponsiveness to inquiries

Absence of alcohol on breath

Incontinence (not always, but a possibleeffect)

Possible belligerency or aggression when

approached

Frightened aspect, easily upset, unable to

communicate

Convulsions- these will result in the personthrashing about on the ground. This will

not be hostile physical behavior, but

uncontrollable spasms of the body and

musculature.


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What is epilepsy? It is a brain disorderthat affects more than two million citizens in

America. It is easily treatable with medication, just as

diabetes. Seizures affect behavior because the

electrical system within the persons brain

malfunctions. Instead of a controlled discharge of

electrical energy, the brain fires a surge of energythat may cause unconsciousness and massive

contractions of the persons muscles. If the episode

does not progress as far as this, generally it is over

within about two minutes. Small episodes such as

this, or petit mals, generally cloud awareness,

block meaningful communication, and may produce

uncontrolled physical movements.If you have never witness a full-blown epileptic

seizure, or grand mal, it can be frightening the first

time around. Ask a jailor in your jurisdiction.

Chances are they have witnessed numerous inmates

suffering from this malady while in custody. The

potential in a confined setting for possible injury on

hard, unforgiving custodial surfaces is real.

Once you recognize this for what it is, your instinct

will be one of sympathy for the person, rather than

enmity. It is not a crime to be ill; people sufferingfrom epileptic episodes need medical treatment, not

incarceration. To the public witnessing an epileptic

seizure, it must appear as if the person is evincing

anti-social or drugged behavior. The corollary to this

is that law enforcement officers are often called to

the scene. Sadly, many times the officer is no more

aware of epilepsy than the complaining citizen.


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What should an officer do when encountering a person in this

situation? The first approach should be to guardedly assume it is a medical

condition unless events quickly prove otherwise. This is the only way a

persons rights can be safeguarded. It is not a crime to suffer from a

medical disability; the quickest way to find yourself find yourself in court is

to arrest a person based on the assumption they are committing a criminal

act. Ti is entirely possible t find yourself involved in a lawsuit based on theAmericans with Disability Act (ADA). Taking a person into custody based on

their actions while suffering a disability deprives them of their rights, and

could be construed by an irate plaintiff as a violation of that federal law.


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Basic first aid treatment should be observed.

People with epilepsy are NOT dangerous to others.

A person experiencing a seizure will NOT swallow his/her tongue. Do not fall

prey to this old myth.

Place the person on their side to avoid possible choking. Place nothing in their mouth.

Do NOT put them face down or put them in a choke hold. You are asking for a

possible fatality if you do.

Do NOT forcibly restrain them or grab them aggressively. Coherent thought is

not possible for the seizure sufferer and may trigger an involuntary reaction.

Gently shepherding a standing epileptic away from crowds is advisable, if

possible. Try it.

A calm, non-threating tone works bet. Loud commands are superfluous and

ineffective. Remember, the persons consciousness is impaired.

Seizures block the sufferers ability to understand police instructions. This is

NOT obstruction of justice or resisting arrest or disturbing the peace.

People in these situations are vulnerable, and should NOT be left on their

own.

How do you as a professional patrol officermanage a situation such as has been described?

Consider the following points:


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Generally, seizures last for less than two minutes and an

ambulance does not need to be called by officers. However, call for

medical assistance if:

Another seizure begins immediately after the first subsides;

If confusion is prolonged and does not improve in a timely

fashion;

If the seizure lasts for more than (5) minutes;

If the person is injured, diabetic, pregnant or has a known

history of cocaine or other drug use;

If you can determine that this is the first seizure the person has

experienced; and/or

If the person does not regain consciousness after muscle

spasms have ended.

As an officer, when youconfront this situation, there


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confront this situation, there

are also several things you

should NOT do. They include

the following:

Do not interfere with the persons movement, unless

something more threatening appears, such as steps orcurbing.

Do not expect a response.

Do not raise your voice or appear threatening.

