If There is a Threat of Assault
Don’t underestimate the risk. People who are acutely psychotic, especially if also delusional and abusing alcohol or street drugs, are not predictable and are capable of extreme violence.
Discuss the situation with the person’s case manager, social worker and/or psychiatrist. Make sure they are aware of the person’s threatening or assaultive behavior. If possible, put your concerns in writing to them and cc the message to others in a position of responsibility: Written notification is much more difficult to ignore.
Safe-proof your home. Have a room to which you can retreat and be safe if needed. It should have a secure lock and a telephone. Do not allow firearms in the house.
Clearly spell out the consequences for the person if he/she becomes assaultive (e.g., may no longer live at home). Be prepared to carry out these consequences.
Minimize alcohol or street drug use in whatever ways are possible. Substance abuse is often a trigger for assaultive behavior.
If threatened by someone with manic-depressive illness (bipolar disorder), remain calm, keep conversation to a minimum and exit the situation.
If threatened by someone with schizophrenia, stay calm, remain physically distant (give the person lots of space), avoid direct eye contact, sympathize, try to find something on which you both agree.
Do not allow yourself to become trapped. Always remain physically between the person and the open door.
Do not hesitate to call the police in a life-threatening situation. See below about what to say when calling the police.
When to Get the Criminal Justice System Involved
In the absence of a well-functioning mental health system, law enforcement officers are often the first responders called to mental health emergencies. Jails, not hospitals, are where individuals in crisis find themselves as a result. Nearly half of all individuals with schizophrenia or bipolar disorder will be jailed at some point in their lives. Individuals with serious mental illness also are significantly more likely to be injured or killed during an encounter with law enforcement.
The following steps before and after the criminal justice involvement of a loved one with serious mental illness are provided to help you prepare and respond for this possibility.
Before Criminal Justice Involvement
If your friend or family member is untreated and has a pattern of unpredictable behavior, make an effort to get to know members of your local police department by visiting your local zone or precinct station during business hours. Ask to speak to the community resource or other officer who works with citizens and explain the circumstances. Ask if the department has a crisis intervention or mobile crisis team of officers with specialized training in responding to psychiatric crisis; ask to meet with one or more of the members to describe the situation.
Familiarize officers with the techniques you know for reassuring and calming your loved one during crisis. If you must call 911 in an emergency, immediately tell the dispatcher, “I am calling about a psychiatric emergency.” Ask that officers trained in mental illness crisis response be dispatched to the scene.
If your loved one is jailed, learn the relevant state or local policies and practices regulating treatment of mental illness behind bars. Ask whether pretrial evaluation to determine competency is available in the community to avoid delays in treatment or adjudication that could result if there is a shortage of psychiatric beds for this service.
After Criminal Justice Involvement
Once your loved one is behind bars, insist upon seeing the psychiatric or medical staff serving inmates to ensure that medication schedules are maintained or treatment is restarted.
Take all the relevant psychiatric history of your loved one – diagnosis, hospitalization history, incarceration history, medication information – to the correctional facility and insist on delivering it to the psychiatric or medical official in charge.
Critical: Be sure corrections personnel are familiar with your loved one’s triggers, symptoms and typical behaviors when in crisis or symptomatic.
Jails and correctional facilities are exempt from some HIPAA provisions and can obtain medical information about an inmate for many purposes, including the provision of health care. If you do not have needed information about a loved one’s diagnosis, prescriptions and other treatment needs, the jail may be able to obtain it. Insist that they do.
Call the county clerk’s office, county prosecutor or your own city councilman or county supervisor/commissioner to ask if your jurisdiction operates mental health courts. Mental health courts are a jail diversion practice in which qualifying offenders may be ordered into mental illness treatment – and the mental health system ordered to serve them – in lieu of incarceration.
Determine whether the charges against your loved one are those considered by your local mental health court. Typically, mental health courts hear cases that involve non-violent misdemeanors.
Advocate with your loved one’s public defender or attorney to seek his or her assignment to the mental health court, which links qualifying offenders to community-based treatment in lieu of incarceration.
What to Say When Calling 911
Ask who in the department is trained to deal with people who are having a mental health crisis. For example: “I am calling about an emergency involving mental illness. Do you have someone assigned to handle mental health emergencies?”
Make it clear that you are calling about someone having a psychiatric crisis. For example: “My daughter has bipolar disorder, she is not taking her medication and she is manic.”
Describe the behavior you are seeing that most closely matches the laws in your state that are used to hospitalize someone for emergency psychiatric care or to initiate civil commitment proceedings. For example, don’t say, “My son is a danger to self,” say “My son says he is going to blow his brains out and I know he has a gun in his car trunk,” or “My daughter is setting fire to wastebaskets all over the house.”
Explain why you cannot handle the situation yourself. For example: “I am frightened he will hurt me,” or “She is throwing things at the walls and I cannot get her into a car.”
Be very clear that you are seeking involuntary psychiatric hospitalization and NOT arrest.
Remember, calling 911 is the LAST RESORT. Preparation is key to not getting into situations where you have to call 911.
In Clark County, if the situation is not life-threatening (no blood, loss of limb, no weapon, etc.) call 311 to reach a 911 operator. They can help you find a CIT-trained officer.
Call the Mobile Crisis Unit in your area for a Mental Health Professional to be dispatched.