My uncle died in 2009 in a room alone, straight jacketed. He suffered a cardiac arrest likely cause by terror at a country hospital in Wisconsin. He had committed himself and was dead within 24 hours.
It wasn't the first time the hospital has killed a patient using the same technique. In the subsequent years I have spent a lot of time thinking about why he died and the indifference of those around him when he was most vulnerable. Law enforcement refused to investigate mostly on the grounds that he was insane and there was nothing anyone could do.
He had three kids and a wife who was a social worker. She was later fired as the state of Wisconsin decided social services where no longer a priority.
I've come to the conclusion that most of us would rather ignore the problem of mental illness rather than solve it. It's more convenient to kill the ill than treat them and society simply looks the other way.
I am given hope that his son is now a leading neuroscience Ph.D. Candidate at UC Davis. He has vowed to not let his father's death be in vain.
FWIW, I anticipate (hope) that addressing the needs of the mentally ill will be the next big civil rights movement, at least in the USA. Mostly due to increased awareness, for better or worse, thru social mediums.
Just like with homosexuality before, I had no empathy because I couldn't relate. But then when you discover that its your friend, your family, your loved ones who is affected, I learned "Oh, they're just people, just like me." And then someone shares their story, like you just did, and I learn "Oh, it's not just me and mine."
This is mainly a cultural and political problem. Hospitals used to overwhelmingly be non-profit. Now they are for profit. There's less and less funding available for what is a public health concern that enrich private for profit mental health facilities.
Over the years I've observed that a certain kind of people goes to work in law enforcement or security. They are often a bit aggressive, they seem to have this feeling of superiority, and they enjoy positions of authority. It's rarely the calm, humble, balanced types that work in those fields.
I think this is extremely dangerous.
Has anybody else made this observation? Is there anything that could be done to change this?
I've been working with (not for) the local police for the last year. Anecdotally, it depends on the cop. The badge and gun carry power, and power attracts the corrupted and corruptible. No one doubts that there are asshole cops.
Most of the officers I talk to are motivated by a strong sense of right and wrong. Some are just happy to be helpful. I talked to one guy who honestly enjoyed answering people's questions about renewing tags and getting a handgun permit.
There are plenty of calm, humble, balanced police officers. What I worry about is a culture of law enforcement that trains them to react with force, disproportionately target minorities and close ranks to any criticism, no matter how valid.
There's probably some truth to this. But another thing happens. Law enforcement and security personnel spend a lot of time dealing with imbalanced individuals. And that probably colors their behavior and attitude quite a bit.
I listened to the This American Life story [1] that went along with this NYT piece. In it they interviewed a hospital worker who pointed out that he and other workers regularly deal with the same imbalanced individuals that police deal with. They get hit. They get attacked. It is part of their jobs. What they don't do is fire weapons at their patients, nor do they carry weapons.
If relatively low-paid, relatively unprotected hospital workers are "tough" enough to deal with difficult and dangerous hospital patients without using violence, why aren't the police? Unfortunately our laws have made it too easy for police to use violence against people in difficult situations where others in the exact same situation could not or would not use violence. These laws even go so far as to protect police who use absolutely brutal violence to injure or kill individuals who really just need medical care, such as Kelly Thomas [2].
I don't live in the US, but here's a story from Israel: a doctor I personally know was threatened by a relative of her patient, along the lines of "if he doesn't get well, I'll kill you." She told that to the police, who asked for the relative's name, and having heard the name, told her "be careful - this guy can actually kill you."
All is well (I guess the patient recovered), but I'm not sure she'd call herself "tough enough to deal with dangerous patients without using violence"!
Seriously - what do you think? If it was in the US, what would you bet on - it being a guy from the mafia or from the CIA? "Mafia", obviously (or whatever you'd call Israel's somewhat-organized criminals.)
It's not about "being above the law", either, it's about the criminal being better protected by the law, in this instance, than the victim. The policeman likely told her the truth - that no action taken against this guy based on her reported threat is going to deter him from fulfilling it, likely the reverse, so she better be careful.
