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Special care for residents with mental illness

One in four people is affected by mental illness. Each year, 40 million Americans experience some type of mental illness, such as major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder or anxiety disorders, according to the National Alliance on Mental Illness.

First responders and municipal staff have frequent interactions with the public, and odds are they will encounter an individual who is mentally ill. Municipal employees need to learn to recognize signs of mental illness, how to handle encounters and where to get help.

Law enforcement officers receive training at the Criminal Justice Academy on how to deal with mentally ill people. Often, when a mentally ill individual sees a police officer, he may panic or get physical because he is afraid of being taken to jail or the hospital. The Academy instructs officers to observe the individual and talk to him to successfully deal with the encounter, said Fred Riddle, director of Crisis Intervention Training for NAMI SC.

"If you have the opportunity and the time—sometimes there’s no time to converse—talk to that individual," Riddle said. "Ask them, ‘how much sleep have you had? When is the last time you’ve eaten?’ Every time they answer a question, that de-escalates the situation."

Riddle, a former police officer, said some officers respond too aggressively when dealing with the mentally ill.

"Even if they handcuff that individual, it makes the situation more difficult," he said. "We try to let police officers know that other resources are available. Jail is not the best place to put our customers."

Once in jail, mentally ill people often don’t receive the treatment they need and end up getting worse, according to NAMI. After leaving jail, many no longer have access to needed healthcare and benefits, and find it hard to get a job or housing. Many individuals become homeless or end up back in jail.

People with mental health issues typically do not pose a risk of immediate danger to themselves or others, Riddle said. In fact, in about 97 percent of their interactions with the police, these individuals disclose being victimized or taken advantage of in some way in the past, he said.

A recent ruling by the Fourth Circuit Court of Appeals led many police departments around the state to change their policies and retrain officers on the use of stun guns such as Tasers, especially when they are dealing with the mentally ill.

This ruling resulted from an incident in Pinehurst, NC, where police used a Taser on a man who was about to be involuntarily committed for mental health issues. He died at the scene, and his estate accused officers of using excessive force. The court ruled in the estate’s favor. After the ruling, many departments moved to only use Tasers when there is a serious, imminent threat to the officer, suspect or public, and instead focus on de-escalating the situation.

Law enforcement officers are not the only ones encountering the mentally ill. City staff also should have training to deal with individuals who have mental health issues, according to Meredith Kaiser, loss control consultant for the Municipal Association.

"Often, folks at city hall encounter these folks when they come to pay a water bill or inquire about city services," Kaiser said. "Also, public works employees encounter folks who are mentally ill while they are reading meters or working on streetscaping projects or sanitation routes."

For law enforcement, cities should send their officers to critical intervention training, and departments should have a policy on dealing with persons of diminished capacity, Kaiser said. The Association’s liability insurance program has a model policy for SCMIRF members addressing this, she added.

For staff, Kaiser recommends that HR identify a resource to provide an employee assistance program. Services would include a place to refer an employee who needs substance abuse counseling, individual counseling, family and couples counseling, financial counseling, stress management or anger management. Cities’ health insurance providers may also be a resource for addiction treatment, smoking cessation, nutrition counseling or chronic disease management (including pain management).

For cities without the financial resources to offer these programs, a recommended practice is to develop a list of agencies which provide similar services in case a need arises. For instance, the Lexington/Richland Alcohol and Drug Abuse Council is the Midlands’ state agency for substance abuse treatment, and it is one of 33 county alcohol and drug abuse authorities recognized by the state of South Carolina. Fifty percent of American adults with a substance use disorder have a co-occurring mental illness, according to NAMI.

"Respecting employees’ privacy, treating them with respect and dignity, and having a working knowledge of ADA and HIPAA laws are critical for employers," Kaiser said. "Working closely with a labor attorney in these matters is highly recommended."