Instructions: Answer the following question(s): What is CIT? How is CIT training different than the training that all officers receive? What are the dangers of a false confession? Do you think of

An example of where this situation can lead is the case of Eddie Joe Lloyd, who spent 17 years in prison before being exculpated by DNA analysis (2). In January 1984, Lloyd, who had been given a diagnosis of paranoid schizophrenia, took an in- terest in the case of a 16-year-old girl who was found brutally raped and murdered in Detroit. Because of his interest, the police came to the men- tal hospital where Lloyd was admitted and interrogated him on three sepa- rate occasions. Lloyd was led into falsely confessing by police who fedhim facts of the crime—his knowl- edge of which was later used against him as evidence of his familiarity with the attack—and who told him that by confessing to the crime, he would help the police “smoke out” the real perpetrator. Perhaps because of his mental illness, Lloyd believed the of- ficers and claimed he murdered the girl. Currently, the police officers in- volved are under federal investigation for their alleged misconduct. The ac- tual murderer was never apprehend- ed, and Lloyd spent 17 years of his life wrongly imprisoned. Persons with mental illness and police interrogations The number of persons with mental illness who encounter the police as suspects is not inconsequential. In- deed, one study found that the prob- ability of arrest was 67 times greater for persons who demonstrate symp- toms of mental illness compared with those without such symptoms (3). Al- though mentally ill persons are most commonly cited for misdemeanors, there is a subgroup of these persons who are suspected of having commit- ted violent crimes, sometimes cor- rectly (4), and are thus subject to for- mal police interrogations. A conserva- tive estimate that 10 percent of in- mates in U.S. state and federal pris- ons suffer from mental illness (5) yields a total of about 140,000 men- tally ill prisoners. This number repre- sents only adults convicted and cur- rently incarcerated in prisons, as op- posed to jails; thus the number of per- sons with mental illness who have been interrogated by the police in re- cent years can be estimated to be much greater than 140,000.

Little to no discussion has taken place in any of the relevant literatures specifically about police interrogation of mentally ill detainees. Even from a legal standpoint, scant attention has been paid to the topic. For a confes- sion to be admissible in court, it must be made voluntarily, that is, it must be noncoerced. Confessions are deemed to be coerced if the police explicitly threaten harm or punishment or promise leniency. Although research has suggested that many contempo- rary police interrogation tactics im- plicitly convey threats and promises (6), no research has been done, and there have been few contested legal cases to determine whether mentally ill persons are more likely to perceive implicit threats and promises as ex- plicit statements, which would be ille- gal for police to utter when interro- gating suspects.

Confessions are also excluded from legal proceedings if it can be shown that suspects did not understand or appreciate their Miranda rights. The U.S. Supreme Court ruled in the 1966 landmark case Miranda v. Arizona(7) that because of the inherent coercion present in police interrogation, all sus- pects must be made aware of their right against self-incrimination and of their right to counsel. Mentally ill de- fendants, particularly defendants with psychotic disorders, are significantly less likely to understand their interro- gation rights than defendants who are not mentally ill (8).

Finally, legal safeguards for persons with mental disorders afford little protection during the investigation phase. In Colorado v. Connelly(9), a case involving a mentally ill defen- dant, the U.S. Supreme Court ruled that a suspect’s mental condition alone is insufficient for a finding that a confession was coerced. Rather, it must be demonstrated that the police Mental Illness, Police Interrogations, and the Potential for False Confession A Al ll li is so on n D D.

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Dr. Redlich is a senior research associate at Policy Research Associates, Inc., 345 Del- aware Avenue, Delmar, New York 12054 (e-mail, [email protected]). Paul S. Ap- pelbaum, M.D., is editor of this column.

L La aw w & & P Ps sy yc ch hi ia at tr ry y used coercive techniques. Although Connelly confessed because the voic- es in his head told him to do so, be- cause the police did not overstep their bounds, the confession was con- sidered to be the product of his free will and rational intellect. Therefore, the confession could be used against him in court. However, it has never been established empirically that the boundaries on police behavior that were put in place for suspects who are not mentally ill are sufficient to pro- tect mentally ill suspects. Examining contemporary police interrogation techniques with an eye toward per- sons with mental illness only height- ens the concern that such persons may not be adequately protected.

Contemporary police interrogation The ultimate goal of interrogating suspected criminals is to gain a con- fession. Establishing psychological control is a critical element toward that end. For the past 50 years in the United States police interrogative procedures have changed from the use of physical intimidation to a more sophisticated use of psychological manipulation. Leo (10), a sociologist, in his analysis of more than 500 hours of observed interrogation, likened po- lice questioning to a confidence game in which detectives “cultivate” and “con” suspects into admitting guilt.

