U.N.T Health Science Center P.D.

To refresh Officers awareness of how to deal with and get help for subjects having a mental disorder episode resulting in a crisis situation that must be resolved.

UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER POLICE DEPARTMENT GENERAL ORDER: Number 301.03 EFFECTIVE DATE: 02/10/2005SUBJECT: Mentally Ill PersonsREVISION DATE: 04/13/2010 Approved: Chief Gary C. Gailliard AMENDS/SUPERCEDES: SOP 301.03CALEA: 1.1.3, 1.2.4e, 41.2.7a-e, 74.2.1 REVIEW BY: Odd years I. POLICY It is the policy of the University of North Texas Health Science Center Police Department that officers shall adhere to the Texas Health and Safety Code with dealing with mentally ill persons. The Departments primary concern shall be to protect the mentally ill person and others. Execution of this process is civil in nature and shall be performed by sworn officers only. [74.2.1] II. DEFINITIONS [41.2.7a] Mental Illness Mental illness as defined in the Mental Health Code does not include epilepsy, senility, alcoholism, chemical dependency, or mental deficiency. However, no person who is mentally ill shall be barred from admission or commitment to a mental health facility because he or she is also suffering one of these conditions. For purposes of this General Order, a person is deemed to be mentally ill if they are suffering from an illness that: 1. substantially impairs a persons thoughts, perception of reality, emotional process, or judgment; or 2. grossly impairs behavior as demonstrated by recent disturbed behavior. III. RESPONSE TO MENTALLY ILL PERSONS A. Non-violent Persons [1.1.3] mentally ill persons who present no substantial and imminent risk of serious harm to self or others may be directed to one of the following facilities (Communications will keep an updated list of phone numbers): [41.2.7b] 1. John Peter Smith Hospital; or 2. Tarrant County MHMR. B. Apprehension by Peace Officer without Warrant (Health & Safety Code Sect. 573.001) 1. A peace officer, without a warrant, may take a person into custody if the officer has reason to believe and does believe that: [41.2.7a] a. the person is mentally ill;

b. because of that mental illness there is a substantial risk of serious harm to the person or to others unless the person is immediately restrained; and i. A substantial risk of serious harm to the person or others under Section 573.001 may be demonstrated by: (a) the persons behavior; or (b) evidence of severe emotional distress and deterioration in the persons mental condition to the extent that the person cannot remain at liberty. c. believes that there is not sufficient time to obtain a warrant before taking the person into custody. 2. The peace officer may form the belief that the person meets the criteria for apprehension: a. from a representation of a credible person; or b. on the basis of the conduct of the apprehended person or the circumstances under which the apprehended person is found. 3. A peace officer who takes a person into custody under Sect. 573.001 shall immediately transport the apprehended person to: a. the nearest appropriate inpatient mental health facility; or b. a mental health facility deemed suitable by the local mental health authority, if an appropriate inpatient mental health facility is not available. c. A jail or similar detention facility may not be deemed suitable except in an extreme emergency. d. A person detained in a jail or a nonmedical facility shall be kept separate from any person who is charged with or convicted of a crime. 4. A peace officer shall immediately file an application for detention after transporting a person to a facility under Section 573.001. The application for detention must contain: a. a statement that the officer has reason to believe and does believe that the person evidences mental illness; b. a statement that the officer has reason to believe and does believe that the person evidences a substantial risk of serious harm to self or others; c. a specific description of the risk of harm; d. a statement that the officer has reason to believe and does believe that the risk of harm is imminent unless the person is immediately restrained; e. a statement that the officers beliefs are derived from specific recent behavior, overt acts, attempts, or threats that were observed by or reliably reported to the officer; f. a detailed description of the specific behavior, acts, attempts, or threats; and g. the name and relationship to the apprehended person of any person who reported or observed the behavior, acts, attempts, or threats. C. Responding to an incident in which a mentally person is involved requires tact, patience, and understanding on the part of the police officer. Incidents arising from activities of a mentally ill person may be extremely dangerous to officers, bystanders, or the mentally ill person. The degree to which an officer can intervene in situations involving a mentally ill