Perhaps it was the word choice: "can" implies that the killing would not be punished. Obviously any person can kill another, so to say "can kill" suggests a "license to kill". If I were a policeman warning someone about a criminal, I would say "might kill" or some other phrase that discusses likelihood rather than capability.
Well, yeah, but if a guy from the CIA murders a doctor in the US, will he be punished? I kinda think he will be. Is he likely to threaten a doctor with murder in the first place, as a way to ensure his relative is properly treated? I kinda think he's not. Why do you think a guy from the mossad is any different or will be treated any differently? Would you ever put "CIA" in the same sentence where you put "mossad" in your comment if the story happened in the US?
Because I can't imagine a policeman ever saying "he can kill you" except in a fictional setting where James Bond is licensed to kill and that policeman somehow knows about Bond.
Right. We have armed officers interacting with the crazies, because we don't take mental health issues seriously enough to have enough mental health care workers do it.
We used to have sanitariums, now we (non-experts) say it's cheaper/better to just release them into the public. Then get all surprised and pissy when things go wrong.
Hospital is not a good choice for most people with mental illness. Even people with severe illness, such as psychosis, benefit from good quality community treatment where possible, reserving hospital for last resort intervention.
That good quality bit is important though.
You might want to look at the literature around "Early Intervention in Psychosis" style working.
"a certain kind of people goes to work in law enforcement or security"
Those people you have observed, did you know them before they went into that line of work? Were they more likely than your other, less aggressive/superior-feeling/authority-seeking acquaintances, to go into that line of work?
I'm not saying your hypothesis is not true (there may be something in it) but there is danger that (i) we mistake the cause for the outcome, and/or (ii) judge people's personality based solely on the way they behave whilst doing their job.
My "hypothesis" is based on three people that I know that wanted to work or did work in law enforcement. I've met two of the people I'm thinking of before they applied to police school.
But I'm aware that those are just anecdotes that just accidentally might fit a plausible narrative...
I think that the expectations of the work lead inherently to being traumatized or at least socially alienated from others after spending a good portion of your waking life scrutinizing their behavior for risks. This change in experience is culturally enclosed by pride and camaraderie around the story of the importance of the work. The security person then emotionally relies on this story to justify the traumatic experience and cover its raw emotional ramifications. It is quite a large leap to then ask them to feel a humane connection to others that could possibly interrupt their ability to carry out the work they've been tasked and for who's sake they have learned to find meaning in their own discomfort. I think that a true reimagination of the work itself will have to come to change the outcomes
I'm sure the loss prevention officer who was slamming an old man's head against the wall, yelling "stop resisting" was just traumatized from all the terrible chicken shop lifters.
I'm not saying your idea of the situation doesn't happen, but there are a good number of already unstable people seeking out the job, long before they have a chance to be altered by it.
People like the one you describe thrive in a culture that is blinded by its reflexive urge to support its officers in the face of the nature of the work.
I'm talking about how the abstract concept of these jobs inherently contains the seeds of their inhumanity. If that is fixed the many who are abusive can be seen clearly by each other. You rightly point out that there are individuals carrying out a far worse sociopathy than even the job could dream up for them. I completely agree.
I once had an acquaintance who was a doctor on the psych ward at a public hospital. He got off on having power over patients and would talk about how he liked locking them up. He also had no respect at all for medical confidentiality and would gossip about patients. Fortunately, he got fired from that job and no longer works with patients.
Warrior Cop - Radley Balko is interesting read. There was observation from LAPD official that created the some of the first SWAT teams that the people most enthusiastic about being in SWAT most often are the one you really don't want there.
I guess it gets even worse in the private sector - you may get a person without the needed background or training to resolve the situation in the optimal way.
The good security guys don't work a hospital security job. As with everything else, you get what you pay for. The calm, humble, balanced types go for greener pastures.
The shooters were police officers, not regular hospital security.
NPR did a piece on this case last night. They emphasized that there are standard procedures for dealing with mentally unstable patients in a hospital setting, and the cops weren't trained in those procedures. They ended up escalating the situation.
They also interviewed a hospital security guard, who said the shooting was ridiculous. He said "We don't carry guns. We get hit all the time. We just deal with it."
