Emotionally Disturbed Persons

This course is a general overview of Emotionally Disturbed Persons It is recommended that prior to starting the course that you expand the Adobe Presenter window in order assist you with reading the text on each individual slide.

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 in your 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

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, law enforcement. 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 the 1960s, continues unabated, forcing law enforcement officers to confront and mitigate situations involving potentially violent subjects.

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 of the 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.

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 defies diagnosis. 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.

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.

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 and intelligent 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 unsure they 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.

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 the difference 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 is asked 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.

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?

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 impact socialization 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.

What is meant by the term: dual diagnosis?

technology beliefs. The fact that a typical Several subtypes of schizophrenia exist, with the paranoid type being most common. paranoid schizophrenics thinking is coherent but is accompanied by delusions makes him, as Paranoid schizophrenia is characterized in the case of Kaczynski, potentially lethal. primarily by delusions or auditory Another, more recent example is Russell hallucinations, in the context of otherwise normal functioning and appearance. In other Weston, the man who shot two U.S. Capitol police officers to death on July 24, 1998. words, the paranoid schizophrenic does not stand out in a crowd. Compared to other forms Weston murdered Officers Jacob Chestnut and of schizophrenia, the thoughts of paranoid John Gibson inside the Capital building. His schizophrenic are coherent, and his delusions motivation for going to the Capitol was a generally revolved around an organized theme. delusion that a government satellite was spying on him, and the control for the satellite system For example, Ted Kaczynski, the Unibomber, was located on the first floor of the Capitol believed the power of society to control the building. Weston survived three bullet wounds individual was expanding rapidly, and if not and is awaiting trial on two counts of murdered. stopped, would lead to the end of individual liberty. Kaczynski also felt entitled to embark upon his bombing spree in service of his anti-

Systems of paranoid schizophrenia are delusional thoughts of a grandiose nature-such as Westons surveillance satellite suspicionsanxiety, 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 medications have 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.

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

Mood disorder is a term describing a variety of mental illnesses, which may be classified as psychotic in that they are serious mental illnesses, or neurotic in that they are minor in nature and usually short-lived. Mood disorders include bipolar 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.

Bi-polar disorder results in mood swings from maniaexaggerated feelings of well-being- to depression, generally with 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 wellbeing. During the manic phase, a subject sleeps less, is easily distracted, and tends to be more irritable. The subject may exhibit 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,

death of a loved one, or financial problems may and exhibit hopelessness. The subject will trigger a bi-polar episode. demonstrate persistent daytime sleepiness, Research indicates bi-polar disorders in the difficulty in concentration, loss of appetite, most treatable of the serious mental illnesses. diminished interest and pleasure in daily activities, and memory loss- amnesia. A person A combination of psychotherapy and medications enables many who suffer from biin the depressive phase is a suicide risk. The causes of bi-polar disorder, or manic- polar disorder to enjoy happy lives. The most common medication used in the treatment of depression, are unknown. However, certain factors have been identified that have a role in bi-polar disorder is lithium carbonate, which works to help balance neurotransmitters in the persons suffering from the illness. Heredity may contribute to bi-polar disorder, for it runs brain, reducing the swings from mania to within families and may be carried by a gene depression. Taking lithium without a physicians inherited from one to both parents. Chemical supervision, however, is dangerous. Side effects changes in the brains neurotransmitters have include delirium, confusion, seizures, coma, and been identified as a possible contributing factor even death in rare instances. 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,

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. The subject may exhibit poor temper control and excessively irresponsible behavior patterns. Delusions or false beliefs, and hallucinations may be present during the manic phase.

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. Major depression 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.

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

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

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 more than 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 classic examples. 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.

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 Fatal Attraction 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.

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 is turned 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.

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 people with 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.

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 (fear of 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.

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.

According to the National Institute of Mental Health, more than nineteen million Americans suffer from some type of anxiety disorder.

Many people having anxiety disorders are likely to experience depression, alcohol and/or drug abuse, or other mental disorders. Because of widespread lack of understanding and the stigma associated with these disorders, many victims suffer privately, as they are not diagnosed properly or are not receiving treatment proven successful through research.

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 to experience 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 event consists 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.

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 the three 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.

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 and family 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.

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, and moving 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 the fingers 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.

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 to phobias, 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.

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.

