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Inside Schizophrenia: A Look into Possible Links Between Violence and Schizophrenia

An in-depth look at violence and its relation to schizophrenia. Is violence a symptom of schizophrenia? Do mass attackers always have schizophrenia? Are schizophrenics dangerous?

Studies say people with schizophrenia are more likely to be a victim of a crime than the perpetrator. However, James Holmes, the movie theater mass murderer, was said to have paranoid schizophrenia. And a person can plead not-guilty by reason of insanity in court. This seems to be contrary to the idea of non-violence in mental illness.

Host Rachel Star Withers, a diagnosed schizophrenic, and co-host Gabe Howard delve into these intense subjects in this episode of the Inside Schizophrenia podcast. Officer Rebecca Skillern, the senior trainer within the mental health division of the Houston Police Department, joins as a special guest to explain police protocol in answering crisis emergencies and what people with schizophrenia, and their loved ones, should do when an episode puts someone in danger.

Highlights From ‘Violence & Schizophrenia’ Episode 

[01:48] “Have you ever killed anyone?”

[03:21] Stigma is not knowing.

[07:10] Consequences of people finding out you have schizophrenia.

[14:22] Not guilty by reason of insanity.

[17:33] Paranoid schizophrenia and mass attackers.

[24:00] Has Rachel ever been violent due to my schizophrenia?

[25:30] Guest interview with Officer Rebecca Skillern.

[27:22] How is a mental crisis team response different than a typical police response?

[31:00] What to do if I need help for a mental health crisis.

[43:55] During a mental health crisis, what do I want to happen?

[46:00] Confusion and fear during an episode.

About Our Guest

Officer Rebecca Skillern, the senior trainer within the mental health division of the Houston Police Department, joins as a special guest to explain police protocol in answering crisis emergencies and what people with schizophrenia, and their loved ones, should do when an episode puts someone in danger.

She is an expert in CIT Training (Crisis Intervention Team) which is a program that provides the foundation necessary to promote community and statewide solutions to assist individuals with a mental illness and/or addictions. The CIT Model reduces both stigma and the need for further involvement with the criminal justice system. CIT provides a forum for effective problem solving regarding the interaction between the criminal justice and mental health care system and creates the context for sustainable change. Learn more by visiting

Computer Generated Transcript for “Violence and Schizophrenia” Episode

Editor’s NotePlease be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: Welcome to Inside Schizophrenia, a look into better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.

Gabe Howard: This is fascinating because it comes up so incredibly often and I imagine that as somebody who lives with schizophrenia people that believe this particular misinformation campaign or myth or misunderstanding sort of visit their fears onto your life. Is that fair?

Rachel Star Withers: Yes, I’m very open about my schizophrenia and not just online and in podcasts but everyday life. OK. Most people who meet me as far as more than once, not just random strangers and I’m just screaming it out. But if you work with me you probably know at some point and I get a lot of different like crazy questions. Some people have asked me like, “What do you see colors?” Yes. I’m not colorblind. That has nothing to do with schizophrenia at all. Oh but the weirdest I’ve gotten that I’ve never quite understand why is, “Have you ever killed anyone?” 

Gabe Howard: Just do they just straight up? When they’re asking questions about schizophrenia. Do they come straight out and say, “Have you killed anyone?”

Rachel Star Withers: No this is like something they lead up to. It’s like OK I’ve been like I know her you know and we’re finally talking and maybe I feel like I can finally ask this question. That would be offensive if I asked right away. But I’ve definitely been thinking about it for the past three weeks I’ve been working with her

Gabe Howard: So it’s on their mind from the moment they find out that you have schizophrenia? I mean when they find out about your illness this is something that pops into their head almost instantly?

Rachel Star Withers: I personally think so.

Gabe Howard: And does it worry you? Is it a concern?

Rachel Star Withers: To me, it doesn’t worry me. I always like to turn it into a joke. People say, “Have you ever killed anyone?” Not yet. I should like to just kind of pause there for a long time, take a nice deep breath and slowly turn my gaze to them and score right. But.

Gabe Howard: But that’s something that you have of course the privilege to do.

Rachel Star Withers: Yes.

Gabe Howard: I mean it

Rachel Star Withers: Yes.

Gabe Howard: You know just both by way of being. I’m trying not to say a tiny little white woman but . . . But you know what I mean. You don’t look physically imposing. It does. Does that make sense?

Rachel Star Withers: No, it does. Yes.

Gabe Howard: I mean if you were, if you were a giant man. If you were you know a giant African-American male?  But if you weren’t as articulate or funny or as approachable or as friendly this kind of a stereotype would be? It could be really impactful to your ability to find a work or a job or housing if they think that you’re dangerous.

Rachel Star Withers: Oh absolutely. You know people hear the word stigma and you always associate it with something bad like. Okay well stigma must mean that everybody thinks schizophrenics are violent or have killed people. But I think a lot of it is also you just don’t know anything. Like the unknown. Like I don’t know what this person is capable of. I don’t know much about schizophrenia so yeah on such and such TV show that was the killer and that I think is more scary than anything.

