Patrol Notes
Hosted by Captain Chuck Mantkus, NRLO Director of Training

Written by George H. Bercaw, M.A., ABDA

Click here for Bercaw's new "Traffic Stops" Article
"Personality Disorders:  What You Might Expect on Traffic Stops"
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If you have any comments on this series, or if you have any comments for Officer George H. Bercaw or for other Contributing Editors, please let NRLO know. Your feedback is desired.  Contact NRLO and state the name of this series and the author. Your remarks on this and other "eTraining" teachings will be considered for publication on this site.  Your participation is highly desired and appreciated. 

About George H. Bercaw

 "Street Assessment" Series  Index
Dealing with Emotionally Disturbed Persons in Crisis Situations
(Click here for "Personality Disorders:  What You Might Expect on Traffic Stops" )

Suggested References
Introduction            Mental Disabilities
Most Commonly Occuring Diagnoses by Incidence 
System Failure        Risk Factors       Safety Concerns        Mental Status Examination 
The Dysfunctional Continuum (GAF Table)    The Role of the Police Officer   The Street Scene
Personality Types and Their Reactions When Stopped or Contacted
Basic Rules for Intervention      The Four Basic Modes of Persuasion       Possible Outcomes
Crisis Escalation Cycle Table 
(Stage Overview)
Adapted from, and used by perission of Randolph Dupont, Ph.D. (see references)
     Uncertainty Stage   (Based on Facial Expressions, Eye Movements, Hand Guestures, etc.) 
 Questioning Stage     Refusal Stage      Demanding Stage     Acting-Out Stage
Recovery and Post-Recovery Stages
There is a Better Way (CIT Program of Memphis PD and Other Ways)
Short Quiz
 Answers to Quiz 

Presented to Northeast Regional Law Enforcement Academy,
Basic Police Recruit School, Greeneville, TN
October 8, 2002 & February 28, 2003

INTRODUCTION

Consider these brief scenarios:  A Police Officer asks a woman to perform some field sobriety tests; and she cannot do so.  Another person ignores an Officer's command to step back on the sidewalk.  Yet another, when stopped for a traffic violation, exhibits slurred speech.  While another is walking in circles with his head down muttering unintelligibly.  A 911 Call describing people with these or similar behaviors might very well result in the Dispatcher misleading the Officer to think there is a problem with a drunk.

Understandably, many well intentioned Police Officers experience a certain amount of discomfort around people with disabilities of almost any kind.  Typically, people with disabilities are viewed by others with a sense of pity, or they simply try to ignore them; and with compassion, they may say:  "Thank God, that isn't me."

By definition, a disabiity is any physical or mental impairment that substantially limits or interferes with one or more of a person's major life functions. About 1 in 5 Americans have some kind of disability, and 1 in 10 have what is characterized as a severe disability.

In our country, there are about 9 million people with disabilities so severe that they need assistance with simple tasks related to daily living.  Even children between the ages of 6-14 account for about 1/8th of those so affected.  More than 1/3 of all persons aged 65 or older have a severe disability.  When I say, "disability," I am referring to an estimated 2 million adults with chronic balance problems (often misinterpreted as being drunk), and equal number with speech impairments, and almost four times that number with developmental disabilities that include cerebral palsy or mental retardation.

While the American Disabilities Act of 1990, mandates special allowances for persons who are disabled; it does not, however, grant special liberty to individuals with disabilities in matters of law, nor does it dictate that Police must take a "hands off" approach toward people with disabilities who engage in criminal conduct.  It also needs to be stated that the role of Law Enforcement is to both protect and to serve.

In the area of special education, there is a concept of "least restrictive enviornment" which involves a number of other concepts; and in its simplest terms, means that you do whatever it takes to get the job done and use whatever means can best accomplish the task without violating the individual's right to dignity and respect; or, "maximum benefit with least negative management."

