Serious About Serious Series: What Every First Responder Should Know About Serious Mental Illness

Here’s the third post in this series about Serious Mental Illness. In this post, I want to address Serious Mental Illness (SMI) in the context of first responders. For the first two posts on this subject, see those concerning Pastors and Mental Health Providers.

For First Responders, the critical takeaway from this information is to be appropriately trained in crisis intervention, and understanding how to compassionately but appropriately respond to those in a state of psychosis, suicidal ideation/depression, and/or mania.

What Serious Mental Illness Is

Serious Mental Illness is not the same thing as mental health, and mental health conditions can be SMI, but not all of them are. The most vulnerable, most severe cases are Serious in name and nature and need to be addressed and distinguished differently from “mental health” cases that are milder. Aggressive, serious brain disorders are what we know as schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, and any other mood disorder with psychotic features.

This means the brain is at risk of actually having neurological damage done to it and regressing in cognition to the potential degree of the person not even realizing they are sick. Anosognosia takes about half of those with these diagnoses and essentially turns us into unrecognizable persons to who we truly are. The lack of insight this condition manifests can be debilitating and is often one of the main reasons why so many people with SMI are incarcerated, homeless, or dead.

What to Expect from Someone with SMI

Refer to this post for a detailed explanation of diagnoses and symptoms to expect.

Here is a profound example of a police officer who responded to a crisis situation with this woman’s son experiencing a psychotic episode. It’s a beautiful picture of how compassion and appropriate responding can deescalate an otherwise tense situation. (Credit to Laura Pogliano, Facebook post July 30, 2020)

I just called the county police precinct that services my neighborhood, but not to complain. I wanted them to know that their officers, and one in particular, were ‘getting it right’ in their response to psychiatric emergencies.
 
 
My 22 year old son has schizophrenia, the paranoid type. Since February, he has phoned emergency services five times, to ask for help with physical symptoms he’s imagining.
 
Sometimes it’s a heart attack, sometimes his throat is closing, and yesterday, it was to report a gunshot wound, which he didn’t have, to his head. He thought he’d heard a group leader at his psychiatric rehab program say, Who wants directions to Zac’s house? earlier in the day. That delusion frightened him and by night time, he thought he’d been shot in the head…
 
 
Each time he calls 911, I almost panic. Police have weapons, and there is no shortage of news articles about tragic incidents when police are called to intervene in a psychiatric crisis. Police intervention should not be the route the severely mentally ill have to take to get to care, but it is. The new mental health page the White House put up advises you to call 911 for care, as the official recommendation.
 
 
As bizarre and sickening as that seems, that you have to call the police when your child is sick, the fact is that they are our new front line for care and our new first responders.
 
 
We waited outside and my son asked me to let him do the talking. He didn’t want them to know he was sick, it would interfere with his reporting the gun shot.
 
A female officer arrived, Officer Langford. My son met her on the sidewalk. She asked his name, shook his hand politely. She asked him what was wrong. He told her he wanted to report being shot in the head.
 
Where were you shot, can you show me? She asked.
 
He pointed to both temples. There was nothing there.
 
She said, oh, I see what you mean. I do see a little spot right there.
 
He told her he was worried about losing brain cells. He thought he’d been shot right in his own bedroom.
 
She asked with what? A pistol, he thought, but he wasn’t sure.
 
She asked when it happened; he didn’t know. He just wanted to report his gunshot wound.
 
Can I check your pockets? She asked. Do you have anything sharp on you that could hurt me?
 
He said no, and she gently patted his pockets. Then she thanked him for letting her check.
 
She looked at me, questioning; she took a few steps toward me, and I whispered, He has schizophrenia.
 
Another officer arrived. Before he could approach Zac, Officer Langford leaned in close to him and whispered something.
 
He looked at me: Is he taking medicine? I said yes, faithfully.
 
