A MENTAL HEALTH NEWSLETTER FOR LAW ENFORCEMENT PROFESSIONALS
 

Mental Health Association of Greater St. Louis A United Way Agency

In this issue . . .

This is the second installment of a three-part series on dealing with grief. 

Once law enforcement officers have attended to their primary duties regarding the investigation of a crime, their attention can then be turned to the victim or the victim’s family and their needs. At this point it is important to remember the variation of responses victims can have regarding their grief. All victims grieve the loss of power and control that is taken, to some degree, when a crime is committed, be it burglary or homicide. The National Organization for Victim Assistance model of Crisis Intervention is very helpful to law enforcement and can be useful during an officer’s communication with a grieving victim or family member. The model consists of the following three techniques. 

1. Safety and Security: This technique may come very naturally to police officers. Ensure the victim’s physical safety as well as assist with the victim’s need to feel safe. Interview the victim away from the place of attack. If the perpetrator has not been apprehended or has threatened to return, be aware of any anxiety the victim may feel because of this. Victims also worry about the safety and security of loved ones. Reassure the victim that they and their loved ones are safe now, only if that is true. If asked by the victim, make phone calls to others affected by the crime. Triggers regarding the crime like the anniversary date or the time of year it happened, could effect clients to where you may need to assist with helping them feel safe again.
2. Ventilation and Validation: By actively listening to a victim (hearing them vent) and responding with empathy and no judgment (validating their reactions), you will have done much toward helping in the victim’s recovery process. Remember to tell the victims you are sorry this has happened to them and don’t use the phrase “I understand” because no one really can. When faced with hostility toward you and/or your job, try to be polite and not become defensive. Normalize reactions for the victim, such as “Many people experience anger.” or “It’s okay to be afraid.”
3. Prediction and Preparation: You can assist with the question “What comes next?” for the victim. You have a wealth of knowledge about the criminal justice system (cjs) that can help the client with questions they may have along the way. You can also let the victim know that the cjs is a trigger in itself because the victim will have to recount the story of their victimization many times and this may cause more trauma reactions. In helping the client to think about future events like financial problems, medical concerns and legal issues, you are helping the client to prepare, even though there may be no concrete solutions to those issues at the time you are raising them.

Much of the above information can be found in the Office for Victims of Crime’s (OVC) booklet, First Response to Victims of Crime 2001 and is available only online, publication number NCJ189631. The website for OVC is www.ojp.usdoj.gov/ovc. 

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CIT Corner appears regularly in Street Talk.

It’s a busy Saturday night. You’re called to a scene where someone is suicidal or is exhibiting other symptoms of a persistent mental illness. You’ve been here many times before to intervene with this person. No actual crime has occurred, but it’s clear this person needs help and a more comprehensive intervention. You call EMS and send the individual to a hospital, but in a few hours he is released and you are called to intervene again. You want to help this person, but you can’t provide the services he needs due to job constraints and other, more urgent cases to be addressed. You know you will continue to receive calls about this person for the rest of the night, through the weekend and into the next week. 

Community Alternatives Can Help 

Meet Maria Pulizzo 

Maria was an officer in St. Louis City from 1996 to 2000. She, like many other officers, was overwhelmed by calls to intervene with people with mental illnesses but was unable to offer the appropriate level of assistance as a police officer. Maria was so moved to help this population that she obtained her Master’s Degree in Rehabilitation Counseling from Maryville University and began working in mental health services. In January of this year, she became the first person in the St. Louis area to become a CIT Outreach Case Manager with Community Alternatives. 

How it Works 

When a CIT officer responds to a call in either St. Louis City or County:

1.      The officer must determine that the subject of the call has a persistent mental illness.

2.      The officer must write a CIT report about the incident.

3.      The officer can contact Sgt. Barry Armfield, who will make a referral to Maria Pulizzo OR The officer can contact Ms. Pulizzo directly at Community Alternatives (314-772-8801 x255).

4.      Maria will contact the subject, explain the concerns of the police department and assess the subject’s mental health and social service needs.

5.      Maria will provide referrals and short-term, intensive case management and community support to address the subject’s needs.  

