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CDU Chair of Psychiatry Dr. Curley Bonds Offer
By Curley L. Bonds, MD, DFAPA
Published August 29, 2014

Curley L. Bonds, MD, DFAPA 


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Alternatives to Force When Confronting the Mentally Ill


News articles and viral videos point to the rise in brutal beatings of the mentally ill by law enforcement.  Abuse of the mentally ill—by anyone—doesn’t have to be. Still, according to MedPage Today, one in four people with mental illness experiences violence of some type in a given year.

Curley L. Bonds, MD, DFAPA has spent his adult life helping the mentally ill and their families who cope with erratic adults, often those who prefer the streets than the structure of an institution.  At Charles R. Drew University of Medicine and Science (CDU) Dr. Bonds is Professor and Chair of the Department of Psychiatry and Human Behavior, Clinical Professor of Health Psychiatry at UCLA, Medical Director at Didi Hirsch Mental Health Services and a highly sought after expert on mental health issues.

When asked about the proliferation of apparently mentally ill persons in our parks, sleeping under freeways, doorways and any available nook, he answered using the term “deinstitutionalization.”

“The idea was that the mentally ill should not be ‘locked up’ for life. Starting in the 1950s, newer medications came out to treat illnesses like schizophrenia and bipolar disorder, previously deemed either untreatable or very difficult to treat,” explained Dr. Bonds. “For the first time, people began to see dramatic examples of recovery. People who had been in psychiatric hospitals for most of their lives were able to return to the community and to their families. Politicians like then Governor Ronald Reagan saw this as an opportunity to save money by shutting down state psychiatric facilities and other hospitals that had traditionally housed the mentally ill in favor of community treatment.  Later, some of the social support programs that benefited the mentally ill to save money were eliminated.”

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Dr. Bonds said there was a major problem with this plan. “The vast network of community clinics and supportive housing that should have been created with the cost savings was never realized. As a result, we are left with the legacy of lots of people who don’t receive proper treatment. That leaves them with plenty of opportunities for interactions with the authorities or those who would take advantage of them.”

Said Dr. Bonds, “Estimates vary, but probably at least 20-25% of those experiencing homelessness have some type of mental illness. If you add in substance abuse problems, that number goes even higher. Generally speaking, the mentally ill who are homeless tend to stay to themselves because of their symptoms – like paranoia, which makes them very distrustful of everyone. Some may talk to themselves or respond to their hallucinations in other ways that we may find disturbing or frightening. But it is important to remember that they’re usually frightened and more vulnerable. If a person who you suspect has a mental illness approaches you for help, treat them like any other person asking for help. Ask if they need something; try to direct them to services. Agencies like Didi Hirsch operate a 24-hour crisis line for those who are suicidal or having other challenges,” Dr. Bonds offered.

“If they seem to be in urgent distress and possibly at risk of hurting themselves or others, then dial 911 as you would for anyone experiencing a medical problem. It’s important to remember that the overwhelming majority of mentally ill individuals aren’t dangerous. They are just trying to make it in society just like the rest of us.”

Most recently, the ill treatment of 51 year-old Marlene Pinnock sparked community protest when millions via social media saw a California Highway Patrol Officer repeatedly punching the hapless woman in the head on a Los Angeles freeway. In Orange County, 37 year old Kelly Thomas, lost his life after a brutal police beating and in Inglewood, 16 year old Donovan Jackson-Chavis was beaten as his restrained father watched.

Dr. Bonds offers this advice, “Law enforcement officials are often the first responders when individuals with mental illness behave in socially inappropriate or threatening ways. Depending on the jurisdiction, they may or may not have the training needed to know how to deal with these situations. Some agencies only provide officers less than 8 hours of training on strategies for working with mentally ill people in crisis. A first step is support for funding for more training. When possible, it is best to have a specialized team respond to these types of crisis. In Los Angeles County we have a Mental Evaluation Unit (MEU) and SMART (System-wide Mental Assessment Response Team) units that are best equipped to deal with problems. But in the meantime, there are some general principles that should be followed so that a bad situation doesn’t become worse:

1) Speak in a calm, measured voice so that you don’t escalate things.

