1. © 2013 by Pearson Higher Education, Inc
Upper Saddle River, New Jersey 07458 • All Rights Reserved
Crisis Intervention
William Harmening
Roosevelt University
Harmening, Crisis Intervention: The Criminal Justice Response to Chaos, Mayhem, and
Disaster
Chapter 12
THE CRISIS OF MENTAL ILLNESS

2. © 2013 by Pearson Higher Education, Inc
Upper Saddle River, New Jersey 07458 • All Rights Reserved
12.1
12.2
12.3
12.4
To describe the problem of mental illness in the context of the
criminal justice mission.
To summarize the traditional police and corrections response to
mental illness.
To list and define some of the more common types of mental
illness faced by crisis responders.
To summarize the accepted best practices for responding to
mentally ill offenders, victims, suspects, and inmates.
CHAPTER OBJECTIVES

3. To describe the problem of mental
illness in the context of the criminal
justice mission.
Learning Objectives
After this lecture, you should be able to complete the following Learning Outcomes
12.1

4. 12.1 The Problem of Mental Illness
OVERVIEW
Handling cases involving the mentally ill can be dangerous, both for the
police and the mentally ill individuals with whom they come in contact.
During the period 1997-2006 there were 1058 officers assaulted in
America, and 13 feloniously killed while responding to calls involving
mentally ill people.
Many, if not most people suffering a mental illness will react negatively to
the police, and this reaction tends to cause the police to resort to their
training and take a defensive posture, many times resorting to the use of
force to de-escalate the situation.

5. 12.1 The Problem of Mental Illness
OVERVIEW
• In the first nine months of 2006, the LAPD had 46,129 contacts with people
suspected of being mentally ill. Of those, 709 had attempted suicide and
4,686 were taken into custody for an involuntary commitment and
psychiatric evaluation.
• The Lincoln, Nebraska Police Dept. reported that in 2002 it handled over
1,500 cases involving mentally ill persons, and that it has spent more time
on these cases than on burglaries, felony assaults, or traffic accidents
involving injuries.
• In 2000, officers in Florida transported more than 40,000 people for an
involuntary 72-hour psychiatric evaluation. This number exceeded burglaries
(26,087) and aggravated assaults (39,120) handled during the same year.

6. To summarize the traditional police
and corrections response to mental
illness.
Learning Objectives
After this lecture, you should be able to complete the following Learning Outcomes
12.2

7. 12.2 The Police Response
THE POLICE RESPONSE
Traditionally, the police have had two major problems effecting their
response to cases involving the mentally ill:
• A lack of training on how to effectively respond to, contain, and de-
escalate such a crisis without the need for heightened or deadly force.
• The perception among police officers that mentally ill people are
always more violent than non-mentally people, a perception that is not
necessarily supported by available research.

8. 12.2 The Police Response
THE POLICE RESPONSE
The problems with police training and perceptions come together to cause
an officer to immediately enter a situation in a more heightened state of
readiness and with an expectation that some level of force will be
necessary. The combination of these two reactions only increases the
potential for a violent outcome if a confrontation occurs.

9. To list and define some of the more
common types of mental illness
faced by crisis responders.
Learning Objectives
After this lecture, you should be able to complete the following Learning Outcomes
12.3

10. 12.3 Types of Mental Illness
Thought Disorders
Characterized by a person’s disordered thinking and a disconnect from
reality. Most common type is schizophrenia.
• Paranoid Schizophrenia
These individuals can be extremely dangerous. Typically fixated on the false belief that someone is out to get
them, or that they are being persecuted in some manner.
• Disorganized Schizophrenia
Typically incoherent. Disorganized speech and behavior are almost always present. Delusions and
hallucinations are common. There is typically no consistent theme to their thinking.
• Catatonic Schizophrenia
Typically withdrawn and unresponsive. They may show very little movement, and may curl up in a fetal
position. They pose essentially no danger to responders.
• Residual Schizophrenia
The after effects of a schizophrenic episode. Individuals typically experience depression and
a loss of interest in life. Their ability to communicate is greatly diminished.

11. 12.3 Types of Mental Illness
Thought Disorders
According to the Diagnostic and Statistical Manual of the APA (DSM-IV-
TR), in order to be diagnosed with schizophrenia, a person must
demonstrate at least two of the following:
• Delusions
Delusions of control, Nihilistic delusions, Delusional jealousy, Delusion of guilt or sin, Delusion of mind
being read, Delusion of reference, Erotomania, Grandiose delusion, Persecutory delusion, Religious
delusion, Somatic delusion
• Hallucinations
Auditory or visual/ positive or negative
• Disorganized Speech
• Grossly disorganized or catatonic behavior

12. 12.3 Types of Mental Illness
Mood Disorders
Symptoms include extremes in how the person feels, either extreme
agitation, excitement, or depression.
Depression
-Depressed most of the day, and almost everyday
-Diminished interest in almost all activities
-Significant weight change
-Insomnia
-Feelings of worthlessness
-Recurrent thoughts of death
-Inability to think rationally
People who are severely depressed can be dangerous if they are having
thoughts of suicide. They may force the police to use deadly force against
them…”suicide by cop.”