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MENTAL DISABILITIES

There are more than 14 million people who may be characterized as having a mental disability  These are individuals who are suffering from any one or more of the following broad categories of mental illness.

• Disorders of childhood such as SLD, MR, ADHD, Elimination Disorders, Tics
• Dementia or Delirium - Alzheimer's, Stroke, Huntington's, Excessive Ammonia Concentration
• Substance Abuse (Alchohol and Drugs) and Substance-Related Disorders
• Schizophrenia and other Psychotic Disorders
• Mood Disorders such as Depression, Bi-Polar Disorder, Anxiety Panic Attacks
• Somatoform Disorders - Hypochondriasis, Conversion, Pain Disorder, body Dysmorphic Disorder
• Dissociative Disorders such as Amnesia, Fugue, Identity Disorder (Multiple Personality), Depersonalization
• Sexual and Gender Identity Disorders
• Eating and Sleep Disorders
• Impulse-Control, Disorders such as Explosiveness, Kleptomania, Pyromania, Trichotillmania (pulling one's hair), Gambling
• Personality disorders such as Paranoid, Schizoid, Antisocial, Histrionic, Avoidant, Dependent, Obsessive-Compulsive, Borderline
• Adjustment Disorders
• The "Stuff-of-Life" Disorders:  Bereavement, Divorce, Job, Phase of Life, Etc.

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MOST COMMONLY OCCURING DIAGNOSES BY INCIDENCE

According to one study, the incidence of the five most common diagnoses among an outpatient mental clinic was as follows:

• Major Depression .................................. 5.0%
• Bi-Polar Disorder ................................... 1.2%
• Schizophrenia ....................................... 1.1%
• Obsessive-Compulsive Disorder .............. 2.1%
• Panic Attack Disorder ............................ 1.3%

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SYSTEM FAILURE

It is a sad commentary that the mental health system is in very large measure a miserable failure.  some of the reasons for this include:

• Poor government funding
• Staffing deficiencies
• Under-trained or poorly trained personnel
• Professional staff over-burdened (Too few in number)
• High rate of staff turn-over and burn-out
• Non-mental health professionals doing case management
• Most effective medication too expensive to prescribe
• Over-reliance on medications
• Very few patients receiving adequate assessment or treatment
• In many cases, psychological testing not being done
• Spending too little time with patients:  National Average = 12 Minutes
• Staff avoids working with those who are potentially dangerous

The Swanson Study (1990)

• The study reviewed the clinical records of 10,000 patients in an attempt to see if there is a link between emotional disorders and violence.
• Patients diagnosed with schizophrenia and/or substance abuse exhibited significantly higher base rates of violence - 15 to 16 times higher than patients with other diagnoses -and accounted for approximately 25% of those patients with a history of violence.  When compared to the population as a whole, the base rate was 5 times as high.
• The critical links, however, were not related to the severity of the patients' diagnoses.
• The presence of hallucinations (auditory or visual) and/or the presence of alcohol or drugs was the primary link to increased violence.  In both cases, there is poor or absent contact with reality, impaired judgment, loss of inhibition, and suspension of morals.
• Otherwise - there does not appear to be any reliable single cue as predictor.

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RISK FACTORS

• Most violence is perpetrated by teens and young adults
• Intelligence is also a factor (cf.Journal of Clinical and Consulting Psychology, July, 1975 - violent prison inmates score exceedingly low on Similarities Subtest of the Wechsler protocol - impulsive, lacking reasoning capabity, one-to-one correspondence between events, emotions, etc.)
• Males raised only by their mothers - perhaps related to insecure ego development, poor or lack of modeling of male behaviors
• SES (Socio-Economic Status): and inverse relationship
• Availability of weapons
• History of antisocial personality disturbance or behaviors
• History of poor anger management skills
• Past behavior proven to be the best predictor of future behaviors

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SAFETY CONCERNS

• High incidence of contact between emotionally disturbed and Law Enforcement agencies
• The 5th most common cause of malpractice law suits against mental health professionals involves misdiagnosing violence - the liability lies not in the failure to predict violence, but in the lack of adequate assessment.
• Studies have shown that 66% of the predictions of violence are inaccurate - either false negatives or false positives.
• In the public's mind, violence is usually associated with emotional disturbance; however, only about 3% can actually be attributed to emotionally disturbed persons.
• Again, alcohol and drug-related violence exhibits the highest incidence!
• Another issue is the fact that those requiring medication to maintain a stable emotional or behavioral state are released from prisons and jails both without a supply of medications or an appropriate referral to a mental health facility.

