Crime / Justice - LiveI train cops about mental illness and help design police departments' response policies as a Director of CE and Mental Health Policy. AMA!

Mar 18th 2016 by thinkscotty • 5 Questions • 427 Points

My short bio: Hey guys, my name is Scotty and I work for the National Alliance on Mental Illness in the Chicagoland area. I have a B.A. in Philosophy and an M.A. in Intercultural Studies & Community Development and have worked previously in Immigrant Legal Policy and child welfare reform in Latin America. I worked as a Chicago City Paramedic for several years after college, where I saw how ridiculously bad our society's response to chronic mental illness can be. Now as part of my job I work with law enforcement officers, learning about their encounters with mental illness on the job and training them how to interact well with people having mental health crises. My goal is to help them get people into treatment whenever possible and avoid violent or demeaning confrontations.

My Proof:


How much does the average police officer know about dealing with the unarmed mentally disturbed, compared to in the past?

Also do you tell officers that telling somebody "calm down" never works?


I uploaded this slide from one of my my powerpoints specifically regarding the phrase "calm down" just for you! In my opinion it's the most useless phrase anyone could ever use. Everything it communicates is wrong. 1) It tells the person that they aren't worth listening to, 2) It stops the individual from venting emotions and thereby de-escalating their symptoms, and 3) It tells the person that their concerns aren't valid. In roll play scenarios I run with the police, I specifically make them replace that phrase.

The average police officer knows a lot more than they used to. In fact, younger officers can often be highly knowledgable about mental illness because it's basically a requirement that officers have college degrees these days and a large number of them study psychology. Still, many times they quickly forget what they've learned and become cynical. Where the "older" cops have the advantage is in knowing that being the loudest person in the room doesn't always mean you're the most in control. So while they may have less "head knowledge" about mental illness they are usually calmer and less "ancy" than their younger colleagues.


It's a great goal, but with the high coincidence of homelessness with mental illness, there are not a lot of options for patrol - level officers. If the person needs substantial medical care, they can be booked for a 72 hour evaluation, but there is rarely enough resources for extended treatment.

Have you seen any other solutions being provided as an alternative?


This is EXACTLY right. As I wrote in one of my comments above, one of the major problems is that we as a society haven't provided services that make sure people with mental illness maintain treatment. Our legal system makes it difficult to get confused/resistant people into treatment and we haven't adopted proactive models that have been proven to work in other countries - weekly social worker home visits, housing, etc. This ends up leaving cops very frustrated that beyond calming people down they don't have much to offer.

The best alternative IMO would be a system that saves both saves money and prevents crime by hiring social workers and therapists to go make sure people are maintaining treatment. Mental illness is highly treatable in todays day-and-age. The problem is that people don't have the capacity or resources to maintain their treatment. With a little extra help and oversight, individuals would be more likely to maintain treatment.

The homelessness and mental health epidemic is caused by a) A lack of public resources to help people with mental illness, b) US cultural attitudes (namely individualism) that expect everyone to make it on their own, even when their illness clearly prevents them from doing so, and c) A legal system that errs very far on the side of individual rights, preventing us from legally requiring individuals to take medications or treatment unless they commit crimes. I won't comment on that last part as to whether it's good or bad. It's just a fact that makes cops jobs a lot harder and makes our mental health treatment FAR more expensive than in other countries.


What are some of the most common mental health issues you train about? What's one of the rarest?


I try to match our training to what research shows police will encounter most often. A study by the APA shows that of all crimes, 3% are directly related to depression, 4% to schizophrenia, and a whopping 10% to bipolar disorders. This is because bipolar causes delusions and impulsive behavior but unlike other disorders, combines these with extreme energy and hyperactivity. This gets people into trouble.

So I focus a lot on bipolar. But police also respond to a lot of calls where no real crime has been committed - like someone hallucinating at a McDonalds or when parents are worried about their teen who's locked herself in her room for 3 days straight. This kinds of situations can be especially frustrating for cops because they don't really know what they're supposed to do to help. So we train them for these less severe interactions as well because it's often in these cases that they can do the most for the person while also preventing future crime.

The rarest disorders I spend time training on are probably Antisocial Personality Disorder and Schizophrenia, both of which affect less than 1% of Americans. But the nature of the disorders mean that police interact a lot with these individuals. I don't train on the rarer disorders like Multiple Personality Disorder simply because of time limits.


Recently there was an article in /r/worldnews that called out the fact that a very high percentage of fatal police shootings in the US were of mentally ill people. What are your thoughts on the use of lethal force by police officers in the US, and do you feel that more could be done to make other, non-lethal options more accessible and lethal options more difficult to access?


This recent study from LAPD found that of the 38 individuals shot and killed by the department last year, almost half had active mental health symptoms. That sucks. It sucks that people end up getting killed because they have a medical disorder.

I feel some empathy for police regarding their use of lethal force and mental illness. I think it's justified in most cases, at least by our legal system. I was working last week with a cop who shot and killed a man with bipolar disorder a couple months ago when the man was trying to break down a door to some random person's house at 5am. The guy threw a hammer at the cops and then took a shooting stance, holding what later turned out to be a paint scraper. The cop's partner tried to taze the guy but missed, so this cop had to shoot. He did a good job, only firing twice -- none of this 16 rounds stuff. The cops have seen the same videos we have where police are shot and killed and their wives and kids are left alone. So in some ways I empathize with them.

Now that said, a whole lot of police officers make the situation worse by antagonizing an indigodual with mental illness and pushing them into a "fight or flight" response with the cops' aggressive attitudes. If they recognize mental illness for what it is and intentionally change their responses, I think a good number of situations could end differently.

I'm a big proponent of less lethal options. I think that a taser should always be a first option above a firearm and that unless the individual is pointing a firearm or is threatening others with a knife, cops should back off and give the situation time or use the taser rather than turning straight to lethal force. I think this is starting to happen more and more -- but unless cops know about mental illness in the first place then they have no tools to change what they're doing.

Finally, the biggest problem is probably that mentally ill individuals are left to fend for themselves when released from treatment. Other developed countries make sure that treatment is maintained with regular social worker visits, etc. and this prevents crises from happening in the first place. A similar program in the US lets departments take matters into their own hands by proactive policing. It's called the Crisis Intervention Team or CIT.


You voting for Trump?


Nope. Nope, nope, nope. In fact I wrote this funny little blog post to express my thoughts on the Donald.