Talking Them Through:
Crisis Communications with the Emotionally Disturbed and Mentally Ill
By
Rory Miller
Published by Rory Miller at Smashwords
Copyright 2011 Rory Miller
http://chirontraining.com
Smashwords Edition, License Notes
This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
Cover design by Kamila Zeman Miller
This book is dedicated to Sgt. Cathy Lamb, Sgt. Ralph Davis, and Counselor Kathy McCullough, leaders and mentors. Tough people who cared.
TABLE OF CONTENTS:
Foreword, by Dr. Drew Anderson
A Joke, A Story and an Attitude
CHAPTER 3:Who You Are Dealing With
CHAPTER 6: Use of Physical Force
FOREWORD- by Dr. Drew Anderson, Ph.D.
There are lots of books out there on dealing with difficult people. There are also lots of books out there on dealing with violence. So why pay attention to this one?
First, it’s written by Rory Miller. If you’ve read any of his other books, this will probably be all the encouragement you need. If you haven’t, wow, are you lucky- you have some great reading ahead of you. Rory is one of the deepest thinkers, and clearest writers, on the topic of violence that you will ever find. Do yourself a favor and buy everything by him you can get your hands on. They’re that good.
Rory’s background in psychology gives him the theoretical foundation to understand emotional disturbance and psychopathology, and his experience as a corrections officer has given him the experience to translate those concepts into practical, useable strategies and tactics. You get the benefit of that unique combination. There is just enough theory to give you a context for understanding emotionally disturbed persons, and a load of practical how-to advice for how to size up and then deal with them.
Second, this book will be useful to you, no matter who you are or what you do. I don’t care if you’re someone who deals with emotionally disturbed individuals frequently or not. The skills Rory presents here are valuable for everyone, from professionals such as cops, ER docs, and corrections officers, to those who may just have to deal with an angry and belligerent teenager on occasion.
As a psychologist and psychology professor, I deal with emotional disturbance (and teach others to do so) every day. But along the way I’ve also been, among other things, a volunteer at a state psychiatric facility, a bouncer, and an EMT. This book would have been a huge help then. It’s a huge help now.
Sure, I disagree with Rory on a couple of minor points, but those are mostly about the theory part of the book. For example, as I write this the DSM is being revised, and may not look like Rory describes it by the time you are reading this. But that doesn’t take away from its usefulness at all- for the most part it is rock solid.
Crisis Communications with the Emotionally Disturbed and Mentally Ill is an absolute treasure of a book that will help you deal with people during stressful, unpredictable circumstances. Read it, practice the techniques, and you will see results.
--Dr. Drew Anderson is an Associate Professor of Psychology and Director of Clinical Training at SUNY Albany.
A JOKE, A STORY, AND AN ATTITUDE
The Joke:
Once upon a time on a cold, dark, stormy night a traveling salesman got a flat tire directly in front of an Insane Asylum. One of the patients, dressed in a bathrobe in the rain, was watching, unblinking, face pressed against the chain link fence.
The salesman got out and started to change the tire. He carefully put the lug nuts in the hubcap by the side of the road, took off the old tire and went to the trunk to get the spare. All the time the asylum inmate just stared.
Just then a car came by, speeding and driving erratically. It missed the salesman, missed the car, but hit the hubcap and sent the lug nuts flying. There was no way the salesman could find them in the dark. The patient just kept staring.
The salesman was pissed. It was cold and rainy and this was before cell phones and he really didn’t want to go ask if he could use the phone in a booby hatch and he shouted some curses and shook his fist at the sky…
“Hey, mister,” the patient said.
Suddenly nervous, the salesman looked into that unblinking, unnerving stare and swallowed hard, “Errrr, what?”
“You could take one nut off each of the other tires and use it to hold the spare on. That’ll get you to the gas station, it’s only a few miles down the road.”
The salesman’s eyes went wide, his jaw dropped. His problem was solved. “That’s… that’s amazing,” he stammered.
“What’s so amazing? I’m in here because I’m crazy, not stupid.”
The Story:
C is without doubt my favorite violent schizophrenic. At his worst, he smears himself with his own shit and attacks anyone who comes near. At the mid-level he walks in circles, never making eye contact with anyone, every muscle tense.
He was my 'project' for a long time. When he started 'decompensating' I'd get a call, "Sarge, see if you can talk to C. He's about to lose it." So I would walk in long circles with him, usually not talking any more then he did. He eventually started talking a little and then a lot. One custody, he shared a goal with me. He wanted to work in the jail kitchen. That probably doesn't seem like a big goal to you, but for him it was huge.
He had to work his way from Severe Mental Housing to Mental Housing to Mild Mental to General Population and then to the worker dorm. That meant that his behavior had to continually improve until he wouldn't 'ping the radar’ of the other inmates in custody at the level he was going to. He had to stay on his meds. He had to consciously watch and modify his behavior. C took it very seriously and we wrote a contract, which was actually more of a list of things that he needed to learn how to watch: a cheat sheet for faking normality (and are any of us normal? Is there a difference between faking normal and being normal?)
