1. Brad Natalizio Village of Chester

2. REALITY FOR VILLAGE OF CHESTER P.D.  15 High Street: House emotionally disturbed persons  69 Brookside Avenue: Life Choices, mental retardation, schizophrenia  3 Maple Avenue: Chester Learning Center. Students must be emotionally disturbed to qualify to get into program. Ranges from ADD, ADHD, Bi-Polar, child- hood schizophrenia  Meadow Avenue: Mental retardation

3. History Police encounters with mentally ill persons first became a major issue in the late 1960’s, when a deinstitutionalization movement began. This was a long legal battle that was designed to protect people who, were believed to be mentally ill.

4. History Prior to the 1960’s the mentally ill were virtually “warehoused” in large state psychiatric hospitals in abject living conditions. Little emphasis placed on their treatment.

5. History Before the movement began, such persons had very few rights, and it was comparatively easy to confine them to harsh mental institutions for long periods. The movement succeeded, making it more difficult to institutionalize people against their will.

6. History As a result of this movement and reduced funding for mental treatment, the number of people confined to mental institutions has declined by at least half a million over the last generation. As a consequence, police are called to respond to more situations involving mentally ill and EDP’s.

7. History Most police departments in the early 1980’s made attempts to incorporate specialized approaches and specific training in how to deal more effectively with the mentally ill.

8. WHY IS IT IMPORTANT FOR POLICE OFFICERS TO KNOW ABOUT EDP’S? Encounters with EDP’s are frequent and sensitive police interactions. Dealing with people who are emotionally disturbed requires a high degree of skill and sensitivity. In these situations, thoughtless or hasty police actions may quickly make things worse, causing EDP’s to act in ways that require officers to use force that might otherwise have been avoided.

9. WHY IS IT IMPORTANT FOR POLICE OFFICERS TO KNOW ABOUT EDP’S? Most EDP calls turn out to involve people who are neither a danger to themselves or others. Nevertheless, police are called to respond to a large number of cases that are dangerous or that, if improperly handled, could quickly become dangerous.

10. WHY IS IT IMPORTANT FOR POLICE OFFICERS TO KNOW ABOUT EDP’S? Police response to EDP situations requires specialized skills and training. Knowing how to communicate verbally and non- verbally, and knowing how to intervene tactfully and sensitively can dramatically enhance the likelihood that situations involving the EDP will be resolved safely and effectively.

11. WHY IS IT IMPORTANT FOR POLICE OFFICERS TO KNOW ABOUT EDP’S? As police, we are responsible for getting such people to mental health professionals, but we also have other responsibilities:  We must protect the lives and safety of EDPS’s.  Lives and safety of other innocent people.  Lives and safety of US.

13. Stats  1 in 5 adults suffers from a recognized mental disorder.  About 10% of all adults may have a personality disorder.  The 3 most common disorders in order of incidence are anxiety, substance abuse, and depression  Only 1 out of 5 people with a mental disorder seek professional help.

14. Stats  Women tend to suffer from phobias and depression, whereas men tend to have problems with alcohol and drugs and antisocial behavior.  The rates of mental problems are higher for those under 45.  College graduates tend to be less prone to mental disorders than those who do not graduate from college.

15. Stats Most people diagnosed with mental illness have never been hospitalized and do not need in- patient care. The main reason for hospital admissions nationwide is an exacerbation of a psychiatric disorder. At any time, almost 21% of all hospital beds are filled with people with mental illness.

16. Stats Mental illness is more common than cancer, diabetes, or heart disease. Mental illness can range from mild to severe. Like other members of the community, mentally ill people may be professionals, office workers, laborers, homemakers, children, elderly people, or people who depend on welfare and other social services for survival.

17. ABNORMAL PSYCHOLOGY Anxiety Disorders Stress Disorders Somatoform and Dissociative Disorders Mood Disorders Schizophrenia Personality Disorders

18. Anxiety Disorders Generalized Anxiety Disorder: Experience excessive anxiety under most circumstances and worry about practically anything. Many individuals with this disorder experience depression as well. Women outnumber men 2 to 1

19. ANXIETY DISORDERS Phobias: Are characterized by a persistent, debilitating, and severe fear of specific objects. Person feels helpless in controlling fear. 10 to 11 % of the adults in the U.S. suffer from a phobia. Twice as common in women as in men.

