7.00.050 THE MENTALLY ILL PERSON (CALEA 41.2.7)
Guidelines for recognizing a mentally ill person
Dealing with people who are known or suspected to be mentally ill carries the potential for violence. Officers should exercise special skills and abilities to effectively deal with the person. Officers are not expected to make a judgment of the mental or emotional disturbance but rather recognize behavior that is potentially destructive and/or dangerous to self or others.
There are many behaviors associated with people suffering from mental illness. In RCW 71.05.020 a mental disorder is described as: “Any organic, mental, or emotional impairment which has substantial adverse effects on an individual's cognitive or volitional functions.”
Behavior of a mentally ill person may include one or more of the following: (41.2.7a)
v Incoherent or disorganized speech
v Delusions or false beliefs
v Talking or laughing to one’s self
v Rapid, uninterruptible speech
v Jumping from topic to topic when talking
v Staring blankly or not moving for long periods of time
v Unreasonable fears
v Loss of memory or confusion
v Rapid mood swings
v Feeling watched or followed
v Hearing commands from the television or radio
v Hearing, smelling, or seeing things that are not there
These behaviors may be changed or intensified by the use of alcohol, illicit drugs or the failure to take prescribed medications.
Not all mentally ill persons are dangerous while some may represent danger only under certain circumstances or conditions. Officers may use several indicators to determine whether an apparently mentally ill person represents an immediate or potential danger to himself or others. These include the following:
v Availability of weapons
v Threatening statements by the person
v Past history of violence
v The amount of control the person exhibits over their emotions
Dealing with the Mentally Ill
If during a street contact, interview, or arrest, an officer determines a person may be mentally ill and a potential threat to himself and/or others, or may otherwise require law enforcement intervention, the following responses are recommended: (41.2.7c,d)
v Request for back-up
v Take steps to calm the situation. Where possible, eliminate the emergency lights and sirens, disperse crowds, assume a quiet non-threatening manner when approaching or conversing with the individual. Where violence or destructive act have not occurred, avoid physical contact, and take time to assess the situation.
v Move slowly so as not to excite the person. Provide reassurances that you are there to help and that s/he will be provided with the appropriate care.
v Ask the person what is bothering them. Relate your concern for him/her, allow them to vent their feelings.
v Don’t threaten the person with arrest. This will only create more stress and potential aggression.
v Avoid topics that may agitate the person and guide the conversation toward subjects that help bring the individual back to reality.
v Always attempt to be truthful with a mentally ill person. If the person becomes aware of a deception, s/he may withdraw from the contact, may become hypersensitive or retaliate in anger.
v If a mentally ill person starts to become combative, remove any dangerous weapons from the immediate area and restrain the individual if necessary, Using restraints on mentally ill persons can aggravate their aggression. Officers should be aware of this fact, but should take those measures necessary to protect their safety.
All commissioned officers and professional staff who may come in contact with the public receive initial training on dealing with the mentally ill during their basic law enforcement academy or initial employee training (41.2.7d) and additionally at least every three years. (41.2.7e). Lateral officers will receive initial in-service training prior to their release from FTO. All training is documented in the employee’s training file located in the Personnel Services Unit.
Types of contact
Non-criminal: generally three types of dispositions result from non-criminal contact; 1) detention for involuntary treatment 2) referral for contact by mental health professions, or 3) no action (because none is necessary).
1) Involuntary treatment- Per RCW 71.05 the following grounds are necessary for an officer to take a person into custody and through the mental health professionals (MHP) order a 72-hour detention:
A. Danger to others- threats or attempts to harm another person or behavior that places a person in fear of sustaining harm such as making serious threats to kill others or engaging in behavior that places others at risk of serious bodily injury.
B. Danger to self- threats or attempts to commit suicide or harm one’s self-All suicide attempts and/or threats shall be taken seriously. Officers will provide for medical treatment (in the field or an emergency room).
C. Danger to property- substantial loss or damage to property of others.
D. Grave disability- behavior which results in the person in danger of physical harm because s/he is unable to provide for his/her basic needs of health and safety. Some examples would be: suffering from extreme dehydration or malnutrition, unable to care for basic health needs, wandering in traffic.
Officers may take persons into custody if the incident requires immediate action. Otherwise, officers should call for an evaluation in the field by the on-duty MHP. This can be done through the Crisis Clinic at (866) 427-4747. TTY/TDD for the deaf at (206) 461-3219. Transportation to a hospital should be arranged by ambulance. Officers will complete a case report documenting the incident and the reasonable belief the person met the criteria for involuntary commitment. The officer may be requested to testify at a detention hearing within three working days of the incident if the individual refuses to remain in treatment voluntarily.
An officer may also be requested to assist a MHP in the field by taking a person into custody for evaluation and treatment based on a written or oral order made by the MHP. An officer may also be requested to take a person into custody through a written notice signed by a MHP and a magistrate authorizing the officer to take a person into custody.
2) Referral for treatment
For the person who does not exhibit behavior that meets commitment criteria and is willing to enter voluntary treatment, the officer can make a phone referral and/or arrange for a crisis outreach. The officer should place a call to the Crisis Clinic at (866) 427-4747 and have the supervisor call the appropriate on-call agency. The officer will document this type of contact through a case report.
3) Treatment Refused/no action
If an officer contacts a person s/he believes to be mentally ill but the person refuses aid, the Crisis Clinic is available to review the facts of the situation. The Crisis Clinic may have some resource suggestions to assist the person. The officer will document this type of contact through (at a minimum) a FIR.
Criminal Contact (41.2.7c)
Officers contacting mentally ill persons who have committed a crime generally have two possible dispositions: 1) arrest and booking 2) arrest and release. Alternatives to arrest (Department Manual 5.00.120, CALEA 1.2.6) should be considered to ensure the best treatment options are used and to keep those with mental illness out of incarceration if feasible. This is for misdemeanor suspects only.
Felony suspects generally should be booked. Please see directives addressing Prisoner transport (Department Manual 24.00.020, CALEA Chapter 71)
Medical Inquiry and Response (CALEA , 41.2.7b, 72.6.3c&d)
During booking, each prisoner will be observed closely for apparent medical problems or injuries, and questioned concerning current illness, injury, medication and treatment. The prisoner's responses, or lack thereof, and the booking officer’s observations will be recorded in the arrest report.
During booking, each prisoner will be observed and any visible body deformities, trauma markings, bruises, lesions, jaundice, or obvious physical limitations will be documented in the case report.
If a prisoner appears mentally ill and either incapacitated or a danger to self or others, a Mental Health Professional will be consulted to determine if the prisoner should be transferred to Harborview Hospital or if s/he can be detained in the King County Jail. Any prisoner appearing to be under the influence of drugs shall be questioned as to what type of drug they have ingested and their condition shall be monitored closely. If necessary, the prisoner shall be transported to Overlake Hospital or Harborview Medical Center for examination by a qualified medical professional prior to being booked and placed in detention.
If the suspect is refused by King County Jail due to their mental illness related behavior, the suspect should be taken to Harborview Crisis Triage Unit. The CTU staff will attempt to stabilize the prisoner’s behavior while treating any immediate medical problems. The CTU will permit a police hold, if officers indicate it so on the mental health contact report form, and speak to the staff of the CTU in person regarding their request. (41.2.7b)