Violence And The Mentally Ill

Violence And The Mentally Ill

Many people believe that all violent, sadistic and dangerous people in our society are mentally ill, thus coming to the conclusion that mentally ill people are dangerous.

The truth is, people with mental illnesses are no more likely to be violent than anyone else. Only about 3% to 5% of violent acts can be attributed to individuals with a serious mental illness.

Many movies depict violent characters as being mentally ill and often the news continuously replays stories of the rare occurrences when someone with a mental illness acted out in violence. We start to associate mental illness with violence.

One of society’s biggest fears are acts of violence that are senseless, random, unprovoked and unpredictable and thanks to the media, we often associate this with mental illness. We somehow take more comfort in knowing a man was stabbed to death walking down the street during a robbery than if he was stabbed to death walking down the street for no apparent reason.

This stigmatization is just one of many things people with a mental illness face. I have often heard people say they were afraid of a suicidal individual or someone who self-injured themselves: “If they would do that to themselves, what do you think they would do to me?” The fact is, most suicidal and self-harming individuals would rather hurt themselves before they would hurt anyone else.

While it is rare, people with mental illnesses, just like anyone else in the general population, can act out in violence. Individuals who have a substance abuse disorder alone are much more likely to become violent than the general public, including those individuals who have a mental illness alone or an associated substance abuse disorder.

However, when it comes to dealing with mental illness, individuals who abuse substances, have a co-occurring mental disorder and are non-compliant with their medication are at higher risk of committing violence.

Even with the combination of substance abuse and non-medication compliance, the general public are not at high risk of being attacked by someone with a mental illness. People who are in close relationship with these individuals such as family and friends, especially if they have troubled relationships and/or are financial dependence are more likely to become victims of violence.

Some of the most predictive variables for violence untreated psychotic symptoms to include suspicion/paranoia, hostility, severe hallucinations and poor insight into their delusions and the overall mental illness.

A Tragic Example

I recently spoke to a young man who appears to have had his first psychotic episode, at-least as far as he knows. He’s in his early twenties and at the prime age for the onset of many psychiatric disorders including schizophrenia.

One day last week he was home watching YouTube videos and became paranoid that someone was going to come and rape his mother. Alarmed and frightened, he armed himself, first with a shotgun, but discovering the shot gun was not operational, he armed himself with a handgun. He proceeded to guard the house from what he thought were real threats to his mother, some mysterious intruder/rapist. What happened next rocked the whole community.

At some point, his mother came downstairs and he shot her twice in the head. He then shot their dog twice in the head as well before setting the house on fire and rowing a boat across a lake. According to the people who were at that house, he came out of the boat shirtless, walking slowly and looking like Jason from Friday the 13th.  He was chased away by the homeowner and ran off into the woods. Soon after he turned himself into authorities and the totality of his behavior was brought to light. When the authorities went to his burned down home they found the charred body of his mother and their dog.

I have worked with a lot of individuals who were experiencing their first psychotic episodes, but I have never spoken to someone so young that went from apparently “normal” to acting out so violently in response to paranoid delusions and hallucinations.

Most individuals, who develop a psychotic disorder or any mental illness for the most part, start off with small signs and symptoms that if left untreated, can lead to worsening symptoms and rarely horrible things like suicide or violence. Usually this takes several months to years to decompensate to this level. It’s very rare for someone’s first psychotic episode to turn out so violent, causing death and destruction.

Thankfully, situations like that are extremely rare.

Warning Signs

Some warning signs to look out for when dealing with anyone, not just someone with a mental illness include:

  • Pacing
  • Psychomotor Agitation (i.e., leg bouncing rapidly)
  • Combative posturing (i.e., fist balled up)
  • Paranoid or threatening remarks
  • Irritability
  • Talking to self in language that includes violence or paranoia

If you see these behaviors, it may or may not mean that the person has a mental illness, but these are signs that someone is possibly in a volatile state. Stay calm, give them space, avoid intimidating eye contact.

If you have to deal with the person because they are a friend, family member or even a customer in your place of business, use a calm/soothing voice, helpful attitude, avoid loud noises, remove potentially dangerous objects and attempt to give positive reinforcement until you can either get help or get out of the situation.

We all probably know someone with a mental health problem and many of us don’t even know it because most individuals with mental health problems are productive members of our community.

When we destigmatize the violence associated with being mentally ill, we make it easier for those individuals to seek treatment and to talk about it with their family and friends instead of hiding it out of fear or shame.

123 Mentally Ill People Killed By Police So Far This Year

In the first six months of the year, nationwide police have shot and killed 462 people. Out of those 462 people, 123 of them were in the midst of a mental or emotional crisis according to a Washington post analysis. c07_jd_02jul_shootinggraphic-640x230

To be fair, most of these individuals were armed, but mostly with weapons less lethal than a firearm such as toy guns, knives or a machete. Only 3 officers have been killed by a knife or machete in the past decade according to the FBI.