Gabe Howard: So you think that people are taking their ignorance essentially because they don’t know if you are safe or unsafe.

Rachel Star Withers: Yes. And it’s one reason that I go out of my way to be so open about my schizophrenia. And that’s a luxury that I have. You know certain jobs I can’t go around saying that if I were to work. So I’m not saying everybody with a mental disorder should you know just tell the world hey guess what. I mean right now I’m working on this podcast with you, Gabe, Inside Schizophrenia. I don’t think I would get fired if anyone found out I actually had schizophrenia.

Gabe Howard: In this particular case it was an advantage. Obviously the show was looking for somebody who had a lot of knowledge about schizophrenia. Somebody who was open to talking about schizophrenia and somebody who was living publicly with schizophrenia. Do you believe, Rachel, that the people who think this are just mean malicious people who just dislike you? You sort of alluded to the fact that you think that it’s just all misunderstanding?

Rachel Star Withers: I’m not going to say all of it’s misunderstanding. There’s horrible people all over the world who are going to believe whatever they want. But I’d say the majority of the people who’ve actually asked me the question, “Have you ever killed anyone?” They weren’t mean people. It was just kind of like someone who was genuinely curious and honestly didn’t know anything about schizophrenia really except for the media.

Gabe Howard: Once you do your humor thing and I agree with you I think that humor has a lot of benefits. It diffuses situations it makes people comfortable in a way. After that sort of dissipates and people are like OK now I’ve realized that accusing you of killing somebody or even thinking that can be really hurtful. Do good conversations come out of that and how do you handle those?

Rachel Star Withers: I usually like to follow that with actually people with schizophrenia are more likely to be the victim of a crime than to be committing the crime and people be like. “Oh really?” Like it that’s just kind of like oh they’re like completely kind of change their thoughts like I just had no clue. I’m like Yeah. So it’s a nice little segue into some fun learning.

Gabe Howard: When you say that people with schizophrenia are more likely to be the victim of a crime, do people believe you? Did they give pushback? Do they ask why that is?

Rachel Star Withers: No one in real life has ever challenged me on that, but definitely over the Internet. People write, “Well, that’s just stupid. I don’t see how that’s possible.” Or they’ll say well schizophrenics hurt lots of people. And I just say again that goes back to kind of not all of it’s ignorance is just refusing to want to look at facts and believe what is true.

Gabe Howard: I think that everybody in America understands why comforting lies are better than uncomfortable truths in the short term. I would rather have somebody tell me that I’m completely right and I don’t have to change. That’s really really easy. But of course you can’t grow and be open to new experiences and the danger of believing these things about people with schizophrenia is that you may be avoiding a diagnosis yourself because after all if you believe that all people with schizophrenia are violent and you think that you might have it, you’re thinking to yourself I’m not violent therefore I don’t have to go get help. You could think this about a loved one you could think Oh my God I’m really worried about my son, daughter, niece, nephew, brother, sister, or best friend but they would never hurt a fly. So I’m not going to get them a diagnosis. I’m not going to take them in . How does that strike you?

Rachel Star Withers: Back years ago the very first time I sat my parents down I tell them Look I have went to the doctor and this is what happened. I’ve been diagnosed with schizophrenia. My mother did not want me to tell anybody, like anybody. When I made the first video I did about schizophrenia she was mortified and she repeatedly was like, “You can’t talk about this, Rachel.” And she was so scared that I was gonna get kicked out of college, that no one would ever hire me, that people would be scared of me. Which is just, you’re never going to get married, you’re never gonna have a job, you’re never gonna finish school. All of those things weren’t real reasons for her to think that, it was just she was frightened of what that word labeled on me. You know what it would do when other people saw that label.

Gabe Howard: So she was more concerned about the reactions of the general public than she was about the illness that you were battling? That does add an extra layer though, right? If everybody thinks that you, and then by extension your family, are violent or dangerous or scary that makes it that much harder to get care. Because like you said, your family’s initial thought was OK how do we manage this information. It wasn’t, how do we manage the illness?

Rachel Star Withers: And I think whenever you have something like a mental illness versus a physical illness you know some sort of disorders and whatnot obviously run in families. But if you hear oh well that person their daughter has schizophrenia they kind of tend to think Oh I bet the whole family’s crazy. My parents never came out and said it. But I think they were worried that if people found out I had schizophrenia they were going to assume my brother did also. So I’m not only potentially ruining my life, but I could be ruining my little brother’s life because well she has it why doesn’t he?

Rachel Star Withers: And it is. It’s a very scary diagnosis to get. And if you aren’t used to anything with mental illness, you’re not used to hearing about bipolar, you’re not used to even hearing about depression, and then suddenly you got schizophrenia on the line. I feel like that can really scare a family.

Gabe Howard: Do you think that the number one reason that people are scared of schizophrenia is its link to violence in pop culture in the media and in the minds of the public?