Do not interpret struggles as hostile or ill willed.

Do not leave the person alone in this vulnerable situation.

Do not expect focused, clear communication for a little while

after the seizure. The person is apt to be dazed andconfused.

It is NOT advisable to use pepper spray at ANY time during

seizure situations. Also, hog-typing or restraints of any kind

are NOT advisable as they may trigger an aggressive

response.

Any additional help to an officer is the presence of medicationfor the treatment of Epilepsy, including Klonopin, Tranxene,

Depokote, Diamox, and up to a dozen more.


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If you must take an epileptic into custody, arrangements

need to be made to secure medication. Missing prescribeddosages can possibly lead to prolonged and more serious seizures

that can threaten life. You do not want it to appear as if you

withheld medication from anyone who needs it. Epileptics should

be monitored while in custody. A confined, hard-surfaced setting

may lead to injuries during a seizure; an episode of non-stop

seizures can kill. Major lawsuits have been filed and successfullyargued regarding epileptic seizures of people while in custody.

The bottom line here is simple: in situations involving

persons suffering from diabetes or epilepsy, the burden is on the

responding officer to recognize and properly respond to the

disability. It is of small comfort, and no legal protection, to say

you were unaware of epileptic symptoms or did not know howhypoglycemia affected driving ability. Convulsions, confusions,

and episodes of agitated behavior in any person who is in police

custody- on the street or in jail- should not be dismissed as

deliberate acting up or as a cause for discipline until the real

possibility of diabetes or epilepsy has been ruled out.


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Involuntary Commitment

Most states have given law enforcement

officers, medical physicians, and psychiatricprofessionals the ability to force a subject into

treatment when certain conditions are met. Usually,

those conditions have to do with a mental condition

or a persons inability to care for his or her own

after, the after of others, or be gravely disabled.

Mental conditions, as used above, is a term that many officers have difficulty defining.Most jurisdictions require that the mental condition be linked with the inability to care for ones

own safety or the safety of others; it is not sufficient for a person to act as if is way out there

or looney. A person attending to his basic needs of food, clothing, and shelter in an otherwise

reasonable manner, even though he might be hearing voices and wearing an aluminum cap to

ward off satellite surveillance ray sis not usually a candidate for involuntary commitment. A

person exhibiting these symptoms walking in traffic lanes on a freeway, lying in a gutter during asnowstorm, or making statements or gestures indicating suicide might be. Consult the statutes

governing involuntary commitments in your jurisdiction; do not assume someone talking to

imaginary being is crazy and subject to involuntary commitment.

To view the Idaho statute that deals with the hospitalization of the mentally ill, see Idaho

Code 66-326.


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Criminal Acts

Since the Roman Empire, civilizations have

recognized certain persons to be exempt fromcriminal sanctions due to mental illness. Lunatics, or

those who were influenced by the phases of the

moon, were not accountable for their actions and,

therefore, not subject to criminal penalties under

the law. An insanity defense is based on a theory

that most people can make rational choices to obey

or disobey the law; those who cannot, due to mentaldefect, should be tried for a crime in a similar

manner as an otherwise sane person. Such people

needs special treatment, as punishment will not

deter future antisocial behavior in a mentally

disordered person.

A person under arrest and indictment for an

offense must be capable of assisting his attorney in

defense of his guilt. A person suffering a serious

mental illness may not be able to perform this vital

function and, therefore, will not be permitted by the

court to stand trial for his crime.

How does a person become capable of

assisting in his defense? Generally, persons suffering

From SMI are treated with a combination ofpsychotherapy and medication in order to improve

their mental capacity to comprehend the nation of

the charges against them and to assist in their own

defense. Such persons agree to this treatment, or

the court ordered it.