Below I have included a video of a mentally ill man shot and killed by police only seconds after they arrive on the scene. The mans mother called because her mentally ill son was acting erratic. He was armed with a screw driver. You can watch the video with caution and judge for yourself.

The police who responded weren’t usually called to respond to a crime, but were called by concerned family members, bystanders and neighbors because a person was acting erratically. 50 of them were outright threatening suicide.

In more than half of those killings, the officers who responded did not have adequate training in dealing with persons with a mental illness. Most of them actually responded with tactics that escalated the already volatile situation.

Yelling and pointing guns at a person with a mental illness is like pouring gasoline on a fire. A person in the middle of a mental crisis is not going to respond like someone else would, they have too much going on in their heads.

Almost a dozen of these individuals killed by the police were military veterans, many who suffered from post-traumatic stress disorder (PTSD). One was even a former California Highway patrolman who was forced into retirement after a severe beating during a traffic stop lift him suffering from depression and PTSD.

Forty five of these cases involved someone who was seeking medical treatment or had been turned away from medical treatment.

John Guillory, a 32 year old father of two had worked as a contractor in Afghanistan. He was having what his wife called a mental health emergency. He went to the Veterans Affairs hospital in Arizona, but was turned away because they were too busy. He went home and called 911 twice, hanging up both times. When the police showed up to his house he pulled a gun out of his waistband saying, “I bet I can outdraw you”. The police shot him six times killing him.

Suicide by cop is real thing and accounts for a number of these killings.

One individual in San Francisco who pulled a BB gun out on a group of officers and was shot and killed, had left a message on his phone telling the officers “You did nothing wrong. You ended the life of a man who was too much of a coward to do it himself.”

On average, police have killed someone who was mentally ill every 36 hours so far this year. Police are starting to acknowledge the lack of effective tools and trainings they have in dealing with this population. Without large-scale retraining and a nationwide increase in mental health services, these deadly encounters will continue.

While officers on average spend 60 hours in firearm training, they only spend 8 hours on learning to de-escalate a tense situation and 8 hours on handling mentally ill individuals. Otherwise they use tactics that are counterproductive and increase the risk of violence when they encounter these individuals. Most of these individuals end up dead within minutes of encountering the police.

Some of these killings probably couldn’t have been avoided. In some of the situations the individuals had guns pointed at the police. However, a large number of these individuals could still be alive if the officers had proper crisis intervention training.

TRAINING OFFICERS TO DEAL WITH MENTAL ILLNESS

istock_000005236471largeThe other day my girlfriend was looking at a video on Facebook. I wasn’t looking at the video, but what I heard was a lot of shouting and then finally multiple gunshots. It was obviously a violent video and I didn’t want to see it.

The next day I saw that she had shared the video on her page which to me meant that whatever the video was about, she felt either passionate about it or angered by it so I decided to watch it. What I saw was an unarmed man, surrounded by five overly aggressive, untrained police officers who end up shooting him.

You can find the video at the end of this post. Warning, some my find it graphic and hard to watch.

During my research for this post, Los Angeles police leaders insist that all of the officers involved in this altercation had some training on dealing with the mentally ill, with some having as little as 11 hours of training. They went as far as they say that the skills learned in the training were used during this encounter, which in some part may be true, but when I see officers taking violent punches at a person and being overly aggressive with little control or coordination, it’s hard for me to see that any crisis intervention techniques were appropriately used.

For over 4 years I worked in a psychiatric hospital where every day we had to deal with at least one hostile patient, some who had just been released from jail and brought directly to our facility. These patients in particular were aggressive and violent and often needed to be restrained for their safety and the safety of others. We often had to “take down” these patients with as little as three staff members actually going hands on. Patients very rarely got hurt. Matter of fact I can’t even think of one incident I was involved in where a patient got hurt. Staff rarely got hurt as well and when they did it was generally superficial scratches. No one ever died. Ever. No patient, no staff member.

Unlike in this video we weren’t armed with more than latex gloves and training in non-violent crisis intervention training. We practiced what is sometimes called “therapeutic hands on” actions, which means that when we did have to put our hands on a patient we did so in a way to quickly gain control of them without trying to hurt them, no matter how violent they are responding to us, unlike in the video where you will see at least one officer swinging away at the inmate as if he were in a mixed martial arts fight.

The officer who says the suspect was reaching for his gun and the officer who appears to have been the most involved with the suspect was the newest officer on the scene with the least amount of training in dealing with mentally ill people.

I’m not saying that all police officers are this way, but many officers when dealing with individuals are overly aggressive and don’t have the patience it takes to appropriately deal with mentally ill people. This is why we see so many unarmed individuals getting killed by police; over aggression and lack of patients. I know their job is dangerous and tough and often times they can’t wait to see what happens before putting themselves in danger.

However, when you have a job where it’s pretty much excepted if you kill someone it’s okay, it makes having to be patient and cautious a lot less likely. Working in the psychiatric hospital, if we killed a patient while trying to restrain him we would most likely get fired, loss our licenses and get sued by the family. Too many officers operate with impunity.