Rachel Star Withers: Yes. I think it’s just, and I always say this, that schizophrenia it is just a scary sounding word. It has a Z in it. Like it just sounds like oh my gosh. It’s just so great. I have I’m writing in a movie like Oh man I’m gonna have the character say schizophrenic or schizophrenia and she’s automatically like whoa. And I’ll even have people try and combat me online and they’ll say well you’d understand because most crime and what not it’s caused by people with mental illness and you know you have to be crazy to go and do all these bad things. Yes I believe a lot of us just in the world, not a lot of schizophrenics, but a lot of people in the world we do suffer from different things. You know if you are in a relationship and you get your heart broken you’re probably going to have some depression. It might not be long term depression and it could be just related and it might have you know ease up after a few months but you’re going to go through some sort of mental situation that is not just optimal mental health. However when you have crime, I think an easy way to just explain it is say, “Oh, they were crazy. Oh, they had schizophrenia. Let’s ignore the fact that they were on drugs. Let’s ignore the fact that they’ve already shown issues with let’s say beating their wife and things like that now because they have schizophrenia.” There’s no other health issue that automatically is linked to violence the way mental illnesses are.

Gabe Howard: I have often postulated that one of the reasons that people are so quick to believe this is because extreme violence. I mean your mass shootings your you know even just murder in general. It is so far outside of the realm of what a typical person is comfortable doing. I understand why people are like well. Doesn’t that have to be mental illness? I mean taking somebodies life is extreme. I mean it’s just really really extreme. There has to be a component of mental illness in there, but that’s not actually what we’re talking about here. We’re talking about does schizophrenia make you kill people? Does it make you hurt people? Is there something innate about the illness that violence is a likely outcome? And that’s where it gets tricky right. Because nobody is saying that people with schizophrenia have never committed a violent crime. You’re just saying that the majority of people with schizophrenia have never committed a violent crime.

Rachel Star Withers: Yes. When you have people mental illness or you’re specifically talking about schizophrenia and you know the majority of us don’t hurt anyone. You’re like, “Well, Rachel, I mean but some of you do.” That still sounds scary. But not all husbands beat their wives. Some of them do but not all of them and that’s not going to keep me from getting married. That’s not going to keep me and or most people from finding a husband.

Gabe Howard: But when it comes to mental illness, we’ve decided that somehow that connects. That all violence is caused by people with schizophrenia and that connection just doesn’t exist in any study that’s been looked at and it’s kind of scary that people are so desperate to believe it. Why do you think that people want to believe this so much?

Rachel Star Withers: I think one of the main reasons is just being able to say somebody who did this horrible thing has mental illness. It makes you feel safer. OK. So I don’t know anyone personally like that so I can feel safe and if I ever met anyone like that I could obviously tell you know they’re like twitching and screaming and things. That’s the person I should be scared of. You know you hear these horrible stories of like a disgruntled employee who comes in and unfortunately does something you know very violent at the office. And a lot of times are like well so-and-so he was suffering from depression for so long. Well you know he was being treated by a psychiatrist. It’s never oh he broke his leg last year. You’d be like well what about him breaking his leg?

Gabe Howard: And even in the cases of schizophrenia the very very very tiny percentage of people with schizophrenia that do have a dangerous or violent outcome. They’re almost universally uncared for or untreated. They’re almost always left to their own devices with a very very very serious illness that isn’t being maintained or managed.

Rachel Star Withers: And many times that’s unfortunately being self managed by taking illegal drugs. So that plays a big part in it. Also we talk about mental health. Mental health is for everybody. Like that’s just a blanket term for all of us and too many people hear it and think oh well you only need mental health if something is wrong with your head. And it’s not. It’s working too much. You know that work life balance with your family. It’s being able to enjoy being out with people, like mental health is so many things. It’s not just dealing with disorders.

Gabe Howard: But to bring it back around to schizophrenia, another thing that comes up a lot is that people say that people with schizophrenia are trying to get away with the bad things that they do and there’s always sort of devolves into a not guilty by reason of insanity defense. That we can’t trust people with schizophrenia because after all, even if they severely hurt, attack, maim, whatever somebody they’ll just be set loose tomorrow because they’ll plead not guilty by reason of insanity and that’s why we have to crack down on this problem. How do you feel about that?

Rachel Star Withers: First I think I mean I watch tons of the judge shows. As you know I’m a huge Judge Judy fan although I rarely hear the insanity defense used on her show but still huge. Just love court dramas and whatnot and all the time we hear the insanity defense. OK. If you’re watching Law & Order as you like that’s a lot of the times what they end up going with. In reality though it’s not as common. It’s actually used in less than 1 percent of U.S. cases. So this isn’t something that’s constantly being thrown out is the insanity defense. Well, oh, I couldn’t have done this. Oh, I didn’t do this because of. It’s a very small percentage that actually used this defense. And of that it only has a 26 percent success rate and 90 percent of that 20 percent those people were already diagnosed. So it means that was somebody who already had a diagnosed mental disorder and something happened.

