Understanding mental illness: what officers may see

Morales begins the second class with a warning. 'You are not going to diagnose anyone,' she says. 'Psychiatrists take years to learn to do that, and they still get it wrong. What you can learn is to recognize the signs that a person's thinking, mood or perception is not working the way it usually does, to understand roughly what they may be experiencing, and to adjust how you talk to them.' She explains that a mental illness is a health condition that changes how a person thinks, feels or behaves, causes distress or makes it hard to function at work, at home or in relationships, and lasts long enough to be more than an ordinary bad week.

Clinicians in Canada use two main classification systems: the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association and now in a revised fifth edition, and the International Classification of Diseases, published by the World Health Organization and now in its eleventh edition. Both describe disorders by their symptoms and how long they last. Neither is a test an officer can apply on a doorstep. Morales mentions them so that the class recognizes the names when they read a hospital report or hear a clinician use them.

A continuum, not a switch

Morales draws a horizontal line across the whiteboard with four sections. On the left is 'healthy': normal mood swings, good sleep, steady functioning. Next is 'reacting': irritability, worry, trouble sleeping after a stressful event. Then 'injured': persistent anxiety or sadness, pulling away from others, trouble concentrating. On the right is 'ill': symptoms that are severe, last for weeks and make it hard to function. This model is used in the Road to Mental Readiness program developed for the Canadian Armed Forces and adapted by the Mental Health Commission of Canada for police and other workplaces. Everyone moves along the line during their life, she says, including police officers, which the class will return to in lesson 11.

The continuum matters on the street because a person who is 'ill' today may be 'healthy' next month, and because the same person may look very different on different calls. A man who was shouting and frightened during a manic episode in March may be calm, embarrassed and grateful when an officer meets him again in May. Treating him as a permanent danger because of one call is both unfair and inaccurate.

How common is mental illness?

The Canadian Mental Health Association estimates that in any given year, about one person in five in Canada experiences a mental health problem or illness, and that by the age of 40, about half of the population has had one. Statistics Canada's surveys find that anxiety and depression are the most common, and that young adults report the highest rates. Priya Sandhu runs the numbers for Port Ardent in the program below.

# Expected number of Port Ardent residents with a condition in a year,
# using rounded national rates per 1,000 adults (illustrative)
adults = 79_000
rates_per_1000 = {"any mental illness": 210, "anxiety disorder": 100,
                  "major depression": 50, "bipolar disorder": 10,
                  "schizophrenia or other psychosis": 7}
for k, r in rates_per_1000.items():
    print(f"{k:34} about {adults * r // 1000:6} adults")
calls = 5400
print("mental health calls in 2025:", calls)
print("calls per 100 adults with any mental illness:",
      round(calls / (adults * 210 / 1000) * 100, 1))

any mental illness                 about  16590 adults
anxiety disorder                   about   7900 adults
major depression                   about   3950 adults
bipolar disorder                   about    790 adults
schizophrenia or other psychosis   about    553 adults
mental health calls in 2025: 5400
calls per 100 adults with any mental illness: 32.5

If one adult in five has a mental illness in a year, about 16,600 adults in Port Ardent do. The service answered 5,400 mental health calls, and some people were the subject of several. So the great majority of people living with mental illness in the city never meet a police officer about it. Officers see a narrow and unrepresentative slice: people at their worst moments, often when treatment has failed or was never available. Morales warns the class not to let that slice define their picture of mental illness.

Mood disorders

Major depression is more than sadness. A person may lose interest in everything, sleep too much or too little, stop eating, feel worthless or guilty, have trouble thinking and, in some cases, think about suicide. On a call, an officer might find a person who is withdrawn, slow to answer, tearful or flat, who has not left the apartment for days. They may not seem to be in crisis at all, yet they may be at high risk. Lesson 7 deals with suicidal crisis in detail.

Bipolar disorder involves periods of depression and periods of mania. During a manic episode, a person may sleep very little, talk rapidly and jump between ideas, feel unusually powerful or important, spend money recklessly or take risks they would never normally take. They may be irritable when others try to slow them down. Officers often meet people in mania because their behaviour has alarmed someone: a man directing traffic at an intersection, a woman who has given away her furniture, a student who has emailed the university president at 03:00. Morales advises officers to keep their own speech slow and calm, to avoid arguing about grand ideas and to focus on immediate safety and practical next steps.