person is limited by law, but the officer must respond to take lawful action in order to: 1. protect the public from harm which may be caused by the mentally ill person; 2. protect the mentally ill person from harm which may be caused by others or himself; 3. provide a stabilizing force as to any conflict which may arise from the actions of the mentally ill person; and 4. aid in acquiring proper medical attention for the mentally ill person. D. Two officers shall be dispatched and assigned to all calls investigating a mentally ill person, when possible. At the discretion of a single responding officer, additional assistance from the Fort Worth Police Department may be requested. E. In all cases, wherein officers believe that an emergency commitment should be conducted, a command staff member shall be contacted immediately. 1. Officers shall interview the complainant and all available witnesses. 2. If, after conducting interviews, investigating officers determine that an emergency commitment is necessary, they shall make an effort to then contact the subject that is to be committed. 3. If the subject can be located and taken into custody in a public place, this should be done without delay. 4. If the subject is not in a public place but is in their private residence and is not posing a threat to self or others, forced entry will not be made into the residence without a warrant. This does not preclude officers from making a forcible entry in an emergency situation where the life of the subject or others is in immediate danger. [1.2.4e] IV. INTERVIEWS, INTERROGATIONS AND ARRESTS [41.2.7c] A. Officers who find it necessary to interview or interrogate a person with a mental illness shall follow all laws and procedures that would apply to any other interview or interrogation. Officers shall be particularly alert for officer safety issues since a person with a mental illness may react unusually. When possible, two officers should be present during the interview. B. Officers shall not interrogate a person who exhibits a mental illness to the point that the officer believes a mental commitment would be warranted or if a magistrate has issued a mental health warrant for the person since the person may not be able to knowingly waive their constitutional rights. C. Officers shall not arrest a person for criminal charges if the person exhibits a mental illness to the point that the officer believes a mental commitment would be warranted or if a magistrate has issued a mental health warrant for the person. The officer shall take the person into custody for the mental commitment or the mental warrant. 1. If the mental health facility determines that a warrantless mental commitment is not necessary, the person may be arrested for criminal charges if any are present. 2. If the mental health facility determines that a warrantless mental commitment is necessary or if the person is taken into custody for a mental warrant, any criminal charges present shall be filed at large.

V.TRAINING A. Recruit officers will receive training on handling mentally ill persons during the Field Training Program. [41.2.7d] B. All officers will complete refresher training on handling mentally ill persons at least every three years. Written documentation verifying the refresher training will be maintained in their personnel files. [41.2.7e]

Formulate a working mind set for recognizing the difference between a subject in Crisis and how to handle the situation as opposed to a subject with a Mental Illness, is off their meds and how to handle this totally different situation.

Sudden, unexpected events that may overwhelm an individuals ability to respond resiliently. Extreme critical incidents may result in traumatic stressors, a personal crisis, or even Post Traumatic Stress Disorder (PTSD).

A temporary state of upset and disorganization, characterized by an inability to cope with a particular situation using customary methods of problem solving, and by the potential for a radically positive or negative outcome.

When a person faces an obstacle to important lifelong goals that is, for a time, insurmountable through the utilization of customary methods of problem solving, a period of disorganization ensues, a period of upset, during which many abortive attempts at solutions are made. (Caplan)

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A crisis occurs when a stressful life event overwhelms a persons ability to cope effectively in the face of a perceived challenge or threat. (Flannery)

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Identify behaviors that detect an individual in crisis

Physical Emotional Psychological

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Discuss examples of personal experiences pertaining to situations you have had with people in Crisis. Such as: Patient in Clinic upset because staff will not give them a refill on a prescription.

Is this person necessarily Mentally Ill?

How do these crisis behaviors differ if there is a preexisting mental health issue?

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Articulate the technique of Crisis Intervention Crisis Intervention techniques assist individuals in returning to a level of functioning that enables them to gain some sense of behavioral control.

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The sooner the better

Intervention by first responders tends to greatly reduce/prevent many crisis symptoms A front-line officer has one critical qualification that a qualified practitioner does notthey are there. (Hogan)

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Provide with sense of security and safety by:

Allowing them to ventilate

Validate
Give honest predictions Prepare for situational outcome
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Defining the problem. ( if Criminal Take to jail ) Ensuring client safety. Providing support. Refer to MHMR / JPS etc. ) Examine alternatives. Making Plans. ( Ours and theirs ) Obtaining commitment. (From the person and the family)

Stabilization, an interruption in crisis escalation behavior, identification of any risk of harm to themselves and others

Reduction in the acute signs of distress

Restore independent functioning or, if needed, referral to higher level of care for assessment/evaluation

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A successful crisis intervention model is comprehensive enough to be implemented by those with little training and flexible enough to be used by those that are trained. As law enforcement officers crisis intervention techniques are used to alleviate immediate symptoms only, followed by a referral to qualified help as appropriate.