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

Panic Disorder is marked by the following. The symptoms of a panic attack include: 1. Racing heartbeat 2. Difficulty breathing 3. Paralyzing terror 4. Dizziness 5. Trembling 6. Sweating 7. Tingling in the fingers and toes 8. A feeling that death or insanity is imminent

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 unrational 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.

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 injury resulting 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, and increased agitation.

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.

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 include a general loss of cognitive abilities, such as reasoning, attention, concentration, and behavioral control. 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.

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 functioning occurring 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.

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.

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 near where 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 clumsily pulls 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.

When you ask the driver for proof of insurance and his drivers license, he greets you with a comical smile, 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 more effort than the usual DUI. Sure enough, when the driver gets out of his vehicle after several repeated requests, 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, you congratulate 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 with diabetes 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 Hayes of the Oregon State Police.

Hypoglycemia and Law Enforcement Officers ... What do they have in Common?
Lieutenant Chuck Hayes Oregon 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 of these 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.

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 sugar intake 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 MedAware" 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 enforcement officers 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 MedAware" 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.

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 medical condition, 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, has had 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.

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 placed Evans 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 NOT show 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.

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

As an officer whose duty it is to monitor the As hypoglycemia progresses, the following symptoms may appear. If they do, you can be public for possible lawbreakers, you cannot depend assured you do not have a DUI in custody but a upon diabetics in public to wear medical alert bracelets or even carry documents that identify them person suffering from the effects of low blood sugar: as having this disease. Also, some diabetics drink and Headaches drive. Some diabetics use illegal drugs as well. This Double vision further middies the water from the standpoint of an Inability to walk officer who feels he has a valid DUI arrest. 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, more informed 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 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-by who 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 into custody, 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 individual would be akin to putting out fire with gasoline.

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 possible effect) Possible belligerency or aggression when approached Frightened aspect, easily upset, unable to communicate Convulsions- these will result in the person thrashing about on the ground. This will not be hostile physical behavior, but uncontrollable spasms of the body and musculature.

What is epilepsy? It is a brain disorder that 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 energy that 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 suffering from 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.

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 the Americans 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.

How do you as a professional patrol officer manage a situation such as has been described? Consider the following points: 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.

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 you 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 or curbing. 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 and confused. 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 medication for the treatment of Epilepsy, including Klonopin, Tranxene, Depokote, Diamox, and up to a dozen more.

If you must take an epileptic into custody, arrangements need to be made to secure medication. Missing prescribed dosages 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 successfully argued 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 how hypoglycemia 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.

Involuntary Commitment Most states have given law enforcement officers, medical physicians, and psychiatric professionals 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 a snowstorm, 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.

Criminal Acts Since the Roman Empire, civilizations have recognized certain persons to be exempt from criminal 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 mental defect, 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 of psychotherapy 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.

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 of irresistible 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.

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 by reason 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 mental incapacity. 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.

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 the verdict, 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 in insanity 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.

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 Andrew Goldstein 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 Theodore Kaczynski was diagnosed as a associated with persons suffering from serious paranoid schizophrenic, as well as Russell Weston. mental illnesses (SMI) is that their behavior is Kaczynski, otherwise known as the Unabomber, unpredictable. They do not live in the world most of transported packages containing bombs to postal us do, where the force of law has an affect on a service offices around the West, hoping to evade persons conduct. detection by origin. Did any law enforcement officer The character played by Jack Nicholson in the on patrol duty stop him for a vehicle equipment movie As Good As it Gets is obsessive-compulsive, violation? Russell Weston, the murderer of two U.S. obnoxious, and rude, but not a danger to law Capitol police officer, traveled from his parents enforcement. Kaczynski, Weston, and Goldstein home in Illinois to Washington, D.C., to locate and were a danger to law enforcement, and continue to destroy the surveillance satellite controls that he was be correctional officers at the prisons in which they convicted were on the first floor of the Capitol. are confined. This section will provide suggestions for police response to calls involving persons with mental disorders.

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 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 near absolute 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.

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 the U.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.

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 goaloriented 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, substance abuse, 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.

In their FBI Law Enforcement Bulletin article, 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 when dealing 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 frustrations. These may take the form of mistrust of the officer, which should be countered with statements paraphrasing the subjects concerns and assuring him the officer is different from others who, in the past, have ridiculed, demeaned, or used violence on the subject.

