Like any type of illness, those which affect a person’s mental health require diagnosis and treatment. But what happens when people are unable to obtain such support? For many people who suffer from a mental health disorder, a lack of support and treatment can lead to a crisis. Certain groups in many modern societies are particularly vulnerable to such an escalation of their illness; particularly if they are unable to access services. Some of the young people I have interviewed over the years have also expressed a dissatisfaction with the mental health provisions they have been directed towards, or feel that there is a stigma attached to seeking professional help.
In the case of some mental disorders, when the person suffering reaches a crisis, their behaviour can be mistaken as being antisocial. For some illnesses the advent of a crisis can cause confusion, which can lead to violent or aggressive behaviour. Most commonly this can occur when a patient has missed their prescribed medication, or has simply not been assessed and diagnosed. In other cases, additional elements of risk for example the use of alcohol or drugs can exacerbate a mental illness.
Law Enforcement Officers are often called out to respond to reports of erratic or concerning behaviour by the public, and have to decide the most appropriate intervention. The first week of my Churchill Fellowship was spent attending a 40-hour course on Crisis Intervention with Harris County Precinct 1 Constable’s Office. The comprehensive course was expertly taught by trainers who have extensive experience of working in Precinct 1’s Mental Health Division, where I spent the second week of my fellowship.
Attending, enabled me to reconsider mental health from a policing perspective, and to think more broadly about how best to inform and support those working in law enforcement to ensure that they can identify and divert people in mental crisis away from the criminal justice system. Officers can serve an Emergency Detention Order, which enables them to take a person in crisis to a psychiatric facility for assessment. I will write more about this process in my next post.
Although the same issue is recognised in the UK (HMICRFS, 2018)*, training in mental health for officers was reported to have been inconsistent. My experience of undertaking research and outreach work in the youth justice system in England reflects this observation. My aim, as a psychologist, who undertakes applied research within the criminal justice system, is to inform the practitioners I work whilst respecting their experience and roles. Attending the crisis intervention course has given me a clearer sense of how this can effectively be done and I will take this knowledge back to the agencies I work with in the UK with the hope informing them in the most appropriate and practical way.
For young people, obtaining a diagnosis and effective treatment for mental illness can prevent their involvement in the criminal justice system. Understanding that what is perceived as antisocial or delinquent behaviour can often mask an underlying illness or trauma which remains untreated is a starting point. Most importantly support for young people needs to be holistic and reactive. This is especially important when we consider that many young people with a range of mental disorders from ADHD to depression and anxiety report self-medicating with cannabis. Not only does this impact negatively on their diagnosed illness, but the use of cannabis during adolescence is associated with alterations to normal brain development (Jacobus & Tapert, 2014).
Mental illness is something that first responders will continue to deal with on a regular basis. Early recognition and intervention is crucial, especially for young people. Effective knowledge transfer between the emergency services and academics/mental health practitioners is essential. For me, the week observing the crisis intervention training in Harris County was a positive step in the right direction.
Lieutenant Shone Sigue
Corporal Wil Moran
Corporal James White
*HMICRFS (2018) Policing and mental health. Picking up the pieces. Her Majesty’s Inspectorate of Constabulary, Fire and Rescue. ISBN: 978-1-78655-741-4
Jacobus, J., & F Tapert, S. (2014). Effects of cannabis on the adolescent brain. Current pharmaceutical design, 20(13), 2186-2193.