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MENTAL STATUS EXAMINATION

The psychological examination basically consists of several parts:

• Reason for Referral:  Identifying the presenting problem
• Behavioral Description:  Observation and Assessment of appearance, behaviors, dress, grooming, attitudes, cooperativeness, etc.... A "pictorial picture: of the individual
• History:  Childhood, Family, Education, Relationships, Medical, Psychiatric, Medications, Substance Abuse
• Description and assessment of ADLs (Activities of Daily Living)
• Mental Status:  Assessment of the person's mental state at time of the examination: 
       Orientation - person, place,and time
       Stream of consciousness
       Rate and flow of speech
       Reality contact
       Signs and Symptoms:  hallucinations, delusions, paranoia
       Thoughts and preoccupations:  suicidal, homicidal
• Diagnostic Impressions
• Prognosis
• Global Assessment of Functioning (GAF)
• Recommendations

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THE DYSFUNCTIONAL CONTINUUM
Global Assessment of Functioning (GAF) Table

The importance of this table is that it stresses "behavioral observation."
"Assessing a person's GAF can serve not only as an indication of their mental state at that point in time, but it can also provide a global assessment of safety - YOUR SAFETY.

Remember this rule of thumb:  The risk level increases as the person's appearance decreases.  A person's appearance declines with hallucinations, drugs, and alcohol.  These are the three things that more often than any other factor determine the Officer's level of danger!  The GAF Table below is provided as a guide to "STREET ASSESSMENT." 

THE DYSFUNCTIONAL CONTINUUM
Global Assessment of Functioning (GAF)

CODE	LEVEL OF FUNCTIONING
100	Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out because of his or her many positive qualities. No symptoms.
90	Minimal Symptoms - usual "stuff of life" problems
80	Slight impairment - difficulty concentrating - usually transient problems
70	Some mild symptoms - depressed mood, insomnia, interpersonal difficulties
60	Moderate symptoms - occasional panic attacks - few friends, problems  with co-workers, no girlfriend or boyfriend
50	Serious symptoms - suicidal ideation - obsessive rituals - unable to keep a  job
40	Some impairment in reality testing or communication - avoidant, neglecting family, unable to go to work, difficulty getting out of bed in the mornings, failing in school
30	Behavior is considerably influenced by delusions or hallucinations - stays in bed all day --  inability to function appropriately on almost all levels
20	Possible danger of hurting self or others - deterioration of personal habits - gross impairment in communication
10	Persistent danger to self or others - problems and dangers are no longer simply potential or possible, but real and imminent
0	Inadequate information - cannot rate level of functioning

The best assessment tool is quite often the "eyes."  You can tell a lot about a person by just observing them.  Do they swagger when they walk, or are they stoop-shouldered and "downcast?"  Are their arms folded, or does their head nod "in agreement" as you speak?  Is the person clean-shaven? .... Have a neat appearance?  .... Look unkept, like they "don't care anymore?"  ..... Is their hair combed?  In conducting prison interviews with "cop killers," the question was asked, "Why did you shoot the Officer?  Time and time again, the shooter said, "I looked at his uniform.  It looked like he had slept in it.  I figured he was sloppy - I could take him!"

One of the things psychologists evaluate about people is what is termed "deterioration of personal habits" - that is, how does the person present himself in appearance.  Are their clothes clean, do they look like they need a shave or a bath, etc?