He wrote that “contemporary interro- gation strategies are based on the ma- nipulation and betrayal of trust” (10).

The most widely used set of inter- rogation tactics are referred to as the Reid technique. The training manual based on the Reid technique, which is considered to be the “bible” of police interrogation, was originally devel- oped in 1947 and is now in its fourth edition (11). Police interrogators who are trained in this method are taught to assume guilt, to manipulate the suspect’s emotions and expectations, and to take into account nonverbal behavioral cues, such as hesitant speech, sweating, or dry mouth, as in- dicators of deception. However, these cues, in addition to being general in- dicators of stress, may appear more frequently among persons with men- tal illness because of their illness or the medications they are taking. Police interrogation approaches can be characterized as involving ei- ther minimization or maximization techniques (6). Minimization tech- niques—such as feigning sympathy, offering a moral justification for the crime, or shifting blame—are used to placate accused suspects and lead them into a false sense of security. In contrast, maximization techniques— such as presenting false evidence— attempt to browbeat the suspect into confessing. Persons with a mental dis- order may be more susceptible to confessing in response to both of these techniques than persons with- out a mental disorder. Characteristic traits of mentally ill persons, such as disorganization of thought, deficits in executive functioning and attention, and impaired decision making, could contribute to self-incrimination. For example, compared with persons without mental illness, persons with mental illness may be more likely to confess, because they believe that the police officer is truly a friend who un- derstands and “has been there” or be- cause they believe that they will be able to go home after confessing.

Another controversial police inter- rogation tactic involves lying to sus- pects. It is legal for the police to use “trickery and deception” during inter- rogations, and thus the police com- monly lie to suspects about evidence they do not have (6). For example, the police can tell suspects that their fingerprints are on the weapon used in a crime or that eyewitnesses saw them commit the act, even when no fingerprints or eyewitnesses exist. Of course, the hope is that guilty sus- pects confronted with such “evi- dence” will break down and confess, but this approach may also lead inno- cent suspects into falsely confessing.

For numerous reasons, persons with mental illness, both guilty and inno- cent, may be more likely than persons without mental illness to confess in response to such tactics. For example, some mentally ill persons have deficits in social skills, such as as- sertiveness (12). Three common as- pects of assertiveness are asking for assistance, saying “no” to others, and providing corrective feedback. All of these aspects are relevant to the in- terrogative situation, and their ab-sence may increase the likelihood of confession. Examples of assertive be- haviors that some persons with men- tal illness may not be able to perform during an interrogation include ask- ing for an attorney, denying commis- sion of the crime, and telling the po- lice officer that one is innocent when the police officer is insisting on one’s guilt.

The Reid training manual (11) provides little discussion of how to recognize and deal with suspects who have mental impairments. Al- though the manual asserts that men- tal disabilities “if actually present” in the context of active persuasion may lead to false confessions, it immedi- ately counters this assertion by not- ing that persons with mental disabil- ities will not be skilled liars, and hence the truth is likely to reveal it- self to the interrogator. However, the police generally have not had train- ing in determining who is and who is not mentally unstable. As Lamb and colleagues (13) pointed out, “A per- son who seems to be mentally ill to a mental health professional may not seem so to police officers—who de- spite their practical experience have not had sufficient training in dealing with this population.” In sum, it is quite possible that modern police interrogation tech- niques used in the United States place mentally impaired suspects at risk of false or legally coerced con- fessions. Indeed, because of the po- tential for false confession, the Unit- ed Kingdom has established proce- dures for handling at-risk suspects.

Specifically, in the United Kingdom psychologically vulnerable suspects, such as juveniles and mentally disor- dered or handicapped persons, may be interviewed by the police only in the presence of an “appropriate adult.” The reasoning behind the mandate is that persons with mental impairment “may without knowing or wishing to do so, be particularly prone in certain circumstances to provide information which is unreli- able, misleading, or self-incriminat- ing” (14). At this point in time the United States does not have compa- rable standards, despite the growing recognition of false confessions from mentally impaired suspects. PSYCHIATRIC SERVICES ♦http://ps.psychiatryonline.org ♦January 2004 Vol. 55 No. 1 2 20 0 Approaches to the problem Regardless of their guilt or inno- cence, all suspects are afforded cer- tain constitutional rights in the inter- rogation room. In 1966, the U.S.

Supreme Court in Miranda v. Ari- zona (7) took steps toward equalizing the “inherently coercive” atmosphere of interrogation by ensuring that all suspects were made aware of their rights before formal police question- ing could ensue. On average, howev- er, persons with severe mental disor- ders are unlikely to be on an equal footing with others in the interroga- tion situation.

