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How would
you know. . .
No doubt you run into a lot of odd people
and people doing odd things in the course of your work. But how would
one know if a person you encounter is just a bit odd or really mentally
ill? In this case, I mean “mentally ill” to refer to individuals
who are out of touch with reality and who may need help to keep themselves
or others safe.
There are no sure ways to know. Sometimes,
it can take mental health personnel weeks to figure it out. And it can
be hard to tell if someone is psychotic or on drugs or both. But there
are some things that should make you suspicious:
- The individual is talking to himself—at least
it looks to you like he is talking to himself. He is probably responding
to voices he hears but you don’t
- He seems unduly frightened—of you, of anything
around him. You don’t see anything really scary but he seems
terrified
- What he says makes no sense. The words might be
mixed up and put into sentences that don’t appear to have
any meaning
- When you ask a question, you get either no answer
or an answer that has nothing to do with what you asked
- He thinks people are out to get him—but it
doesn’t seem likely given the specifics. Maybe it is the Martians
or the KGB—maybe it is the neighbors all trying to break in
repeatedly when you see no evidence of that
- Clothing doesn’t match the weather. It is
July and he is wearing a winter coat and mitts—or it is February
and he is wearing a light coat but seems immune to the cold
- He doesn’t respond—he has a blank expression,
a wide-eyed stare. You say things and it’s like he didn’t
hear you
- He uses words in strange ways. They might be normal
words but he uses them as if they meant something else—or
he has made up words altogether.
- He thinks he has special powers. He can jump off
the bridge but won’t get hurt, he can wave his hand and strangers
will come to his rescue
- He thinks thing have special meanings—the
fact that you parked on the left side of the street means that you
are a spy; the fact that there is a hydrant means that a tidal wave
is coming to drown us all
- He assumes odd postures—stands or sits in
strange ways—and stays that way for long periods
- He repeats the same word or phrase over and over,
or makes the same gesture over and over or paces or walks in circles
over and over, for no apparent reason
There are other symptoms of mental illness
as well but these are the ones that you are most like to come across
in your work.
OK—but if you do decide someone is likely mentally ill, then what?
What are you supposed to do?
- Assess risk as you would in any other situation
- Keep your distance-but don’t hide if you can
avoid it. They are less likely to react if they can see you than
if you sneak up on them (but of course safety comes first..)
- Listen
- Don’t argue with things that don’t make
any sense to you. Be sympathetic. It must be very scary to think
there are people out to get you. You can say that. “Gee, it
must be very scary for you…” We all say things that
don’t make sense at times and none of us like to have it pointed
out!
- If a person is hearing voices, remember that you
are essentially butting into a private conversation when you address
the person. Be courteous and remember that there’s a lot going
in their head right now.
- Remember that a show of force may well make things
worse not better, especially if they are scared already. You never
know what this person’s past experience has been with “uniforms,”
or what they might mean to him in his current frame of mind.
- Take your time
- Smile. It’s amazing how much that can defuse
a situation—unless it looks like you are laughing at them
- Keep communication short and simple. If their speech
is confused, you can be sure their thoughts are confused. It is
going to be hard for them to understand and follow your directions.
Make one request at a time.
- Slow and steady. Unless they are clearly out of
control or getting violent, just keep steady—don’t raise
your voice, repeat things, offer simple choices, reassure
- But no matter how confused they are, they are likely
aware you are there and may be aware of what you saying. Don’t
talk as if they are not there.
- Try not to look threatening. Again, it makes them
more scared and thus more likely to risk some kind of violence.
- Take the least action possible. If a person simply
appears mentally ill but is not doing anything to harm himself or
anyone else, no action may be the best action
- Try to locate a contact—case worker, a family
member, a friend
- Don’t lie—if you are taking them to
hospital or jail or wherever, you might as well be upfront about
it because they will know soon enough! And since statistics indicate
that many of our callers are repeat callers, there’s no point
making things worse for the next time
- It is ok to back off. Closing in may put you at
risk of harm and without an “escape” route, you may
feel compelled to take action that harms the subject.
- Good questions to ask to find out if the person
has a psychiatric illness without saying that point blank:
“Do you have a problem with your
nerves?”
“You look upset—what is bothering you?”
“Is there someone I can call to help? Do you have a worker or
a doctor?”
“Are you taking any medication?”
“I can’t hear the person you are talking to. What they are
saying?”
“You seem very frightened.
But above all, respect, a calm demeanor and patience
combined with a healthy regard for safety issues is the key.
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