That wasn't the police approach. One got hit, so they responded like they would on the street and deployed tasers, then lethal force, and followed up with felony charges.
Another issue was that the family asked for a mental health evaluation of the patient. Standard procedure is to immediately provide that upon request. Instead the hospital ignored it. Had they done a proper evaluation, the patient would have been moved to an area where they used regular security instead of police.
As of now the hospital is at risk of losing federal funding, if it doesn't reform its policies to the satisfaction of federal investigators, including better training for the cops and further restriction of their areas of operation.
On the one hand, it deserves to be shut down. On the other, its loss would be bad for the community due to lack of nearby hospital capacity and competition.
It's stupid that we now have this idea of competing hospitals. It's a competition to the most efficient lowest common denominator cost wise yet maximalized cash cow.
Seriously. Stay healthy. Stay away from doctors. Stay away from hospitals. (Family full of doctors who always say this.)
It looks like it's working out. Initially the CEO said their policies were fine and they would take the same actions again. Now that the feds threatened funding, the hospital is in fact making those changes.
One of the standard perks of being a policeman in most jurisdictions is that you're allowed to take paid gigs off-hours as a security guard and use your gun and uniform, and in some cases your patrol car if it's assigned to you permanently as it is for many state police officers.
Cops do that all the time. A long time ago I had a part-time job doing security at a YMCA; on busy days we'd have off-duty police directing traffic. I talked with some of them, who said most of the cops take side jobs doing traffic or security. The department even had an official system for distributing the work.
So we have a person clearly very ill and he can get seen more quickly by armed police officers than a medical professional who can actually help the situation? If he was in a room alone why, instead of sending in armed men, didn't they lock the door, get a doctor and some sedatives and then get security to restrain him while they actually gave him the care he came to the hospital for? I'm absolutely blown away that this could happen.
The victim survived, but is now being persecuted by the government prosecution complex, including being charged with a crime for rushing himself to the hospital for treatment. I hope he finds a strong lawyer who can find justice and win a large settlement from the Rambo cops.
Lucky for him, department guidelines only allow officers to shoot unarmed naked people of mixed or indeterminate race a single time, even if the officers yell "stop resisting" and/or "he's coming right for us" [0] first. They narrowly missed his heart, but had he been a single minority race, they could have kept shooting as long as they didn't stop to reload.
Working in hospitals over the last ten years, I have noticed an increase in how violent patients are. I believe the increasing use of synthetic rec drugs and the failing mental health system is to blame.
Previously many of these dangerous cases would be locked up until they were safe. Now, everybody just tries to treat them as an outpatient. That with the easy access to guns makes hospitals very dangerous places these days.
I caught pneumonia when I visited NYC a few years ago and was brought by ambulance to a hospital in Brooklyn. Some of the things I heard in the emergency room were shocking compared to what I'd experienced in emergency rooms before (I'm from the UK). The most surprising thing to me was how many of the patients were verbally abusive to the nurses. Perhaps these people were mentally unstable, I don't know, but I never expected to hear any patients attacking the people that were there to help them.
Nurses generally get treated terribly compared to doctors and others in the profession, despite the fact they are often the ones who are actually taking care of you (doctors diagnose, nurses treat). I guess it's because they're considered lower in the hierarchy simply because doctors went to school longer.
I suffer from deep bouts of depression. Lately I've had to go back and forth with myself about going to the hospital when things get bad, but now I'm just scared even more. I was afraid that not going to the ER would kill me, but now... it's like fuck, who will help you? When you have a mental health emergency, the police will shoot you, fellow citizens will ignore you, the hospital may or may not treat you, and now they might even kill you. With mental health, it's so important for the patient to feel safe, and if a hospital isn't safe then, well, I dunno. Humans are always making other humans suffer needlessly, it's awful.
The most common times are when there is a size or numbers disadvantage, but all it takes is a reasonable fear of imminent grave bodily harm or death. Those are the rules for private citizens (the details vary from state to state).
Official security probably has more latitude to take action because they are responsible for the safety of everyone in the area.