A quick remedy to the problem of unfair interrogations of suspects with mental illness is not likely to be found.

Clearly, additional research is needed.

Among the unanswered questions are:

What percentage of suspects who are interrogated have a mental illness?

Among the suspects who have a men- tal illness and are interrogated, in what percentage of cases do the police recognize the mental illness? If the mental illness is recognized, what ac- tions do the police take; for example, do the police determine the compe- tency level of the suspect, call an at- torney or a mental health professional or both, or simply continue with the interrogation? Are persons with men- tal illness more likely than persons without mental illness to waive their constitutional rights? Will innocent persons with mental illness confess to a crime more frequently than inno- cent persons without mental illness? A clearer understanding of the relation- ship between mental illness and the outcome of interrogation is necessary to advance knowledge on police han- dling of persons with mental illness and to prevent miscarriages of justice.

In the meantime, as part of many U.S. communities’ crisis intervention training initiatives, exemplary efforts are being made to increase the po- lice’s knowledge of mental disorders and the people who suffer from them.

However, efforts are focused almost exclusively on police involvement in crises that involve persons with men- tal disorders. Police recruits as well as experienced detectives would benefit from training on how to interrogate persons with mental illness and the potential risk of false confession. Cur- PSYCHIATRIC SERVICES ♦http://ps.psychiatryonline.org ♦January 2004 Vol. 55 No. 1 2 21 1 ricula about interrogating persons with mental illness could be incorpo- rated with relative ease into existing and developing police training pro- grams. To date, structured curricula have not been developed to train in- terrogators in the questioning of per- sons with mental impairment or other risk factors. A few jurisdictions have sponsored one- or two-day training seminars on the topic; perhaps not sur- prisingly, these initiatives usually come after false confessions have been ex- posed. Prevention is almost always preferable to intervention, and in the case of false confessions, prevention means not having an innocent person languish in prison, not allowing the true perpetrator to go free to poten- tially commit more crimes, and not creating embarrassing and costly situa- tions for the criminal justice system.

With increasing awareness that people can and do admit to criminal acts that they did not commit, the number of false confession cases that are identified is likely to increase as well. Because persons with mental impairment appear to be dispropor- tionately represented among these false confession cases, a greater un- derstanding of the relationship be- tween mental illness, interrogation, and confession is needed. ♦ References 1. Innocence Project: False Confessions.

Available at www.innocenceproject.org/ causes/falseconfessions.php2. Wilgoren J: Confession had his signature; DNA did not. New York Times, Aug 26, 2002, p A1 3. Teplin LA: Keeping the peace: police dis- cretion and mentally ill persons. National Institute of Justice Journal 244:8–15, 2000 4. Monohan J, Steadman HJ (eds): Violence and Mental Disorder: Developments in Risk Assessment. Chicago, University of Chicago Press, 1994 5. Lamb HR, Weinberger LE: Persons with severe mental illness in jails and prisons: a review. Psychiatric Services 49:483–492, 1998 6. Kassin SM: The psychology of confession evidence. American Psychologist 52:221– 233, 1997 7. Miranda v Arizona, 384 US 436 (1966) 8. Viljoen JL, Roesch R, Zapf PA: An exami- nation of the relationship between compe- tency to stand trial, competency to waive interrogation rights, and psychopathology.

Law and Human Behavior 26:481–506, 2002 9. Colorado v Connelly, 449 US 157 (1986) 10. Leo RA: Miranda’s revenge: police interro- gation as a confidence game. Law and Soci- ety Review 30:259–288, 1996 11. Inbau FE, Reid JE, Buckley JP, et al: Crim- inal Interrogation and Confessions, 4th ed.

Gaithersburg, Md, Aspen Publishers, 2001 12. Dilk MN, Bond GR: Meta-analytic evalua- tion of skills training research for individu- als with severe mental illness. Journal of Consulting and Clinical Psychology 64:

1337–1346, 1996 13. Lamb HR, Weinberger LE, DeCuir WJ:

The police and mental health. Psychiatric Services 53:1266–1271, 2002 14. Home Office: The Police and Criminal Ev- idence Act 1984 (s 66), Codes of Practice, revised ed. HMSO, London, 1995 C Co om mi in ng g i in n F Fe eb br ru ua ar ry y ♦ ♦ Should patients participate in the DSM-Vdevelopment process?

♦ ♦ Ethnicity and the choice of medication for schizophrenia ♦ ♦ Service needs among offenders with dual diagnoses