Gabe Howard: And to be clear those people don’t then just go home. They’re not back out in the community in the public. They go to state hospitals rather than prison.

Rachel Star Withers: Yes.

Gabe Howard: So the best outcome for a not guilty by reason of insanity defense is that you go to a state mental hospital versus state prison. So pop culture has sort of misled us on this one again where again I think that the average person believes that you plead not guilty by reason of insanity and then you go home and nothing happens.

Rachel Star Withers: Or I think though there I hear is oh they’ll go to like a hospital for a few months as if that’s it. Three months instead of a life in jail. Now it doesn’t work like that.

Gabe Howard: It is true that somebody may get out of a state hospital before they would get out of a state prison sentence for example. But it’s very very rare that it’s used. That’s number one. It’s not successful three out of four times. And when it is successful, it’s a very high threshold to be met. So that’s probably not the worst thing. As you said this happens all the time on Law & Order. It’s always the twist in that in the courtroom dramas et cetera. And maybe television isn’t the best place to get information about how life with schizophrenia works.

Rachel Star Withers: No. Going back to stigma being not knowing though most people don’t actively seek to learn. You know we’re given all this media and that’s just what they consume. So that’s what I believe to be true. It seemed like it was a really true movie I saw, they had like a judge. Seems right.

Gabe Howard: Let’s switch gears slightly. Everything that you just said was about fictional movies. You know you’re talking about you know your courtroom dramas and your reality TV. I mean stuff that I think the average person really should understand is fictional. But now let’s talk about media portrayals. This is the news. This is the evening news, the prime time news. This is expected to be factual. And one of the things that we hear about on the news all of the time, especially in the wake of some national tragedy, you know a mass shooting for example, is the term “paranoid schizophrenia.” This happened because of paranoid schizophrenia. It is almost a verbatim headline for many many examples of violence and schizophrenia.

Rachel Star Withers: Yes. It’s like if you have schizophrenia that’s bad, but paranoid schizophrenia? Well that’s just give up. That’s the worst. That’s also my official diagnosis. However they do not use those subtypes anymore. That was dropped in 2013. But as someone who has a piece of paper that says paranoid schizophrenic on it, it’s unnerving to me to hear it in the news because I feel like my heart drops every single time and you’ll hear them especially I always think of James Holmes. He was the guy with the the Batman movie went in and unfortunately shot up a theater and we all got to see him on TV and he had like orange hair. Not helping, OK. And he has this crazy look in his eyes and we find out he’d mailed out things to the school counselor and it was just like telling everyone he was crazy. He actually used the insanity defense and he was still found to be legally sane and he is someone who they’re flat I’ll say this guy was a paranoid schizophrenic. The court said, yes, but that didn’t cause him to do all this. So even though like that diagnosis is slapped on things there’s probably a lot of other diagnosis. We could probably also say he was depressed. We could probably also argue the fact that he just failed out of college, that pushes a lot of people over the edge. We could probably argue the fact that he was an extreme comic book nerd. Which as a comic book nerd also, I wouldn’t want to go down that route but I know like a whole bunch of it like a little basement people just gasped.

Gabe Howard: That was one of the things that came out during the media coverage. Just how much time he spent alone reading comic books and how much he loved the comic book culture and superhero culture. Yet Marvel movies are still wildly successful. The most successful comic book franchise ever because when people said that this one person consumed a lot of comic books and then was violent and committed a mass shooting in a theater people didn’t say oh well we have to be worried about all people who read comic books. No. People understood that that was this person’s story. Not everybody’s story. Again it’s not the same way people think about schizophrenia and as you said schizophrenic or schizophrenia, it sounds like a scary word. And then you put paranoid in front of it. Well we all know that paranoia is bad. You’re a paranoid schizophrenic and you can see why people are drawn to these stories. Here in a few moments we’re gonna talk to police officers about what they see because they’re the first responders for people who are having a crisis because of mental illness. How do you think that their comments are going to line up with how you feel? And as a person who lives with schizophrenia, how do you feel about the police? Knowing that in general society is blaming people with schizophrenia for large amounts of violence?

Rachel Star Withers: Well first I do want to make it known if you weren’t sure that I am a white female. I’m 5′ 7″ so taller than some women but yeah not like freakishly towering over everybody and all of my encounters with police for the most part have really been good. I’ve never had the police called on me over any issues. Really the only time I’ve called the police have been situations where things have happened, twice when someone was having a heart attack in front of me and I called 9 1 1 and they were not coming for me. They were immediately rushing in to save the guy both times. So it’s hard for me to kind of fully to fully express how I feel because I know so many other people have different interactions with the police and I’m very lucky that I have not been in situations where you know no one called the police on me as at hey there’s this crazy girl outside my house and she’s screaming up to the sky. My grandfather had Alzheimer’s and the neighbor, before it got we realized how bad it was. The neighbor called her boyfriend who was away at work and said I’m really scared. There’s an old man out here and he’s screaming at the house and he wants us to turn the lights on to the night sky. She was terrified and we are just very blessed that she called her boyfriend and the boyfriend immediately called us as opposed to calling police. And I can only imagine if they would’ve pulled up. My grandfather out there you know not understanding that the lights aren’t off, it’s just nighttime and we were able to calm him down. I know people rolling up to him as police officers would not have calmed him down. The 90 year old World War II veteran, I imagine he would have like dove in their fists up swinging. So I don’t want to just be like oh well it’s gonna be great for everybody because it’s not and I personally have not had a situation where I’ve been at let’s go with receiving end of the police being called on me.

