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Many of us come into contact with individuals who have undiagnosed/early psychosis in our everyday lives. Law enforcement may be called upon to respond to situations involving such individuals when others in the community report odd or unusual behavior. These behaviors may be characteristic of psychosis, but will seem strange to people unfamiliar with these experiences.
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Law enforcement and criminal justice professionals, along with their corresponding institutions, can help serve the first episode psychosis community by being well trained to recognize the symptoms of early psychosis and knowing how to best handle an encounter when someone may need mental health support.
While we at HeadsUp support clinical intervention at the earliest possible point by providing mental health services to individuals through approachable and convenient avenues, we recognize the systematic limitations of these efforts. Some young people experiencing psychosis will engage with the criminal justice system before, or even during, their course of treatment. We therefore encourage law enforcement to learn about psychosis and strategies to de-escalate situations involving individuals experiencing psychosis.
Psychosis is a symptom or set of symptoms, not a disorder. The first time someone experiences an episode of psychosis can be confusing and distressing. Behavioral and emotional changes associated with psychosis can be concerning because of a lack of understanding about what’s happening. This lack of understanding often leads to a delay in seeking help, which means this treatable condition is sometimes left untreated.
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COMMON SYMPTOMS ASSOCIATED WITH PSYCHOSIS:
Voices or auditory hallucinations
Hearing single or multiple voices, which can be simple or complex, abusive, neutral or soothing. People may hear whispers or clear/distinct voices; they may describe changes in their hearing acuity (e.g., hearing things from another room); they may describe indistinct or clear noises or sounds (e.g., buzzing/ringing) which are new/distressing. They may tell you directly that they are experiencing these perceptions, or you may notice cues in their behavior such as: they may appear to be talking to themselves, looking somewhere and you don’t know why, or focusing on certain body parts.
Tactile or somatic sensations or hallucinations
Body sensations or feelings that are new and strange. These are sometimes described as electrical charges or feeling something crawling on a body part. People sometimes feel that a part of their body has changed in some significant and troublesome way (e.g., bigger/smaller). Paranoia and/or feelings of persecution
Unusual or delusional thinking
A person may report thinking other people are watching them or that they are under surveillance, feeling very good at certain tasks, having a connection to a famous person, or any number of thoughts that are different and unusual. They sometimes report that television, music or other media are communicating directly to them. You may also notice they seem uneasy with others, or make comments indicating suspiciousness about others’ intentions.
Depersonalization/Derealization
Feeling they are an outside observer of their own thoughts, feelings, and actions. Examples are feeling that their speech or movements are uncontrollable or controlled by outside forces, that parts of their body are distorted, or feel their memories are not their own. They may feel alienated from their surroundings or disconnected from people (as if they were separated by a glass wall). Their surroundings may seem distorted, colorless, two-dimensional or artificial and they may have misperceptions of time and space.
Cognitive disorganization
A person’s speech and writing may become disorganized and/or tangential. They may draw connections between words or terms that seem illogical or non-sensical, or they may have more difficulty than usual following conversations.Slowing of speech, movement and motivation A young person may demonstrate changes in the amount, tone, rate, pitch, or rhythm of speech. Psychosis may slow people down and significantly lower one’s motivational energy.
Depression and demoralization
Many individuals with psychosis experience significant depression and/or demoralization.
The path to appropriate treatment for a young person is not always linear, but as awareness and treatment options for early psychosis continue to grow, we can work together to streamline connections to the best treatment as early as possible. As with most issues, the earlier someone gets help, the better.
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Our programs and first episode psychosis programs across the country typically offer a team of people who will help. Each program is a little different but will often include:
Psychotherapy
Talk therapy to help build personal skills of resiliency, management, and coping.
Supported Employment & Education
Assistance with continuing to engage in or adjust to school and work goals while receiving care.
Medication Management
If necessary, finding the best medication at the lowest possible dose.
Peer Support
Guidance from those currently on their own recovery path.
Case Management
Skills and support to organize the practical issues presented during treatment. This includes communication with other team members.
Family Support and Education
Tools designed to keep family members engaged and informed.
There are many opportunities for the criminal justice system to assist in connecting young people potentially experiencing their first episode of psychosis to the most effective care early on. Intervention at any point of the engagement process can help individuals with a mental illness bypass the potential trauma of involvement with the criminal justice system.
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These include (Adapted from SAMHSA):
Law Enforcement
Law enforcement officers play a key role as possible identifiers of potential early signs of psychosis and can divert people to more appropriate care such as a First Episode Psychosis Center.
Initial Detention/Court Hearings
In the time between initial detainment and first court appearance, there is a brief window of opportunity for screening to flag early psychosis and use that information to develop more effective pretrial release and detention recommendations.
Jails
If a person ends up with jail time when cases are not disposed at arraignment and a person does not qualify for diversion, it is important that jails bolster their capacity to detect early psychosis and provide early, evidence-based treatment.
Re-entry
If someone being released from jail is experiencing first episode psychosis, planning for reentry into the community should ideally begin at jail booking. Periodic screening and assessment during a person’s incarceration can help inform the services and supports that are appropriate for them to receive upon release.
Community Corrections
Once released, probation agencies should collaborate with Coordinated Specialty Care programs. Probation officers play a key role in early detection education campaigns.
Catherine (Cat) Conroy, M.Ed, Manager of HeadsUp
Neurodevelopment and Psychosis Section, Department of Psychiatry
Perelman School of Medicine, University of Pennsylvania
10th floor, Gates Pavilion, HUP
3400 Spruce Street, Rm. 10054, Philadelphia, PA 19104
headsuppaorg@gmail.com
We are available during standard business hours (Monday-Friday, 9am-5pm) to answer any questions you may have about our organization or to direct you to programs in Pennsylvania that can offer clinical help.
