HomeMy WebLinkAbout41O-Responding to the Mentally Ill 2019
Policy & Procedure Page 1 of 11
Lexington Police
Department
Subject: Responding to the Mentally Ill
Policy Number:
41O Accreditation Standards:
Reference: 1.1.3; 41.2.7 Effective Date:
3/11/13
New
Revised
Revision
Dates:
1/24/19
By Order of: Mark J. Corr, Chief of Police
The Municipal Police Institute, Inc. (MPI) is a private, nonprofit charitable affiliate of the
Massachusetts Chiefs of Police Association. MPI provides training and model policies and
procedures for police agencies. This policy is an edited version of MPI Policy 1.16, “Handling
the Mentally Ill.”
GENERAL CONSIDERATIONS AND GUIDELINES
Reaction to persons impacted by mental illness covers a wide range of human
responses. People impacted by mental illness are ignored, laughed at, feared, pitied
and often mistreated. Unlike the general public, however, a police officer cannot permit
personal feelings to dictate his/her reaction to the mentally ill. His/her conduct must
reflect a professional attitude and be guided by the fact that mental illness, standing
alone, does not permit or require any particular police activity. Individual rights are not
lost or diminished merely by virtue of a person's mental condition. These principles,
as well as the following procedures, must guide an officer when his/her duties bring
him/her in contact with a mentally ill person.
Every year police officers are severely hurt or even killed when responding to calls
involving behavioral health/mental illness. It is extremely important that officers are
professional and cognizant of officer safety when handling these calls for service.
It is the policy of the Lexington Police Department that:
Officers shall accord all persons, including those with mental illness, all the
individual rights to which they are entitled; and
Officers shall attempt to protect mentally ill persons from harm and shall refer
them to agencies or persons able to provide services where appropriate.
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PROCEDURE
A. Definitions
1. Bipolar: Also known as “manic-depressive illness,” the disorder causes
extreme swings in a person’s moods, emotions and behaviors. In the
“manic” state, these strong moods may include intense elation or
irritability. In the “depression” state, a deep sadness or hopelessness is
prevalent. Both are manifested in the “mixed state.”
2. Schizophrenia: A serious disorder, which affects how a person thinks,
feels and acts. The illness is characterized by dramatic changes in
behavior and thinking. Someone with schizophrenia may have difficulty
distinguishing between what is real and what is imaginary; may be
unresponsive or withdrawn; and may have difficulty expressing normal
emotions in social situations. The person suffering from schizophrenia
may also become or display symptoms of paranoia.
3. Paranoid personality disorder: is a psychiatric diagnosis characterized
by paranoia and a pervasive, long-standing suspiciousness and
generalized mistrust of others.
4. Hallucinations: Perceptual experiences that are not actually occurring,
such as hearing voices telling one to harm oneself.
5. Delusions: Fixed false beliefs about the self, such as: “Everyone is out
to get me.”
6. Mental Illness: For purposes of admission to an inpatient facility under
Section 12, “Mental Illness” means a substantial disorder of thought,
mood, perception, orientation, or memory which grossly impairs
judgment, behavior, and capacity to recognize reality or ability to meet
the ordinary demands of life. Symptoms caused solely by alcohol or drug
intake, organic brain damage or developmental disabilities do not
constitute a serious mental illness.
7. “Likelihood of Serious Harm:” (1) a substantial risk of physical harm to
the person himself as manifested by evidence of, threats of, or attempts
at, suicide or serious bodily harm; (2) a substantial risk of physical harm
to other persons as manifested by evidence of homicidal or other violent
behavior or evidence that others are placed in reasonable fear of violent
behavior and serious physical harm to them; or (3) a very substantial risk
of physical impairment or injury to the person himself as manifested by
evidence that such person’s judgment is so affected that he is unable to
protect himself in the community and that reasonable provision for his
protection is not available in the community.
8. Pink Slip or “Section 12”: Refers to an involuntary commitment to an
emergency mental health facility pursuant to M.G.L c. 123 s. 12.