Gabe Howard: Rachel, before we bring on our guest I just have one big big question to ask you. Have you ever been violent because of schizophrenia?

Rachel Star Withers: I have been violent. I have not ever been violent because of my schizophrenia. The closest I would say that had to do with my schizophrenia was as a teenager me getting just upset. Not really understanding what was going on, and my father trying to control me and not physically harm me in any way, but yes trying to physically control me. Like kind of grabbing me and me thrashing and becoming violent towards him. At that moment, again, not physical abuse really on either side, but I was just like me reacting to him grabbing me trying to control me where I was you know moving or radically screaming at the time he thought that’s what he needed to do. And then I flipped out even more. Those are the only times I can think of in my life where the schizophrenia and the violence was connected at all. I’m real big into boxing. I have an incredible amateur competitive record of 0 and 1.

Gabe Howard: But I don’t think when people consider violence they consider combat sports. The type of violence that we’re talking about, I mean I

Rachel Star Withers: Yes.

Gabe Howard: I know that you also wrestle alligators and you’re a stunt woman and you set yourself on fire. And I understand that you can make an argument that those are violent acts, I suppose. But I mean sincerely, have you ever flipped out at a mall? Have you ever started throwing things at people? Have you attacked a stranger? Have you ever been unable to control your own body in a way that was physically dangerous to those around you?

Rachel Star Withers: I have not. No. I’m 33 years old and it’s never been an issue for me and I don’t foresee it becoming an issue with me.

Rachel Star Withers: For our guest today we are excited to have a senior police officer Rebecca Skillern. Rebecca tell us a little bit about your training, your experience, what it is that you do.

Officer Rebecca Skillern: I am the senior trainer within the mental health division at the Houston Police Department and myself along with my two co trainers provide the crisis intervention training within our department and also to outside agency personnel.

Gabe Howard: Now the crisis intervention training I think a lot of people might be more familiar with its acronym C I.T. Can you explain when somebody hears CIT, to kind of what that means for a police department.

A large portion of what CIT means is that we provide specialized training for our personnel so that when they encounter people who are having mental health crises they can better and more humanely respond to those individuals so that we work to get them into appropriate treatment and care rather than criminalizing their behavior and putting them in jail which is not helpful to them.

Rachel Star Withers: I had no clue that a police department would have an entire section for mental health. Is that common with police stations or bigger cities?

Officer Rebecca Skillern: It is, I wouldn’t say common, but it is becoming more common. It is something that’s been in the making within our police department for going on three decades now and it’s something that we have built over the course of time. It certainly didn’t happen overnight. It’s something that smaller agencies are still working to establish and a lot of agencies both within Texas and outside of Texas are working to establish mental health units or sections within their departments to better respond and to also train their officers and other personnel so that they can keep them safer when they respond to these situations.

Rachel Star Withers: How is a mental health division, or crisis team of that sort, how is that a different response than let’s say a normal police response?

Officer Rebecca Skillern: Traditional police responses include kind of a fact finding mission you get in and you get the information you settle it and you move on and you get back into the calls or service loop and continue to respond to criminal activity. We work in a different world today where there are a lot of other elements that do not or should not involve making arrests when people go into crises for instance, people don’t pick up the phone and call their therapist they pick up the phone and call 9 1 1. You know, if a family member is losing control, and they’ve been diagnosed with a serious mental illness, even sometimes when they’ve not yet been diagnosed. But when things are getting out of hand people are calling 9 1 1 they’re not calling the local mental health authority, they’re not calling the person’s psychiatrist. They’re calling the police because they’re scared and they want help. What we’re doing with crisis intervention is we’re training police officers to better be able to recognize those situations for what they truly are. And in essence we refer to it as officer safety training because with officers being more educated about what they’re dealing with they are able to remain safer. They are also able to better de-escalate the situations and get the people who are in crisis into appropriate care and treatment rather than putting them in jail.

Gabe Howard: One of the things that you said is that you’re working to help decriminalize mental illness but you are still the police force. So I think it creates maybe some confusion in the community that hey if the police are coming and somebody has a mental illness, ipso facto a mental illness is criminal behavior. Can you talk about that a little bit because I know that the public can be very confused about what it means to live with mental illness.

