Earlier this year, VirTra submitted and received certification on the curriculum “Mental Illness: A Practical Approach.” This curriculum covers the signs and symptoms associated with different mental illnesses as well as communication and intervention techniques. Most importantly, officers will learn how respond to the specific behaviors a person displays instead of focusing on the mental illness itself. People should be treated as individuals and not as their diagnosis.
One of the mental illnesses covered in the curriculum is Schizophrenia. Schizophrenia is a serious mental illness that affects about 1% of the national population. Schizophrenia can interfere with a person’s ability to think clearly, make decisions, manage emotions and relate to others. The severity of unmanaged schizophrenia can be extremely debilitating and disabling.
Depending on the severity of the schizophrenia, an individual may experience hallucinations or delusions. Hallucinations are false perceptions and experiences absent certain stimuli and can manifest as visual, auditory, olfactory or tactile. Delusions are false beliefs that conflict with reality. Hallucinations and delusions are common with schizophrenia, but that does not mean that person has a schizophrenia diagnosis.
A person with schizophrenia may also experience psychosis. Psychosis describes a condition where an individual has lost touch with reality, usually aligned with severe disturbances in behavior, cognitive processing and emotional regulation. The disturbance in perception makes it challenging for an individual to determine what is real and what is not. This can be especially challenging for officers.
Instead of focusing on a diagnosis, officers will learn to respond to the behaviors and clarity in thought process an person exhibits at the time of contact. This allows officers to coordinate an intervention response that is as safe and effective as possible for everyone involved. Each section of VirTra’s “Mental Illness: A Practical Approach” goes further in-depth in recognition of signs and symptoms as well as effective and safe intervention techniques.
For each curriculum, instructors are given slide presentations, booklets, pre- and post-tests, evaluation forms and simulator scenarios. This allows officers to learn the material in the classroom, then implement their new training in a real-life situation displayed in the simulator. Training in this manner ensures officers are well-rounded and skills are easily transferred to the field.
VirTra’s “Mental Illness: A Practical Approach” is part of V-VICTA, is NCP certified and meets rigorous quality training standards for the curriculum. This includes extensive research, citations, correct knowledge retention format, comprehensive testing materials and more.
Author:
Nicole Florisi started her public safety career in 1999 as a communication specialist. In 2002, she became a certified peace officer for the state of Arizona. She has been a law enforcement trainer and instructor for the past 15 years. Her areas of expertise are in crisis intervention and de-escalation, crisis negotiations, child abduction response, domestic violence, and human trafficking. She was also a Drug Recognition Expert and Instructor, Standardized Field Sobriety Test Instructor, and forensic phlebotomist. Nicole was the lead negotiator for the regional SWAT team for 12 years.
Mental Illness training is no longer important knowledge: it is crucial knowledge.
Now more than ever, officers must know how to properly recognize and interact with every member of their community. VirTra makes teaching this curriculum easy and effective by providing instructors with 15 hours of nationally-certified training material and professionally filmed simulation training scenarios.
Our Mental Illness Training: A Practical Approach curriculum includes training manuals, slide presentations, pre and post-tests, evaluations and real-life scenarios to help instructors teach the concept in the classroom, then cement the teachings by practicing the concepts in a simulator.
This training also includes interviews with individuals that have experienced mental illness and what they feel law enforcement should know from their perspective. These insightful videos are critical in helping with empathy and understanding.
Through this curriculum, officers learn to recognize a variety of mental illness symptoms—including depression, suicide, anxiety, trauma, PTSD and schizophrenia—and communicate and engage in the proper techniques for the situation.
Learn more about our Mental Illness training here.
Or watch officers engage in real Mental Illness scenarios below:
Subscribe to our YouTube channel to find other ways of maximizing training with VirTra’s curriculum.
Recently, VirTra’s “Mental Illness Training: A Practical Approach” training was nationally-certified through IADLEST’s NCP program. This unique V-VICTA curriculum contains 15 hours of nationally-certified training material that contains 10 lessons, an in-depth instructor booklet and corresponding training slides.