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B. Dispatching of Personnel
1. A minimum of two officers should be dispatched to incidents involving the
mentally ill.
2. If a street supervisor is available [s]he will also be dispatched to the call.
3. Medical personnel will be dispatched to the location upon request of the
officers on scene or if there is a belief of potential injuries.
C. Recognition and Handling [41.2.7 (a)]
1. It is helpful in handling a situation properly if an officer is able to recognize
some of the characteristics of a person who is mentally ill.
2. Factors that may aid in determining if a person is disturbed are:
a. Severe changes in behavioral patterns and attitudes;
b. Unusual mannerisms and/or appearance;
c. Distorted memory or loss of memory;
d. Hallucinations or delusions;
e. Irrational explanation of events;
f. Hostility to and distrust of others;
g. Fear of others such as paranoia;
h. Marked increase or decrease in efficiency;
i. Lack of cooperation and tendency to argue;
j. One-sided conversations; and
k. Lack of insight regarding his/her mental illness.
3. These factors are not necessarily, and should not be treated as,
conclusive. They are intended only as a framework for proper police
response. It should be noted that a person exhibiting signs of an
excessive intake of alcohol or drugs might also be mentally ill.
4. Medications: Some medications commonly prescribed for mental illnesses
are:
Trade Name Generic Trade Name Generic
ATIVAN LORAZEPAM LITHOBID/
LITHIUM
LITHIUM
CARBONATE
CALAN VERAPAMIL NEUROTIN GABAPENTIN
CLOZARIL CLOZAPINE PROZAC FLUOXETINE
DEPAKENE VALPROIC ACID RISPERDAL RISPERIDONE
DEPAKOTE DIVALPROEX SEROQUEL QUETIZPINE
GEODON ZIPRASIDONE TEGRETOL CARBAMAZEPINE
HALDOL HALOPERIDOL TOPAMAX TOPIRAMATE
KLONOPIN CLONAZEPAM WELLBUTRIN BUPROPION
LAMICTAL LAMOTRIGINE ZYPREXA OLANZAPINE
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D. Common Mental Disorders
1. Bipolar Disorder: This is typically a lifelong illness that most often
begins in the later teenage years or early adulthood. It commonly runs
in families, but not always, and affects more than two million Americans.
It is a treatable illness.
a. Warning Signs: These signs, outlined in the chart below, are often
painful, last a long time and are serious. They usually interfere
with a person’s ability to conduct a normal family, work and
personal life.
Signs of Mania Signs of Depression
Excitability or feeling “high” Feeling sad, depressed or guilty
Increased talkativeness Slowed or sluggish behavior
Fast speech Hopelessness
Decreased need for sleep Thoughts or plans of suicide
Excessive energy Change in sleep, appetite, energy
Risky behaviors Problems concentrating
b. Some people will self-medicate with alcohol or illegal drugs.
2. Schizophrenia: Persons in a psychotic state may have high anxiety,
faulty reality testing, poor judgment, or diminished impulse control.
a. They may be at risk of harming themselves or others.
b. Warning Signs include:
i. Delusions (false or unreal beliefs);
ii. Hallucinations (hearing, smelling, tasting or feeling something
that is not really there);
iii. Disorganized speech and/or speaking less;
iv. Bizarre behavior;
v. Blunted or dulled emotions;
vi. Withdrawing emotionally from people;
vii. A loss of interest in school or work;
viii. Difficulty paying attention;
ix. Lack of energy and motivation;
x. Thoughts of death or suicide, or suicide attempts;
xi. Outbursts of anger; and
xii. Poor hygiene and grooming.
3. Depression: This is more than just feeling sad or a little “under the
weather.”
a. Depression is a mental illness that can seriously affect a person's
feelings, thought patterns, behavior and quality of life.