Officer Rebecca Skillern: The public is very confused about what it is or what it is like to live with mental illness. Many of the people who have mental illness live their lives every day. They are managing their illness and they are doing what they need to do to take care of themselves. And there’s not a problem. Where it becomes a problem where law enforcement gets involved is when they’re not able to manage it as well as their counterparts and people get scared. The bottom line with law enforcement is we’re here to protect and serve. It’s not just about making arrests. It is sometimes protecting people from themselves and sometimes protecting people from their family members. We do get called when people go into crisis and we do respond to those situations because we are trying to protect the community. We’re trying to protect individuals from self injurious kinds of behaviors as well. And so we do get called for things like that and we do respond to things like that. We want officers to be better capable of handling those situations and to verbally de-escalate rather than having to engage in like hand-to-hand combat with people. We want them to be able to use their verbal skills. We also want them to be able to identify situations where they can get someone into a treatment regimen rather than into the criminal justice system. It takes a lot more and is much less economically responsible to try to treat someone in the criminal justice system. Then it would take or be to treat someone within the community.

Rachel Star Withers: Okay. I love that answer. Awesome.

Gabe Howard: Yeah. Thank you.

Rachel Star Withers: I have a question. I do have schizophrenia and that is what this whole podcast is about and I have different you know yes I have depressive types episodes that I go through psychotic episodes. So let’s say that I’m scared I’m going to hurt myself or I’m scared I might you know hurt somebody else and it’s a pretty intense feeling. And what would you suggest I do right away? What do you like what is my protocol for how I should react?

Officer Rebecca Skillern: If you are in imminent danger of hurting yourself or someone else, I would suggest that you call 9 1 1 and that you ask for a crisis intervention trained officer to respond to you. I would also encourage you to make sure that you are not near any kind of weapon and would want to make sure that when you do you let them know what you’re wearing that you don’t have any weapons that you respond well to if you respond well to a certain kind of approach let them know that as well. If you don’t respond well to a certain kind of approach let the call taker know that you know I need someone to come out here who’s not going to use loud voices. There’s someone who is going to be able to be calm someone who’s trained in crisis intervention would be ideal. I don’t have any weapons but I have thought of hurting myself and or someone else and I need help.

Officer Rebecca Skillern: When I was reading about the training and what you all do as far as like telling people how to prepare, I guess, for the police coming was to turn on all the lights in the house. I just thought that never occurred to me to do that. But yeah I could see that being really important because I’m usually creeping around in the dark and so I like to have the other lights low and I don’t. That’s just it never occurred to me. That was interesting right.

Officer Rebecca Skillern: It had the lights on. Make sure if you have any tests that you have them secured so the officers aren’t going to have to contend with that. It would also be important to make sure that you don’t run up to the officers and that when the officers approach they can see your hands so that they can make sure that there aren’t any weapons on your hands and feel confident with that. It’s sometimes easier said than done when you tell someone to please stay calm especially if they’re actively hallucinating and delusional. You know a lot of times there will be a theme with people who who experience psychosis that the government is out to get them. You know it’s real important to reassure yourself they’re here to help they’re here to help. They’re here to help. And to repeat that out loud to them sometimes too because officers, like anybody else, are human beings and they may become reactive if they’re caught off guard. I understand you’re here to help. Here’s what I need. Here’s what’s going on. You know please help me because I don’t want to act on this. I don’t want to do anything but you know this is what I’m thinking this is what I’m feeling. So just to be forthright with what there is and also to identify if you have a diagnosis to say I have a diagnosis and this is the medication I’m supposed to be taking and hopefully they will ask questions like, “When was the last time you had your medication? Have you had any breakthrough symptoms?” You know hopefully they will have been through the training and know the follow up questions to go through as well. But if they don’t be prepared to offer that information even if you’re not asked.

Gabe Howard: I really like of course all of this information and I think it’s all very very helpful. But as you kind of alluded to it it’s going to be a tall order for somebody who’s in crisis hallucinating and experiencing symptoms that are so intense that they needed to call 9 1 1. So it sounds like this involves training maybe the people that you live with or your family or your friends your support staff. Do you have any advice for how somebody living with schizophrenia can help their loved ones understand that it would be very beneficial that if they do need to call nine one one they say all of those things? Other than listening to this podcast.

Officer Rebecca Skillern: Right. We actually at the Huston Police Department we worked with our local mental health authority and we put together a mental health emergency assistance guide which is a one page form. One side is English one side is Spanish, and it gives basic information like this with the contact numbers but it also says when calling 9 1 1 here’s what you should do. And when law enforcement arrives here’s what you should do. The other piece is that I would highly recommend that family members be part of the treatment team, be part of that support system, learn about the illness. You know, attend NAMI, attend the family to family meetings to become educated themselves because oftentimes family members can be the biggest hindrance to getting the person help.

Rachel Star Withers: Oh yeah.

Officer Rebecca Skillern: And we encourage family members look if you have a family member who’s experiencing this in his or her life then become educated about it because it’s going to be a very important piece for you to help that person manage their situation. Help your family member by becoming educated, by knowing what to say when you call and ask for help by even the individual him or herself can write the basic information down on a piece of paper so that if they do go into crisis and a person comes to respond to a call a law enforcement officer response to the call they can hand them that piece of paper. They may not be able to communicate exactly what’s going on with them in that moment in time but if they have that piece of paper they can hand it to him and say, “Here, read this.” And it’ll give the officers some information about what might be going on with the person.