The goal of this new initiative is to reduce the frequency of police calls to respond to individuals needing mental health treatment by providing crisis outreach and targeted interventions. With former officer Ms. Pulizzo as Community Alternatives’ official contact with CIT officers, we hope to make the communication and referral process simple, comfortable and effective. 

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January, 2007 St. Louis City Graduates

March, 2007 St. Louis County and Municipalities Graduates
 

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When dealing with a person with mental illness or anyone in a mental health crisis:

• Ask only one question or give only one command at a time. If the person’s responses aren’t making much sense, try to get them to talk about how they are feeling emotionally. This can help you know if the person feels fearful or safe.

• If the individual’s level of functioning is low, find out who checks up on them. Ask if a social worker, case manager or relative is involved.

• If the individual’s behavior indicates they might need a mental health evaluation or hospitalization, call Behavioral Health Response (BHR) to request an on-site assessment. BHR has a 24-hour hotline for crisis situations, and can suggest actions to take.

General tips to help you interact with a person with mental illness or a person who is suicidal:

• Keep your body language open and try to maintain eye contact.

• Use a moderate tone and rate of speech. This gives the impression you have things under control and are able to help.

• The presence of police can have different meanings to individuals. Stating that you are there to help can clarify the situation.

• Acknowledge that you see the person is upset (angry, sad, etc.) and encourage them to talk about what their feelings are.

• If an individual mentions something that has no meaning to you or that you do not understand, ask questions about it. Often people will make mention of things that they are uncomfortable bringing up, but would really like to talk about.
• Use open-ended questions and statements to allow the person to describe things in the way that is the most comfortable for him/her. For example, “How did that happen?” or “Tell me more about that.”

• Find out and get permission to use the person’s first name. This builds rapport and can be a powerful tool when used properly.

Specific tips for dealing with a person who is suicidal:

• Ask if he/she has a plan to kill him/herself. If the plan is very specific and the method (pills, gun, etc.) is available, the risk is higher for the plan to be carried out.

• Dispose of the means, if possible.

• Make a verbal or written contract with the person that he/she won’t try to harm his/herself without talking to someone first.

• Give the individual the number to the 24-hour suicide/crisis hotline (314-647-HELP).

• Don’t leave the person alone if the risk appears to be high. If the risk is high, he/she may need to be taken to the hospital.

When interacting with family members after an individual has committed suicide or died unexpectedly (massive heart attack, accident, etc.):

• Let them know the coroner can direct them to individuals that will clean the area (for a fee) after the body is removed.

• If at all possible, give the family members a chance to be with the body. (You may need to cover up disfigured parts.) It helps them to have closure and accept that the person is really dead.

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In recent news stories, the term “Stockholm Syndrome” has been mentioned. I know it has to do with being held captive, but could you explain it in more detail? By Steven E. Bruce, Ph.D., Associate Professor of Psychology and the Clinical Director at the Center For Trauma Recovery at the University of Missouri-St. Louis.

Over the past few years, the term “Stockholm Syndrome” has gained increasing attention due to several high profile kidnap cases. Stockholm Syndrome describes the behavior of individuals who, over time, become sympathetic to their captors. It is based on an event in 1973, where four hostages were taken in an attempted bank robbery in Stockholm, Sweden. Over the next six days, hostages were repeatedly threatened with death, were tied together with dynamite and had nooses placed around their necks. At the end of this ordeal (after police stormed the bank vault they were kept in), to everyone’s dismay, the hostages actively resisted rescue. In fact, they refused to testify against their captors and even raised money for their legal defense. More unbelievably, one of the hostages became engaged to one of the kidnappers.  

In a more recent case of Stockholm Syndrome, a 10-year old Austrian girl, Natascha Kampusch, was kidnapped in 1998 and was held by her captor until 2006, when she escaped from his home. Now 18 years of age, she had spent eight years of her life in a hidden, locked room under her kidnapper’s home. During an interview, Natascha sympathized with her captor because he protected her from many things she may have experienced had she grown up in a normal environment. She also became emotionally distraught upon hearing about his subsequent suicide after her escape.   