20. Anxiety Disorders Panic Disorder: Experience repeated episodes of periodic, discrete bouts of panic that occur suddenly, reach a peak within 10 minutes, and gradually pass. Symptoms of panic: palpitations of the heart, tingling in the hands or feet, shortness of breath, hot and cold flashes, trembling, chest pains, choking sensations, faintness, dizziness, and a felling of unreality.

21. Anxiety Disorders Obsessive-Compulsive Disorder: A person has recurrent and unwanted thoughts, a need to perform repetitive and rigid actions. Excessive, unreasonable, causes great distress, consumes considerable time, and interferes with daily functions. Equally common among men and women. Usually begins in young adulthood.

22. STRESS DISORDERS Acute Stress Disorder: An anxiety disorder in which fear and related symptoms are experienced soon after a traumatic event and last less than a month. Post Traumatic Stress Disorder (PTSD): long after the event Event usually involves actual or threatened serious injury to the person or to a family member or friend. Ex: combat, rape, earthquake, airplane crash

23. Stress Disorders PTSD: People may be battered by recurring memories, dreams, or nightmares connected to the event. A few relive the event so vividly in their minds (flashbacks) that they think it is actually happening again. People will usually avoid activities that remind them of the traumatic event and will try to avoid related thoughts, feelings, or conversations.

24. Anxiety Disorders PTSD: Reduced responsiveness to events in the external world. May lose their ability to experience such intimate emotions. May feel dazed, have trouble remembering things, may feel that their body is unreal or foreign to them. May feel overly alter, easily startled, develop sleep problems, and have trouble concentrating. Guilt

25. Somatoform and Dissociative Disorders Somatoform Disorders: A pattern of physical complaints that is explained largely by psychosocial causes. They believe their problems are generally medical and a change in physical functioning may occur.

26. Somatoform and Dissociative Disorders Dissociative Disorders: Disorders marked by major changes in memory that do not have clear physical causes. May be the inability to remember important personal events or information.

27. MOOD DISORDERS Unipolar Depression Bipolar Disorder

28. MOOD DISORDERS Depression: A low, sad state marked by significant levels of sadness, lack of energy, low self worth, guilt, or related symptoms. Depression may be triggered by stressful events. Other explanations focus on biological, psychological and sociocultural factors.

29. Symptoms of Depression: Feeling of emptiness Lose their sense of humor Crying spells May have to force themselves to work, talk with friends Lack of drive, initiative, spontaneity May experience anxiety, anger, agitation Loss of desire to pursue their usual activities May speak slower Less productive Lack of energy Negative views of themselves

30. MOOD DISORDERS Mania: A state or episode of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking. Dramatic inappropriate rises in mood to abnormally high or irritable. People with mania seem to want constant excitement, involvement and companionship during manic episode.

31. MOOD DISORDERS Bipolar Disorder: A disorder marked by altering or intermixed periods of mania and depression. Emotional rollercoaster which shifts back and forth between moods.

32. MOOD DISORDERS Unipolar disorder: Depression without a history of mania. Normal mood of depression. Between 5% -10% of adults in the U.S. suffer from severe unipolar depression. Women being twice as likely to suffer.

33. SUICIDE A self inflicted death in which the person acts intentionally, directly, and consciously.

34. WHAT TRIGGERS SUICIDE? Suicidal acts may be connected to recent events or current conditions in a person’s life. Common triggering factors include stressful events, mood and thought changes, alcohol and other drug use, and mental disorders.

35. Approaching Suicidal People Most are not acutely psychotic at the time of the attempt. Most are depressed, the nature of their problem is usually more understandable, making them easier to communicate with.

36. Approaching Suicidal People Have feelings of hopelessness and helplessness and do not believe there is any way out of their situation. There are many different reasons why people commit suicide.

37. Approaching Suicidal People Remember that a suicidal person may attempt to have others kill him. “Suicide by Cop” or provoking an officer to kill a person is not uncommon. Remain calm, displays of tension can heighten a critical situation.

38. Approaching Suicidal People Make a plan and follow it, rushing to rescue a person increases risk to all. Be alert- crisis situations are unstable; continuously evaluate the crisis. Remember that a suicidal person may be come homicidal.

39. Approaching Suicidal People If suicidal gestures are not apparent, ask the person about suicidal intent. Minimize the presence of people with no need to be at the scene, including law enforcement personal. This will reduce embarrassment as well as potential negative stimulation in the environment.

