The Honorable Gus Bilirakis: H.R. 3717 modifies the Justice Assistance Grant program to provide training to police officers to recognize mental illnesses and better intervene in situations. Would this help ensure that police officers receive training to recognize a veteran suffering from Post-Traumatic Stress?
Dr. Michael Welner: Let me first disclose for the record that I have treated police officers and veterans with psychiatric illness, examined officers for fitness for duty evaluations, have examined police shootings in the context of the behavior and presentation of the individual shot, and have consulted in the assessment of adequacy of police training to deal with the mentally ill and developmentally disabled, including currently in Albuquerque, New Mexico.
As the Subcommittee knows, the Albuquerque Police Department has been the subject of a critical report from the Department of Justice this month. The DOJ report is not without its notable shortcomings, but criticism can focus to needed improvement to how police respond to mental health crisis. HR 3717 is a solution that provides for gaps in police officer training in many jurisdictions today. The legislation has a vision for enhancing police response to mental health crisis, enhancing departmental partnerships with families, and training police officers to be extenders to mental health professionals for those suffering, whose denial turns them away from help as their symptoms worsen.
With that said, let’s first recognize that police officers confront symptoms of mental illness more than ever before because of numerous factors:
- Because of deinstitutionalization, more individuals with serious mental illness are maintained in the community than ever before. Commitment standards of imminent dangerousness, coupled with the far more curtailed length of hospital stays under current medical economics, push more acutely ill individuals into the community. Even if not dangerous, their behaviors may inspire complaints from passersby or neighbors. Or, their disorganization may include law-breaking.
- Family disintegration is far more common in contemporary America than in earlier decades. Many acutely ill who would have been absorbed into caring structures within families are living unaffiliated lives. With no one looking after them in the family, if they become increasingly disorganized, they encounter police.
- The nation continues to labor under an economy of unemployment and underemployment. Economic adversity contributes to emotional illness, substance abuse, suicidality, and domestic strife. Some of the most perilous encounters occur in officer responses to domestic disputes involving one of more of the above factors.
- Communities, especially cities, have more dynamic population flows. Many areas reflect less neighborhood connectedness, and mindfulness to those who are struggling. Social infrastructures of cities with an eroded tax base, and other budget priorities, may offer poor supports to the seriously mentally ill or those in crisis. AOT, for example, is of only recent vintage and available only in certain areas. It is easier in cities and communities with more limited social infrastructure for those with serious mental illness or in mental health crisis to drift toward tragedy. At that point, behavior eventually brings police contact because there is no other source of intervention to a crisis that can no longer be ignored.
- Lengthy participation in the combat theater has left many military returnees with post-traumatic stress disorder. The symptoms of the condition may be hard to confirm and to identify. Reintegration from the military has many challenges beyond merely the presence of posttraumatic stress disorder, traumatic brain injury, amputation, or other physical disability.
- More are recovering from head injury with greater independence than ever before – veterans and non-veterans. Head injury may be disinhibiting, among numerous less pervasive but enduring effects. Impulsivity, disinhibition, poor judgment, or bad temper manifests between neighbors, in road rage, at the workplace and may contribute to complaints to police. Sexually inappropriate behaviors may likewise reflect traumatic brain injury’s effects on the above. Those same qualities may likewise afflict someone who has a firearm and is encountering police, and therefore reflects a potentially even more dangerous subject.
- Substances of abuse now include such homemade concoctions as crystal methamphetamine, bath salts, and synthetic marijuana, which are known to instigate wild and out of control behavior that may not be responsive to customary de-escalation. Recognizing the history of intoxication and its relative time course may defuse a situation by simply containing it, but the affected party is quite volatile in the interim. To appreciate how dramatic this can be, I’m reminded of a California case, in which we were recently called in, which where police were called to a scene where two professional fighters had been partying with their girlfriends. Police arrived to find one holding, in one hand, the heart of his friend, which he had torn out with his bare hands, along with his eyes. Yes, that level of destructive fury presents to police, with no toxicology screen beforehand.
- Autism is more common than ever before. Less obvious developmental disabilities may result in behaviors that are misinterpreted as aggressive and threatening. As demonstrative as the social inappropriateness of autism is, it is not socially predatory. Those who attribute developmental disabilities to their own predatory behavior, on the other hand, stigmatize others with autism by creating false fears that violent motive is an expression of autism. It is not. Autism is a style of relating, not a deviant ideology; those with developmental disabilities who are deviant are so for reasons ranging from concurrent paraphilia (sexual deviance disorders) or personality disorders (sociopaths and psychopaths) or mood or psychotic disorders (Adam Lanza, for example).
- Contemporary American culture idealizes recreational public drunkenness, especially on college campuses, during spring break, and in association with the most popular and most physical spectator sports and at times of extreme celebration. Numerous corporate interests promote it. Alcohol is more directly causal of violence than even heroin, stimulants, marijuana, or cocaine. The public health problem of alcohol and violence has been completely neglected while police departments confront its public expression. Laws regulating alcohol use in motorists, or promoting responsible vending of beverages at stores and bars cannot impact domestic disturbances in which police engage well-lubricated members of the general public. Under such circumstances in which citizens cannot interpret their environment rationally, any presence of police in their home may endanger officers.
