SNOW HILL POLICE DEPARTMENT OPERATIONS DIRECTIVE Calls Involving Mental Illness Distribution: All Employees Index: OPS 08.07 Issued: 09/01/2015 Revised: 03/28/2017 Reviewed: N/A Next Review: 09/28/2018.01 Purpose To provide guidance on responding to calls involving mental illness..02 Policy Officers will respond to calls involving mental illness in accordance with this directive and, if necessary, complete an emergency petition for evaluation on the individual..03 Definitions EMERGENCY EVALUEE: an individual for whom an emergency evaluation is sought or made EMERGENCY FACILITY: designated by the Maryland Department of Health and Mental Hygiene, in writing, as an emergency facility. This includes a licensed general hospital that has an emergency room. EMERGENCY EVALUATION FOR MENTAL DISORDER (Emergency Petition or EP): document that allows a sworn peace officer who has contact with a person who has a mental illness, and has observed signs or received information that the subject is in immediate danger to himself or others, to take the person into custody, for transport to the hospital and a subsequent emergency evaluation. MENTAL DISORDER: the behavior or symptoms that indicate to a lay petitioner who is submitting an emergency petition (EP), a clear disturbance in the mental functioning of another individual; and to a health professionals doing an examination, at least one mental disorder that is described in the American Psychiatric Association's Diagnostic and Statistical Manual - Mental Disorders that is current at the time of the examination. The term Mental Disorder does not include mental retardation. MENTAL HEALTH PROFESSIONAL: physician, psychologist, clinical social worker, licensed clinical professional counselor, clinical nurse specialist, psychiatric nurse practitioner or their designee operating as part of a Mobile Crisis Team. MENTAL ILLNESS: any of various conditions characterized by impairment of an individual s normal cognitive, emotional, or behavioral functioning, and caused by social, psychological, biochemical, genetic, or other factors, such as infection or head trauma..04 References MD. CODE ANN., HEALTH-GEN. 10-622 MD. CODE ANN., HEALTH-GEN. 10-624 MD. CODE ANN., HEALTH-GEN. 10-626 1 of 6
.05 Procedures A. Training 1. All new employees who have the potential to come into contact with the mentally ill will receive instruction regarding the identification of, response to, and reporting of persons with a mental illness. 2. As resources can vary officers should be aware of all local resources available to assist with mental health emergencies. B. Recognizing Mental Illness 1. By self-initiation or directed activity, officers may come in contact with persons who have a mental illness, and those impacted by persons with a mental illness. 2. Officers shall be alert to the signs of mental illness, to ensure the safety of the officer, the person with a mental illness, and those affected by the person with a mental illness. 3. Other members may come in contact with persons who have a mental illness as well. All members should understand that the ADA requires law enforcement agencies to make reasonable adjustments to routine procedures, on a case-by-case basis, to provide equitable service to all. 4. Individual characteristics of mental illness may include: a. non-responsiveness; b. delusions; c. depression, deep feelings of sadness, hopelessness or uselessness; d. auditory and/or visual hallucinations; e. manic behavior, accelerated thinking and speaking or hyperactivity; f. subject s affect appears inconsistent with the circumstances; g. confusion; h. incoherence; or i. extreme paranoia. 5. Environmental characteristics may be indicators, however alone, do not constitute mental illness. Environmental characteristics to be considered may include: a. homelessness; b. extensive clutter (in cars as well as homes or residences); c. clothing inappropriate for season; d. restricted living area (food, bed, etc. all in one room); e. restricted access to parts of residence (missing/broken handles, locks, doors nailed shut); f. windows/vents/electrical outlets covered or modified; or g. possession of an excessive number of similar items. C. Contact with Persons Diagnosed with, or Exhibiting, a Mental Illness 1. An assessment should be based upon personal and environmental indicators, behavioral indicators, and information received from witnesses and other involved parties. 2 of 6
2. In the event of a call for service or self-initiated activity, the officer should immediately attempt to obtain the following: a. Primary Information, such as the: (1) nature of the problem behavior; (2) precipitating event; and (3) presence of weapons. b. Secondary Information such as: (1) past occurrences of this or other abnormal behaviors; (2) past incidents involving injury or harm to the individual or others; (3) prior suicide threats; (4) reliance on medication or failure to take medication; (5) relatives, friends or neighbors available to assist officers; and (6) physicians or mental health professionals available to assist officers. 