40. Approaching Suicidal People Do not make sudden moves- use physical tactics as a last resort. Do not leave person unattended. Do not deny the person’s suicidal feelings. Do not rush/ pressure the person to make decisions or to abandon their suicidal plan.

41. SCHIZOPHRENIA There are a wide variety of schizophrenic conditions, ranging from fairly good reality contact to major disorganization and deterioration of behavior. Patterns of bizarre conduct Individual may show a loss of control, often with paranoia, an inability to communicate logically, and hallucinatory behavior.

42. Schizophrenia Thoughts and speech appear illogical, or loosely and incoherently connected Unrelated attitude in conversation Words may be combined in a meaningless string Attention fades in and out

43. Schizophrenia Severe indecisiveness and an inability to carry out normal activities Disheveled appearance Lack of drive or motivation Withdrawn or absorbed in their own thoughts Hallucinations

44. Schizophrenia Paranoid thinking Irrational belief that he is superior; has a special calling; is God Hostility and belligerence Repetitive movements

45. Schizophrenia Incoherent and illogical patterns of thought and speech Belief that someone is controlling their thoughts put thoughts into their head, or that people can read their thoughts

46. Schizophrenia Dramatically increased or decreased body movements (characteristic of what is called catatonic schizophrenia) Impaired impulse control

47. Schizophrenia Medications that are used to treat individuals who are psychotic and/ or delusional include: Haldol Prolixin Stellazine Clozaril Risperdal Zyprexa Geodan Abilify

48. PERSONALITY DISORDERS A very rigid pattern of inner experience and outward behavior that differs from the expectations of one’s culture and leads to dysfunctions Pattern is stable and long-lasting, and its onset can be traced back at least to adolescence or early adulthood.

49. PERSONALITY DISORDERS Personality disorders are separated into 3 groups: 1. Odd or eccentric behavior 2. Dramatic behavior 3. High degree of anxiety

51. RECOGNIZING EDP’S Recognizing and properly handling EDP’s is critical to the effectiveness of Police Officers. EDP’s often exhibit behavior patterns and verbal indicators that seem Inappropriate, Inflexible, and Impulsive.

52. RECOGNIZING EDP’S Inappropriate Physical Appearance: Disheveled or bizarre physical appearance Appearance that is inappropriate to the environment (ex: a person who wears shorts in winter, or a heavy coat in the summer)

53. RECOGNIZING EDP’S Inappropriate Body Movements: Strange posture or mannerisms (ex: continuously looking over ones shoulder as if being followed, maintained the same or unusual body positions for an extended period of time, pacing or agitated movements, repetitive movements, or lethargic or sluggish movements)

54. RECOGNIZING EDP’S Disturbances in Perception  Responding to voices or objects that are not there  Expressions of extravagant ideas (ex: the person believes they are Dan Marino)

55. RECOGNIZING EDP’S Disturbances in Perception  Hallucinations, delusions or other false beliefs.  Major memory lapses, confusion, or unawareness of people or surroundings  Rapid shifts in subject in a manner that seems incoherent.

56. RECOGNIZING EDP’S DISTURBANCES IN THOUGHT It may be hard to follow an EDP’s train of thought. They may jump from subject to subject in a manner that appears incoherent. Their speech may be difficult or impossible to interrupt.

57. RECOGNIZING EDP’S INNAPPROPRIATE MOODS OR RAPID MOOD SWINGS Rapid or extreme mood swings from elation to depression. Overreacting to a situation in an overly angry or frightened manner Speech patterns that lack the normal ups and downs of emotion, or that contain uncontrollable bursts of emotion

58. RECOGNIZING EDP’S INNAPPROPRIATE MOODS OR RAPID MOOD SWINGS Expressing feelings of persecutions (ex: expressing ideas of being harassed or threatened) Obsessive thoughts or preoccupation with subjects such as death or guilt

59. RECOGNIZING EDP’S Acting or Threatening to Cause Injury to Self or Others Cutting self with a sharp object, causing cigarette burns on body, starving self, or expressing a desire to do the same to self or others

60. RECOGNIZING EDP’S Inappropriate Decorations Strange trimmings or inappropriate use of household items (ex: aluminum foil covering windows)

61. RECOGNIZING EDP’S Inappropriate Waste or Trash Hoarding or accumulating extraordinary amounts of household items (ex: accumulating extraordinary amounts of string, newspapers, paper bags, or trash to the extent that it becomes a safety and health hazard) The presence of feces or urine on the floors or walls

62. PROPER TACTICS WHEN HANDLING EDP’S Before arrival on scene of a possible EDP, or substance abuse incident, think TACTICS.

