Law enforcement interaction with the dangerously mentally ill

For years now the controversial debate has raged on regarding people who suffer from mental illness and if they pose a significant threat to the general public, law enforcement and to public safety.  The answer is, ‘No, they don’t.’  Statistically if you look at the most recent data presented it does show that people who suffer from mental illness are no more prone to be violent then people in the general population.  However, the major distinction is when people who do suffer from mental illness demonstrate particular behaviors then the answer is a definitive Yes, they are more violent. 

For years, not only as a police trainer in Crisis Intervention Techniques (CIT), but as a hostage negotiator, patrol officer, and later as a Psychologist who specialized in crisis intervention, I responded to virtually thousands of incidents in which my interactions with the severely mentally ill were not dangerous.  Conversely there were also many more that did involve people who were mentally ill that were extremely dangerous.  They were dangerous due to a number of conditions all of which I would say were not only controlled by some form of mental illness, but also with accompanying factor of substance abuse — this condition is known by clinicians as a Co-Occurring Disorder. 

In fact, never during my 30 years of abovementioned experience in law enforcement, did I ever encounter any subject in a mental health crisis who was not under the influence of some chemical.  Never. 

A Perfect Storm Brewing
The combinations of substances they were under the influence of are endless.  Then if you add a Traumatic Brain Injury (TBI) and Mental Illness combined with Psychotropic medications and then add street drugs — you have a major problem on your hands, which unfortunately can end in tragedy. 

I did begin to notice a troubling trend when I was working in the Crisis Management Unit where it appeared that increasingly not only my own department’s patrol officers, but other officers throughout the state, were having more lethal confrontations with the severely mentally ill.  In fact I started to conduct research and found that my suspicions weren’t wrong.  According to Dr. E. Fuller Torrey, of the Treatment Advocacy Center, when the (Severely Mentally Ill) SMI demonstrates certain conditions then they are indeed dangerous.  He lists 7 indicators that when present can be precursors to violence.  I will be referring to those indicators after looking at a case that was going on in Northern California with a SMI individual named Aaron Bassler who according to his father had undiagnosed Mental Illness.  Tragically since I began writing this article there have been many more.

The Case of Aaron Bassler
The most recent case that comes to mind — for which I was interviewed on the local TV news — was Aaron Bassler in Mendocino County.  Bassler was unofficially diagnosed with a mental illness by his father, James, who recounted stories of his gradual psychological demise since the age of 18 and many of his behaviors.  To make matters worse Bassler got addicted to Methamphetamine and, if he wasn’t paranoid and delusional enough, the Methamphetamine addiction only served to exacerbate the intensity of his Mental Illness.  Aaron Bassler fits the “profile” of dangerousness exactly according to what Dr. Torrey describes.  At the time of this article I was not aware of what his family or friends had done on his behalf to obtain Mental Health care or intervention for him.  Aaron Bassler shot and killed Jere Melo, a former mayor, and Matthew Coleman, a naturalist, when they came upon Bassler’s Opium farm.

According to Dr. Torrey there is a condition that exists with many people who have Traumatic Brain Injuries (TBIs) and SMI called Anosognosia; or more simply put, an inability to have insight into their illness.  Under the conditions of Mental Illness the person may be exhibiting Delusions and Hallucinations which to them they are very real.  So real in fact that when you come upon them on the street they are convinced that God commanded them to kill someone, or cut off a limb, or kill a child. 

These Hallucinations are called “Command Hallucinations” where an alternate power, often times they believe it is God, is commanding them to commit some heinous act, which to them makes complete sense.  According to Aaron Bassler’s father his son felt that Martians were ordering him to commit certain acts.  Regardless of the commands being given they are most often so intense that the result is often of tragic proportions. 

After the Columbine High School tragedy, although effective in many types of criminal situations, SWAT teams are limited in their response times to Active Shooter types of situations.  The average Active Shooter situation is over in about seven minutes.  As I began to study these conditions I thought that based on many of the mentally ill calls where violence had occurred it made sense that police agencies should adopt a similar response to mentally ill crisis calls.  For many agencies this can create a logistical problem based on available resources, related to manpower and equipment. 

If it is practical to do so the responding officers should “stage” momentarily until the necessary manpower arrives then they can confront the potential threat more safely.  What this clearly means is that some amount of training would be necessary to take on this challenge which is becoming more commonplace throughout the U.S. 

Regardless, it would take far less time than what is necessary for the average SWAT callout.  Part of the team would consist of a less than lethal weapon such as a stun bag and/or TASER, another one or two officer’s on gun — service weapon or other alternative — and then still another officer who would be the CIT officer.  With the dwindling resources of many departments I acknowledge that having this many officers on a call of this magnitude may be remote at best.  The worst case scenario is when the officer’s arrive someone is being assaulted and the officer’s have to take immediate action to save that person’s life, or their own, to prevent any further violence.

Finally, First and Foremost
Obviously officer safety is always first and foremost with any call and if it is a life and death situation upon the officer’s arrival then staging can be a luxury.  However, if at all possible by momentarily staging and having a tactical plan in place it can reduce the likelihood of people being seriously injured or killed. I highly recommend that if at all possible the responding officer’s, if they have been to a particular residence multiple times, that they make a sketch of that residence.

I previously mentioned Dr. Torrey’s research based on mentally ill crisis calls throughout the U.S. and what he has developed.  I will go into more detail here in regard to what those conditions are and the precursors to violence.  Dr. Torrey has conducted years of research and his findings, although they may be new to the general public, are facts that we have known for years in law enforcement as we have confronted the severely mentally ill time and again who were dangerous. 

The seven conditions listed below have been the predominant factors with people who suffer from mental illness and are prone to violence. If these conditions exist there is a strong likelihood that person will be violent in the future.  The truly tragic situations are ones where the police are called due to the violence against loved ones such as family members.  Many times I have asked family members this critical question: “Have you in the past, or do you presently sleep with your bedroom door locked at night?” Obviously if the answer is yes to this question then there is a potential for violence.  As emotionally painful as that question may be to answer there is little doubt in my mind about the potential for violence regardless whether the person is a loved one or not. 

Here is Dr. Torrey’s potential-for-violence checklist:

1.) Past history of violence — the individual’s past history of violence is the most important predicator of future violence among all people-whether mentally ill or not
2.)  Substance abuse — Typically alcohol, amphetamines, cocaine, and PCP can exacerbate violent tendencies
3.) Anosognosia with medication non-compliance — those individuals who are not aware of their illness and refuse to take medication.
4.) Antisocial Personality Disorder — The combination of severe psychiatric disorder in an individual with these personality characteristic leads, as would be expected to more frequent incarceration and violent behavior.
5.) Paranoid Symptoms — SMI individuals who have fixed false beliefs due to paranoid symptoms can become extremely violent
6.) Neurological Impairment — Those who suffer from neurological impairment have been found to be more violent.
7.) Gender — Typically men account for 85-90 percent of violent behavior throughout the world; women for only 10-15 percent. Women with severe psychiatric disorders are the exception to this rule. Many studies have shown that women with psychosis are equally assaultive as men. 

If some or all of these conditions exist then the role of the call-taker and/or police dispatcher becomes even more critical.  Based purely on my anecdotal experience on the street I completely agree with Dr. Torrey’s assessment.  If law enforcement is going to reduce the amount of injuries or deaths related to mental illness, having these signs in mind may be the key to enhanced officer safety as well as safety of the SMI individual.

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