4. The following guidelines should be considered when interacting with people who may have a mental illness, and who may be a crime victim, witness or suspect: a. Speak calmly when engaging an individual with a mental illness. Loud, stern tones will likely have either no effect or a negative effect on the individual. b. Use non-threatening body language, including soft gestures and avoidance of quick movements. Keep your hands by your sides if possible and do not touch the person unless absolutely necessary. c. Eliminate commotion, including loud sounds, bright lights, sirens, and crowds. If possible, move the individual to a calm environment before assessing the situation. d. Keep animals away. Individuals with mental illness are often afraid of dogs or other large animals. e. Look for personal identification. Medical tags or cards will often indicate if a mental illness is present and will supply the individual s name, a contact name, and a telephone number. f. Call the caregiver. The caregiver is often the best resource for specific advice on calming the person and ensuring the trooper s safety. g. Prepare for a lengthy interaction. Individuals with a mental illness should not be rushed unless there is a true emergency. h. Be aware of different forms of communication. A person with mental illness, especially in a crisis or under stress, may use signals or gestures instead of words to communicate. The person may even choose not to speak at all. Their communication skills may be different under stress or impaired. As such, do not automatically interpret odd behavior as belligerent. In conversing with the individual, the officer should repeat short and simple direct phrases, avoid talking too much, and maintain a low key non-threatening demeanor. i. Be attentive to sensory impairments. Many individuals with mental illness have sensory impairments that make it difficult to process certain types of information. j. In many situations and particularly when dealing with someone who is lost or has run away, the officer may gain improved response by accompanying the person through a building or neighborhood to seek visual clues. 3 of 6
k. If any non-sworn member having contact with an individual with mental illness becomes concerned for the safety of the individual or themselves, or they feel that an immediate intervention is necessary, they should request the presence of a officer. 5. Interviews & Interrogations a. Officers conducting interviews or interrogations of a person who is mentally ill, or who the officer suspects may have a mental illness, should consult with a mental health professional and the State s Attorney s Office to determine whether the person is competent to understand his Constitutional rights. These rights include: (1) prompt presentment; (2) the voluntary nature of interviews; and (3) the Miranda rights to counsel and against self-incrimination. b. If officers interview or interrogate such persons as suspects, witnesses, or victims, those officers should observe the following in order to obtain valid information: D. Non-Custodial Dispositions (1) Do not interpret the lack of eye contact and strange actions or responses as indications of deceit, deception, or evasion of questions. (2) Use simple straightforward questions. (3) Do not employ common interrogation techniques, suggest answers, attempt to complete thoughts of persons slow to respond, or pose hypothetical conclusions. (4) Recognize that persons with a mental illness are easily manipulated and may be highly suggestible. 1. TERMINATION OF CONTACT When an o f f i c er has contact with a person who has a mental illness, but has not observed any signs or received any information that the subject is a danger to himself or others, and is functioning at a level which provides a minimum level of self-care and nutrition, the officer should terminate the contact, as it does not require police intervention (assuming no other legitimate law enforcement concern exists). 2. TERMINATION OF CONTACT WITH REFERRAL When an officer has contact with a person who has a mental illness, but has not observed any signs or received any information that the subject is a danger to himself or others, but the officer s knowledge, training and experience indicates the need for improved self-care and nutrition, the officer will: a. Refer the person with the mental illness, or person concerned on their behalf, to the appropriate agency, such as the Department of Social Services, the Mental Health Authority, or initiate contact with the appropriate agency. Contact numbers can be obtained through Communications. The employee can also make contact via telephone, in person, or via forwarding a copy of the written report to the appropriate agency. b. Notify Animal Control immediately if either the individual is taken into custody and the animal(s) must be removed or if any animals under the individual s care are in need of intervention (e.g., unsanitary conditions, improper nutrition, veterinary care needed, etc.). 3. IMMEDIATE INTERVENTION: When an officer has contact with a person who has a mental illness, and has observed signs or received information that the subject is a possible danger to himself or others, the officer shall make immediate notification to the appropriate agency, such as a Mobile Crisis Team, the Department of Social Services, the Mental Health Authority, or other agency depending upon the circumstances. A non-sworn employee will 4 of 6