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Primary tool Ventilation

Do not take risks

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Identification
Problem areas Issues needed addressing

Questioning Process
Narrow options List alternatives Best solution

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Incorporate the technique of Crisis Intervention into Officer Safety. Keep in mind that you are making a Legal decision not a Medical diagnosis.

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Illness, disease, or condition that either substantially impacts a persons thought, perception of reality, emotional process, or judgment, or grossly impairs a persons behavior, as manifested by recent disturbance behavior.

HSC 573.001 Apprehension by a Peace Officer without a Warrant. a. A Peace Officer as defined per CCP 2.12 .. b. who has reason (singular 1 reason) to believe and does believe.. c. the person to be detained is mentally ill and because of such mental illness represents a substantial risk of serious harm d. to himself or others e. unless immediately restrained.. f. and there is not time to obtain a warrant.. g. the Police Officer shall immediately transport the person.. h. to a facility deemed suitable by local MH Authority and file an Application for Detention.

The following are but a few of the laws allowing ( and in some cases REQUIRING ) Officer to take the actions he deems necessary to handle the situation.

P.C. 9.21 Public Duty P.C. 9.22 Necessity P.C. 9.31 Self Defense P.C. 9.32 Deadly Force in Defense of Person (3rd. Party) P.C. 9.34 Protection of Life or Health P.C. 9.51 Arrest and Search

1. CCP 2.13 - Duty and Powers 2. CCP 6.05 Duty of Peace Officer as to Threats 3. CCP 6.06 Peace Officer to Prevent Injury

A person May truly be mentally ill, but that does not Always negate his legal culpability for his actions. When taking a mentally ill person into custody do not always assume that he has to be transported to a mental facility at that time. He may be taken to jail and then referred from there to get the help that he needs. If you automatically apply to detain a person, who has committed a crime, to a mental facility you may lose all possibility of filing a case later.

Questions about what we have covered and/or Discuss examples of situations you have had with people with a Mental Illness.

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The essential difference between suspect encounter trainingand how to approach the mentally ill is the need to be non-confrontationalto shift gearsopposed to the way officers are routinely expected to control conflict (Police Magazine)

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Critique intervention techniques for their proactive abilities

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Proactive Interventions: Address needs prior to a problem or action Reactive Intervention: Already escalated behavior

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Apply knowledge of cultural background to crisis behavior

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but crisis response varies. Consider: How culture impacts ones perspective of trauma Perception or interpretation of a threats meaning Cultures nature of expression

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Compile general categories of the most prominent mental disorders and the mental illnesses that populate these categories

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Most common:

Depression Bipolar Disorder

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Most Common:

Organic Brain Disorders Pain Syndromes Drug Withdrawal

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Most Common:

Panic Attacks Phobias Obsessive-Compulsive Disorder Post Traumatic Stress Disorder (PTSD)

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Most Common:

Alzheimers Disease

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Most common:

Stimulants Alcohol Heroin

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Most Common:

Paranoid Antisocial Borderline

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Develop an increased understanding of the legal process; evaluation and techniques for appropriateness of apprehension

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Analyze the law enforcement decision-making process utilizing the concept of discretion

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Dependent on:

Severity Resources

Major Areas of Disposition:

Emergency Psychiatric Apprehension Informal Disposition

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Appraise the legalities and ethical considerations of consumer rights

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Competency Age Criminal Residency Court Orders Orders of Protective Custody

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Illustrate the reasoning of arresting to manage

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Exceeds community tolerance Person will continue to cause problem Behavior not severe enough Too dangerous Rejected for treatment

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Give examples of the types of mentally ill consumers that are handled in an informal manner by law enforcement

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Neighborhood Characters Troublemakers Quiet Consumers

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Compile a list of mental health referrals/resources in the community. 1. JPS 2. Tarrant Co. MHMR

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