In the case of Russell Weston, the accused

murderer of two U.S. Capitol police officers in 1998,the defendant refused to sign documents agreeing to

the administration of medication that would enable

him to stand trial. When prosecutors sought a court

order to forcibly medicate Weston, his attorneys

intervened. Since July, 1999, Westons lawyers have

preented the government from medicating him,

saying to do so is to march him to the execution

changer. The possible motivation for this tactic is to

prevent Weston from being tried for murder, herby

preventing him from being punished-executed-for

the crime. Court appointed psychiatrists have

testified Westons mental condition has worsened.

He remains in custody.


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The Insanity Defense

Insanity defenses became matters of the court process in 1843 with the attempted

assassination of Prime Minister of England Robert Peel, the father of modern law enforcement.Daniel MNaghten, a psychotic individual, believed he was being persecuted by Sir Robert Peel

and attempted to murder him. Sir Robert Peels assistant was killed in the attack. At trial

MNaghten was declared insane and the prosecution was discontinued.

Queen Victoria and the House of Lords strongly disapproved of the verdict, and

commissioned a panel of fifteen judges to establish a specific test to be applied by a jury in

determining insanity. The outcome became known as the MNaghten Rule, and was to be the

standard in the United States from the mid-1800s until 1954. The MNaghten Rule, also known

as the right-wrong test, required the jury to determine if the person accused of the crim know

it was wrong at the time of the commission of the crime. The prosecution only needed to prove

a person understood the moral consequence of the crime; mental illness did not matter.

During the late 1800s,many states expanded the MNaghten Rule, adding the concept ofirresistible impulse to the test of insanity. While it was widely acknowledged everyone has

impulses, insanity defense language was adopted indicating a person should be acquitted If he

was incapable of preventing himself from committing the act despite the knowledge of it s

wrongfulness. The theory was that a mental disease could for a person to act against his own

will, if driven by an irresistible impulse.


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Interest in psychology surged during the 1950s. The mental problems experienced by

returning military personnel brought government attention to psychiatric disorder. The

invention of psychiatric drugs gave the public hope for a cure for mental illness. The U.S.Supreme court, in the case of Durham v. United States, adopted the Durham Test, which

provided a person was not criminally responsible for an act if the act was the produce of a

mental disease of defect. Recognizing for the first time that a mental illness was a disease that

could be treated and possibly cured, juries were required to answer two questions: (1) Did the

defendant have a mental disease of defect?; and (2) Was the disease or defect the reason for

the unlawful act? If the answers to these questions were yes, the person was not guilty byreason of insanity. The test never received wide acceptance in the United States. By 1972, the

Durham Test was abandoned in favor of the American Law Institute Test.

The American Law Institute, a group of distinguished medical and legal professionals,

developed an alternative insanity test in the late 1950s, one which lowered the insanity

standard from MNaghtens absolute knowledge of right from wrong to a substantial incapacity

to appreciate the difference between right and wrong, thereby recognizing degrees of mentalincapacity. Once enough evidence was presented at trial to raise an insanity defense, the

burden was on the prosecution to prove was not insane. In a period of time just over 150 years,

the pendulum of insanity defense had swung from one extreme to the other, shifting from a

defense burden to the prosecution. All this was to change, however, was the 1981 assassination

attempt of President Ronald Regan by John Hinckley.


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One June 21, 1982, just fifteen months after shoot the president and three others, John

Hinckley was found not guilty by reason of insanity. The public outcry and backlash following

the acquittal by reason of insanity was tremendous. During the three years following theverdict, Congress and half of the states enacted changes in the insanity defense, all limiting use

of the defense. Two states, Idaho and Utah, eliminated the insanity defense altogether.

Changes to the insanity defense were sweeping nationwide. Congress and nine states

limited the substantive test of insanity; Congress and seven states shifted the burden of proof

from the prosecution to the defendant, and eight states created an additional verdict of guilty

but mentally ill (GBMI). As of the turn of the century, most states have adopted changes ininsanity defenses that used the federal rule as the model.