The problem came in the transition from Mental to Mild Mental. I was talking to him every day. He seemed to be doing really well. At the bi-weekly meeting of the Mental Health Team I made the case for moving him on... it was soundly rejected. I thought he was doing better. Everyone else thought he was losing ground fast. I made the case at the next meeting and the next...
It was imperative that he didn't get the idea that we were manipulating him. He had to learn from this that controlling his behavior worked- it got what he wanted. That goal setting and planning worked. It would be a huge disaster, and play nicely into some of his paranoid delusions, if he came to believe that the people who had developed rapport with him had only done so for our own purposes, to make him easier to manage.
I made the case again and one of the deputies sighed. "Sarge, he's complaining about bugs everywhere. We can't send him to Mild, much less General, if he's seeing imaginary bugs."
Crap. "I'll tell him," I said. So I did. I went up to his housing unit and told him that as long as he was seeing things, we couldn't move him. Maybe a medication change...
No. He was adamant. There really were bugs and no one would listen to him. I sighed. 'No one listening' fell right in with the paranoid aspect of his schizophrenia. "Show me." He brought me up to his cell. It was crawling with little maggoty bugs. The only cell in the whole jail.
Sometimes the bugs are real. It was a good lesson for all of us. Everyone had seen what they expected to see and stopped looking when they saw what they expected. He made it all the way to the kitchen and did a good job until his release.
The Attitude
I admired these guys. Understand that I was working with severely mentally ill people in a jail. Mental illness is one thing. Some (but not all) were also pure criminals. Most, outside of the jail, were homeless. How many people do you know, including yourself, that could handle being homeless? Could figure out where to get food and shelter and clothes and the occasional shower?
Add to that that you can't even trust your own mind. Not all of the things you see and hear are real. You are sometimes compelled to do things you don't want to do or can't force yourself to do things you need to do...
And these guys (and gals) survived. They didn't thrive, not by any stretch of the definition, but they survived. Would I? Dumpster diving and hustling would be hard enough, coming from my old-school ranching background (Stoics suck at panhandling) but not knowing if the person I was begging from was even real?
Every time I looked at the inmates in the Mental Health units, every time I was tempted to look down on them or feel superior, all I had to do was look at the other officers or counselors or nurses or myself and wonder if we would even have survived.
Right? Wrong? Doesn’t matter. The attitude allowed me to avoid some of the traps. The joke reminded me that treating EDPs like they were stupid would backfire. C taught me to listen. The attitude helped me maintain respectful compassion. Sometimes without cutting slack:
“I know you’re bipolar, Zane, but that’s not why you stole Terry’s food…”
The following essay was written about 2004 or 2005, right after I found out that Mark had died. I didn’t want to forget:
Mark was once the subject of a two-page special feature in the local paper about the failure of the mental health care system. Over three hundred pounds and aggressive, Mark was paranoid schizophrenic, bipolar and learning disabled. He was in and out of custody in our county and the neighboring counties, notorious for staff assaults, always ad-seg (administrative segregation, a housing unit for the more dangerous inmates) and moved with multiple deputies.
About four years ago we'd just started an "open booking" process. Instead of going from cell to cell to cell, constantly either restrained by handcuffs or contained in a cell we were experimenting with booking fresh arrestees in a setting that looked like an airport waiting area. There were a handful of ‘Separation Cells’ for special situations, but otherwise there was no secure containment.
We were a little nervous, of course. Open booking (or direct supervision) is the ultimate test of people skills and it usually works well, but the math is bad. Five deputies and one sergeant (all unarmed) responsible for controlling as many as fifty arrestees... still drunk, high, angry, delusional without any containment or separation.
That night Mark came in. Mark usually left jail into the care of a social worker...and often came back to jail when he threatened or assaulted the social worker.
I talked him through the basic process: search, fingerprinting, digital picture, medical assessment and interviews with classification and recog (Recognizance, the people who decide if it is feasible to release someone without bail). Within a few minutes of sitting in the common area he was glaring at a female arrestee, mumbling.
I sat down next to him, in the inmate chairs.
"She's looking at me, Sarge. I'm gonna lose it. Make her stop looking at me or I'm gonna tear her up."
"Mark, you're letting her get to you. Yes she's staring at you, but if you react, you'll be the one to get in trouble. Don't let her control you."
"She's laughing at me!"
"And if you go off, she wins, Mark. Don't let her win. Ignore her. Show her she can't get to you."
The other inmate was laughing at Mark. Mark was huge, greasy, filthy. Like a lot of schizophrenics and developmentally disabled he couldn't take care of himself.
I took the other inmate aside and told her that Mark was "retarded" and it wasn't his fault and it was cruel to laugh at him... she apologized.
I spent probably an hour with Mark, kept him calm. Then I went to lunch. Within five minutes, the call came over the radio, "Sarge, one to sep." Mark was going to a Separation Cell.
