IV. Crime Victims Who Have Mental Illness

Background

Mental illness encompasses a number of distinct brain disorders—such as manic-depressive illness, schizophrenia, major depression, and severe anxiety—that disrupt a person's mood balance, thought processes, memory, sensory input, feelings, and ability to reason and relate to others. More than 7 million adults and 5 million children in the United States have severe mental illness which diminishes their capacity to meet the ordinary demands of life.

Mental illness should not be confused with mental retardation. People with mental illness are usually of normal intelligence but may have difficulty functioning at normal levels due to their illness.

Symptoms of mental illness vary from individual to individual depending on the type and severity of the disorder. Many symptoms are not readily observable from outward appearances but are noticeable in conversation. Although the first responder cannot be expected to recognize specific types of mental illness, the following symptoms are indicative that a victim may have mental illness:

• Accelerated speaking or hyperactivity.

• Delusions and paranoia. For example, false beliefs that one is a famous person or that others are trying to harm one.

• Hallucinations, such as hearing voices or seeing, feeling, or smelling imaginary things.

• Depression.

• Inappropriate emotional response. For example, silliness or laughter at a serious moment.

• Unintelligible conversation.

• Loss of memory. Not ordinary forgetfulness, but rather an inability to remember the day, year, or where one is.

• Catatonia, which is characterized by a marked lack of movement, activity, or expression.

• Unfounded anxiety, panic, or fright.

• Confusion.

Anyone who is a crime victim may be traumatized and experience one's victimization as a crisis. For people with mental illness, this crisis may be experienced more profoundly. The following guidelines can help you respond to victims who have mental illness.

Tips on Responding to Crime Victims Who Have Mental Illness

• Approach victims in a calm, nonthreatening, and reassuring manner. Victims may be overwhelmed by delusions, paranoia, or hallucinations and may feel threatened by you or afraid of you. Introduce yourself personably by name first, then your rank and agency. Make victims feel they are in control of the situation.

• Determine whether victims have a family member, guardian, or mental health service provider who helps them with daily living. Contact that person immediately.

• Contact the local mental health crisis center immediately if victims are extremely agitated, distracted, uncommunicative, or displaying inappropriate emotional responses. Victims may be experiencing a psychiatric crisis.

• Ask victims if they are taking any medications and, if so, the types prescribed. Make sure victims have access to water, food, and toilet facilities because side effects of the medications may include thirst, urinary frequency, nausea, constipation, and diarrhea.

• Conduct your interview in a setting free of people or distractions upsetting to victims. If possible, only one officer should interview victims.

• Keep your interview simple and brief. Be friendly and patient and offer encouragement when speaking to victims. Understand that rational discussion may not be possible on some or all topics.

• Be aware that victims experiencing delusions, paranoia, or hallucinations may still be able to accurately provide information outside their false system of thoughts, including details related to their victimization and informed consent to medical treatment and forensic exams.

• Avoid the following conduct in your actions and behavior with victims:
  • Circling, surrounding, closing in on, or standing too close.

  • Sudden movements or rapid instructions and questioning.

  • Whispering, joking, or laughing in their presence.

  • Direct continuous eye contact, forced conversation, or signs of impatience.

  • Any touching.

  • Challenges to or agreement with their delusions, paranoia, or hallucinations.

  • Inappropriate language, such as "crazy," "psycho," and "nuts."

• Back off and allow victims time to calm down before intervening if they are acting excitedly or dangerously and there is no immediate threat to anyone's safety. Outbursts are usually of short duration.

• Break the speech pattern of victims who talk nonstop by interrupting them with simple questions, such as their birth date or full name, to bring compulsive talking under control.

• Do not assume that victims who are unresponsive to your statements cannot hear you. Do not act as if they are not present. Be sensitive to all types of response, including a victim's body language.

• Understand that hallucinations are frighteningly real to victims. Never try to convince victims that their hallucinations do not exist. Rather, reassure victims that the hallucinations will not harm them and may disappear as their stress lessens.

• Acknowledge paranoia and delusions by empathizing with victims' feelings but neither agree nor agitate victims by disagreeing with their statements. For example, if victims state that someone wants to harm them, reply with: "I can see that you're afraid. What can I do to make you feel safer?" Recognize also that victims who state that others are trying to harm them may be the victims of stalking or other crimes.

• Continually assess victims' emotional state for any indications that they may be a danger to themselves or others.

• Be honest with victims. Getting caught by victims in your well-intentioned deception will only increase their fear and suspicion of you.

• Provide for victims' care by a family member, guardian, or mental health service provider before leaving them.