In performing an assessment, each psyhological report concludes with three items:  (1) the diagnostic impression of what is "wrong" with the person, (2) the prognosis for recovery within a given time frame, and (3) the current GAF versus their GAF at some prior point in their history.  The difference between the two GAF Scores (the "best" and "now") is a measure of just how "sick" the person is, the extent to which they have decompensated, and whether or not they can be treated on an out-patient basis or will they require hospitalization.

Assessing a person's GAF can serve not only as an indication of their mental state at that point in time, but it can also provide a global assessment of safety - YOUR SAFETY.  The more deteriorated the person appears, the more likely it is they are psychotic, or under the influence of drugs or alcohol. 

Remember this rule of thumb:  The risk level increases as the person's appearance decreases.  A person's appearance declines with hallucinations, drugs, and alcohol.  These are the three things that more often than any other factor determine the Officer's level of danger!  The GAF Table above is provided as a guide to "STREET ASSESSMENT."

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THE ROLE OF THE POLICE OFFICER

In order to avoid violence, Police Officers must do several things which, in my judgment, parallel that of the psychologist or psychiatrist in conducting an examination of an emotionally disturbed person.  Unlike the Police Officer whose very appearance projects a sense of command and "take-charge," the mental health professional has to use intellect, body posturing, and words to take charge and to re-direct human behavior.  That repertoire of "skill" in patient management can be summed up in one word:  "communication."

• Communicating "command" by taking charge of the where the patient is seen and where he or she sits.  Among the six levels of "force," the Officer's presence and ability to utilize communications skill is all that is required 97% of the time.
• Setting limits with the patient - what will and will not be tolerated.
• Maintaining a balance between compassion and control via body posturing, choice of words, tone of voice, use of hands and gestures, and affect.
• At all times: respect and courtesy - do not demean, ridicule, or fail to affirm the individual as one worth of concern and attention.
• Perhaps the singularly most important thing anyone can do is to treat the emotionally disturbed as people with the same needs and desires as anyone else.
• Accept the disturbance in a matter-of-fact manner both as an unfortunate illness and a fact of life that must be dealt with.

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THE STREET SCENE

One thing that makes the EDP Call different from others is that it is the EDP who is concerned about safety - not just the Officer.  One of the first things an Officer must do is to reassure the EDP that the Officer is there to help, not to harm.

Be mindful that whenever a Police Officer "enters" the scene or situation that two things happen:

1. the situation changes in some way either escalating or de-escalating, and
2. the Officer by his or her presence generates a variety of feelings which may include positive (safety, calm, welcoming) or negative feelings (anxiety, fear, or anger).

• Approach each situation in an unbiased manner - assess the situation before committing yourself to a course of action.
• Screen the area or person(s) for weapons.
• Control and re-direct the "audience" - bystanders are always a potential threat and hindrance.
• After having "isolated" the EDP as much as possible, RE-ASSESS the situation. Sometimes by simply removing the audience, the situation can change or improve.
• Gather information (cf: GAF Assessment Table).
• Note the signs of impairment present (cf: GAF section of notes).
• Follow the basic rules for intervention (cf: Rules section of notes).
• Be aware of how a crisis situation can escalate and that things can go sour faster than that of a speeding bullet! (cf: Crisis Escalation cycle section of notes).
• In George Thompson's book, "Verbal Judo," he describes words and communication as "a force option" noting that the "voice carries a message; if the voice is wrong or inappropriate, the message, no matter how well intentioned, will not be accepted."  He further states, "The Officer must not only be professional, he must also appear professional, both to the subject and to any bystanders in the area."

Be mindful of the many assumptions held by both Law Enforcement Officers and citizens:

• Cops have control because they carry weapons
• Cops always take people to jail
• People expect cops to use power tactics
• People do not like or trust cops
• Fear is the best way to get things done
• People are basically corrupt
• You can't influece street people via verbal persuasion
• People will always resist a cop in one way or another
• You can "judge a book by it's cover"
• It's the badge that conveys authority!
  