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b. Warning Signs include:
i. Ongoing sad, anxious or empty feelings;
ii. A loss of interest in activities that normally are pleasurable,
including sex;
iii. Appetite and weight changes (either loss or gain);
iv. Sleep problems (insomnia, early morning wakening or
oversleeping);
v. Irritability;
vi. A loss of energy and a sense of fatigue, or being "slowed
down";
vii. Feelings of guilt, worthlessness and helplessness;
viii. Feelings of hopelessness and pessimism;
ix. Difficulty in concentrating, remembering and making
decisions;
x. Thoughts of death or suicide, or suicide attempts; and
xi. Ongoing body aches and pains or problems with digestion
that are not caused by physical disease.
E. Mental Health Resources Contact Information
1. Advocates Psychiatric Emergency Services
675 Main Street
Waltham, MA 02453
Main # 781-893-2003, 800-540-5806, Fax -781-647-0183.
2. Lexington Human Services Department: 781-861-0194;
3. Massachusetts Department of Mental Heath: Phone: 617-626-8000,
http://www.mass.gov; and
4. National Alliance on Mental Illness (NAMI): 1-800-950-NAMI (6264),
http://www.nami.org/.
5. Central Middlesex Police Partnership: 339-223-1730
F. Dealing with the Mentally Ill in Administrative Settings
1. Non-sworn employees may interact with mentally ill persons in an
administrative capacity, such as dispatching, records request, animal
control issues, etc.
2. If an employee believes [s]he is interacting with a mentally ill person,
[s]he should proceed patiently and act in a calm manner.
3. Although the person is mentally ill, his or her requests or inquiries should
normally be treated as if the person making the request or inquiry were
not mentally ill.
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4. Understand that due to the person’s illness, the person could make
bizarre claims or requests.
6. At all times, employees should act with respect towards the mentally ill
person. A person with mental illness may be both highly intelligent and
acting irrationally.
7. If the person’s behavior makes the employee feel unsafe, a police officer
should be summoned. The police officer need not deal with the person
directly, but be present during the interaction to react if the person
becomes disruptive or violent.
8. If the person is disruptive, violent, or acts in such a manner as to cause
the employee to believe that the person may be harmful to him/herself or
others, a police officer should be summoned to address the situation in
accordance with this policy.
G. Interactions/interviews with the Mentally Ill in the Field [41.2.7(c)]
1. If an officer believes [s]he is faced with a situation involving a mentally ill
person, [s]he should not proceed in haste unless circumstances require
otherwise.
a. An officer should be deliberate and take the time required for an overall
look at the situation.
b. An officer should ask questions of persons available to learn as much
as possible about the individual. It is especially important to learn
whether any person, agency or institution presently has lawful custody
of the individual, and whether the individual has a history of criminal,
violent or self-destructive behavior.
c. An officer should obtain information regarding current or previous
Doctor’s care.
d. It is not necessarily true that mentally ill persons will be armed or resort
to violence. However, this possibility should not be ruled out and
because of the potential dangers, the officer should take all precautions
to protect everyone involved.
2. It is not unusual for such persons to employ abusive language against
others. An officer must ignore verbal abuse when handling such a
situation.
3. Avoid excitement. Crowds may excite or frighten the mentally ill person.
Groups of people should not be permitted to form or should be dispersed
as quickly as possible.
4. Reassurance is essential. An officer should attempt to keep the person
calm and quiet. [S]he should attempt to show that [s]he is a friend and
that [s]he will protect and help. It is best to avoid lies and not to resort to
trickery.
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5. An officer should at all times act with respect towards the mentally ill
person. Do not "talk down to" such person or treat such a person as
"child-like." A person with mental illness may be both highly intelligent
and acting irrationally. Mental illness, because of human attitudes,
carries with it a serious stigma. An officer's response should not increase
the likelihood that a disturbed person will be subjected to offensive or
improper treatment.
H. Involuntary Examinations (Section 12) [1.1.3]
The authority for an application for Involuntary Examination is described in
M.G.L. c. 123 s. 12.