13. 12.3 Types of Mental Illness
Mood Disorders
Symptoms include extremes in how the person feels, either extreme
agitation, excitement, or depression.
Bipolar Disorder
A second type of mood disorder, and one that can be extremely dangerous
for those who confront people suffering from this disorder, is bipolar
disorder, also called manic-depressive disorder.
People diagnosed with this disorder will experience periods of elevated
mood, energy, and cognition (mania), as well as periods of depression.
Typically the two extremes are separated by periods of relatively normal
functioning, and psychotic-like features, such as delusions and
hallucinations, are sometimes experienced at the extremes.

14. 12.3 Types of Mental Illness
Anxiety Disorders
These disorders are marked by abnormal amounts of fear, worry, or
uneasiness. At their extreme, these disorders can include physical symptoms
such as chest pains and shortness of breath. A person suffering from a
severe anxiety disorder may be entirely unable to function normally without
some type of therapeutic intervention, to include medication.
If they are in the midst of an anxiety episode, whichmany of them are
during a personal crisis, then they have the capacity to behave in
unpredictable and erratic ways, and can be dangerous.
- Generalized anxiety disorder
- Panic disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder (PTSD)
- Separation anxiety

15. To summarize the accepted best
practices for responding to mentally
ill offenders, victims, suspects, and
inmates.
Learning Objectives
After this lecture, you should be able to complete the following Learning Outcomes
12.4

16. 12.4 Best Practices
The Memphis Model (CIT)
Developed in 1988 to reduce violent encounters between mentally ill
individuals and the police.
Included the formation of a specially trained crisis intervention team (CIT) to
respond to cases involving mentally ill individuals. Team members received
training from mental health professionals and family advocates.
Goals of the program:
• To de-escalate a situation involving a mentally ill individual without the use of
force.
• To avoid arrest where possible, and divert the individual to needed services.
• To work in partnership with community mental health centers and drug-alcohol
treatment centers.

17. 12.4 Best Practices
The Memphis Model (CIT)
Benefits that have been seen in Memphis…
- Crisis response is immediate
- Arrests and use of force have decreased
- Underserved consumers are identified and provided services
- Patient violence in the ER has decreased
- Officers are better trained in de-escalation techniques
- Officer injuries have decreased
- Officer appreciation in the community has increased
- Less “victimless” crime arrests
- Decrease in health care liability in jail
- Cost savings

18. 12.4 Best Practices
De-escalation Techniques
• ENGAGEMENT
- Non-threatening approach
- Be cognizant of the person’s boundaries
- Identify self in a calm and professional voice
- A simple purpose statement, “I’m only here to help you.”
• ESTABLISH RAPPORT
- Ask their name
- Look for a point of connection (i.e., tattoos, sports logo, military, etc.)
- Establish trust through honest disclosure
• ACTIVE LISTENING
- Minimal encouragements
- Paraphrasing
- Emotion-labeling
- Open-ended questions
- “I” messages
- Effective pauses

19. 12.4 Best Practices
Community Resources
It is important that all officers have a knowledge of the available resources
within their communities. They may include…
- Primary care facilities
- Counseling centers
- Support groups
- Advocacy groups
- Faith-based providers
- Shelters

20. © 2013 by Pearson Higher Education, Inc
Upper Saddle River, New Jersey 07458 • All Rights Reserved
Every year mentally ill individuals are killed while interacting with
police, and every year police officers are killed during those
interactions. It is a volatile situation that requires an understanding on the
part of the police of the various types of mental illness.
The traditional police response to mentally ill individuals has been
problematic. Officers receive very little training in this area, and are
quick to resort to the appropriate level of force in a given situation
regardless of the person’s mental condition.
Programs such as the “Memphis Model” have been established to
provide a specialized response to cases involving the mentally ill.
Essentially all police jurisdictions now have access to a crisis
intervention team (“CIT”) with officers trained for this purpose. The
benefits have included less injuries, cost savings, and an increase in
public awareness of the problem of mental illness.
CHAPTER SUMMARY
12.1
12.2
12.4
There are many types of mental illness officers should be aware of. Most
can be classified as either thought disorders, mood disorders, or anxiety
disorders.
12.3

21. © 2013 by Pearson Higher Education, Inc
Upper Saddle River, New Jersey 07458 • All Rights Reserved
DISCUSSION QUESTIONS
1. Discuss the concept of personal responsibility, and whether you
believe the mentally ill should still be held accountable for their
crimes?
2. Do some basic Internet research, and then discuss the differences
between the verdicts of “guilty but mentally ill” and “not guilty by
reason of insanity.”
3. Do you believe the criminal justice system should recognize a
difference between a mentally ill person who is psychologically
impaired and an intoxicated person who is chemically impaired?
Assuming both commit the same crime, and both are unable to
understand the implications of their actions, should they be treated
differently?