The police can handle dangerous mentally unstable individuals only after they have committed a crime, while prevention would require more information and efficient referring to psychiatrists.
The police view stabbing attacks in public space, especially mass events as the song festival or other summer festivals as currently one of the most serious threat scenarios. If such an attack happens and the attackers later turns out to be mentally unstable individual who had forgotten to take his medicine, the police can only ask; what to do to prevent such incidents?
If the police later investigate such acts classified as insanity, it often appears that the person’s sense of reality had been weakened for some time, his statements and actions had seemed dangerous – the attack had not come as a bolt from the blue. The police believe that if they had better exchange of information with medics about people, whose mental problems make them a threat to themselves or others, everyone would benefit from the arrangement.
Roger Kumm, head of the North Prefecture’s criminal police bureau’s service of criminal assault investigation, says that one option would be providing the police with information about diagnosed psychiatric patients, who have become dangerous, stopped taking medication or receiving treatment and have also attracted the next of kin’s attention with aggressive conduct or obsessive statements.
Urmet Tambre, head of the North Prefecture criminal police bureau, said that the police do not need direct access to health information, but someone should consistently assess whether the changes of a person’s health make him dangerous. «It could be helpful if the police learn from a doctor or a family member that a person has stopped visiting the doctor or taking medication. Then the district officer could visit him and find out if everything is all right. There are paranoid individuals who carry knives fearing an attack. If such a person should visit some event, we need to know to reckon with it. It is necessary for us to know, whether a person in a detention cell or a drunk tank has been suicidal or needs medication. Now we rely on the previous experience of the police and the individual’s own statements, which need not be truthful,» Tambre said.
Psychiatrists do not approve
Andres Lehtmets, chairman of the Estonian Psychiatric Association, said that the police initiative of prevention is highly welcome, but the information they desire concerns health records, which are delicate information in democratic societies and their release without the individual’s consent should be well founded. He said that it is important to keep in mind that informing the police about mental problems may result in unwillingness to visit psychiatrists out of fear of information leaks. This could increase the number of people with mental problems who do not receive treatment.
Lehtmets explained that there are no psychiatric disturbances which would make a person automatically dangerous. Alcohol and narcotics also play a large role in crimes committed by mentally disturbed people.
He agreed that the police should have the opportunity to prevent risks, but the existing psychiatric assistance act, in his opinion, grants quite efficient opportunities to the police in case of skillful approach: the police can detain people for a brief period and an earlier diagnosis is not required to take a person for a psychiatric check-up.
Same problems all over again
Tambre remarked that when the police or paramedics take a person to a doctor, they would not be informed whether the individual was dangerous or received treatment. It would happen again next time.
Kumm provided an example of his recent experience: the police took a woman to a doctor on duty at the psychiatric hospital – talking to her had raised suspicions of obsession. The woman had approached the police on her own and claimed that she would have to kill somebody. She had been thinking about it for some time and reached the state where the urge had become intense. She was worried about herself.
The police talked to her, she understood her problem and agreed to be taken to a psychiatrist. Such an individual could be taken to hospital even against her will. But if she had not stated her intent to kill someone, compulsory visit to the psychiatrist would not have been that easy, despite the serious mental problems.
According to Kumm, dozens of people contact the police that way, but they do not legally pose a threat and cannot be forced to turn to a psychiatrist. It rarely happens that a person perceives the deterioration of his mental state in time and seeks for help against obsession. The greater is their need for others to pay attention and react.
«The police officer first has to convince the person with problems that he should seek for help. Then the officer will have to contact and convince the psychiatrist to see the patient who could be dangerous. We have to present our record of his actions. This does not seem right. And every doctor is different,» Kumm said.
Lehtmets admitted that if the need for psychiatric help is obvious, but the person has not been dangerous in any way, he cannot be treated against his will. But the meaning of posing a threat and where to draw the line is a major issue in all democratic societies. He remarked that the Estonian law is quite vague about it as well.
The police believe that if a doctor has prescribed medication to someone who could become dangerous without the effect of the drugs, the state should be informed whether the individual has purchased the drugs and is using them. «If one does not buy the medicine, we currently have no idea whether anyone checks up on it. The police will generally know it only after the person has attracted out interest,» he said.
According to Lehtmets, medics can check whether the patients have used the prescriptions issued by them, but unfortunately, they have little time for that. But even if the medicine is purchased, the doctor cannot monitor its use. The medics have no right to view a person’s health records after the patient has ceased visiting their office.
Lehtmets suggested that mental health nurses working at family doctors’ receptions could remind the patients of the need to take medication and generally help them to cope, much like it is done in the Nordic countries. «We still have a lot of room for improvement in the initial-level medicine, especially regarding mental health. Psychiatry is not always a universal tool, there are problems which should be handled by social welfare,» Lehtmets said.
Mental problems are stigmatized in Estonia
If a person’s psychiatric problem is under control, it does not yet change his personality, for example empathy, said Ingrid Ots-Vaik, advisor of the Ministry of Social Affairs health system development department.
In her words, statistics show the opposite - that a normal and legally qualified person poses much higher threat to mentally disturbed individuals. The latter face a five times higher probability of becoming a crime victim.
She said that tens of thousands of new incidents of psychic disturbances are diagnosed in Estonia annually, some 10,000 of them receive hospital treatment, while compulsory treatment concerns approximately 3,000. Roughly 450 psychiatric analyses are ordered vis criminal process annually and 50-60 of cases are committed to treatment. But the number of violent crimes in Estonia is approximately 7,000 per year.
She thus asked what information health records could provide to the police. «Health records are meant for documenting medical services provided. The purpose of gathering this information is quite different. One could ask whether their risk-assessment system covers the need for information about someone’s diagnosis? Do the police consider everyone using anti-depressants a high-risk group?»
According to the expert, a major problem is posed by the fact that mental illnesses are not «respectful». Everyone understands that a person has cancer, but mentally disturbed persons are stigmatized. The accessibility of medicines helping to cope with mental problems is also much lower compared with cancer drugs. Ots-Vaik said that the monitoring of use of prescriptions should apply to all chronically ill patients.
Mental health nurses are already being trained and hopefully they will operate in all health centers in the future. But now they are mostly working in psychiatric hospitals to reduce the psychiatrists’ workload, Ots-Vaik said.