Medical Personnel: Any physician, qualified psychiatric nurse, mental health
clinical specialist, or qualified psychologist, after examining a person and
having reason to believe that failure to hospitalize such person would create
a likelihood of serious harm by reason of mental illness, may restrain the
person and apply for hospitalization for a three (3) day period.i
Police Officers: In an emergency situation, if a physician or qualified
psychologist is not available, a police officer who reasonably believes under
the circumstances that failure to hospitalize a person would create a
likelihood of serious harm by reason of mental illness may restrain such
person and apply for the hospitalization of such person for a three (3) day
period at a public facility or a private facility authorized for such purpose by
the Massachusetts Department of Mental Health.ii
Any Person (including a police officer) may petition a district court to commit
a mentally ill person to a facility for a three (3) day period if failure to confine
that person would cause a likelihood of serious harm.iii
I. Taking a Mentally Ill Person into Custody
1. A mentally ill person may be taken into custody if:
a. [S]He has committed a crime.
b. The officer has a reasonable belief, under the circumstances, that [s]he
poses a substantial danger of physical harm to himself/herself or other
persons
c. [S]He has escaped or eluded the custody of those lawfully required to
care for him/her.
2. At all times, an officer should attempt to gain voluntary cooperation from
the individual.
3. If an officer believes an emergency commitment is required under M.G.L.
c. 123 s 12, the following guidelines should be followed: [41.2.7 (b)]
a. The Commanding Officer shall be consulted about the facts of the
situation.
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b. The current Psychiatric Emergency Service provider will be contacted by
phone. (Currently we use Advocates Psychiatric Emergency Services
800-540-5806.)
c. The circumstances will be conveyed to the on call clinician regarding the
request for a section 12 committal.
d. If it is agreed that a section 12 is warranted it shall be completed by the
on call clinician and faxed to the Police Station, as soon practicable.
e. Once it has been confirmed that a section 12 has been issued a private
ambulance should be contacted for transportation to the psychiatric
facility listed on the section 12.
f. Officers will stay with the mentally ill subject until custody has been
transferred to ambulance personnel.
g. If the subject has a Doctor that they have been currently dealing with and
contact is easily accessible, this is also an option for obtaining the
Section 12.
h. A section 12 has no expiration date. As a matter of best practice if a
section 12 is outstanding for more than 48 hours prior to being served
the issuing authority should be re-contacted in order to confirm that the
section 12 commitment is the best course of action for the subject named
on the order.
Note: Although the law clearly permits a police officer the ability to sign
a section 12 Pink slip the best practice is to initiate the process through
the current Psychiatric Service provider. Commanding Officers should
contact a Captain to discuss when, or if, Lexington police officers will
issue a section 12 without a physician.
4. Officers may affect a warrantless entry into the home of a subject for
whom a section 12 application for temporary hospitalization (pink slip)
has been issued, provided:iv
a. They have actual knowledge of the issuance of the pink slip.
b. The entry is of the residence of the subject of the pink slip.
c. The pink paper was issued by a qualified physician, psychologist, or
psychiatric nurse in an emergency situation and where the subject
refused to consent to an examination.
d. The warrantless entry is made within a reasonable amount of time after
the pink slip has been issued.
* NOTE: Each situation is fact specific; the special needs and interests
of the subject whom the pink paper is directed towards will be examined
thoroughly prior to entry into any home. If all the above criteria are met,
and reasonable exigent circumstances are present, entry may be gained.
If exigency does not exist and consent is not granted a warrant must be
obtained prior to any entry of a residence to execute a pink slip.
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J. Transporting Mentally Ill Persons to Treatment
1. Normally, a person who is to be transported to a hospital for a mental
health evaluation pursuant to M.G.L. c. 123 s. 12 will be transported by
private ambulance.
2. The Lexington Fire Department, if authorized by the Fire Chief, may also
transport mentally ill patients in an ambulance.
3. A Lexington Police Officer may transport such person in a police cruiser
equipped with a protective barrier if, in the opinion of a police officer, the
person poses a threat due to violence, resisting, or other factors. The
Commanding Officer or Patrol Supervisor must be consulted for
authorization prior to transport. Alternatively, officers may escort or
accompany Fire Department personnel in a Town ambulance.
