Law Enforcement and Mental Illness: A Sometimes Fatal Encounter

Gary Fields write on the Wall Street Journal's writes in "Live of Mentally Ill, Police Collide" the story of a police officer who shot and killed a mentally ill man who charged at him with a butcher's knife.  The man died, and the police officer, whose brother suffers from bipolar disorder, is haunted.  Fields writes:

Law-enforcement professionals and mental-health advocates believe they are seeing an increase in fatal encounters between police and the mentally ill. They point to a narrowing range of treatment options that has shifted more responsibility for the mentally ill to law officers, jails and prisons. 

"No police officer does well with shooting someone, let alone someone with mental illness," said Michael Biasotti, immediate past president of the New York State Association of Chiefs of Police and a mental-health and law-enforcement policy researcher. "That destroys a bunch of people at once."

Fields writes: 

The Federal Bureau of Investigation keeps track of instances of "justifiable homicide," which it defines as "the killing of a felon by a law-enforcement officer in the line of duty," but it doesn't note which of those involve mental illness. While crime rates nationally have fallen almost every year since the late 1990s, justifiable homicides by police officers have risen, from 297 in 2000 to 410 in 2012.

Hidden within that category is what is known informally as "suicide by cop," when a person intentionally provokes an officer into using lethal force. Chuck Wexler, executive director of the Police Executive Research Forum, in Washington, D.C., which researches law-enforcement issues, said he believes this type of suicide is increasing in frequency. 

Then over on Pete Earley's blog, he has video up of an unarmed mentally ill man who was shot by police.  Unarmed.   Mr. Earley writes:

This shooting terrifies those of us who love someone with a mental illness or have a mental illness. I’ve been asked to help this video go viral so that the public will recognize the need for better police training. Please do your part and send it out.
http://youtu.be/4U1GOTzvBLQ

And over on Clinical Psychiatry News, ClinkShrink is talking about law enforcement from a totally different perspective.  She received a call from a homicide detective who wanted her suggestions for how to interrogate a suspect.  Not quite the job of a forensic psychiatrist, but she talks about the ethical issues in a way that only ClinkShrink can.  See Consultation to Law Enforcement.

Podcast Number 55: What Happens to Shooters with Mental Illnesses?

There has been a lot in the media recently about mental illness and it's relationship to violence.
In this episode we have ClinkShrink walk us through what happens to a mentally ill defendant in a violent crime. First, there is the question of Competence: is the defendant able to meaningfully participate in his/her trial, this is the present mental capacity. If the defendant never becomes competent, he generally remains in a forensic facility indefinitely. At some point (10 years in our state for a capital crime), the law requires a final disposition, and the defendant who is not likely to ever attain competence will be civilly committed and will remain in a forensic facility.

The second question is one of sanity at the time of the crime. ClinkShrink talks about the complexities of insanity evaluations and the rarity of having a Not Criminally Responsible plea. We discuss the idea that incidental mental illness is not enough to be found not guilty by reason of insanity, that the mental illness must have influenced the criminal behavior or obscured the defendant's ability to appreciate the criminality of his behavior. Finally, Clink talks about what happens after an insanity acquittee is released and what type of aftercare planning gets put into place.

The photo is Billy Bob Thornton in Slingblade--he's our example of an insanity acquittee.

Once again, thank you for listening and please do write a review on iTunes.

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Peter Kramer on Slate.

While we're waiting on ClinkShrink, I'll steal a link to a Slate article on paranoia by Peter Kramer. He won't mind.

Fanning the flames of paranoia

A psychiatrist wonders how a culture of Birthers and Truthers feeds the delusions of people like Jared Loughner

Dr. Kramer writes:

The experience in my training years made me comfortable with paranoia. As a result, I have always had one or two paranoid patients on the roster in my private practice here in Providence, R.I. I should stress that no one I see resembles Jared Lee Loughner. I travel a good deal, and I can't leave the covering doctor with potentially violent patients. When my patients have schizophrenia or related conditions, they tend to be the most accomplished, most reliable, and nicest people to suffer these terrible afflictions. Their needs are serious enough.

Not much specific is known about how to treat paranoid patients. Generally, they don't come in hoping to lessen their delusions, which can be wholly convincing to them. They want relief from depression or insomnia -- or from an employer who has insisted they get help. Their mood symptoms may respond to medication, and they may even become less isolative, but generally the system of thought does not budge. After months of trials of different drugs, the patient will be less agitated and less pained but still solidly convinced that he is being watched and threatened. Always, too, there are prices to be paid in terms of medication side effects.

One thing we all seem to agree on with mental illness of this magnitude is that violence of this extreme and horrific nature is rare. It's all pretty horrible.

The Killers I've Known

Some blog readers have been asking for a post about the Arizona shooting incident. The issue of spree killing has come up on the blog before, after the Amish killings in Pennsylvania, after Virginia Tech and the Fort Hood incidents. This will officially be my third poster about shooter psychology and it's getting hard to find something new to say.

First of all, most murderers don't have multiple victims. According to the Uniform Crime Reports, the number of multiple-victim killings has remained pretty stable over the last five or so years, at about 350 per year. Almost all multiple victim killings are committed using guns, although in 1987 there was an anomaly in which 24 people were killed by poison. More about that later.

In most cases, the killer knows the victim and that's true both for single and multiple victim offenses. The nature of the relationship varies with the setting and type of killing: spree shooters most often kill co-workers or other students, while single victim killers murder their partners or drug acquaintances. Psychotic killers will usually murder a caretaker, a mother or wife, but only if the killer is a young male. Female psychotic killers tend to kill their children. It's rare for a psychotic killer to murder multiple strangers. Locally I can recall only one case like this over the last twenty years. In this case the killer suffered from a grandiose delusion, and the victims were killed in a car crash. Psychotic people can stalk or threaten political or other high profile figures, but this usually doesn't result in violence. Typically what motivates psychotic political stalkers is a delusion of some type, for example the belief that a political (or other stranger victim) is threatening them in some way. For example, one political stalker I examined believed that a U.S. Senator was a devil worshiper, and that he was destined to kill all devil worshippers. Another psychotic letter writer had a delusion about the president, although he was so thought disordered it was a little hard to sort out the "logic" behind the delusional motivation.

Multiple victim killers could be spree killers or serial killers. That 1987 anomaly with the poison deaths was partly due to Donald Harvey, a serial killer in Ohio who poisoned patients at the hospital where he worked.

Non-psychotic spree killers have the same motivations as "regular" single victim murderers: frustration over the loss of a job, the loss of a relationship, loss of a living situation, lack of money or friends, alienation from family and substance abuse. Killing is an act of desperation whether you're killing one person or many. Political motivations may come into play, but without the "nothing left to lose" factor political motivation isn't enough.

So why did the Tucson shooter act? Ya got me, I haven't examined him so we can only speculate based on what's in the news. All I can tell you about is the usual characteristics of the killers I've known.