63. PROPER TACTICS WHEN HANDLING EDP’S Gather as much information as possible prior to arrival on scene: Whether the person is armed with weapons Medical or psychiatric history Location of subject (home, park, ect.) Presence of other adults, children, friends Whether the person is violent

64. PROPER TACTICS WHEN HANDLING EDP’S Gather as much information as possible prior to arrival on scene: Whether the person has an arrest record or history of violence Whether the person has a history of alcohol or substance abuse Whether other uniformed personnel are on the scene (ambulance, fire department, police) Whether other officers know the person

65. PROPER TACTICS WHEN HANDLING EDP’S Get as much information regarding the EDP as possible from family members or other present. This might include past incidents where police have been called, hospitalizations, medications, drug and alcohol use, past suicide attempts, history of violence, availability of weapons, and/ or what triggered the current incident

66. PROPER TACTICS WHEN HANDLING EDP’S One officer should assume the role of the “Contact Officer”. The contact officer will do all of the talking with the EDP. (This prevents the confusion and agitation that might ensue as a result of too may people talking at the same time).

67. PROPER TACTICS WHEN HANDLING EDP’S If you are the “contact partner”, lower you radio. The “cover officer” will handle the radio Coordinate your plan of action

68. PROPER TACTICS WHEN HANDLING EDP’S Be aware of you surroundings (look for weapons, dangerous conditions, entrances, exits, ect.) Maintain a safe distance from the EDP. When an EDP is violent, maintain a barrier between yourself and the EDP.

69. PROPER TACTICS WHEN HANDLING EDP’S Respect the EDP’s personal space (personal space is defined as the amount of space an individual needs between him and you to feel safe) Avoid attempts to intimidate or threaten EDP’s. Such techniques may work with rational criminals, but are likely to further excite EDP’s.

70. PROPER TACTICS WHEN HANDLING EDP’S Do not take offense at any actions or words directed against you. Remember that you are there because EDP’s have mental health problems. Even those who may have committed crimes may not be in control of themselves, and are not purposely trying to offend you or anybody else. Their actions are not deliberate choices. Instead, they are the results of a psychiatric illness or other condition.

71. PROPER TACTICS WHEN HANDLING EDP’S  Do not rush unless necessary to protect yourself or others  Do not make sudden movements  Move deliberately and slowly  Keep a distance. DISTANCE EQUALS SAFETY  Keep a barrier between yourself and any potentially dangerous EDP

73. PROPER TACTICS WHEN HANDLING EDP’S Unless there is no other way to protect yourself or others against imminent harm, avoid behavior that causes agitation Do not lie or try to deceive. Once you break trust with an EDP, it is almost impossible to get it back Do not try to intimidate or frighten the EDP into submission

74. PROPER TACTICS WHEN HANDLING EDP’S  Do not “crowd” an EDP  Do not challenge the EDP’s perceptions. These may be hallucinations or delusions, but they are real to him  Do not stare at or maintain ongoing eye contact with the EDP, who may see this as challenging or threatening

75. PROPER TACTICS WHEN HANDLING EDP’S Do not act in a confrontational manner by arguing with or challenging the EDP Remember, be empathetic and a good listener If you are the designated “contact partner”, listen and try to maintain empathy Act as calmly as possible

76. PROPER TACTICS WHEN HANDLING EDP’S Do not surprise your partner by taking any sudden or unexpected action unless someone’s safety is in imminent danger Take as much time as you need to avoid injury to anybody Don’t lose this advantage by rushing or by forcing a confrontation

77. Communicating with EDP’s In order to assess the situation, you may want to ask questions of the EDP. When you try to communicate, be attentive to your tone of voice and body language. Listen carefully, be empathetic, and avoid phrases that will trigger anger, misunderstandings, or agitation.

78. Communicating with EDP’S If there is something about you or your partner’s way of talking that appears to agitate the EDP, have the officer with the best rapport be the designated contact officer He or she will do all the talking with the EDP, while the other officer acts as the cover officer.