Rachel Star Withers: Got it. So.

Gabe Howard: Thank you thank you.

Rachel Star Withers: In our society unfortunately the term schizophrenia gets kind of thrown around a lot on people who necessarily don’t have it. We have all the issues obviously with school shooters and different things and then everybody who’s ever taken a psychology class suddenly can diagnose. People looking at all of that, I say in the media in general it’s made people really scared of the word schizophrenia and hearing that somebody has it. Do you think with all of your training that schizophrenics are responsible for all of this violence in society?

Officer Rebecca Skillern: Absolutely not. In fact that’s one of the biggest misnomers and one of the biggest things that kind of drives the stigma associated with mental illness is that people don’t know. In fact they’re ignorant. But ignorance is something we can educate and get rid of. People with mental illness are no more likely to be violent than the average person. In fact statistics show that people with mental illness are probably more likely to be victimized rather than perpetrators of crime. The stigma is one of the many things we work to try to educate amongst our law enforcement personnel so that we get rid of some of those false belief. Their false beliefs not based on fact. Thinking that people with mental illness are more violent than the average person is just something that’s clearly someone not being educated. The media does not do justice to mental illness because they do often portray people with mental illness to be much different than what the reality is. You look at movies like split or Shutter Island or something like that and people get this idea that someone with schizophrenia has to be completely out of it in order to be diagnosed with schizophrenia when that is just certainly not the case. More often than not people with schizophrenia or major depression or bipolar disorder can be productive contributing members of society given the opportunity and having the people around them who support them and learn to understand how the illnesses affect the person.

Officer Rebecca Skillern: Awesome. Thank you very much for that response.

Gabe Howard: That is wonderful. Thank you.

Rachel Star Withers: So I don’t live in Houston. How do I found out about my local law enforcement agencies protocol when it comes to a mental health crisis?

Officer Rebecca Skillern: I would recommend calling them call and find out. Do you have a crisis intervention team? Do you have a police and Mental Health Collaborative Program in helping train the personnel on your department in how to better respond to people with mental illness?  Is there an PMHC in essence? Is there a Police Mental Health Collaborative? Do your officers receive something beyond the basic mandated training or is it optional or is it mandatory for them to get fully trained in crisis intervention so that they can offer a more humane response to people who are living with mental illness?

Gabe Howard: Wonderful. I really like what you said about you know listen the police are there to serve and protect not just to track down criminals or arrest people. They’re there to help people who are in need. And that goes along with that. You know if you have a question about your local police force we should be empowered to call up and ask you know ask the question ask about CIT, ask about mental health training. Ask about the things that we need and if they don’t have it in your area you know advocate for those services because it’s probably a you found that it’s been vital that it’s been vital and helpful in Houston.

Officer Rebecca Skillern: Absolutely. And it’s a strong selling point to law enforcement agencies to help them understand that it’s just as much about officer safety as it is about keeping those in our community safe. Having the training so that an officer is better capable of understanding and identifying what they’re dealing with when they encounter someone is priceless. Having that available to your personnel, which keeps them from encountering situations you know full force hands on straight off the bat, and instead teaching them verbal de-escalation skills and how to pay attention to the signs and symptoms that may be visually present that they don’t recognize or they don’t understand because mental health is not traditional for law enforcement training and getting training around mental health issues is not something that is part of your standard law enforcement training protocol. Although, it should be especially in today’s world because more and more people are going into crisis and officers are the ones responding to those crises and it’s much better if they go in knowing what they’re dealing with then if they go in cold turkey not understanding it and just see it as a fight.

Officer Rebecca Skillern: Got it got it. Well I definitely have to thank you so much for coming and talking on our podcast today. Very awesome information. It’s really nice to know from somebody who has a serious mental health disorder. It’s nice to know that there are people working in the police department trying to, I don’t want to say. Learn more about me? But, you know, learn the best ways to address these different kind of crisis that might come up, right.

Officer Rebecca Skillern: Well, Rachel, I want to applaud you as well because you represent a very large portion of our community. It’s not just you. One in four people will experience some form of mental illness at some point within their lives. You’re not just a small portion or a token portion of our community you are our community as well.

Rachel Star Withers: Awesome.

Gabe Howard: Wonderful.

Rachel Star Withers: You make me feel all warm and fuzzy. Thank you.

Gabe Howard: You should, Rachel. You are incredible. Thank you so much for for being here and agreeing to do this and helping to get the word out.

Rachel Star Withers: We really appreciate you so much for coming and talking with us today it’s so rare that you get to talk to a law enforcement official like this and really kind of learn the other side of things, so thank you so much. That was really great for them to come on here and talk with us. Really giving us a side to the police and how they operate that you normally don’t get to see or know about.