What are the causes of Stockholm Syndrome? Experts believe that four important variables need to be present. First, the victim is usually threatened with death (or their family’s death) with a firm belief that the captor will carry out this threat. Second, the person correctly (or incorrectly) believes that escape is not an option, even if they have the chance. Third, the victim is isolated to the extent that only the captor’s perspectives of the situation are the ones that are heard. Finally, there is usually a perceived act of kindness from the captor to the victim. In some cases, merely allowing the victim to live is seen as an “act of kindness.” 

The underlying goal of Stockholm Syndrome is survival. Thus, in their view, the only chance at survival is obedience. An individual learns strategies over time to behave in ways that makes their captor happy in order to survive. Subsequently, the captor may be perceived as less threatening as time passes, and the hostage’s beliefs about the situation (however irrational we believe them to be) begin to shift as well. Survival is not just physical, but psychological too. Thus, in order to reduce the overwhelming stress of the situation, there is a psychological shift in which the hostage begins to believe that the captor is their ally and that they can work together. They lose sight that the kidnapper is the one who placed them in this situation. Police and family members trying to find and rescue the hostage begin to be viewed negatively because they may hurt the person who is protecting them from harm. Unfortunately, the fact that this person is also the one threatening them with harm or death gets lost in their distorted perception of reality. Ironically, resisting rescue may also occur because the hostage believes that a rescue attempt will actually increase the likelihood of being harmed during the attempt.  

It is extremely important to note that symptoms of Stockholm Syndrome occur under unimaginable emotional and physical stress. It is not only a common survival strategy for kidnap victims, but also for individuals suffering from domestic violence, sexually abused children, prisoners of war, and concentration camp survivors.

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Open Mind is a column produced by the Mental Health Association, which appears weekly in many Suburban Journals. Click here for the reprint above and access to the entire Open Mind Archive on this website.

We have archived past issues of Street Talk on this website.  All back issues also include a Mental Health Directory and a link to a relevant Open Mind column.

January, 2007

• Cover Story: Many Facets of Grief and Loss
• At Your Service: Representative Payee
• Street Talk Survey: Tell Us What You Think
• Street Tips: Education for Family Members
• CIT Corner
• In the Limelight: Officers Michael Mainieri and Tara Edsall
• Open Mind: Loss of Loved Ones
• Street Talk Archives
• Mental Health Directory

October, 2006

• Stress on the Street: Line of Duty Death
• Do You Know?  Domestic Violence
• Street Talk Survey: Tell Us What You Think
• Open Mind: Husband's Temper
• In the Limelight: Officer Shannon Woolsey
• CIT Corner: CIT at Work
• Street Talk Archives
• At Your Service: DHSS Can Help
• Mental Health Directory

July, 2006

• Stress on the Street
• 20th Annual McAtee Award Winners
• Street Talk Survey: Tell Us What You Think
• At Your Service: Survivors of Suicide Response Team 
• CIT Corner: CIT at Work
• Street Tips: Self-Mutilation - "Cutting"
• Open Mind: Teen Self-Mutilation
• Street Talk Archives
• Mental Health Directory

April, 2006

• Family Effects of Police Work
• 20th Annual McAtee Award Nominations
• Street Talk Survey: Tell Us What You Think
• Open Mind: Stress Management
• CIT Corner/March 2006 CIT Graduates
• Street Talk Archives
• Street Tips: Eating Disorders
• Mental Health Directory

January, 2006

• The Stress of Shift Work
• At Your Service: NAMI St. Louis
• Street Talk Survey: Tell Us What You Think
• Open Mind: Stress Management
• CIT Corner
• Street Talk Archives
• Street Tips: Guardianship and Conservatorship
• Mental Health Directory

October, 2005

• A Police Officer's Guide to Mental Retardation vs. Mental Illness
• At Your Service: Productive Living Board
• NPSF Survey: We Need Your Help
• Open Mind: St. Louis Mental Health Resources
• CIT Corner
• Street Talk Archives
• Street Tips: Recognizing BiPolar Disorder
• Mental Health Directory
• Current Issues: Mental Health Court