- Lawlessness during certain political activities may accompany important events such as the G8 Summits. As the Occupy protests, which I personally visited and observed in New York City demonstrated to me, these spectacles attract disproportionate hordes of news media eager to provoke chaotic behavior by those in turn attracted to their cameras. Like other spectacle crime by attention seekers, when the television cameras go away, so does the public disorder and threat to public safety.
- Incidents of police misperception of aggressive but otherwise harmless displays, mishandling of incidents due to cultural illiteracy, sadistic overreaction in power struggles likewise contribute to a cultural paranoia. The anger of tragedies is stoked by socially irresponsible news media and those dependent upon media attention who provoke unrest and poison relations between the police and African-American communities, particularly in some cities. In turn, the encouragement of violence toward police in popular entertainment and the idealizing of an anarchist thug culture engender fear among police.
- Gang violence occurs to a degree never before seen in earlier decades. Youth opting for such choices include a substantial population with diagnoses stemming from substance abuse problems, oppositional defiance and conduct disorder, to the emotional effects of early abuse and neglect, posttraumatic stress disorder, or depression. Adolescents, now given more far more lenient consideration by courts, endanger law enforcement because they are deputized by senior gang members, who know younger offenders will see only short-term justice consequences, even for violence. More unrestricted traffic into the United States from its Mexican border further confronts officers with gang soldiers who culturally have no hesitation about killing anyone, including law enforcement.
- Flashmobs of looting in broad daylight draws even participants who often have no criminal records and abandon inhibitions due to group reinforcement. These often involve school age children, as does the hate crime most well known as the knock-out game. In my professional opinion, the instigation of a sociopath leader, group reinforcement, and poor police training and lack of initiative in the schools enables greater lawlessness.
- Contemporary school culture sharply restricts teacher discipline even as it tolerates the permissiveness of teacher-student sexual exploitation. Those who misbehave are accommodated, and when behavior escalates to a more shocking degree, law enforcement now steps in instead of the emasculated school administration.
- Those with developmental disabilities are especially prone to victimization, particularly the intellectually disabled. We now more readily appreciate that mental retardation is not always visible to the naked eye; police must be able to better recognize the adaptive subtleties of intellectual disability in order to better flag the vulnerable and potentially victimized.
What is most notable about the above observations, based on my experiences from litigation casework? That psychological sophistication incorporates local elements of culture by necessity. How else to really determine normal from not normal? And, that knowing diagnosis is but a small part of the mental health universe that law enforcement needs to be trained in, and to master.
In my professional opinion, too much emphasis is placed on recognizing diagnoses of illness as opposed to symptoms of psychopathology. When one is too oriented to ascertaining whether a person of interest has the symptoms of post-traumatic stress disorder, for example, that officer may make the mistake of looking for an illness as if collecting its criteria in a treasure hunt. If the diagnosis is present, that’s a good pickup. But if it is absent, a person may still be very impaired and in need for help, but overlooked because the seriousness of their situation is equated with the presence or absence of post-traumatic stress disorder.
In my professional experience, those with PTSD actually pose very little risk to others. They are numb and reserved. On the other hand, their flashbacks may be startling to witness and may specifically be responsible for high agitation.
More importantly, if these veterans have dissociation with their PTSD, their behavior may become chaotic and even destructive. It is the hyper-vigilance and irritability of posttraumatic stress disorder that are most associated with violence toward others; the hopelessness of the condition that most directly links to suicide, and self-medication with alcohol that facilitates or may directly cause suicide or homicide.
Yet dissociation, hyper-vigilance, irritability, hopelessness, and alcohol intoxication are also symptoms of other conditions – and sometimes, no conditions at all. This teaches us that it is first important for law enforcement to recognize not only symptoms but the potential public safety implications of those symptoms, as well as how to defuse non-directed agitation without violent confrontation.
There are advantages to law enforcement training in diagnosis, however. An officer who does correctly identify posttraumatic stress disorder may be the first to identify child abuse or a battered woman. Jaycee Duggard, kidnapped from her family and held captive for many years, would have been flagged by better police training to recognize PTSD. Investigators operating within polygamous sects, notorious for enforced silence, can use such training to distinguish the numbing of PTSD in an abused adherent from uncooperative obedience to the elders. Better recognition of dementia and delirium, likewise enhances law enforcement’s ability to respond to the needs of the elderly who are in harm’s way but cannot articulate it as such.
In that regard, one of my criticisms of HR 3717 is that it needs to better appreciate that major mental illness is not limited to the schizophrenia spectrum, bipolar disorder, and depression, but encompasses severe personality disorders, dissociative disorders, dementia and delirium, autism, and severe PTSD. Doing so will not only enhance the approach to mental health crisis by law enforcement, but by the other relevant disciplines as well.
