Subject: Handling the Mentally Ill Policy & Procedure Effective Date: Review Date: By Order of: Mark J. Corr, Chief of Police
The Municipal Police Institute, Inc. (MPI) is a private, nonprofit charitable affiliate of the Massachusetts Chief’s of Police Association. MPI provides training and model policies and procedures for police agencies. This policy is an edited version of MPI Policy 1.16, “Handling the Mentally Ill.” GENERAL CONSIDERATIONS AND GUIDELINES
Reaction to the mentally ill covers a wide range of human responses. People afflicted with mental illness are ignored, laughed at, feared, pitied and often mistreated. Unlike the general public, however, a police officer cannot permit personal feelings to dictate his/her reaction to the mentally ill. His/her conduct must reflect a professional attitude and be guided by the fact that mental illness, standing alone, does not permit or require any particular police activity. Individual rights are not lost or diminished merely by virtue of a person's mental condition. These principles, as well as the following procedures, must guide an officer when his/her duties bring him/her in contact with a mentally ill person. Every year police officers are severely hurt or even killed when responding to calls involving the mentally ill. It is extremely important that officers are professional and cognizant of officer safety when handling these calls for service. It is the policy of the Lexington Police Department that:
Officers shall accord all persons, including those with mental illness, all the individual rights to which they are entitled; and
Officers shall attempt to protect mentally ill persons from harm and shall refer them to agencies or persons able to provide services where appropriate.
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1. Bipolar: Also know as “manic-depressive illness,” the disorder causes
extreme swings in a person’s moods, emotions and behaviors. In the “manic” state, these strong moods may include intense elation or irritability. In the “depression” state, a deep sadness or hopelessness is prevalent. Both are manifested in the “mixed state.”
2. Schizophrenia: A serious disorder, which affects how a person thinks,
feels and acts. The illness is characterized by dramatic changes in behavior and thinking. Someone with schizophrenia may have difficulty distinguishing between what is real and what is imaginary; may be unresponsive or withdrawn; and may have difficulty expressing normal emotions in social situations. The person suffering from schizophrenia may also become or display symptoms of paranoia. 3. Paranoid personality disorder is a psychiatric diagnosis
characterized by paranoiaa and a pervasive, long-standing suspiciousness and generalized mistrust of others.
4. Hallucinations: Perceptual experiences that are not actually occurring,
such as hearing voices telling one to harm oneself.
5. Delusions: Fixed false beliefs about the self, such as: “Everyone is out
6. Mental Illness: For purposes of admission to an inpatient facility under
Section 12, “Mental Illness” means a substantial disorder of thought, mood, perception, orientation, or memory which grossly impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary demands of life. Symptoms caused solely by alcohol or drug intake, organic brain damage or developmental disabilities do not constitute a serious mental illness.
7. “Likelihood of Serious Harm”, (1) a substantial risk of physical harm to
the person himself as manifested by evidence of, threats of, or attempts at, suicide or serious bodily harm; (2) a substantial risk of physical harm to other persons as manifested by evidence of homicidal or other violent behavior or evidence that others are placed in reasonable fear of violent behavior and serious physical harm to them; or (3) a very substantial risk of physical impairment or injury to the person himself as manifested by evidence that such person’s judgment is so affected that he is unable to protect himself in the community and that reasonable provision for his protection is not available in the community.
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8. Pink Slip or “Section 12”: Refers to an involuntary commitment to an
emergency mental health facility pursuant to M.G.L c. 123 s. 12.
A minimum of two officers should be dispatched to incidents involving the mentally ill.
If a street supervisor is available [s]he will also be dispatched to the call.
Medical personnel will be dispatched to the location upon request of the officers on scene or if there is a belief of potential injuries.
It is helpful in handling a situation properly if an officer is able to recognize some of the characteristics of a person who is mentally ill.
Factors that may aid in determining if a person is disturbed are: [41.2.7]
a. Severe changes in behavioral patterns and attitudes; b. Unusual mannerisms and/or appearance; c. Distorted memory or loss of memory; d.
e. Irrational explanation of events; f. Hostility to and distrust of others; g. Fear of others such as paranoia; h. Marked increase or decrease in efficiency; i. Lack of cooperation and tendency to argue;
k. Lack of insight regarding his/her mental illness.