July, 2005

• Police Recognition Awards
• At Your Service: Life Crisis Services
• Officer of the Year: Lori Bethmann
• Do You Know?  Effects of Stress
• CIT Corner
• Open Mind: Inheriting Schizophrenia
• Street Report: Police Suicide
• Street Talk Archives
• Street Tips: Mental Health Glossary
• Mental Health Directory
• Current Issues: Effects of PTSD

April, 2005

• Police Recognition Award Luncheon
• Current Issues: Police Could Bear Brunt of Budget Cuts!
• CIT Corner: CIT at Work - Case Examples
• At Your Service: National Council on Alcoholism and Drug Abuse
• Law In Action: March, 2005 CIT Graduates
• Open Mind: St. Louis Resources
• Street Tips: Medication Non-compliance
• Street Talk Archives
• Tip Sheet: Common Psychiatric Medicines
• Mental Health Directory

January, 2005

• Post-Holiday Blues
• At Your Service: CenterPointe Hospital
• Law In Action: Nov. 2004 CIT Graduating Class
• Q&A: Not Guilty by Reason of Insanity
• CIT Corner: CIT Training Pays off on the Street
• Street Report: Cops Have Feelings, Too
• CIT Appreciation Dinner
• Open Mind: St. Louis Resources
• Street Tips: Keys to Tactical Communication
• Street Talk Archives
• Current Issues: State Budget Affects Mental Health Services
• Mental Health Directory

October, 2004

• Living with Killing
• Current Issues: Important Ballot Issues
• Law In Action: July 2004 CIT Graduating Class
• CIT Corner: Update on CIT
• Street Tips:Encountering the Homeless
• At Your Service: Family Support Program
• Street Report: The Brotherhood
• Q&A: Not Guilty by Reason of Insanity
• Open Mind: Supporting a Friend with Mental Illness
• Street Talk Archives
• Mental Health Directory

July, 2004

• 2004 John J. McAtee Award Winners
• Q&A: Schizophrenia - What Officers need to Know
• In the Limelight: Officer Emily Mancuso
• ASIST Training
• Law In Action: March 2004 CIT Graduating Class
• Open Mind: Schizophrenia and the Brain
• Street Tips: Dealing with Mentally Ill or Suicidal People
• Tips from NAMI: Responding to a Mental Health Crisis
• Mental Health Directory

April, 2004

• 2004 John J. McAtee Award
• State Budget Cuts Affect Law Enforcement
• St. Patrick Center Programs
• Homeless People are Not All the Same
• Mental Health Directory
• Say YES to Homeless Youth
• Youth In Need Provides Services to Young People
• Roll Call
• P.O.S.T Approved Training
• Open Mind: Homelessness

January, 2004

• CIT: Safety, Understanding, and Service
• Street Tips: When Someone is "Acting Strangely."
• CIT: Training Makes it Happen
• Law in Action: Jail Diversion Program
• Do You Know? Obesity
• Q&A: Criteria for Involuntary Commitment
• At Your Service: Hawthorn Children's Psychiatric Hospital

October 2002

July 2002

April 2002

Following is a dated index of previous articles that have appeared in Street Talk.  To get a copy of any article or a previous issue, please call LaDonna Haley at 314-773-1399.

"It Worked for Me" (Officer Gorman)

Holiday blues vs. Seasonal Affective Disorder (SAD)

What should I know about Bipolar Disorder?

"When it finally hit home – part 1" (FBI agent Burt Jensen)

Public policy, mental health, your work

Liability issues for officers and departments

In the Limelight: Hazelwood PD

At Your Service: St. Patrick Center

I’d like you to know (helpful hints)

Dealing with frequent callers

"When it finally hit home – part 2" (FBI agent Burt Jensen)

Officer and Department of the year awards

At Your Service: Provident Counseling

Q&A: All about EAP’s

Know your mental health options

What does confidentiality really mean?

Rethinking our strategies (John Bozarth)

Anger management

Helping peers in distress

In the Limelight: Ballwin and Hazelwood PD’s

January 2002

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