In 1984, Congress passed the Insanity Defense Reform Act of 1984, which reads:

It is an affirmative defense to a prosecution

under any federal statute that, at the time of

the commission of the acts constituting the

defense, the defendant as a result of a severe

mental disease or defect, was unable to

appreciate the nature and quality of the

wrongfulness of his acts. Mental disease or

defect does not otherwise constitute a

defense.


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Theodore Kaczynski was diagnosed as aparanoid schizophrenic, as well as Russell Weston.

Kaczynski, otherwise known as the Unabomber,

transported packages containing bombs to postal

service offices around the West, hoping to evade

detection by origin. Did any law enforcement officer

on patrol duty stop him for a vehicle equipment

violation? Russell Weston, the murderer of two U.S.

Capitol police officer, traveled from his parents

home in Illinois to Washington, D.C., to locate and

destroy the surveillance satellite controls that he was

convicted were on the first floor of the Capitol.

While he was en route, did any officer share a

table with him at a fast food restaurant? How many

New York City police officers stood near AndrewGoldstein on a subway platform, and were luck

enough not to have been pushed in front of an

arriving train, unlike Kendra Webdale?

The point here is officers are frequently in the

company of persons suffering mental disorders,

some innocuous, some lethal. The danger

associated with persons suffering from serious

mental illnesses (SMI) is that their behavior is

unpredictable. They do not live in the world most of

us do, where the force of law has an affect on a

persons conduct.

The character played by Jack Nicholson in the

movieAs Good As it Getsis obsessive-compulsive,obnoxious, and rude, but not a danger to law

enforcement. Kaczynski, Weston, and Goldstein

were a danger to law enforcement, and continue to

be correctional officers at the prisons in which they

are confined. This section will provide suggestions

for police response to calls involving persons with

mental disorders.


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Prior to the 1970s, most people diagnosed with serious mental illness (SMI), such as a paranoid schizophrenia, were

institutionalized and, therefore, kept away from public interaction. During the 1970s, the institutionalization pattern

reversed, due to the advent of antipsychotic medications, changing attitudes about people with mental illnesses, and

concerns about costs of confining these people, which were primarily borne by the public. This pattern of outpatient care,

rather than institutionalization continues today.

The turn of the century has seen many people with SMI lead normal lives, thanks to advances in medications and

their personal commitment to do so; without the commitment, and a lack of funding for community-based care facilities,

persons suffering from SMI may deteriorate and lapse into behavior that becomes a law enforcement issue.Law enforcement knows what is happening; the hand-writing is on the wall. Your agency is the community-based

care agency. You probably should have seen this coming: whenever society is confronted with an issue that defies easy

classification and assignment to some public agency, you are elected. Many examples of this tendency exist, such as public

intoxication- illness or crime?- and unit homes. Those who signed on to what they thought was a law enforcement career

are finding themselves working in a twenty-four-hour mobile social service, roadside assistance agency. Get used to it:

more of the same is on the way.

At one time, contrary to public opinion, mental health professionals denied a link between mental illness and

violence. Recently, however, researchers have found persons suffering from SMI, primarily schizophrenia, are five times

more likely to be engaged in violent acts than persons with no disorder.

Schizophrenia in prisons and jails remains three times higher than the general population. The percentage of those

people, who actively experience psychotic symptoms, such as delusions or hallucinations that are involved in incident of

violent behavior is several time higher than the general population with no disorders.

Several factors may elevate the risk of violence

in a person with SMI. Drug and/or alcohol abuse is


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the most common. Paranoid schizophrenics often

feel a need to protect or defend themselves against

an imaginary enemy, and arm themselves with

weapons, thereby increasing their feelings of safety

and power. These factors, coupled with a nearabsolute distrust of everyone and their delusions and

hallucinations, make these people potentially

violent, unpredictable, and dangerous. What a

combination: under the influence, paranoid

schizophrenic, task directed, and distrustful of

police.