3. These factors are not necessarily, and should not be treated as,
conclusive. They are intended only as a framework for proper police response. It should be noted that a person exhibiting signs of an excessive intake of alcohol or drugs might also be mentally ill.
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4. Medications: Some medications commonly prescribed for mental
Trade Name Trade Name
GEODON ZIPRASIDONE TEGRETOL CARBAMAZEPINE HALDOL HALOPERIDOL
KLONOPIN CLONAZEPAM WELLBUTRIN BUPROPION LAMICTAL LAMOTRIGINE ZYPREXA
Bipolar Disorder: This is typically a lifelong illness that most often begins in the later teenage years or early adulthood. It commonly runs in families, but not always, and affects more than two million Americans. It is a treatable illness.
Warning Signs: These signs, outlined in the chart below, are often painful, last a long time and are serious. They usually interfere with a person’s ability to conduct a normal family, work and personal life.
Signs of Mania Signs of Depression
b. Some people will self-medicate with alcohol or illegal drugs.
Schizophrenia: Persons in a psychotic state may have high anxiety, faulty reality testing, poor judgment, or diminished impulse control.
They may be at risk of harming themselves or others.
i. Delusions (false or unreal beliefs); ii. Hallucinations (hearing, smelling, tasting or feeling
iii. Disorganized speech and/or speaking less; iv. Bizarre behavior;
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v. Blunted or dulled emotions; vi. Withdrawing emotionally from people; vii. A loss of interest in school or work; viii. Difficulty paying attention; ix. Lack of energy and motivation; x. Thoughts of death or suicide, or suicide attempts; xi. Outbursts of anger; and xii. Poor hygiene and grooming.
Depression: This is more than just feeling sad or a little “under the weather.”
Depression is a mental illness that can seriously affect a person's feelings, thought patterns, behavior and quality of life.
i. Ongoing sad, anxious or empty feelings; ii. A loss of interest in activities that normally are
iii. Appetite and weight changes (either loss or gain); iv. Sleep problems (insomnia, early morning wakening or
v. Irritability; vi. A loss of energy and a sense of fatigue, or being "slowed
vii. Feelings of guilt, worthlessness and helplessness; viii. Feelings of hopelessness and pessimism; ix. Difficulty in concentrating, remembering and making
x. Thoughts of death or suicide, or suicide attempts; and xi. Ongoing body aches and pains or problems with digestion
that are not caused by physical disease.
E. Mental Health Resources Contact Information
Advocates Psychiatric Emergency Services
675 Main Street Waltham, MA 02453 Main # 781-893-2003, 800-540-5806, Fax -781-647-0183. 2. Lexington
Massachusetts Department of Mental Heath: Phone: 617-626-8000,
National Alliance on Mental Illness (NAMI): 1-800-950-NAMI (6264),
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F. Interactions with the Mentally Ill in the Field [41.2.7(c)]
If an officer believes [s]he is faced with a situation involving a mentally ill person, [s]he should not proceed in haste unless circumstances require otherwise.
An officer should be deliberate and take the time required for an overall look at the situation.
An officer should ask questions of persons available to learn as much as possible about the individual. It is especially important to learn whether any person, agency or institution presently has lawful custody of the individual, and whether the individual has a history of criminal, violent or self-destructive behavior.
An officer should obtain information regarding current or previous Doctor’s care.
It is not necessarily true that mentally ill persons will be armed or resort to violence. However, this possibility should not be ruled out and because of the potential dangers, the officer should take all precautions to protect everyone involved.
It is not unusual for such persons to employ abusive language against others. An officer must ignore verbal abuse when handling such a situation.
Avoid excitement. Crowds may excite or frighten the mentally ill person. Groups of people should not be permitted to form or should be dispersed as quickly as possible.
Reassurance is essential. An officer should attempt to keep the person calm and quiet. [S]he should attempt to show that [s]he is a friend and that [s]he will protect and help. It is best to avoid lies and not to resort to trickery.
