Helping People to Live Safely with Mental Illness: Police Training and CIT Joel A. Dvoskin, Ph.D., ABPP Tucson AZ [email protected].

Helping People to Live Safely with Mental Illness:

Police Training and CIT

Joel A. Dvoskin, Ph.D., ABPPTucson AZ

[email protected]

If You Think This Is Funny…

If You Think This Is Funny…

• …you might be too old for this work.

The Difference between Us and Them

• Them is scarier than us

The Difference between Us and Them

• Them has dark motivations• Us makes well-intentioned mistakes

The Difference between Us and Them

• Them has symptoms• Us has “coping strategies”

The Difference between Us and Them

• Them has disorders• Us has personalities

The Difference between Us and Them

• Them is manipulative• Us has social skills

THEM AND US

• Them is crazy.• Us is quirky…• …no, wait.• Us is creative. (Yea, creative! That’s the

ticket!!!)

Is It Always “Crazy” to Refuse Treatment?

• Treatment-resistant clients? Or client-resistant treatments

• Why I hate the word “empower.”• “Freedom’s just another word…”• Chronic hiccups and the fear of drugs • MH professionals can be kind of bossy• The definition of insight• “And they call it help.”

What I Hate about Psychology and Psychiatry

• The Book of Insults• The thing we’re the worst at• Which would you rather get when you’re

hungry, advice or a ham sandwich?• “Judge not, lest ye be judged.”• Basic credibility – Where do we get off telling

other people how to live their lives?

Manipulation

• The difference between manipulation and exploitation.

• Only psychologists think manipulating people is a bad thing.

• The real definition of manipulation…• …is getting your needs met without violence.• Why do you think they’re called “needs?”

Manipulation (cont.)

• Criminal justice settings tend to place a relatively low priority on meeting an offender’s perceived needs.

• The definition of “intolerable” anxiety• Trying to feel safe in unsafe places• Example: Preventing suicide by punishing

people

Malingering• Malingering is a question – not an answer.• Malingering does not preclude real mental

illness or severe emotional distress.• “We can’t treat you – You’re not suicidal.”• Trying to get help when there isn’t enough

help to go around.• “If this isn’t mental illness…”• Pathological strategies are…well…• …pathological.

Jail and Prison Ethics

• Mind your own business• Never ask an authority figure for help• Never show weakness or self-doubt• The only acceptable emotion is anger

How do you think there ethical principles will work in the free world?

SURVEY

• Raise your hand if you think of yourself as a “Violent Person.”

• Now raise your hand if you can honestly say that you would never, ever behave with violence.

Are You a Violent Person?

• The difference between us and them• “We do everything we can to avoid the use of

force.”• “I haven’t fired my service weapon in 35 years

on the force.”

Are You Sure You’re Not a Violent Person?

• What would push you “over the line?”• Survey says: – “If someone was going to hurt my kids.”– “To save a life.”

• The special role of emotions in unplanned, non-predatory violence

• The monsters within us all– Fear– Anger

Case Example

• A man is in front of a well-known church, waving a real sword at apparently imaginary enemies, and cursing loudly

• TV Police Officers approach, yelling, “Drop the sword, or I’ll shoot!”

• Likely result?

Case Example

• What is missing from this picture?• Why is this man behaving this way?• What are his likely motivations?• What are his likely goals?• What is the desired outcome of this police

encounter?• What would you do or say?

Response Options

• “Drop the sword.”• “DROP THE SWORD!”• “DROP THE FREAKIN’ SWORD!!!!!!”• “Drop the sword or I’ll shoot.”• “Good news. You’re safe now. You don’t need

your sword any more. I have a gun, and it’s my job to make sure nobody hurts you.”

The Front Lines of Mental Health

• “Who you gonna call?”• Police officers are the most prolific MH

workers in America• Police officers can make it better…or worse.• “To serve and protect” • Spectacular tragedies• Don’t get mad at police officers for doing

exactly what we trained them to do.

Stuff You Already Know about Dealing with a Person in Crisis

• Speak clearly, not too fast, and very respectfully. • The person may be having trouble

communicating because of confusion. Be patient, and consider the possibility that the person is doing the best they can.

• It's OK to say their name as a way of helping them attend to you, but it is neither helpful nor particularly polite to yell at them.

• If you become frightened, back off.

Stuff You Already Know about Dealing with a Person in Crisis (cont.)

• Dealing with delusions: – No need to agree or disagree with “delusional”

statements; you are not in charge of the "truth." – Look for common ground. – Validate their feeling of distress without getting into

an argument with them about the truth of their belief– If you disingenuously pretend to believe them, they'll

probably know you’re lying – Remember, words are your most potent weapon. Keep

your powder dry by maintaining your credibility.

Case Example

– “I’m Jesus Christ, and Satan is trying to kill me.”

– "You must be exhausted!”

Stuff You Already Know about Dealing with a Person in Crisis (cont.)

• Personal Space: – Avoid getting too close to the person, unless

you’re trying to get into a fight. – Don’t try to get into a fight. – They may not be able to verbally tell you to give

them space, which might cause some physical act that will appear aggressive, but is in fact defensive.

Stuff You Already Know about Dealing with a Person in Crisis (cont.)

• If you are never afraid…• Either you’re some sort of alien, or …• …you’re kind of stupid. (I was going to say “No

offense,” but then I realized how silly that would be.)

• Anyway, you need to retire, because you’re endangering your colleagues.

• Fear is your friend. It tells you when to duck.

Stuff You Already Know about Dealing with a Person in Crisis (cont.)

• When people are confused, it may be hard for them to communicate.

• Try to avoid asking a bunch of questions, and consider giving the person a little time and space…

• …so long as they are not putting themselves or others in any danger.

• Doing nothing is an option.

Stuff You Already Know about Dealing with a Person in Crisis (cont.)

• High on everyone's list of "wants" is to feel safe. Whether a person's fear is reasonable or unreasonable, we all want to feel safe.

• If the person is able to tell you, it is a very good idea to ask them what would make them feel safer.

Stuff You Already Know about Dealing with a Person in Crisis (cont.)

• Don't take it personally. • Their crisis is probably not about you. • There may be something that they want, and

it may be reasonable. • So don't be afraid to ask them what they

want. But…• …don’t reward threats.

CIT and Kids

• Adolescence and other mental illnesses• How good was your judgment at 15? So cut

‘em a break.• “There’s impulses and then there’s impulses”– Angry impulsivity– Hedonistic impulsivity

• “There’s worse things than juvy.”– Why would a kid run away from a safe home?

CIT and Kids (cont.)

• Can you afford a separate CIT program for kids?

• Adding child development information to CIT training

• Know your local resources• The consequences of ejecting children from

their communities

The Worst Thing about This Work

• Prevention never says thank you• You seldom get to know what you prevented• The offensive linemen of a safe society…• The only time they call your name• Sometimes the people you are trying to serve

and protect call you ugly names…• And sometimes they try to shoot you

But Here You Are

• You show up for work• Sometimes you risk your lives• You take the abuse• You get branded and insulted when one

percent of you don’t act right• You serve and you protect

And So…• From a grateful public…• From the people in crisis whose lives you have

saved (even if you don’t know it)…• From the loved one whose lives you have

saved (even if you don’t know it)…• And to your own families, who wait for you

and hope you’ll come home safe…

THANK YOU!