Some subjects who believe others intend to harm them may make a preemptive strike to stay safe.Others, like the Unabomber, may hear voices commanding them to harm others.

Certain delusional beliefs may compel individuals to commit crime that can escalate into

confrontations with law enforcement, e.g. hostage or barricade situations. The actions of these subjects

challenges law enforcements resourcefulness to prevent action of violence and possible confrontations.

When confronted with a person who exhibits unusual behavior, officers should initially focus on deescalating

the situation and the safety of those involved, rather than criminal responsibility. A criminal investigation

should not be the primary concern upon arrival.


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Early Warning Signs

Prior to committing acts of violence, many subjects suffering SMI provide clues to their illness in letters

written to government agencies, telephone calls, and personal visits. Russell Weston, the murderer of theU.S. Capitol police officers, drove to the Central Intelligence Agency headquarters from his home in Montana

to report the existence of a surveillance satellite and accuse governmental officials of outrageous

misconduct. The challenge for law enforcement is not to perceive these individuals as nuisances, but to

make an assessment of the level of their debilitation and conduct an intervention before violence occurs.

One method of assessment that has been successful is the New Orleans Police Department mode, in

which teams of mental health professionals respond to psychiatric emergencies and provide crisis

intervention and health evaluations. These teams respond to calls from patrol officers who have made initial

assessment of the psychiatric impairment. Comprised of volunteers working everyday between noon and

midnight, members of the unit are not sworn law enforcement officers, but have a limited commission that

empowers them to make involuntary psychiatric commitments whenever necessary. Deployed since 1983,

volunteers have sustained physical injury in only two cases. The program has been very effective in reducing

citizen complaints and lawsuits and saving New Orleans approximately $300,000 each year by accurately

diagnosing mental illnesses and making proper referrals.


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Law enforcement officers should conduct assessments of people who are thought to have a mental

disorder. This assessment should include the following:

Whether the person is organized and coherent, or is disorganized and unable to engage in goal-

oriented actions;

Whether the person remains fixed on one or more themes or explanations for their concerns that

involve blame for their problems, or if they are confused as to the natural and causes of his

delusions;

Whether the persons focus is on a particular person, as opposed to not having determine who or

what is responsible for their problems; Whether an action imperative has been developed, a plan generated because of the persons

perceptions that other alternatives have been exhausted. They now believe matters that have to

be taken into their own hands; and

Whether a time imperative exists, and a sense of urgency and desperation is communicated.

If any of the above behaviors are present, it should indicate to law enforcement that an intervention is

necessary to prevent violence, particular if the person has a history of violence, weapons access, substanceabuse, delusions, and hallucinations. Many of these individuals communicate with law enforcement for

years at a relative harmless level, providing humorous locker room anecdotes, and they rapidly escalate into

violent episodes, usually because of medication issues.


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In their FBI Law Enforcement Bulletinarticle, Understanding Subjects with Paranoid Schizophrenia,

Dr. Kris Mohandie, a police psychologist for LAPD, and James Duffy, an FBI agent assigned to the Behavioral

Sciences Unit, suggest intervention techniques useful to first responding or negotiating officers whendealing with a person who has a serious mental disorder.

From the beginning to the end of the exchange with the person, strive to show respect and treat

the person with dignity through verbal comments and physical actions. Maintain a professional

demeanor no matter how bizarre the persons delusions or hallucinations may seem.

Make a noticeable attempt to understand the context of the subjects comments. Tell the subject,

I understand what you are saying, but I cannot hear the voices. Can you tell me about them?

Avoid arguing about the subjects delusions while attempting to develop reality-based issues.

Telling the subject the belief of this delusion is foolish will damage your intervention.

Use active listening skills such as paraphrasing emotion labeling- I understand that you are upset at

your neighbor- and other I statements to show you identify with the subject.

Use suggestibility statements and empathy to attempt a behavioral exchange.

Allow the subject to vent frustration

Emotionally Disturbed Persons

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