One of the topics covered in this Mental Illness training for law enforcement is Traumatic Brain Injury, or TBI. While this may seem out of place in the Mental Illness curriculum, TBI is in fact a big risk factor for conditions such as neurocognitive disorders, substance abuse and more.
About TBI
Simply put, TBI is caused by a sudden injury to the head that causes damage to the brain. This can be classified as one of two injuries: closed head or penetrating injury. These are fairly self-explanatory; closed head injuries are caused by a blow bump or jolt to the head while penetrating injuries are caused by an object penetrating the head.
Since the definition is wide, TBI can be sustained in many places and among any age group. This includes head trauma caused during intense sports such as football or soccer, falling, active duty combat or car accidents. Penetrating injuries are more intense and caused by more extreme actions, such as shrapnel, being hit by weapons such as hammers or baseball bats, or other injuries powerful enough to cause bone fragments to penetrate the skull.
Symptoms of TBI
TBI symptoms can range from mild to severe, depending on the injury and degree of severity. A good example of mild TBI are concussions, which many people have experienced and recovered from. However, the more intense forms and symptoms of TBI include serious physical and psychological symptoms, comas or even death.
Symptoms of Mild TBI: These include brief loss of consciousness, headaches, confusion, lightheadedness, dizziness, blurred vision and trouble with memory, concentration, attention and thinking.
Symptoms of Severe TBI: Just as the cause is more severe, so are the symptoms. Officers can look for: worsening headaches, repeated nausea and/or vomiting, larger pupil(s), slurred speech, loss of coordination, weakness and/or numbness and increased confusion, restlessness and agitation.
Officer Training of TBI
As an officer, you cannot diagnose a subject with TBI or any other mental illness unless you have the proper training and credentials. Instead of teaching officers to diagnose, VirTra’s Mental Illness curriculum is designed to teach officers how to recognize a variety of potential mentally ill subjects, the best forms of interaction and how to maximize officer and subject safety.
Through these 15 certified hours and corresponding real-life scenarios, officers learn appropriate verbalization techniques, can demonstrate they recognize the different behaviors displayed and how to implement the best response through every step of the interaction. Learn more about our Mental Illness training here or view the list of V-VICTA law enforcement curriculum here.
If your department could benefit from our Mental Illness curriculum, contact a VirTra specialist today.
Reference:
“Traumatic Brain Injury | TBI.” MedlinePlus, U.S. National Library of Medicine, 30 July 2020, medlineplus.gov/traumaticbraininjury.html.
Schizophrenia, psychosis and mood disorders are often misunderstood by the public. Though it only affects a small percentage of the population, stigmas fueled by the media have caused some people to view it as a disorder that triggers violence in the people it affects.¹ Law enforcement must be cautious not to fall for such stereotypes or make assumptions based on the diagnosis.
Schizophrenia, as stated before, only affects around 1% of the national population. An even smaller fraction of those affected by schizophrenia and similar disorders have a marked increase in violence. Data shows that people with schizophrenia are actually 14 times more likely to become a victim of a crime than be arrested. ² What may increase the chances of violence, however, are the use of drugs and alcohol in combination with any disorder.
So how can an officer – or anyone, really – tell if a person they are interacting with might have schizophrenia or a similar disorder? Everyone shows symptoms differently, but in order to have a true diagnosis, a person must display certain “positive” and “negative” symptoms. Positive and negative, in this case, don’t mean whether the symptoms are positively or negatively affecting someone, but rather about adding and subtracting symptoms.
Positive symptoms:
• Hallucinations (false perceptions)
• Delusions (false beliefs that conflict with reality)
• Thought disorders
• Movement disorders
Negative symptoms:
• Reduced expression of voice tone and facial expressions
• Reduced feelings of pleasure
• Difficulty beginning and sustaining activities
• Reduced speaking
Those experiencing schizophrenia may also express cognitive symptoms such as difficulty focusing, memory problems or decision-making.