 Be respectful or the subjects personal space. Do not crowd or violate this space. Be mindful of spatial limits; the subjects personal space may be much larger than you expect it to be. If rapport appears to be developing, use terms like us and we instead of you and me. Vitally important to your intervention and resolution is the fulfillment of any promises you make to the subject. Remember, another officer may one day be in the same position you are with this subject. A broken promise on your part may damage the future officers chances for a successful, peaceful resolution. Use caution when a family member or other acquaintance of the subject expresses a desire to assist in the intervention/negotiation. This third party may have some previous negative interactions with eh subject and aggravate the situation.

Requirements for involuntary commitment vary from state to state, but they generally require a mental condition that causes a person to be a danger to himself or others, or a condition of grave disablement. Circumstances suggesting these conditions would be the following: Danger to himself: the subject has attempted suicide. Danger to others: the subject has assaulted another person. Gravely disabled: the subject demonstrates an inability to meet his own physical needs, such as food, clothing, and shelter. Officers should realize their state requirements for involuntary commitments must be viewed as narrowly as criminal codes are: the elements of the section authorizing involuntary commitments are specific. When investigating a robbery, for instance, the circumstances surrounding the taking of anothers property from his person by the use of implied or actual force is explicit. (A guy with a gun took my money against my will.) Unfortunately, making determinations of grave disablement are not so clear when deciding whether to involuntary commit a person. Due to the lack of emphasis on this subject in basic academies, many young officers have an inaccurate opinion of actions of a subject that constitute grave disablement. (Do you hear what this guy is saying? He must be crazy!) A person who appears to be crazy may not meet the definition of gravely disabled. If you are unsure, consult a mental health professional for guidance.

Incarceration of the mentally ill subject may seem to be a waste of the resources of the criminal justice system, but it should be reserved for the last resort cases. If there is a medical facility available and the subject falls under the involuntary commitment statute-danger to self or others, or gravely disabled-use that option. If criminal custody is necessary to resolve an otherwise dangerous situation peacefully, take the subject into custody. If neither of these options applies to the situation at hand, officers may be forced to turn away and leave, hoping the situation resolves itself. There is no easy solution for all situations, particularly those that involve the emotionally disturbed. When your family, friends, and acquaintances say, I couldnt do your job, these are the times to which they refer.

Final Exam
You may now take the final exam. There is no time limit and you have an unlimited amount of attempts to pass the exam. Once you pass the exam you can proceed to the last slide in order to print off your certificate of completion.

Developmental disability was historically known by what other name? A) Schizophrenia B) Alzheimer's Disease C) Mental retardation D) Down's Syndrome
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Persons with developmental disability are usually suspicious and untrusting, and are often unwilling to speak to law enforcement officers. A) True B) False

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Which of the following are symptoms of schizophrenia? A) Delusions B) Hallucinations C) Catatonic behavior D) All of the above are correct
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A majority of young adults afflicted with schizophrenia are male. A) True B) False

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Which of the following is the most treatable of the serious mental illnesses? A) Bi-polar disorder B) Paranoid schizophrenia C) Phobias D) Major depression
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An antisocial personality disorder is apparent by what age? A) 13 B) 15 C) 17 D) 19

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Because of the nature of the events causing posttraumatic stress disorder, men are more likely to experience it than women. A) True B) False

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What is an action imperative?

A) A plan generated because of a perception that alternatives have been exhaused. B) A tactical plan for intervening in a hostage/barricade situation C) A mission statement reflected by department policy D) None of the above are correct
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Which of the following is NOT a symptom of low blood sugar? A) Pale face B) Dizziness C) Confusion/uncooperative behavior D) Verbal hilarity
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The symptoms of a hypoglycemic driver closely mimic the actions of a person intoxicated by alcohol. A) True B) False

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The following symptoms are indicative of an epileptic seizure? A) Unreasponsiveness to inquiries B) Beligerency/Aggression C) Inability to communicate D) All of the above are correct
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An epileptic seizure is essentially uncontrolled electrical energy surging through the brain. A) True B) False

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The danger of the emotionally disturbed person to law enforcement is his unpredictability. A) True B) False

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When intervening with a seriously mentally ill subject, the person's personal space is an important factor. A) True B) False

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Involuntary psychiatric commitments usually require which of the following? A) Danger to himself B) Dangers to others C) Gravely disabled D) All of the above are correct
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Final Quiz
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