2) Redirect the person so that they focus on something other than hurting themselves.

3) Whenever possible, try to offer the mentally ill person clear instructions. This helps to reduce their sense of things being out of control.

4) Most of all, just be respectful. Sometimes dealing with a person who’s cognitively impaired and in distress can be a challenge. Both parties will be better off if you can slow down, stop, and think before acting.

5) Call one of the Mental Evaluation Agencies for assistance. (See phone numbers below.)

 “Force should never be the first approach. I’ve worked in environments where restraints are used for containing the mentally ill. But in many cases, they ended up making a bad situation worse. When it comes to law enforcement – it’s a different story. They are the people who we call when we’re unable to safely deal with a situation. Then they have to use their judgment and training to determine when to use force and in what manner. Their safety and the public safety always have to come first,” warns Dr. Bonds. 

So, how did we get here? 

Dr. Bonds said most mental illnesses are biopsychosocial. “This means that it isn’t just one thing that causes them. Usually there is some genetic vulnerability or pre-disposition to have the illness. We know from research studies that many serious illnesses like schizophrenia and bipolar disorder can be inherited. But just having a gene usually isn’t the only factor. Stress, trauma, substance abuse – all of these things can increase the odds that you’ll actually develop the disorder, said Dr. Bonds. “I don’t know of any solid evidence to suggest that vaccinations or FDA approved drugs actually cause mental illness. In our community, it is very common that exposures to violence in the home and outside lead to an increase in anxiety related conditions like Post Traumatic Stress Disorder.” Of course, many veterans are in the number of those who suffer from PTSD.

Dr. Bonds has been with Didi Hirsch for four years and offers it as a solution to many problems the people face when it comes to the mentally ill. “For 70 years, this agency has been a great option for finding assistance for those who have a severe and persistent mental health problem and limited resources. Depending on the area where you live, we have centers that treat both adults and kids” he said.

A good idea is to add this number to your contacts in your cell phone.  You never know when you will need to call Didi Hirsch: (877) 7-CRISIS or at (877) 727-4747. The agency serves over 74,000 adults and children each year in 11 sites in Inglewood, metropolitan and South Los Angeles, Glendale, Pacoima, Venice and Culver City. The website is www.DidiHirsch.org.Another good place to start is your family doctor or primary care physician,” advises Dr. Bonds. “They can make sure that you don’t have an underlying medical condition – and they’re also trained to treat basic problems like anxiety and depression. They’d also be able to tell you if you need more assistance. If you have health insurance, a good place to start is to contact your carrier to find out who accepts your plan. Increasingly, services are carved out so that you can only go to providers in your network – so it’s useful to call ahead of time to avoid the frustration of trying to hunt down a provider.”

Dr. Bonds speaks directly to communities of color.

“Mental illness has always been around in our community. Traditionally, though, communities of color don’t talk about how it affects them. This results in a lot of problems being swept under the carpet or into the closet. So, when people who are ill get better, no one knows that side of the story. There are many remarkable people who are doing incredible things despite having been diagnosed or treated for depression or other problems. We need to work to reduce the shame and stigma around being treated for these illnesses. When we’re more open about the problems that people confront, they’ll be more likely to seek help.”

Dr. Bonds is also a Distinguished Fellow in the American Psychiatric Association and has  contributed the chapter “Psychiatric Aspects of Skin of Color” to the Dermatology for Skin of Color textbook, authored by the late Dr. Paul Kelly and Susan Taylor, former editor of Essence Magazine (1st Ed 2009).

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He has been speaking out about the poor treatment of the mentally ill locally, nationally and internationally. For more information about Dr. Bonds and his work at CDU visit www.cdrewu.edu.

Categories: Family

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