An officer should at all times act with respect towards the mentally ill person. Do not "talk down to" such person or treat such a person as "child-like." A person with mental illness may be both highly intelligent and acting irrationally. Mental illness, because of human attitudes, carries with it a serious stigma. An officer's response should not increase the likelihood that a disturbed person will be subjected to offensive or improper treatment.
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G. Involuntary Examinations (Section 12)
The authority for an application for Involuntary Examination is described in M.G.L. c. 123 s. 12.
Medical Personnel: Any physician, qualified psychiatric nurse, mental
health clinical specialist, or qualified psychologist, after examining a person and having reason to believe that failure to hospitalize such person would create a likelihood of serious harm by reason of mental illness, may restrain the person and apply for hospitalization for a three (3) day period.
Police Officers: In an emergency situation, if a physician or qualified
psychologist is not available, a police officer who reasonably believes under the circumstances that failure to hospitalize a person would create a likelihood of serious harm by reason of mental illness may restrain such person and apply for the hospitalization of such person for a three (3) day period at a public facility or a private facility authorized for such purpose by the Massachusetts Department of Mental Health.
Any Person (including a police officer) may petition a district court to
commit a mentally ill person to a facility for a three (3) day period if failure to confine that person would cause a likelihood of serious harm.
H. Taking a Mentally Ill Person into Custody
A mentally ill person may be taken into custody if:
The officer has a reasonable belief, under the circumstances, that [s]he poses a substantial danger of physical harm to himself/herself or other persons
[S]He has escaped or eluded the custody of those lawfully required to care for him/her.
At all times, an officer should attempt to gain voluntary cooperation from the individual.
3. If an officer believes an emergency commitment is required under
M.G.L. c. 123 s 12, the following guidelines should be followed:
a. The Commanding Officer shall be consulted about the facts of
b. The current Psychiatric Emergency Service provider will be
contacted by phone. (Currently we use Advocates Psychiatric Emergency Services 800-540-5806.)
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c. The circumstances will be conveyed to the on call clinician
regarding the request for a section 12 committal.
d. If it is agreed that a section 12 is warranted it shall be completed
by the on call clinician and faxed to the Police Station, as soon practicable.
e. Once it has been confirmed that a section 12 has been issued a
private ambulance should be contacted for transportation to the psychiatric facility listed on the section 12.
f. Officers will stay with the mentally ill subject until custody has
been transferred to ambulance personnel.
g. If the subject has a Doctor that they have been currently dealing
with and contact is easily accessible, this is also an option for obtaining the Section 12.
h. A section 12 has no expiration date. As a matter of best practice if a section 12 is outstanding for more than 48 hours prior to being served the issuing authority should be re-contacted in order to confirm that the section 12 commitment is the best course of action for the subject named on the order. Note: Although the law clearly permits a police officer the ability to sign a section 12 Pink slip the best practice is to initiate the process through the current Psychiatric Service provider. Commanding Officers should contact a Captain to discuss when, or if, Lexington police officers will issue a section 12 without a physician.
4. Officers may affect a warrantless entry into the home of a subject for
whom a section 12 application for temporary hospitalization (pink slip) has been issued, provided:
They have actual knowledge of the issuance of the pink slip.
b. The entry is of the residence of the subject of the pink slip. c. The pink paper was issued by a qualified physician,
psychologist, or psychiatric nurse in an emergency situation and where the subject refused to consent to an examination.
d. The warrantless entry is made within a reasonable amount of
time after the pink slip has been issued.
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* NOTE: Each situation is fact specific; the special needs and interests of the subject whom the pink paper is directed towards will be examined thoroughly prior to entry into any home. If all the above criteria are met, and reasonable exigent circumstances are present, entry may be gained. If exigency does not exist and consent is not granted a warrant must be obtained prior to any entry of a residence to execute a pink slip.
I. Transporting Mentally Ill Persons to Treatment
1. Normally, a person who is to be transported to a hospital for a mental
health evaluation pursuant to M.G.L. c. 123 s. 12 will be transported by
The Lexington Fire Department, if authorized by the Fire Chief, may also transport mentally ill patients in an ambulance.
3. A Lexington Police Officer may transport such person in a police cruiser
equipped with a protective barrier if, in the opinion of a police officer, the person poses a threat due to violence, resisting, or other factors. The Commanding Officer or Patrol Supervisor must be consulted for authorization prior to transport. Alternatively, officers may escort or accompany Fire Department personnel in a Town ambulance.
