I am of the mindset that police and college campus police could do well with more training as to what constitutes a paranoid episode that is largely safe and what constitutes a paranoid episode that is largely unsafe. I feel that the police serve in a hugely defining role as to whether someone experiencing an episode of bipolar illness should go the hospital or be incarcerated. There is no such distinction for any other type of intervention that the police are called upon to mediate. It takes a great amount of training about paranoia and how it operates particularly in the minds of our youth. If psychiatrists are largely unable to determine when paranoia is linked with violence or not after days or months or years of working with that person, think what a challenge it is for a police man or woman intervening with no case history on the patient while being charged with the safety of that patient and all bystanders. It is a huge responsibility that falls on the police and college police.
I have worked through NAMI (the National Alliance on Mental Health) in their In Our Own Voice Program to talk with these First Responders and provide more insight into the patient’s point of view when these incidents occur. I found the reception at that event quite welcoming as if the police or campus police had never had a conversation with someone prone to paranoia when that person was outside of that paranoia event.
In any case, I find the work of police and campus police to be a gargantuan task. It almost requires the intervening police officer to be all-knowing and to be able to size up the situation in a matter of minutes as to whether the person before them is paranoid and a danger to others or paranoid, a danger to themselves and needing hospitalization. I feel that additional training in differentiating these behavioral health outcomes should be mandatory both for crisis interventionists as well as medical and clinical professionals. As a person who has experienced mania and being a danger to self and perhaps others, I readily do not see a clear line for police to follow from which to determine how best to intervene. If I am unclear on that intervention after 30 plus years of managing (or trying to) the illness, I would imagine most police and campus police feel that they are overwhelmed and alone as First Responders in assessing the case of a behavioral health incident.
I feel for the police and the campus police and their courage in this line of work and believe that greater training like that of NAMI’s In Our Own Voice Program is extremely important. I had one first responder come up to me at that In Our Own Voice presentation and thank me. The officer had never talked to someone with a tendency toward paranoia when they were not in a paranoid state. All he had ever seen was the patient at the height of a paranoid event – he must have assumed through no fault of his own that that state of paranoia was the norm for that person rather than a state that comes and goes and can be managed for the most part through medications and talk therapy.
The First Responders should have some sort of script that allows them to assess if the danger is being directed internally toward the patient or if the danger is more generalized to people external to the person experiencing the breach of reality. I do not claim to have the content to that script in full, but my current thoughts about how questions for this script might go is something like what follows. This script below should be vetted by a team of first responders, therapists, doctors and other professionals and is only a “strawman” from the point of view of one patient.
I am going to ask you a series of 20 questions. I would like for you to respond to each question to the best of your ability. OK, are you ready? First question:
1) What is your name?
2) Are you a student here?
3) Are you feeling OK?
4) What is the date today?
5) Are you feeling suicidal?
6) Have you ever felt this way before?
7) Do you have a mood disorder illness? Have you ever been hospitalized for a mood disorder?
8) Are you hearing voices?
9) What are the voices saying?
10) Are the voices asking you or telling you to harm yourself?
11) Are the voices asking you or telling you to hurt anyone else?
12) Do you have a weapon? Are you intending to use it?
13) Where did you get it? Have you had it on you for several days or just a few hours?
14) How long has it been since you took a shower?
15) How long has it been since you had a full meal?
16) Have you been using any mind-altering, recreational or prescription drugs?
17) If so, what are they?
18) Do you feel safer now that the paramedics are here and we are talking?
19) Is there someone in particular you would like to talk to? Your parent? Your friend? Your psychiatrist? Your therapist?
20) What do you need to feel more calm?
If there had been such a script available for use by First Responders at the West Ferry airport back in 1985, perhaps my first episode would not have been so cataclysmic. Perhaps I would not have been plagued by security concerns for several years after this first episode if that episode had been less threatening and less dramatic.