• Remember, there is always someone out there who is bigger and badder; and it can be any subject at any time!
• Rigidity is weakness - flexibility is strength.
• The Officer's best approach is one of "disinterest" (not "UNinterested")
• Six crucial questions:  Who? What? When? Where? How? Why?
  1. Who is this person?  Get to know the subject.  Use his/her first name.  Introduce yourself.
  2. What is happening?  What clues do I have about this person's behaviors?
  3. When?  Is there an antecedent to what is happening now?  Events always occur in the midst of things - the present is always attended by a past and a sense of the future.  Again, Who?  What?  When?  - Who did what to whom when?
  4. Where?  In a sense, "Where is this person's head at right now?  Is he paranoid, agitated, angry, confused, afraid, anxious, hallucinating?
  5. How?  How does the person feel?  How can I best communicate with him?
  6. Why?  Why is this person this way?  Argument?  Off of medication?  Running away?

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 SUGGESTED REFERENCES:

I am indebted to Randolph Dupont, Ph.D., UT Medical Center, Department of Psychiatry, for the two handouts, and Major Sam Cochran, CIT Coordinator Memphis Police Department, for the video tape on "Violence and Emotional Disturbance" which were used in this presentation.  In my judgment, there is no better example of the Community Police Model than that of theCIT Program.  Personally, I would like to see a psychological practitioner as a member of every law Enforcement Department either as a staff member, full-time paid Officer, or Reserve Officer. With the advent of "9-11," Law Enforcement agencies are reconsidering their operations and are exploring ways of utilizing community resources with greater frequency and within a greater and broader scope of involvement.

Bercaw, George H. "Psychological Assessment and Law Enforcement Needs," Law and Order Magazine, Vol. 50, No. 7, July, 2002,  pp.132-136

Borum, Randy, Deane, Martha W., Steadman, Henry J., and Morrisey, Joseph, "Police Perspectives on Responding to Mentally Ill People in Crisis: Perceptions, of Program Effectiveness," Behavorial Sciences and the Law, Vol. 16, pp. 393-405,1998

Dupont, Randolph, and Cochran,Sam, "Police Response to Mental Health Emergencies: Barriers to Change," Journal of American Academy of Psychiatry Law, Vol. 28, pp. 338-344, 2000

Heuston, George Zell, "Police Reserve Specialists," Law and Order Magazine, Vol. 50, No. 9, pp. 260-263, September, 2002

Lester, Gregory W., "Power With People: How to Handle Just About Anyone To Accomplish Just Anything," Ashcroft Press, Houston, TX, 1995

Scheflen, Albert, and Scheflen, Alice, "Body Language and Social Order: Communication as Behavorial Control," Prentice-Hall, Englewood Cliffs, NJ, 1972

Thomason, George J., "Verbal Judo," Charles C. Thomas, Publisher, Springfield, IL, 1983

Miller, Linda S. and Hess, Karen M., "The Police and the Community: Strategies for the Twenty-First Century," Third Edition, Wadsworth/Thomson Learning, Belmont, CA, 2002

NAMI: National Association on Mental Illness 1-800-950-6264

"Diagnostic and Statistical Manual of the Mental Disorders," 4th Edition, American Psychiatric Association, Washington, DC, 1994

Major Sam Cochran, CIT Coordinator, Memphis Police Department, Memphis, TN

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TRAFFIC STOPS
Click here for "Personality Disorders: What you Might Expect on Traffic Stops"
Also refer to Traffic Stop article by Firearms Instructor Donnie W. Daniels  

 COMING SOON to Patrol Notes:
Look for this soon:  Survey/Poll related to Reserve Law Enforcement.  Results to be published on nrlo.net as soon as they become available.