> Official security probably has more latitude to take action because they are responsible for the safety of everyone in the area.
probably, but they should have less latitude because of their training in other, non-violent methods to remove the threat. negotiation can help defuse most situations better than a taser or gunshot would.
When your officers carry guns, there's an implicit duty to never lose control of that weapon in a situation, and that necessitates a certain distance, often "enforced" with a gun.
You don't want to end up grappling with someone who might actually be much better at it.
Just hopeful, I'm afraid. It's easy to assume from the distance of many miles and a computer screen that every single situation can be addressed safely and easily by a soft word or three.
Abstractly, that may be true, if you free yourself of certain constraints imposed by reality. For one, you have to assume that every single person in every single situation is open to negotiation. Second, you have to assume that nuanced and complex communication of the sort that enables negotiation is readily possible. Third, you have to assume that entering into negotiation will remove any threat the subject may pose to other people nearby. Fourth, you have to assume that trained negotiators arrive sufficiently fast for their magic stop-all-threats-to-everyone powers to engage in time.
In reality, some or all of these can fail. I read about an incident in my city in the past few months where a mentally ill man was reported to police as wandering the streets, carrying a chain. The police arrived. An officer approached the man, attempting to speak with him. She wanted to find out if anything was wrong and see if there was a problem that needed addressing. He proceeded to beat her with the aforementioned chain. If memory serves, the situation was resolved when the armed, actively violent, mentally ill man was shot dead.
And this is a scenario where presumably everyone speaks English! Where in there was she supposed to negotiate with him to solve all the problems at hand? What non-violent methods do you expect to bring a rapid halt to someone actively beating a police officer with a weapon that will be remotely as fast as lethal force? What happens if you have no shared languages, someone deep in the grips of hallucinations, and actively shooting people nearby? Do you expect negotiating police to defuse that problem by negotiating with someone incapable of recognizing them as people who want to negotiate?
> It's easy to assume from the distance of many miles and a computer screen that every single situation can be addressed safely and easily by a soft word or three.
It's easy to assume for me because I've seen the vast amounts of work currently happening around "behaviour seen as challenging" in people with mental illness or learning disability[1] or brain injury.
Here shooting people is absolutely not possible in the vast majority of cases of behaviour seen as challenging. Tasering people is also absolutely not acceptable.
Rapid tranquillisation is common, but not acceptable because of the amount of restraint needed immediately prior to the injection.
Various methods of restraint are common, but are not acceptable because of the risk of injury or death.
A lot of money is being spent on better training on de-escalation, diversion, prevention, etc.
It's fucking baffling to me that people think it's okay to kill someone in distress just because the people doing the shooting are so lacking in skills that they have no other option. To me it's clearly a failure of everyone involved (and the departments they work for).
In your example with the chain: you seem to think this is a situation where a violent response is undeniably the right thing. I see that and I think how fucking clueless the woman was, and how fucking clueless the people who shot the man were. There are plenty of Youtube videos comparing UK and US police responses to these situations.
In the scenario I described, what do you think that the right non-violent solution was? I should also add that the PD had no way to know ahead of time that they were responding to a situation with a victim of mental illness in a time of distress who would exhibit behavior seen as challenging.
Incidentally, this was not a situation where there were a half-dozen officers on hand to swarm the guy. Should officers always move in groups of six or more, so that any sudden violence can be handled with grappling? Seems expensive, at the very least. How do you propose that a single officer being actively beaten about the head with a chain de-escalate the situation? I'm deeply curious how you think that could be reasonably accomplished. Maybe saying please?
What would an officer in the UK do in the situation I described when being actively beat about the head with a chain? How would it be totally different and reliably yield an ideal outcome?
Another detail of relevance: the incident did not provide the officer with an opportunity to speak to the victim of mental illness in a time of distress. The victim attacked immediately upon the officer exiting her vehicle. If any and all forms of violence are ruled out, with de-escalation and negotiation being the order of the day, how should this officer have reacted to being beaten with a chain? What peaceful, non-violent, resolution skills are available to someone subject to such immediate violence?