Where I live we are lucky to have Crisis Intervention Team (CIT) officers who have went through specialized training to deal with mentally ill individuals. Whenever I had to call law enforcement for someone I believed was mental ill I always requested a CIT officers for that individuals safety. CIT officers are more likely to approach mentally ill individuals calmly and take them to the mental hospital instead of jail. They generally don’t over-react or act aggressively. Unfortunately, not all police and sheriff’s departments have CIT officers or good training programs.

What I am advocating here is for more training like the training done by the Clark County Sheriffs Department.

With the appropriate training on how to calm a person down, even when restraining them, the number of unarmed killings by law enforcement officers would go down drastically, mentally ill or not.

Involuntary Hospitalization

depression_woman_640Last week I did my very first involuntary hospitalization (or as we call it here in Florida, a Baker ACT) of an adult.

Involuntary hospitalization or commitment is actually a legal procedure where an individual who is showing severe signs of a mental illness such as suicidal thoughts, homicidal thoughts, self-neglect or any other potential to intentionally or unintentionally harm themselves or others is placed into a hospital even if they don’t want to go.

Here in Florida it’s generally a 72 hour hold where the person is evaluated by a nurse and other mental health professionals and then a psychiatrist who will decide if that person is well enough to be released or should stay longer. Technically a 72 hour hold can be extended for as long as a week to much longer in severe cases including state hospitalization which is typically months. It’s a major responsiblity because it’s basically taking away part of someone libery and forcing them into treatment.

In Florida, a doctor, a police officer, a physicians assistant and licensed social workers, marriage and family counselors and mental health counselors all have the authority to put someone involuntarily into the hospital if they feel that person is a threat to themselves or someone else.

I personally don’t take this responsibility lightly, especially working in my new job where I work mostly with adults who’s circumstances generally aren’t as black and white when it comes to meeting criteria to be placed into involuntary hospitalization compared to children. However I know that sometimes it is necessary to keep people safe from themselves, other people and even their illness.

Most of the children and adolescents I had to place into involuntary hospitalization were fairly easy decisions for me. They usually came straight out and told me that they wanted to kill themselves, wanted to kill a parent, or was doing something so outrageous that it was obvious they were imminent dangers to themselves. Most of them, once I told them I was going to have to have them put into the hospital for observation didn’t fight it much. Some cried, but most knew it was for their own good.

Adults however are different. Yes there are plenty of adults who are as obvious as the adolescents, but when it comes to adults, most of them won’t say that they want to kill themselves or someone else, but will skate around it and it becomes not black or white, but grey.

Working in a mental hospital makes it even worst because many of the adults present with some signs of psychosis and it’s not illegal to show sings of psychosis or to be symptomatic, meaning, I can’t hospitalize a schizophrenic just because she’s hearing voices and talking to herself, or a manic woman just because she’s speaking at a thousand miles an hour and bouncing from topic to topic driving her husband and kids up the wall, not as long as both of those people aren’t homicidal or suicidal and are oriented which is the majority of the case.

Often times people will want these people placed into the hospital against their will because they are acting “crazy”, but that doesn’t meet criteria to take away someones liberty and placing them into the hospital.

Because adults have been much more complicated than children when it comes down to deciding if they meet criteria for involuntary hospitalization or not, I was always nervous about writing my first adult involuntary hospitalization order, but when I got this current job, I knew it was only a matter of time. At least 2 to 3 times a week I was asked to evaluate an adult to see if they met criteria for involuntary hospitalization, but most of the time the adults were just symptomatic, maybe in need of some medication, but didn’t meet criteria for involuntary hospitalization.

That was until last week. Last week I was in a training when I got asked me to come evaluate a woman because her therapist thought she may need to be placed into the hospital for her safety.

I met with and evaluated the woman who was obviously in distress. Through my evaluation she told me she hadn’t eaten, slept or bathed in days, nor has she taken her medication because “demons” were telling her not to and were physically holding her down at night.

She then started telling me about being commanded by her deceased mother to do things like book an airplane ticket to another state. She also did not know where she was or what year it was. It was obvious to me that she needed to be hospitalized for her own safety so I had to write an involuntary hospitalization order and she was subsequently placed into our hospital where she would be evaluated, stabilized and released to go back home with a follow up plan of both medication and therapy.

I was nervous as I wrote it, but this one was obvious enough where I felt confident that I wasn’t violating anyones rights and where the power I have to place someone in the hospital against their will was being used for the right reason.

So that was my first adult involuntary hospitalization and I know there will be many more to come because as a licensed mental health counselor I evaluate people’s mental state everyday and working in a large mental health hospital where people come for medication appointments and therapy appointments, but sometimes end up presenting in ways that suggests they need to be placed in the hospital for stabilization, writing involuntary hospitalization orders is part of my job and it’s a responsibility I don’t take likely.