Hallucinations: The Ultimate Betrayal of the Mind

Implications for Law Enforcement

If someone begins to hallucinate and is detached from reality, a prompt medical evaluation should be sought.   Many medical and psychiatric conditions that can cause hallucinations may quickly become emergencies.  People who are hallucinating may become agitated, paranoid, and frightened.  They should never be left alone.  Assess for signs and symptoms of excited delirium, if ED is suspected, advanced life support paramedics should be called to stand by.

If an individual is mentally ill, acutely psychotic and experiencing hallucinations, it is crucial to remember that you, your partners, and others may be in harm's way. The presence of command hallucinations is a heads-up to exercise superior cautionary skills. Usually violence against officers by a psychotic individual is related to the subject's misinterpretation of the officers' intent, equipment, and a feeling of being cornered.  The subject’s perception of law enforcement presence may also be based on the command hallucinations he/she is experiencing, a voice telling the individual “Kill him before he kills you”.  If the subject is actively violent or threatening there is no question that you should respond with the appropriate level of force. Command hallucinations of violence are a definitive indicator that the subject requires psychiatric inpatient hospitalization. Inform emergency department staff of the violence potential so that they can institute appropriate restraints.

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.  Remove distractions and disruptive people from the scene.  One officer should try to establish rapport and speak with the subject. Back up, slow down, don’t crowd or force eye-contact, do not posture, and maintain a calm and confident composure.  Speak simply and briefly, giving clear and firm directions. Do not give the subject multiple choices; this will only further confuse him/her. Understand that a rational conversation may not take place. Ask about his/her hallucinations, but do not challenge them. Get updates on what the voice is currently telling the subject.

Don't forget to run a criminal check. Does the subject have a criminal record?  Does he/she have a history of substance abuse?  Is the subject under the influence, or in possession of illegal drugs? Any wants/warrants? This will help you determine if it is best for this individual to get his/her psych services from a hospital or from jail.

About The Author:

Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.