It's not about whether the other guy is armed or not. While I can't speak for other jurisdictions, in the UK it's about what's reasonable in the circumstances (with allowance made for the fact that someone in that situation does not have the time to make a full objective assessment of the situation). Sure, if the person attacking me is unarmed and I'm bigger, stronger, wearing armour and carrying a baton, shooting them might be considered unreasonable (but might be considered reasonable). If I'm in fear of my life and all I have is a handgun, shooting them is very reasonable.
Of course, in the UK, the next question from the police would be "What's with the handgun?" :)
All that said, in the case of Alan Pean in the article, I could well believe that the two off-duty police officers moonlighting as security guards were basically incompetent amateurs with weaponry, believing their own hype.
Imagine you are in a small hospital room and unable to get out. A 300 pound 6'2 dude is yelling that he's going to kill you. His brain is so scrambled that the tazor did nothing. You are backed into a corner and he's walking toward you.
In an age where such places have surveillance video you would think we don't need hypothetical scenarios. We'd have video of someone taking a solid hit from a Tazer and continuing an attack. But let's try this hypothetical: Imagine you are in a country without armed private security and only a subset of police are armed. Where are all the people who've been killed by 300 lbs crazed people?
European nations will likely have fewer such problems than we do - our population is much more violent. As Scott Alexander once quipped, "Who'd have thought populating half a country with the descendants of a group of people called "Border Reavers" would cause so much trouble?"
I'm not trying to say that the police were justified in this incident - note that I'm a huge critic of American policing. I'm merely pointing out that the threat is quite real.
That's not what I was asking. I was asking: Does armed security, or, for that matter, armed police make for fewer such cases.
There are places where security guards and police do without guns in normal duties. Perhaps it's, at least in part, because policing and security sets the tone, that they have to do more deescalation before drawing a gun, that they have less violence.
[EDIT:] Has anyplace ever become more safe by putting more guns in the hands of armed security and police?
Presumably the incident where the crazed lady stabbed the (unarmed) security guards could have been prevented by tazering her. Having practiced (simulated) knife combat, I'd certainly consider a long range weapon to be more effective than grappling.
If you are charged with protecting people from a crazy lady with a knife, would you turn down the tazer or gun? (If you believe it doesn't improve your odds of survival, you of course would.)
Given that many of these crazy people incidents happen away from security guards, it's hardly clear that "policing and security sets the tone". The US is just a highly violent place.
Mental illness is not a predictor of violent behaviour. You're falling for (probably) conjunction fallacy and confirmation bias. You find newspaper reports because those incidents are rare compared to all other murder; you use those newspaper reports (of rare events) to say "look how common it is".
(The SOMD link isn't loading for me) Note that all but one of your links involve drug abuse. Here the violence isn't due to mental illness, but to drug abuse. Drug & Alcohol addiction is a predictor of violent behaviour. (Much stronger than mental illness.)
This is a thread about mental illness, and you are using slurs associated with mental illness ("crazed"). If you're not talking about mental illness you probably need to be more careful with your lazy use of stigmatising language.
When many people keep misunderstanding what you say perhaps the problem is with your poor communication style, not their comprehension.
A quick google search suggests various mental illnesses (bipolar disorder, schizophrenia, and the catch-all "serious mental illness" category) are strongly linked with violence.
The latter article also describes a study suggesting "matched controls" (read: siblings of mentally ill people) are also disproportionately violent which is interesting.
Many citations are provided therein. I didn't provide it because it's completely tangential to the main point, namely that there exist crazed and violent people who should be tazed and tied up. I'll note you didn't provide a citation either.
You risk assess the situation before you go in the room. You make sure every room has panic alarms, or that individuals have panic alarms. You make sure that the patient is never between you and the door. (All of this is standard practice).
You have two (or more) members of staff dealing with that person.
You de-escalate at every opportunity.
You have stuff like rapid tranquilisation and restraint available (although these are methods of last resort).
I am also 5'3. I don't carry a gun, so I never 'have to' shoot anyone.
The article described a situation in which two people with police training used a taser and a gun to restrain a naked man. It was two against one. Did they really need the taser? Even if they did, did they really need to shoot him with a gun, too?
If you're a hospital worker, then you deal with the individual in the story exactly as the other hospital workers did before the police arrived, as they always do, and nobody gets killed.