79. Communicating with EDP’s Determine reasons for the individuals actions Be honest- perceptions of deceit may escalate violence and be perceived as a challenge Listen to the person- be an active, empathetic listener

80. Communicating with EDP’s Ask simple and direct questions Ask open-ended questions Develop a rapport- this helps to overcome the persons fear and mistrust

81. Communicating with EDP’s Recognize and respond to physical needs Paraphrase responses and check for understanding Identify and communicate with the healthy aspects of the person

82. Communicating with EDP’s  Continually assess the situation for danger  Maintain adequate space between you and the EDP  Be calm  Give firm, clear directions

83. Communicating with EDP’s If possible only one officer should talk to the person Respond to apparent feelings, rather than content Respond to delusions and hallucinations by talking about the person’s feelings rather than what he is saying

84. Communicating with EDP’s Be helpful. People, generally will respond to questions concerning their basic needs (What would make you feel safer? Calmer? Address basic needs when appropriate (tissue, cup of coffee, ect.)

85. Communicating with EDP’s Use simple acknowledgements- this encourages further communications: Ex: “uh huh”, “I see” Allow sufficient time for response

86. Communicating with EDP’s Encourage the person to respond Use calm, simple, direct instructional/ request Restate person’s statements: ex: EDP: “I can’t sleep” Officer: “You’re having difficulty sleeping?”

87. Communicating with EDP’s Use the term “go on” and “and then…?” as general leads Give broad opening such as “you look like you need to talk things over with someone” This indicates willingness to listen and relieves tension

88. Communicating with EDP’s Seek clarification and problem for specifics. This encourages talking and provides accurate information Ex: “I’m not sure I understand, could you explain?”

89. Communicating with EDP’s Avoid expressing approval or disapproval Discuss alternatives. This enables the person to consider options Ex: “When you feel this depressed, what can you think of that might make you feel better?”

90. Communicating with EDP’s Use position of authority in a positive manner Keep person talking; never reach complete closure Stress positives, such as person’s strengths, qualities, and resources.

91. Communicating with EDP’s Respect, attentiveness, openness, acceptance and positive attitude increase effectiveness of communication Appeal to emotions rather than intellect if you know the person is under the influence of drugs Be quiet after asking a question; listen as carefully as you question

93. Communicating with EDP’s- DO NOT Not join into behavior related to the person’s mental illness (agreeing, disagreeing with delusions/ hallucinations) Not stare at person- This may be interpreted as a threat Not confuse the person- One officer should interact with the person. If a direction or command is given, follow through

94. Communicating with EDP’s- DO NOT Not give multiple choices- Giving multiple choices increases the person’s confusion Not whisper, joke or laugh- This increases the person’s suspicions and the potential for violence

95. Communicating with EDP’s- DO NOT Not deceive the person- Being dishonest increases fear and suspicion; the person will likely discover the dishonesty and remember it in any subsequent contacts Don’t make promises/ threats that you can’t follow through on

96. Communicating with EDP’s- DO NOT Do not challenge the person’s delusions Do not allow yourself to be manipulated Avoid yes or no responses to personal questions Do not falsely threaten arrest

97. Communicating with EDP’s- DO NOT Do not legalize Do not overreact to gang language, sexual, racial, ethnic insults Do not order, command, warn, or threaten- this creates fear/ resistance, invites testing, promotes rebellious behavior

98. Communicating with EDP’s- DO NOT Do not moralize, preach, or judge- this communicates a message of self righteousness. Do not name-call or ridicule Do not negate the seriousness of the crisis- this causes misunderstanding, evokes hostility, and causes the person to be embarrassed

99. POSITIONAL ASPHYXIA Positional asphyxia is death by inability to breath because of the position of ones body. Occurs when subject is confined or held down in probe positions, rear-cuffed, lying on their abdomens.

100. HOW TO AVOID POSITIONAL ASPHYXIA 1. Do not hogtie anybody 2. Get people in custody off their stomachs as soon as possible 3. Do not use ropes on anybody

101. MHL LAWS SEE HANDOUT

102. The five most frequent scenarios are as follows: 1. A family member, friend, or other concerned person calls the police for help during a psychiatric emergency. 2. A person with mental illness feels suicidal and calls the police as a cry for help. 3. Police officers encounter a person with mental illness behaving inappropriately in public. 4. Citizens call the police because they feel threatened by the unusual behavior or the mere presence of a person with mental illness. 5. A person with mental illness calls the police for help because of imagined threats.

103. BE SAFE