When I arrived he was screaming and kicking the steel door, frothing at the mouth and yelling death threats. I keyed the door open, stepped in and asked him to have a seat. I listened, mostly, but I stayed on message. "You need to calm down. I have civilians like the nurse out there and I will not let you out of this cell if you are acting out in any way."
It dawned on Mark that he outweighed me by over a hundred pounds and I was alone with him in a tiny concrete cell and showing no fear. You could see him try to puzzle it out, using all of his available cunning to guess what my secret security came from...
He asked a lot of questions and finally asked if I'd been in the military. I said, "Yeah. Army." And he relaxed. This poor kid, who never got any closer to the service than a Rambo movie, relaxed. I wasn't afraid because I was a soldier. Of course.
I remember him trying to remember everything he was taught in therapy and classes about socializing, about how normal people make friends and Mark reached out to ask a question, the kind of question he imagined friends asked friends, "So what did you like best about the Army? Living in the barracks with all the guys or the uniforms?"
"Honestly, Mark, the only thing I miss was crawling around in the mud and shooting people. I enjoyed that." On one level, that was a screwed up thing to say, truth or not. But it gave me one of the best moments in my career.
Mark said, "Man, that's not right. You should talk to someone about that. I know some good counselors." Mark, the paranoid/schizophrenic, bipolar, developmentally disabled, violent and assaultive criminal was giving me fatherly advice. He recommended a shrink.
We talked some more, and he promised to be quiet and keep control even when I wasn't there watching. He kept his word all the way up to housing.
******
I found out yesterday that Mark died about three weeks ago. I don't know when or where or the exact circumstances, it was just one of those passing comments in briefing: "By the way, they found Mark R*** dead a couple of weeks ago."
He probably died alone. Hypothermia or OD on an attempt to "self-medicate" or maybe his diabetes got out of control. I wonder who knows or cares, who, outside of a handful of social workers and jail guards remember him. I wonder if anyone else has a good memory of Mark.
The news article mentioned was still available at:
http://www.mentalhealthportland.org/?p=8914
Dealing with the mentally ill or people in crisis, is a specialized skill and something of an art.
No. That’s bullshit. ‘Art’ is the word that we use when we don’t know how and why stuff works. The word we use when there is a big difference between individuals no matter how we train them. As a teacher or writer, ‘art’ is the word we use when we really don’t know the inner workings.
That’s the case here. I spent a lot of time working with mentally ill people, many of whom were also criminals. Some were violent, many, over the years went through crises. I got good enough at it that I was asked to write and teach courses on it, so part of it is a teachable skill.
That’s where this book will focus: things that worked, rules of thumb discovered, insights. I wish I really knew the inner workings, could find the one insight that would snap everything into focus. Then this would move from art to science.
But I don’t. So what you will get here is only what I can give, and you can use it to your ability and limits. Which may be well beyond my abilities. That’s cool.
Working corrections I dealt with larger numbers of mentally ill than most civilians; a higher percentage of those had a history of violence than in a dedicated mental health facility. I worked with fewer tools (including weapons) and resources than an enforcement officer, but the resources available were closer and, unlike a road officer I often had some knowledge and history with a given individual.
Almost everyone will be able to use this information, but different people need it for different reasons and will use it under different conditions. The conditions are important.
Cops need the tools. Dealing with “1234s” or whatever your agency calls them is a special problem. Often there is no criminal intent in someone acting unstable or chaotic, yet they can be dangerous to self and others. Under “duty to act” the officer is often required to intervene. A subject not in touch with reality is unlikely to see the intervention as helping and likely to see it as an attack. Unlike an experienced criminal, a panicked, emotionally disturbed person doesn’t know the game, doesn’t know how to surrender.
This ugly dynamic often means that more force is required on a panicked EDP (Emotionally Disturbed Person) than on a hardened, violent criminal…and whatever force used, in the end, was used on an innocent.
Sometimes people will be outraged and media and rights groups will have a feeding frenzy. But even worse, it hurts in a different way. When we use force, we want it to be on a bad guy, not on a confused, scared kid with unbalanced brain chemistry. We are taught at the academy that force is used to stop danger, not as an instrument of justice… but we are human enough that deep down if force must be used, we want it on the side of justice.
So any tool that can prevent force can help officers avoid the double trauma of an ugly use of force and a long civil case. That’s a good thing. And if force must be used, a deeper understanding leads to better articulation. You must have the words to explain your decisions to reasonable people.
Other Emergency Services personnel, like paramedics and ER doctors, also deal with unstable and chaotic people and situations. For the most part, they don’t have the force options available to officers. The ability to recognize trouble and either talk it down or recognize where talking is too dangerous is a critical skill.
For ordinary citizens confronted with people acting strangely, some rules of thumb won’t hurt. It’s nice to be able to tell someone who might be in trouble from someone acting crazy in order to scam some change. But without a duty to act, you have to carefully consider when and if to intervene directly.