contact an officer if he has contact with a person who has a mental illness and has observed or received information that the subject is a danger to himself or others. E. Custodial Dispositions (Emergency Petitions) 1. Any service of an EP requires an incident report. The original copy of the EP and Additional Certification must be left at the hospital with the evaluee because it is used in subsequent mandated hearings if the person is committed by the hospital. A copy of the EP and Additional Certification should be attached and submitted with the written report. 2. An EP May be issued in the following manner: F. Transportation & Custody a. A COURT ORDERED EP from a Judge An interested person may go before a Judge, and provide information that leads to the issuance of an EP. In this case, the Court will call the police department to have someone retrieve the EP. b. EPs completed by an authorized mental health practitioner: (1) The authorized mental health practitioner must have examined the individual in order to complete an EP. Members of a Mobile Crisis Team may sign emergency petitions, under their own authority as licensed mental health professionals or as designees of the Health Officer. (2) The petition must contain a description of the behavior and statements of the emergency evaluee or any other information that led the practitioner to believe that the emergency evaluee has a mental disorder and that the individual presents a danger to the life or safety of himself or of others. (3) An officer may respond to a call at the location of a mental health practitioner, who will give the officer a completed EP for service. The officer shall explain to the petitioner the serious nature of the petition and the meaning and content of the petition. The officer will sign the petition on the bottom of page three under Certifications by Other Person Qualified Under HG 10-622 and Peace Officer. c. EPs Completed By a Sworn Peace Officer (1) An officer may take an individual into custody for an EP if the officer believes said individual has a mental disorder, AND if the individual presents a danger to the life or safety of himself or others. (2) An EP will be completed after the officer takes the person into custody. This petition must contain a description of the behavior and statements of the emergency evaluee or any other information that led the officer to believe that the emergency evaluee has a mental disorder and that the individual presents a danger to the life or safety of himself or others. 1. All persons being detained pursuant to an EP should be treated with caution and due regard for the safety of the officer, of themselves, and of others present. Normal procedures for handcuffing and transportation will be followed. 2. Any person taken into custody pursuant to this directive will be taken to the nearest emergency facility for evaluation. Notification should be made to the hospital prior to arrival. 3. The officer will deliver the evaluee to the emergency room and advise the staff of the circumstances that led to the evaluee being taken into custody. If the officer is making the petition himself, he shall complete two forms: 5 of 6
a. District Court Form #CC-DC-13 - Petition for Emergency Evaluation; and b. CC-DC-14, Certification by Peace Officer. 4. If the evaluee is not violent, the officer may leave the hospital if he notifies the physician, and the physician does not request that the officer remain. 5. If the subject is violent, the physician may request that the officer remain. If this request is made, the officer will contact his supervisor who will determine if the officer s presence is necessary. 6. In making this determination, the supervisor will consider the involuntary nature of the petition, and the evaluee s potential for violence. Consideration should also be given to the evaluee s past actions and propensity for violence and the supervisor s observations of the evaluee. 7. If the supervisor determines that the officer s presence is necessary, the officer will remain. The supervisor will inform the physician that an examination of the emergency evaluee is required as promptly as possible. 8. If the supervisor determines that the o f f i c e r s presence is not necessary, the o f f i c e r may leave. The physician and hospital security shall be notified prior to the officer s departure. 9. Criminal Charges a. If an arrestee, whose mental status is in question, is in police custody for criminal charges, the officer will transport the arrestee to the local detention facility for processing. b. The officer will ensure that facility is aware of any potential threats/danger. The arrestee shall be processed on the criminal charge and remanded to the custody of the facility. c. If the arrestee is taken to the commissioner and is to be released from custody and there is a concern regarding the arrestee s mental status or potential to harm himself or others, facility staff will detain the individual and contact the local barrack to return. An officer will respond, evaluate and complete an EP, if warranted, and transport the individual to the hospital for an emergency evaluation. Approved: Thomas G. Davis Chief of Police 03/28/2017 6 of 6