He handed me a note with a hotline number to call in case of crisis. I asked him to introduce himself to Zac since we need to get to know the police in our area (unfortunately).
 
He shook Zac’s hand, introduced himself and then said he had another call to go out on and left.
 
What Officer Langford did next was miraculous.
 
She told Zac, I’m going to go to the car now, and I’m going to check all our databases and see what they say. You wait right here, and I’m going to check the databases for you and find out who’s responsible, ok? We have a lot of databases I can check for you and see how this happened. He agreed to wait.
 
You just hang on, I’m going to check for you! She looked at me. I said quietly, there’s nothing wrong. What are you doing? She said, I know, I’m just going to pretend to check…Ok?
 
When she came back from the car, she told him: I checked all the databases, we have a lot of them, I checked every single one, and I didn’t find anything at all. No one can get your address, there was no one listed except us, and we’re the police. Nobody can get your address, not your friends or people at the school, nobody. OK?
 
He said he’d heard a group leader giving out his address at the hospital program he attends. He heard him ask, Hey, who wants Zac’s address?
 
She told him, You know, sometimes people at school or your friends–they just like playing with you. They just tease or say things to cause trouble. I have kids at home, and I know how kids can be, they just like to say things and cause a little trouble. But you don’t have to worry about that. I just checked the databases for you, all of them, and nobody can get your address except us, and now you can laugh if that happens again. You can laugh because you know, if they’re playing you, the police told you nobody can get your information. It can’t happen ok?
 
He agreed.
 
I’m trying not to tear up as I relate this next piece: She asked, is there anything else I can do to make you feel better right now?
 
He said, Well, no. But did she think he should get his head wound checked out?
 
She said, oh, I don’t think so. I’ve seen that injury before, lots of times. She rubbed the spot on his temple that he indicated had a bullet hole. Yep, I’ve seen that before, it should clear up by itself in a couple days. Ok?
 
He said Ok, but it was obvious he was worried. She repeated it a few more times: I’ve seen that before, it should be ok, it’ll be fine in 4 or 5 days, Ok?
 
She told Zac she couldn’t stay, she had another call to go on, but she was positive he would be fine in a couple days. She told him to have a good night, we thanked her, and she left.
 
I couldn’t believe my eyes and ears: if she wasn’t trained in CIT and from a pro, she was undoubtedly the most compassionate police officer I’ve ever met, not to mention very skilled in handling psychiatric patients. She validated his concerns; she had an immediate solution for calming him; she asked how she could make him feel better; she addressed every worry he presented, without once asking if he was sick, if he took his medicine; without once ridiculing the delusion.
 
This morning, I took great pleasure in phoning the Towson precinct and asking that someone tell her sergeant, or captain, or whoever supervised her, to thank her; I have friends whose children with psychiatric illnesses have been tasered, beaten, even shot at…Officer Langford treated my son with respect, with incredible skill, with patience and compassion.
 
I said that Officers like her were so necessary to our journey. And while we’ve met many of your officers as they’ve responded to psych calls here, she went above and beyond what could even be reasonably expected of any of them. She made a fearful young man feel better, something I often cannot do. The officer who answered the phone said he would be glad to pass the message along; most of the calls they got were complaints. I said, I believe you.
 
But this officer needs to be held up as an example of Doing It Right!
 
My son came in the house after that experience, drank some juice, got ready for bed. He knocked on my bedroom door. He had his pills in his hand and a glass of water. He took them in front of me, said good night, then lay down to sleep.
 
There are myriad ways the police visit could have gone wrong. But it didn’t, because a police officer was willing to do whatever she had to, to make a scared and worried young man feel better, and she did.

How To Handle Someone with SMI

Depending on the degree of stability, the person with SMI may or may not be able to comprehend, cooperate, or cope with your intervention. Thus, CIT (Crisis Intervention Training) should be afforded your police precinct/local municipality’s law enforcement squadron.

Crisis Intervention Training