A command hallucination is when a voice tells an individual to carry out a specific act(s). A person experiencing this kind of hallucination frequently feels under a powerful obligation to carry out such actions. The results are often devastating. Approximately 30% of schizophrenics have command hallucinations in which they feel compelled do what the voice tells them to do. Studies indicate that approximately 40% of these individuals report they have complied with such commands. Statistically, over 50% of command hallucinations are to commit suicide, 10% for homicide, and 10% for some other non-lethal injury.
Implications for Law Enforcement Officers
If the subject is in the act of attacking you, another, or himself, there is no question that you should respond with the appropriate level of force. However, if the situation is secure, and if no one can be accidentally harmed, you should adopt a non-threatening and non-confrontational stance with the subject. If you have access to a psychiatric crisis intervention team, have them respond to the scene.
Remove distractions and disruptive people from the scene. Understand that a rational conversation probably will not take place. One officer should try to establish rapport and speak with the subject. Speak simply and briefly. Give clear and firm directions. Do not give the subject multiple choices; this will only further confuse him or her. Ask about his/her delusions and hallucinations; but do not challenge them. Ask "Are you hearing voices?", "How many voices?", "What is the voice(s) telling you?", "What does the voice(s) want you to do?", "Do you believe you must do what the voice(s) is telling you?" Repeat these questions if you identify a change in the subject's behavior. Recognize and acknowledge that a person's delusional or hallucinatory experience is real to him or her.
Move slowly. Announce your actions before initiating them. Let the subject know that you are there to help; that you want to understand them. Your uniform, gun, handcuffs, etc. may be frightening to the subject; reassure them that you mean no harm. Do not maintain continuous eye contact. Except in situations in which the person must be physically detained, avoid any physical contact with the person. Do not crowd or surround the subject. Realize that his/her comfort zone may be much larger than that of other individuals. If the subject is acting dangerously but is not directly threatening to harm others or them self, allow the person to calm down. Have less-lethal force methods in place.
Once the situation is secure other officers should try to obtain as much information as possible from family or bystanders, especially related to psychiatric diagnosis, medication compliance, substance abuse and previous history of violence. Should this subject get psychiatric treatment at a behavioral health hospital or the county jail?
Once the subject is apprehended do not leave him alone in the patrol car, speak to him, or turn on music, as these methods may distract him from the voices. Inform the jail or hospital emergency department staff of the violence potential so that they can institute appropriate restraints.
The current mental health system will only provide treatment to the severely mentally ill once a person becomes dangerous to themselves/others or if they are gravely disabled. Police officers and sheriff's deputies have now been forced to become the front line mental health workers. Your job is to protect and serve, bottom line. Fortunately, related to officer safety, most acts of violence by the severely mentally ill are against family and friends, not you. However, 911 is the most frequently called phone number when there is violence; when there are voices. As first responders to these types of calls, it is crucial to remember that you, your partners, and others may very likely be in harm's way. Usually violence against officers by a severely mentally ill individual is related to the subject's misinterpretation of the officer's intent and a feeling of being cornered.