For the V-VICTA™ curriculum “Mental Illness for Contact Professionals,” VirTra staff got a chance to speak with a woman who lives with schizoaffective disorder. M – a woman in her 20’s – takes medication to control the effects of her mental illness that cause her to experience visual and auditory hallucinations as well as paranoia.
One night, M was pulled over for speeding and was visibly nervous. Due to her shaking, the officer began to ask pressing questions and seemed to believe she was on drugs. After explaining what medication she was taking, the officer let her go, but she needed to go to the hospital later on due to the trauma it caused.
“I was having all these other voices, it’s just very overwhelming” M said about the incident. We asked M what she would want officers to know about her mental illness. “Really, we’re just trying to go about our lives, do our own thing and be normal,” she replied. “Of course, sometimes it can get dangerous, anyone can get dangerous. It just really bothers me that schizophrenia is painted as this monster mental illness, and it’s not that way at all.”
While it is important to be aware of potential dangers, remember to avoid falling into the traps of stereotypes and stigmas. The first step to doing this is to understand the types of mental illness that can affect people from all walks of life – not only schizophrenia. By using the “Mental Illness for Contact Professionals” V-VICTA course, VirTra aims to prepare law enforcement for any kind of interaction.
References:
1. Wehring, H. J., & Carpenter, W. T. (2011). Violence and schizophrenia. Schizophrenia bulletin, 37(5), 877–878. doi:10.1093/schbul/sbr094
2. Brekke JS, Prindle C, Bae SW, Long JD. Risks for individuals with schizophrenia who are living in the community. Psychiatry Serv. 2001;52:1358–1366.
3. National Alliance on Mental Illness. Schizophrenia. Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Schizophrenia
Neurocognition is an important function that allows us to think, remember, understand language, use motor movements and perform routine tasks. When these functions decline, it may be due to a Neurocognitive Disorder, (NCD’s). Common examples of NCDs are Alzheimer’s, Parkinson’s, and Frontotemporal Dementia. Dementia is an umbrella term for numerous types of NCD’s. For example, Alzheimer’s is a disease and dementia is not.
The main trait of NCDs is that they cause decline in previously attained levels of neurocognitive function. NCDs are not developmental, but are acquired and are the result of an underlying brain pathology, most commonly affecting the elderly population. Major cognitive disorders affect approximately 1-2% of people by age 65, and 30% by 85.
Signs that a person may be suffering from an NCD include:
• Memory impairment
• Difficulty concentrating, planning or problem-solving
• Problems finishing tasks
• Confusion with location or passage of time
• Language problems
• Poor judgment in decisions
Alzheimer’s Disease is the most common NCD, accounting for about 70% of cases. That being the case, officers may interact with people who have Alzheimer’s more frequently than other types of NCD’s.
Officers must be aware that while not all behavior is dangerous, people with Alzheimer’s (or other NCD’s) may display aggressive behavior – both verbally and physically.
To manage behavior and avoid confrontation if possible, officers should identify themselves and speak in a slow, non-threatening manner. Ask one question at a time and repeat yourself if necessary, while asking simple yes or no questions. It may be wise to avoid using restraints unless absolutely needed because they may increase agitation.
IACP recommends that officers ask the following basic questions when encountering someone who they believe to be suffering from Alzheimer’s or Dementia:
• Where are you coming from? Where are you going?
• What route are you taking to get there? Who are you meeting?
• What is your name and address? What is your phone number?
• What day of the week/month is it?
• What city and state are we in?
• What time is it right now? (Answer should be correct within one hour)
If the individual cannot answer the questions or gives incorrect answers, the person should be moved to a safe and comfortable location and officers should attempt to locate their family or caregiver. Officers should also check for a tracking device or Medic Alert Alzheimer’s Association and Safe Return ID.
Keep in mind the best practices for law enforcement during these encounters. Recognizing the signs and managing behaviors are the most important tools for dealing with NCDs.