If you give people guns, empower them to use them, and protect them from the legal ramifications, then stories like this are the obvious outcome.
For those who found this story to be interesting, I’d recommend listening to the associated This American Life episode. [1]
It provides an insight into the internal experiences of somebody suffering from delusions. In his interview, Alan Pean tells a vividly detailed account of how he experienced the manic episode. He recalled how, at times, he would be able to rationalise the delusional thoughts away but they came so quickly, it was difficult to stay rational as the delusions had their own internal coherence.
One memorable part of his story was when he described how he “escaped” from his third floor apartment building to get to the hospital: he locked his front door (which he thought was being watched by enemy agents) and then swung down from his balcony to the one below it and on to the ground, all the time telling himself to “Remember your training, remember your training” (while in reality, he’d never trained as a secret agent).
In his delusion, Alan thought he would be killed by either a missile strike on his apartment complex or be shot by the enemy agents who were circling in for the kill. The interviewer points out the tragic irony that when Alan finally made it to the place he felt would be safe, that he was actually shot.
Alan still finds it difficult to deal with the fact that a police officer was willing to take his life with a gunshot to the chest. I can imagine such an experience being deeply traumatic for those of us with good mental health but it must be much more difficult for someone already dealing with psychological issues.
From a personal point of view, a woman in my social circle about 15 years ago was suffering from bipolar disorder. I’d known her for about a year but had no clue that she had any problems with mental health. Then one day my brother and I met her on the street while she was having a manic episode. We took her into our home to look after her. I can’t recall the details but we found looking after her to be a distressing experience. We invited other friends in common around to help as we felt very much out of our depth. The next day her parents took her to a psychiatric hospital where she spent a few weeks while the doctors found a combination of medication that helped even out the mood swings.
I don't know whether anyone else is seeing it but the subject's eyes appear to move when I use the scroll wheel on my mouse. I'm using the current Firefox Developer's Edition. It could be some effect of my graphics hardware, monitor or even the refresh rate versus the distance being scrolled but the effect is really creepy!
If I weren't being so lazy on a sunny Saturday, I'd be inclined to see whether my screen-casting software would capture it. Of course, then I'd be accused of tampering with it! When my wife gets home I'll ask her if she sees it too.
>While St. Joseph does have a psychiatric ward, Mr. Pean was never seen by a psychiatrist
Why does this happen? I know someone who showed up to the ER after crashing his car during a delusional manic episode. His wife showed up and said he has a history of bipolar disorder and needs a psychiatric evaluation. The nurse literally laughed at her!
This happens because psychiatric units will not take patients who are not "medically cleared". Meaning that, if a patient has any evidence of injury or medical illness (or they think that the symptoms may be caused by something physiologic that has gone wrong -- leaving aside the fact that mental illness is physiologic at some level, you know what I mean) the psychiatric units want nothing to do with them.
Think about it for a second. You can hire cops, doesn't matter what the cost. Oh, hi officer, you work for me as a security officer in your down time. Hey, if you still want that work, why don't we just agree to ignore that traffic infringement?
That customer posting a bad review of my restaurant. He's acting like he's been on the wacky tabacky, nudge nudge... Best get him out of here to the police station, and whilst you're about it those comments are clearly drug affected. Just clear them. Incidentally, about that bonus for working extra hours - I put that in your account last night.
Good work officer!
edit: my new iPad didn't pick up the fact I wrote restaraunt. Aside from being a great typo to say aloud, wtf?
It wasn't the first time the hospital has killed a patient using the same technique. In the subsequent years I have spent a lot of time thinking about why he died and the indifference of those around him when he was most vulnerable. Law enforcement refused to investigate mostly on the grounds that he was insane and there was nothing anyone could do.
He had three kids and a wife who was a social worker. She was later fired as the state of Wisconsin decided social services where no longer a priority.
I've come to the conclusion that most of us would rather ignore the problem of mental illness rather than solve it. It's more convenient to kill the ill than treat them and society simply looks the other way.
I am given hope that his son is now a leading neuroscience Ph.D. Candidate at UC Davis. He has vowed to not let his father's death be in vain.