J. Escapes from Mental Health Facilities (Chapter 13 Section 30)
1. If a patient or resident of a facility of the Massachusetts Department of
Mental Health is absent without authorization, the superintendent of the facility is required to notify the state and local police, the local district attorney and the next of kin of such patient or resident.
2. Such persons who are absent for less than six months may be returned
3. Persons who have been found not guilty of a criminal charge by reason
of insanity or persons who have been found incompetent to stand trial on a criminal charge and have escaped from a mental health facility may be returned directly to the facility they escaped from, regardless of the length of absence.
4. Taking a subject into custody for return to a mental health facility shall
not be considered an arrest. The subject may be turned over directly to employees of the facility.
Police officers are immune from civil suits for damages for restraining, transporting, applying for the admission of or admitting any person to a facility if the officer acts pursuant to the provisions of Chapter 123. Policy & Procedure Page 9 of 11 41O-Handling the Mentally Ill
L. Interrogating Mentally Ill Suspects [41.2.7(c)]
1. Whenever a mentally ill or mentally deficient person is a suspect and is
taken into custody for questioning, police officers must be particularly careful in advising the subject of his/her Miranda rights and eliciting any decision as to whether [s]he will exercise or waive those rights. It may not be obvious that the person does not understand his/her rights. The department policy on Interrogating Suspects and Arrestees should be consulted.
2. In addition, it may be very useful to incorporate the procedures
established for interrogating juveniles when an officer seeks to interrogate a suspect who is mentally ill or mentally deficient. Those procedures are set out in the department policy Handling Youthful Offenders.
3. Before interrogating a suspect who has a known or apparent mental
condition or disability, police should make every effort to determine the nature and severity of that condition or disability; the extent to which it impairs the subject's capacity to understand basic rights and legal concepts, such as those contained in the Miranda warnings; and whether there is an appropriate "interested adult," such as a legal guardian or legal custodian of the subject, who could act on behalf of the subject and assist the subject in understanding his/her Miranda rights and in deciding whether or not to waive any of those rights in a knowing, intelligent and voluntary manner.
4. CONFIDENTIALITY: Any officer having contact with a mentally ill
person shall keep such matter confidential except to the extent that revelation is necessary for conformance with department procedures regarding reports or is necessary during the course of official proceedings.
1. If a mentally ill or deficient person is reported lost or missing, police
should follow protocols described in the department policy on Missing Persons.
2. Officers may additionally refer the family of the missing person to the
National Alliance for the Mentally Ill (NAMI)/Homeless or Missing Persons Service which operates an emergency hotline to assist all families and friends who have a missing relative or friend. The Information Helpline telephone number is 1-800-950-NAMI (6264), and the web site is Policy & Procedure Page 10 of 11 41O-Handling the Mentally Ill
3. COMPLAINTS WITH NO IMMEDIATE THREAT: An officer who
receives a complaint from a family member of an allegedly mentally ill person who is not an immediate threat or is not likely to cause harm to himself or others, should advise such family member to consult a physician or mental health professional and provide the name and number of our Family Services Detective for additional assistance.
1. Department personnel shall be trained in this policy upon initial
employment during their Field Training Program. [41.2.7(d)]
2. The Captain of Administration shall through the Commanding Officers
and Patrol Supervisors ensure that employees undergo refresher training at least once every three years. [41.2.7(e)]
Public record laws specifically prohibit the publishing of mental health calls in a public log.
Any journal note, that clearly involves a mental health problem, should be identified in the comment line and excluded from the public log by entering A1 in the “geo-code” field of the journal note.
i M.G.L. c. 123, §12 (a). iiM.G.L. c. 123, §12(a); Ahern v. O’Donnell, 109 F.3d 809 (1st Cir. 1997). iiiM.G.L. c. 123, §12(e). ivMcCabe v. Life-Line Ambulance Service, Inc., 77 F.3d 540 (1st Cir. 1996). vM.G.L. c. 123, §30. viM.G.L. c. 123, §30. viiM.G.L. c. 123, s. 22
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