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders fifth edition (DSM-5). American Psychiatric Association; 2013
Simpson JR. DSM-5 and Neurocognitive Disorders. (2014). The Journal of the American Academy of Psychiatry and the Law. June 2014;42(2):159-164.
International Association of Chiefs of Police. (n.d.) Model Policy for Missing Persons with Alzheimer’s. Retrieved from http://alzaware.org/Content/PDFs/IACP-Model-Alzheimers-Policy.pdf
6.9% of adults in the United States – 16 million – have suffered from at least one major depressive episode in the past year. Chances are most of us know someone with depression , and with a staggering statistic like this, it is even more likely law enforcement officers have encountered subjects suffering from depression. A person with depression can function normally in society or have their daily life severely impacted.
However likely it is an officer will interact with a person suffering from depression, it is not their job to diagnose. This information, as well as lessons provided in the V-VICTA™ “Mental Illness for Contact Professionals” course, is meant to provide law enforcement with additional tools and insight in encounters where a person appears to be suffering from mental illness.
Signs of Depression
Depression is more than feeling sad or depressed for a fleeting moment. Instead, people diagnosed with depression are often undergoing a daily struggle with controlling negative emotions. While it is difficult to pinpoint the cause of depression, some triggers may include: a chemical imbalance in the brain, severe stress or living in an unstable environment.
The following list of signs and symptoms is not all-inclusive. Rather, it provides a general look at what first responders may notice or learn about when interacting with a subject who suffers from depression:
• Subject feels sad, empty, hopeless and/or pessimistic.
• Loss of self-esteem and self-worth.
• Loss of interest in hobbies and fun activities.
• Abnormal sleep patterns, such as oversleeping or not getting enough sleep.
• Decreased energy and fatigue.
• Difficulty concentrating and sitting still.
• Changes in weight and appetite.
• In rare cases, depression can cause psychotic symptoms such as hallucinations.
Crisis Behaviors
Unfortunately, depression can lead to extreme behaviors not seen in otherwise mentally well persons . For those unaware of the crisis behaviors, they may come as a shock and leave officers feeling unprepared. It is recommended that when a crisis occurs, mental health support staff should be utilized. With severe events, medical staff should be staged nearby so the subject can receive immediate medical attention if necessary.
With severe depression, people may consider suicide or attempt it. In situations where a subject is deemed suicidal, it is imperative to talk to them and find out more information. Ask them if they are considering suicide, if they have a plan and what the plan might be. This allows the officer to determine the level of suicidality to determine next steps. Remember, saying the words “suicide” or “killing yourself” will not put the idea into the person’s head. A person discussing suicide may be desperately asking for help.
Depression can cause people to intentionally cause physical injury to themselves, which is known as Non-Suicidal Self Injury (NSSI). Typically, this manifests as cutting, bruising, inserting objects into the skin, etc. This becomes more than a mental health crisis, often a physical one, depending on the severity of the injuries.
How to Help & Communicate
Officers can help subjects suffering from depression by speaking to the subject calmly, directly and openly. Allow the person to express their feelings without interruption or expressing your own thoughts or feelings—do not make them feel judged. It is important to make them feel their feelings are accepted and active listening plays a significant role in helping a person feel understood.
Most importantly, encourage the depressed subject to seek help. Just because a person is not actively suicidal or engaging in NSSI does not mean behavior health intervention is not needed.
For more information on depression and other mental illnesses, visit the V-VICTA “Mental Illness for Contact Professionals” lesson plan. Instructors can learn more about V-VICTA and how to incorporate it into training here.
