You see them on the street every day. But if you look past their rags and vices, can you determine the real problem?
For the law enforcement community, calls for service involving the mentally ill have increased dramatically over the past 10 years. This increase is a product of numerous factors, such as the closing down of large state mental hospitals, reductions in insurance coverage and reductions in funding for mental health services. Because of this increased exposure between police and mental patients, police must become more sophisticated in their approach to the mentally ill (Wellborn, 1999).
Help on the Street
The New Orleans Police Department has dealt with disturbances involving the mentally ill through creation of its Crisis Unit and the use of mental health clinicians as advisers. The Crisis Unit, manned by mental health technicians, provides the department with a team of specially trained civilians who have years of experience with the mentally ill. The NOPD has also increased academy training in this area, using these same mental health clinicians as instructors.
It is very possible that the reduction in SWAT rolls (from 26 in 1995 to nine in 1998) is due to these efforts. Subjects successfully removed to a hospital by the Crisis Unit or a district unit do not become SWAT rolls.
The purpose of diagnosing the mentally ill is not only to match the proper treatment with the correct disorder, but to predict behavior. It is this second goal that can be invaluable to law enforcement officers in the field.
The NOPD, through its SWAT and Crisis Team, has established simple guidelines for field diagnosis to help the on-site SWAT commanders, negotiators, officers and crisis technicians make accurate predictions of a subject's behavior. This helps to establish safer, more effective approaches and procedures.
Diagnosing the mentally ill remains an arduous task, no matter what the setting. But since 1980, due to major advancements, diagnoses have become more accurate, reliable and useful in predicting behaviors (Maxman and Ward, et al, 1995).
A review of SWAT rolls since 1994 shows that the majority of calls for service can be narrowed down to three major diagnostic categories:
- Schizophrenia, a severe, chemically based thought disorder, is described by the Diagnostic and Statistical Manual IV (DSM-IV) as "a set of behaviors that include delusions, hallucinations, disorganized speech and grossly disorganized or catatonic behaviors."
- Bipolar disorder is described in the DSM IV as evidenced by "distinct periods of abnormally and persistently elevated, expansive or irritable mood." During this period, according to the manual, the subject will be more talkative than usual, exhibit inflated self-esteem or grandiosity, decreased need for sleep, flight of ideas, distractibility and excessive goal-directed activities that have negative consequences because they are very quick to anger.
- Personality disorders, on the other hand, are ingrained, enduring patterns of behaviors, feelings and thoughts. Typically, a subject with personality disorder will be functioning at a higher level than someone with either schizophrenia or bipolar disorder. For instance, most individuals with personality disorders do not require or benefit from hospitalization. In the strictest sense, even the most severe personality disorders are not psychotic. They may be very hostile and dangerous, even suicidal or homicidal, but they are not suffering from hallucinations or complete breaks with reality. However, because these individuals do not seem to benefit from medications or therapy, they continue to come in contact with the police. Because of their high level of functioning and low reliance on medications, personality disorders may be difficult to identify.
Police Interaction and Field Diagnosis
The easiest way to diagnose a subject in the field is to find out if the subject is on any medications. This can be done by asking the subject or family members what medications the subject is taking. Like any illness, certain disorders are treated with particular medications. Common medications used to treat schizophrenia are Haldol, Resperidol, Clozoril, Prolixin and Chlorpromazine. Prolixin and Haldol can be injected.