K. Escapes from Mental Health Facilities (Chapter 13 Section 30)
1. If a patient or resident of a facility of the Massachusetts Department of
Mental Health is absent without authorization, the superintendent of the
facility is required to notify the state and local police, the local district
attorney and the next of kin of such patient or resident.v
2. Such persons who are absent for less than six months may be returned
by the police.
3. Persons who have been found not guilty of a criminal charge by reason
of insanity or persons who have been found incompetent to stand trial on
a criminal charge and have escaped from a mental health facility may be
returned directly to the facility they escaped from, regardless of the length
of absence.vi
4. Taking a subject into custody for return to a mental health facility shall
not be considered an arrest. The subject may be turned over directly to
employees of the facility.
L. Indemnification
Police officers are immune from civil suits for damages for restraining,
transporting, applying for the admission of or admitting any person to a facility
if the officer acts pursuant to the provisions of Chapter 123.vii
M. Interrogating Mentally Ill Suspects [41.2.7(c)]
1. Whenever a mentally ill or mentally deficient person is a suspect and is
taken into custody for questioning, police officers must be particularly
careful in advising the subject of his/her Miranda rights and eliciting any
decision as to whether [s]he will exercise or waive those rights. It may
not be obvious that the person does not understand his/her rights. The
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Department policy 41K - Interrogating Detainees and Arrestees
should be consulted.
2. In addition, it may be very useful to incorporate the procedures established
for interrogating juveniles when an officer seeks to interrogate a suspect
who is mentally ill or mentally deficient. Those procedures are set out in
the Department policy 44B - Handling Youthful Offenders.
3. Before interrogating a suspect who has a known or apparent mental
condition or disability, police should make every effort to determine the
nature and severity of that condition or disability; the extent to which it
impairs the subject's capacity to understand basic rights and legal
concepts, such as those contained in the Miranda warnings; and whether
there is an appropriate "interested adult," such as a legal guardian or
legal custodian of the subject, who could act on behalf of the subject and
assist the subject in understanding his/her Miranda rights and in deciding
whether or not to waive any of those rights in a knowing, intelligent and
voluntary manner.
4. CONFIDENTIALITY: Any officer having contact with a mentally ill person
shall keep such matter confidential except to the extent that revelation is
necessary for conformance with Department procedures regarding
reports or is necessary during the course of official proceedings.
N. Lost or Missing
1. If a mentally ill or deficient person is reported lost or missing, police
should follow protocols described in the Department policy 42J - Missing
Persons.
2. Officers may additionally refer the family of the missing person to the
National Alliance for the Mentally Ill (NAMI)/Homeless or Missing
Persons Service which operates an emergency hotline to assist all
families and friends who have a missing relative or friend. The
Information Helpline telephone number is 1-800-950-NAMI (6264), and
the web site is http://www.nami.org/.
3. COMPLAINTS WITH NO IMMEDIATE THREAT: An officer who receives
a complaint from a family member of an allegedly mentally ill person who
is not an immediate threat or is not likely to cause harm to himself or
others, should advise such family member to consult a physician or
mental health professional and provide the name and number of our
Family Services Detective for additional assistance.
O. Training
1. Department personnel (sworn and non-sworn) shall be trained in this
policy upon initial employment during their Field Training Program.
[41.2.7(d)]
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2. The Captain of Administration shall through the Commanding Officers
and Patrol Supervisors ensure that all employees undergo refresher
training at least once every three years. [41.2.7(e)]
P. Public Log.
1. Public record laws specifically prohibit the publishing of mental health
calls in a public log.
2. Any journal note, that clearly involves a mental health problem, should
be identified in the comment line and excluded from the public log by
entering A1 in the “geo-code” field of the journal note.
i M.G.L. c. 123, §12 (a).
iiM.G.L. c. 123, §12(a); Ahern v. O’Donnell, 109 F.3d 809 (1st Cir. 1997).
iiiM.G.L. c. 123, §12(e).
ivMcCabe v. Life-Line Ambulance Service, Inc., 77 F.3d 540 (1st Cir. 1996).
vM.G.L. c. 123, §30.
viM.G.L. c. 123, §30.
viiM.G.L. c. 123, s. 22