"Field Sobriety Tests"
George Bercaw just returned (March, 2003) from taking a course in "Field Sobriety Tests."  Officer Bercaw will be publishing his notes on this course on this site for the edification of Reserve Law Enforcement Officers everywhere.  Officer Bercaw is appreciative to the Winchester Police Department in Winchester, Tennessee, which presented the three-day DUI School, and to the Department of Transportation for the several hundred-page manual on DWI Detection; but most of all, to Corporal Clint Shrum who taught the course.  Officer Bercaw told NRLO: "Having spent much of my life in college and graduate schools, I can honestly say that all of the Instructors I have had in my training as a Reserve Police Officer have been truly exceptional teachers."

Officer Bercaw also plans on doing research related to Reserve Officer issues.  Look for reports and articles on same.

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 About George H. Bercaw, M.A., ABDA
Mountain Crest Psychological Center
2307 Napier Road, Suite 107
Chattanooga, TN 37421-1847
(423) 894-4106

George H. Bercaw is currently a Reserve Deputy with the Sequatchie County Sheriff's Department in Tennessee.  He is a licensed psychological examiner who has been engaged in private practice since 1975.  He earned his Master's Degree in Psychology from State University of West Georgia, and he graduated "With Distinction" in 1975.  Bercaw did his clinical internship at the former Chattanooga Psychiatric Clinic, and he later received a "doctoral research fellowship" from George Peabody College at Vanderbilt University where he was a research trainee at the John F. Kennedy Center.  Mr. Bercaw's practice has been almost exclusively devoted to psychological assessment and Law Enforcement consultation.

Bercaw is a Board Certified Senior Disability Analyst and Diplomat in the American Board of Disability Analysts, is the current President of the Tennessee Association of Psychological Examiners, and is a Committee Member on the Board of Directors of the Tennessee Psychological Association.  In addition, he chairs a Task Force on Law Enforcement Assessment issues.  In October, 2001, the Tennessee Psychological Association acknowledged Bercaw with an "Award for Outstanding Contributions Benefiting the Profession of Psychology."

A member of the Advisory Board of the Public Safety programs at Walter State Community College and Northeast State Community College, George H. Bercaw is also an adjunct faculty member at the Basic Recruit Police School at the Northeast Tennessee Regional Law Enforcement Academy in Greeneville, Tennessee, where he teaches courses on Abnormal Psychology with special emphasis upon criminal behavior and personality types.  A second course titled, "Dealing With Emotionally Disturbed Individuals" is published on-line by NRLO on this site (above).

Additionally, Mr. Bercaw provides psychological assessments of Police Academy applicants including over twenty-five (25) Police and Sheriff Departments throughout upper East Tennessee; plus he provides similar risk-assessment evaluations for those seeking admission to the two Paramedic Training programs referenced above.  In July, 2002, Mr. Bercaw published an article entitled, "Psychological Assessment" in Law and Order magazine.

Bercaw's special interests involve personality assessment, critical incident debriefing, criminal behavior, hostage negotiation, and field training methods.  In the past, Mr. Bercaw has been involved with the training and supervision of clinical psychology interns and would eventually like to become similarly involved with Reserve Officer training and do research related to Reserve Officer issues.  He is a sworn Reserve Officer formerly with the Collegedale Police Department in Tennessee, and is a member of NRLO.

In November, 2003, George was given an award for "Professionalism, Integrity, and Dedication to Psychology" by the Tennessee Association of Psychological Examiners at their Annual Convention.  Later this Summer (2004), he will take advanced training in "Crisis Negotiation."

Married to a Registered Nurse and the father of four grown children, George H. Bercaw's hobby is Cowboy Action Shooting and Reloading.  He is an active member of the Single Action Shooting Society.  His friends call him "Trooper" because of the blue Indian Scout Cavalry uniform he wears at cowboy shoots.  To help pay for his cowboy shooting, Mr. Bercaw sells reactive steel targets to cowboy shooting clubs and to rifle and pistol ranges.  He and his wife reside in Chattanooga, Tennessee.

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2003/11 Updated 2004/01
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