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PST 321 INSTRUCTOR'S NOTES - WEEK SEVEN
EMOTIONALLY DISTURBED INDIVIDUALS

Welcome to week seven.  We are about to cover the area I like to call the meat and potatoes of negotiations.  Over the next three weeks we will be discussing the areas of negotiation that I believe apply most to the field of 911 emergency communications.  Because of the amount of information, we will be covering chapter seven both this week and next week.  I doubt very seriously that a day goes by that some telecommunicator in your center doesn’t get a call from at least one person who is emotionally disturbed.  Over the last 15 to 20 years this country has gone through an era where institutionalized mental health patients are being released onto the streets.  Research indicates that mentally disturbed individuals are involved in 50 to 85 percent of all hostage-taking incidents.  This means that if your dealing with a hostage taker there is a greater than 50 percent chance that he is suffering from some form of mental illness.  While it may not be feasible for every 911 telecommunicator to become an expert in mental health, it is vital that all telecommunicators have a thorough understanding of how best to deal with these individuals in high stress situations.  I listed the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition - Text Revision (DSM-IV-TR) as a recommended additional text for this course.  The DSM-IV-TR is an expensive book.  If you are looking to save some money, go to a used bookstore and purchase the DSM-IV.  While it is not as up to date as the text revision edition, it should give you enough information about the various mental disorders to make it a useful reference. 

The crisis negotiation text identifies four groups of emotionally disturbed people who are most frequently involved in hostage/barricade incidents.  They are:

·        Depressed.

·        Paranoid.

·        Inadequate (dependent).

·        Antisocial.

This week the focus will be on the depressed individual and I will also discuss the Borderline Personality.  Many times when we speak of a depressed individual, we are referring to an individual who is going through what is known as a major depressive episode.  The criteria for a diagnosis of this problem as it appears in the DSM-IV is as follows: Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 
   A. depressed mood or
   B. loss of interest or pleasure. 

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood. 
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) 
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 
(4) Insomnia or Hypersomnia (major sleep period) nearly every day 
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 
(6) fatigue or loss of energy nearly every day 
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide 

If you are dealing with a subject that is suffering from this disorder, it usually is obvious.  It is possible that a major depressive episode is actually a symptom of another disorder, such as depressive mood disorder, substance-induced mood disorder, or bipolar disorder (manic-depressive).  However, from the standpoint of negotiations, your way of dealing with a depressed person will basically be the same regardless of the specific disorder involved.  My encounters with people experiencing a depressive episode have taught me to look for specific signs, some of which were listed in the text.  The most obvious will be the negative and morose attitude and mood of the individual.  The subject may appear “un-kept” and lacking basic hygiene, where he may usually be a neat person, according to family or friends.  He may appear “mentally slow.”  Many times the subject will take forever to answer a simple question.  We get accustomed to communicating at a certain pace.  If someone does not respond quickly enough, we try to fill in the gap of silence.  You will have to be aware of this when dealing with a depressed individual.  You will find yourself wanting to talk to fill in the gap, don’t.  Depending on the level of his depression, it can seem like an eternity before he answers a question.  In my first experience with this type of individual I thought the subject could not hear me, so I spoke louder. 

As with any negotiation, you will want to try to build rapport with this subject as soon as possible.  I have negotiated with depressed individuals who wanted help badly and were reaching out for this help.  Rapport is easily established in these situations.  However, sometimes the depression is so pronounced that the subject feels that he is beyond help and will express a desire to just be left alone.  The best way to deal with this situation is to try to keep the subject engaged in conversation.  After a few minutes you might want to move the conversation up a notch by trying to get the subject to start thinking about specific individuals in his life, family, friends etc.  If the subject tries to leave you a “verbal will,” focus the topic on the people he mentions.  Try to get him to tell you about these individuals.  Many times the root of a person’s mental health problem lies in the past actions of a family member.  Therefore, be careful about the individuals that you bring up.  For example, if the subject is listing many valuable objects that he is leaving to certain individuals, but he leaves very little to one particular individual, he may have issues with that individual.  This is another reason you must be careful about letting family members talk to anyone with whom you are negotiating.  The family member may believe they have a close relationship with the subject.  However, from the subject’s point-of-view their may be serious problems in the relationship.  The subject’s point-of-view is what counts.  There may be times when you are told to put a family member that has called on the line with the subject.  You don’t have much choice in those situations.  However, you might want to recommend that the family member be briefed on what topics to avoid.  The reason many agencies will want to put family members on is because of fear of litigation.  If the subject commits suicide and the sister was not allowed to talk to him, then the family will always believe that the sister could have prevented the suicide.  While in most cases this is not true, many times truth is irrelevant when it comes to lawsuits. 

The main thing about depressed people is to keep them talking, about anything.  In my career I have negotiated with several individuals that would be quantified as suffering from a major depressive episode.  In every case except one the subject was suicidal.  If you confirm that you are dealing with a depressed individual, start preparing your case for addressing the suicide issue.  It will come up.  I will discuss suicide at length in the last week of class.

Although the Borderline Personality is not listed as one of the top four personality types encountered in hostage situations, I have had to deal with people who are borderlines in my career so I want to take a few minutes to discuss this personality disorder.  If you have ever watched the movie Fatal Attraction then you have seen a fairly accurate (for Hollywood anyway) depiction of the borderline personality.  The movie depicts a female suffering form this disorder.  Coincidentally, borderline personality disorder is more frequently diagnosed in females.

While it may not be that frequent that you deal with borderlines in hostage situations, I guarantee that you have already dealt with this individual on other types of police calls that you have handled.  Borderlines tend to be involved in domestic quarrels quite often.  Therefore, you have probably already dealt with this personality disorder and just did not know it.  The text gives several good tips on how to negotiate with borderlines.  One that I would add is to be careful about allowing borderlines to vent their emotions.  In most situations you want the subject to vent, to release possible pent-up emotions.  The borderline is the exception to this rule.  Because borderlines have a difficult time controlling emotions, allowing them to unreservedly express intense anger can actually make them feel more out of control.  You will probably have to address extreme mood swings.  You may find yourself comparing (only in your own mind not verbally) this person to a “spoiled rotten adolescent,” because the behavior patterns are very similar.  The borderline is not certain what she wants.  You may have to constantly remind this person that everything is OK.  They may ask for validation of their viewpoints, “I am right. Aren’t I?”  Borderlines can become very dependant on others quickly.  After dependence is established, they resent the person on whom they are dependant because this dependence reveals their own weaknesses.  Active listening and redirection of emotions are your best tools to use when dealing with a borderline.  Keep a list of “smilers” close at hand because you will need to get adept at changing the subject of conversation when dealing with a borderline.  Be prepared to go from being their best friend to their worst enemy in the span of just moments.  I have heard this described as being like riding a roller coaster.  I think that is an accurate analogy.