How should our police handle the mentally disturbed?

Despite the mounting death toll from the use of Taser guns, police are loath to give up their use. Their reluctance is understandable. They are mostly a non-lethal alternative to the use of hand guns in life threatening situations; and a tool for subduing those who are out of control and non-compliant.

Modern society no longer incarcerate the mentally ill indefinitely. Instead most patients are managed in the community on an outpatient basis.

As a rule, treatment is voluntary. Close professional supervision of all out-patients is difficult to meet.  Not all are fully cooperative. Some just stop taking their medicine, loosing control of their symptoms. They are then likely to limp from crisis to crisis. Potential causes of acute exacerbation of their illness requiring expert assessment and management include:

  • acute psychosis
  • over-whelming depression with suicidal intent
  • uncontrollable manic states with extreme agitation
  • paranoia and aggression
  • a break-down in social skills resulting in severed relationships
  • violent and criminal behaviour
  • inability to concentrate and work constructively
  • their situation may be made worse by substance abuse
  • there may be diagnostic difficulties due to coincidental inter-current medical conditions.

Most crises are resolved with the support of family and friends and with appropriate medical intervention. It is only when there are public disturbances, that police become involved. We expect the police to risk their own lives, for our own safety.

They face complex situations, requiring them to make difficult decisions on the spur of the moment.  I believe the community should always be supportive of police action, even when the outcomes result unfortunately in injury and/or death.

At the same time, victim families have a right  to know the true circumstances of incidents that go horribly wrong, and receive an authoritative assessment of what could have been done better.

The question arises as to whether it is better to avoid using life-endangering weapons, and  instead draw on the services of psychiatrically trained paramedics/ nurses/ doctors to sedate the mentally disturbed and start appropriate treatment. Large public hospitals have on-call retrieval teams to provide primary management of major medical emergencies. Why do we not have emergency psychiatric staff to aid the police in the assessment and management of emergencies due to mental illness?

This blog has already reviewed the story of the death of 19-year-old Brazilian student Roberto Curti in 2012. His death followed police attempts to bring him under control by tasering him multiple times, when he was suffering from an acute drug induced psychosis, with manic agitation.

The story of Adam Salter is an example of the injudicious management of mentally ill patients in this case not involving the use of Tasers.

Adam had grown up a happy well-adjusted young man with a good job until he developed schizophrenia, and became depressed.

Adam Salter in happier days

He died at 36, in November 2009, after stabbing himself in the chest with a knife.  He collapsed bleeding, on the kitchen floor but was struggling to reach the knife on the kitchen sink when his father came to his rescue.

His father called emergency services, and set about trying to calm his agitated son, putting his arms around him. An ambulance paramedic arrived first who thought his injuries were not fatal and his condition stable.

When the police arrived they took control of the situation. They asked his father to leave, because of the  danger, and instructed Adam to submit to their commands. Instead their  presence increased his agitation and he again struggled to get to his feet. The move towards the knife contrary to their orders, was thought to be threatening, when he was in all likelihood just still suicidal.

At this point another police officer entered the kitchen from another room, shouted Taser three times, but then shot him three times with a hand gun, killing him,

This incident demonstrates:

  • that police authoritarianism can worsen such tense situations, and increase patient agitation.
  • that police may over-react in emergencies. The patient was suicidal and wounded, and unlikely to have been able to harm anyone other than himself.
  • that they terminated his father’s supportive presence, and ended his medical treatment.
  • that they failed to try alternative non lethal measures. Instead they shot to kill, without proper warning.

http://www.abc.net.au/4corners/stories/2012/03/01/3443486.htm

The mentally ill rarely obey orders and may be unable to do so because of  uncontrollable inner turmoil and agitation.

To attempt to restrain them and physically bring them under control simply heightens their distress.  Repeated tasering is agonising, and greatly increases the risk of death probably by compromising their heart and lung function.

95% of more than 500 patients dying in the United States since Tasers were first introduced, were unarmed. This suggests a need more accurate diagnosis and assessment of risk. The present police approach is appropriate for aggressive and armed individuals, but for the majority who are unarmed and in need of medical attention, a calm, reassuring, and conciliatory approach is likely to be more successful.

The emphasis should be on sedatives, not weapons. 

This post is a contribution to a community debate we should have, about what we can do better in such emergencies.  Mental illness is a major and increasing problem in our society.

 

 

 

 

About Kenneth Robson

I studied at Adelaide Boys' High School, and the University of Adelaide, Medical School. graduating in 1961. My field of specialisation was Plastic and Reconstructive Surgery. Prior to establishing my practice in Adelaide, I spent 5 years working in India, and Papua-New Guinea, in the field of reconstructive surgery for leprosy. In retirement I joined the Australian Technical Analyst Association and passed the two examinations for a Diploma inTechnical Analysis, and the designation Certified Financial Technician (CFTe) by the International Federation of Technical Analysts.
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