Anxiety and panic

Anxiety disorders are the most common mental illnesses. A panic attack can feel to the person like a heart attack: a pounding heart, chest pain, shortness of breath, dizziness, a sense of doom. Officers may be called to a panic attack in a store or on a bus. Because the symptoms can overlap with real cardiac emergencies, Morales tells the class to call paramedics when in doubt. A calm voice, slow breathing together and a quieter space often help. Shouting commands at a person in a panic attack makes it worse.

Psychosis and schizophrenia

Psychosis means losing contact with shared reality. A person may have hallucinations, most often hearing voices that others do not hear, or delusions, which are fixed false beliefs, such as being watched by cameras in the walls, being poisoned or having a special mission. Their speech may be disorganized and hard to follow. Psychosis can occur in schizophrenia, in bipolar disorder, in severe depression, with some drugs, with some medical illnesses and during withdrawal from alcohol. Schizophrenia usually first appears in the late teens or twenties, and about one person in a hundred will develop it in their lifetime.

Morales describes a call from last year. A 19-year-old university student, home for the holidays, was found by his mother talking to the television and refusing to eat because he believed the food had been tampered with. It was his first episode of psychosis. The officers who attended did not challenge his beliefs and did not agree with them. They acknowledged that he seemed frightened, asked what would help him feel safer, and offered to drive him and his mother to the hospital, where an early psychosis program took him on. 'First episodes are a crucial moment,' Morales says. 'Early treatment improves outcomes. A frightening first encounter with police can make a young person avoid help for years.'

How should an officer talk to someone who is hearing voices? Morales gives four tips. Ask about the voices plainly: 'Are you hearing voices right now? What are they saying?' Do not pretend to hear them, and do not argue that they are not real; acknowledge that they are real to the person. Keep sentences short and repeat key information, because the person may be distracted. Ask whether the voices are telling them to do anything, because voices that command harm are a safety concern that should be passed to clinicians.

Trauma and post-traumatic stress

Post-traumatic stress disorder can follow events such as assault, war, serious collisions, abuse or disasters. People may relive the event in flashbacks or nightmares, avoid reminders, feel constantly on guard and react strongly to sudden noises or being touched. Many people police meet in crisis have long histories of trauma, including childhood abuse, intimate partner violence or the intergenerational effects of residential schools. A shouted command, a hand on the shoulder from behind or handcuffs can trigger a reaction that looks like aggression but is fear. Trauma-informed practice, which the class will see throughout the course, means assuming that trauma may be present and acting in ways that do not repeat it: explaining, asking before touching, offering choices.

Personality disorders and other conditions

Some people live with longstanding patterns of thinking and relating that cause them great distress, which clinicians may diagnose as personality disorders. Borderline personality disorder, for example, involves intense and rapidly shifting emotions, a deep fear of abandonment and, in some people, repeated self-harm. These are among the most stigmatized conditions, even among health workers. Morales asks the class to remember that the behaviour usually grows out of pain and often out of early trauma, and that consistent, calm, respectful responses help more than impatience. Eating disorders, obsessive-compulsive disorder and others also occur, though they less often bring police to the door.

Medication and why people stop it

Many people with serious mental illness take medication, and it often helps. But antipsychotic and mood-stabilizing medications can have hard side effects: weight gain, drowsiness, restlessness so intense the person cannot sit still, tremors, stiffness or sexual side effects. People also stop medication because they feel well and believe they no longer need it, because they cannot afford it, because the illness itself makes them doubt they are ill, or because they distrust the people who prescribed it. When a family member says 'he stopped his meds', an officer should hear it as information, not as an accusation. Morales adds that restlessness from medication can look like agitation, and that a person may move constantly because their body will not let them stop.

Danger and stigma

Marco asks the question everyone is thinking: are people with mental illness more violent? Morales answers carefully. Large studies have found that most people with mental illness are never violent, and that they are far more likely to be victims of violence than perpetrators. Some factors are linked to a higher risk of violence: a history of violence, substance use, recent threats, and untreated psychosis with paranoid beliefs about a specific person. These are the same kinds of factors officers already consider. A diagnosis alone tells an officer very little. Stigma, on the other hand, causes real harm: it discourages people from seeking help, and it leads officers to treat a frightened person as a threat.