References:
National Alliance on Mental Health. (n.d). Mental Health by the Numbers. Retrieved from https://www.nami.org/Learn-More/ Mental-Health-By-the-Numbers1.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders fifth edition (DSM-5). American Psychiatric Association; 2013
National Alliance on Mental Illness. (n.d.) Depression. Retrieved from https://www.nami.org/Learn-More/Mental-Health- Conditions/Depression
Nock MK, Favazza AR. (2009). Nonsuicidal self-injury: definition and classification. Understanding Non-Suicidal Self-Injury: Origins, Assessment, and Treatment. Washington, DC: American Psychological Association; 2009:9–18
Law enforcement officers encounter individuals from all walks of life, sometimes all within a single day. Officers are instructed to keep diversity in mind, which includes physical and mental diversity. To help prepare and educate officers, VirTra created V-VICTA—Virtual Interactive Coursework Training Academy “Mental Illness Training: A Practical Approach.” This curriculum covers multiple mental illnesses and disorders officers need to be conscious of, including:
• Anxiety
• Dementia
• Depression
• PTSD
• Schizophrenia
• Substance use
• Suicide
• Traumatic Brain Injury
While officers are not trained to diagnose disorders, this valuable knowledge provides the ability to recognize symptoms, helping the officer know how to deploy the correct communication techniques. In addition to symptom awareness, there are a few critical ways officers can help those they encounter, even with emotionally disturbed persons (EDP). These include: breaking stigmas, showing sympathy and knowing when to stage medical personnel. By doing so, officers increase the probability of these encounters ending on a positive note.
Breaking Stigmas
As with any group seen as ‘different’, there are stereotypes and stigmas that surround mental illness. The first is how these individuals may be thought of as slow or dull. Being diagnosed with a mental disability, illness or other deficiency does not equate to a lack of intelligence. While communication may need to be altered to increase understanding, these individuals are often very bright.
Another misconception relates to depression and suicidality. Many believe saying “suicide” or “ending your life” to a depressed and possibly suicidal person could put the idea into their head. However, the only way to find out if a person is considering suicide is to ask them, and people who openly discuss it may be reaching out for help.
Finally, the most harmful stigma is the swift assumption that mental disabilities leave a person prone to violence. Due to media coverage, certain illnesses such as schizophrenia are thought to cause subjects to behave unpredictably and sometimes violently. While certain sub-groups can exhibit violent behavior, it is not considered a common demeanor.1
Sympathy and Understanding
It is important to respond to subjects’ concerns with a level of understanding to ensure they feel valid. Be cautious when saying you “understand” what a person is going through, as it may be inadvertently inflammatory.2 By providing a listening ear and suggesting to get help, you may provide a solution instead.
A critical part of being sympathetic is not minimizing what the subject is going through. Do not imply that they are weak, not trying hard enough, etc. Even if a person is hallucinating, telling that individual what they are experiencing is “not real” will invalidate their experience.
An Officer’s Role
If a mentally ill person is in distress, it may be beneficial to stage medical personnel nearby should they need to be treated, evaluated or transported to a hospital. Remember: law enforcement’s job is not to diagnose. Recognizing symptoms and being familiar with symptoms is crucial to providing effective intervention, but should not be confused with a proper mental evaluation.
There are a few ways officers can help de-escalate a situation if it appears to be out of control.3, 4
• Speak in a low, calm voice
• Listen with empathy
• Respond to some aspects of communication with understanding
• Be clear but non-confrontational
• Use active listening skills
To take a deeper dive into this curriculum and to learn how your department can benefit from these training topics, contact a VirTra specialist here.
References:
- Swanson JW, Borum R, Swartz MS, et al. Psychotic symptoms and disorders and the risk of violent behaviour in the community. Crim Behav Ment Health. 1996;6(4):309-329.
- Florisi, Nicole, 2019
- Weaver, C. M., Joseph, D., Dongon, S. N., Fairweather, A., & Ruzek, J. I. (2013). Enhancing services response to crisis incidents involving Veterans: A role for law enforcement and mental health collaboration. Psychological Services, 10, 66-72. doi:10.1037/a0029651
- National Institute for Mental Health. (n.d.) Suicide Prevention. Retrieved from https://www.nimh.nih.gov/health/topics/ suicide-prevention/index.shtml