Gabe Howard: It is true that a lot of people living with schizophrenia feel, a lot of people living with mental illness, feel fearful of the police so it’s wonderful when you know people like officer Rebecca can help us and talk to us and give us information so that both sides can get what they want which is for all of us to be safe. Which kind of leads me to a question that I have for you, Rachel. We talked about what police officers really need and want so that police officers can feel safe and get the best outcome. You know great information but as the person living with schizophrenia, what do you want to have happen? I mean other than the police not need to be called. But the police need to be called. A crisis has occurred. And you’re involved. Rachel, this is your only answer from yourself. What do you want? What do you want to have happen?

Rachel Star Withers: For me watching various you know we have so many people now that whenever there is a police altercation there’s someone somewhere filming it. Whether we’re saying you know someone’s chest cam on a police officer or just someone standing by filming the situation. And a lot of the ones that I’ve watched online I feel like that the officers come off very aggressive right off the start. Whereas if you’re already kind of mentally off and if you can tell this person may be causing a disruption but they aren’t like they don’t have a gun or a knife. They’re not actively hurting anybody is to come up a little bit calmer. I know that whenever I’m mentally off everything is more intense. So if you get mad at me I’m going to think it’s like 10 times worse than it is. If you’re hollering at me it’s almost like I can’t take it. The noise is so loud and I kind of freak out. When I was a teenager, it was just everything would become too much and I would be hallucinating. I would be getting confused and my dad would get you know angry not understanding this. And again, he grabbed me but I everything was just too intense. So I would just react. So a lot of it is just knowing to interact with somebody who is in a psychotic episode or a mental health crisis calmly. Just doing your best to stay calm.

Gabe Howard: You’re really a big proponent of de-escalation.

Rachel Star Withers: Yes. I’d much rather have someone calm me down and kind of back off away from me even but just kind of let the situation calm even maybe let it. I said get it out of my system because I’m not talking about a violent situation getting out of my system but just that energy okay and letting everything calm down for a second. It’s me I usually once everything else is calm I said sort of slowly start to kind of chill out to be okay. No one’s trying to hurt me, I’m safe. And if you’re out there and you’re thinking you don’t have schizophrenia or mental disorder you might be like, “Well, Rachel, you should have known you were safe or whatever.” But no, a lot of times I have my hallucinations I’m seeing very scary things. I’m hearing very confusing things and I don’t necessarily know that I’m safe. And if on top of that I got someone trying to grab me, it’s horrifying. So just being able to do whatever you can to just calm the situation. It works great.

Gabe Howard: It’s an interesting point that you just sort of raised there. You said you know I’m not calm, I’m not in my right mind, I’m in crisis because of schizophrenia. And then I have somebody try to grab me. Your exact words were, “somebody tried to grab me with everything that’s going on.” And you might just think that you’re in danger. You might not realize that it’s a police officer, or you might not realize that it’s somebody who’s trying to help you. And this is where we sort of get into the nuanced discussion about schizophrenia and violence because, for example, if a police officer tries to bear hug you to keep you safe, and then you punch that police officer, that will be seen as violence against a police officer or assault on a police officer. But from your perspective, from the perspective of somebody who’s not in their right mind, somebody who’s living with schizophrenia, you’re just trying to defend yourself and get away because you feel deeply deeply threatened. You’re not actually trying to harm a police officer in any way. Do you think that’s some of the misunderstanding when it comes to why people are so afraid of people with schizophrenia and why you may be accused for so much violence?

Rachel Star Withers: Yes on some level. Definitely not all of it. To kind of give you an idea though, I mean I’ve had times where I didn’t recognize my mom. So yeah, I totally might not recognize that this person dressed in all black, similar to my hallucinations which are usually black figures, is, you know, somebody good. All right I might not realize that this is a good person or this is a helpful person coming to assist me or assist those around me by helping me get under control. And I just might react wrong. That’s why I’m so glad we have these crisis intervention teams where police are learning to tell the difference between somebody who is actively violent trying to hurt others and then somebody who is in the middle of a mental breakdown and can’t understand what’s going on around them.

Gabe Howard: One of the things that we heard the officer say is that people with schizophrenia are in fact not responsible for all of the violence and in fact not even responsible for most of it or even a significant portion of it. As somebody who lived with schizophrenia how did that make you feel to hear the police acknowledge this?

Rachel Star Withers: When senior officer Skillern brought that up it makes me feel really good to know that not just advocates of schizophrenics, or people who work in mental health care. People with family and friends of schizophrenics are the only ones that are working to make a difference that it’s even the police officers that are working to make a difference in this kind of this issue alone. Violence in schizophrenia that they’re actually that hey we’re the ones who respond to the violence so we know firsthand and know it is not just about having schizophrenia is what makes somebody violent. When we were putting the show together I think when the most interesting things is when we’re looking for a police officer to speak with us. They came from Houston, Texas. I kind of was thinking maybe be a more liberal type state like California or maybe even like up in New York would have started this program or like a small town where yeah there’s not many of us. So it’s pretty easy. You know there’s only five police officers and only 20 people in the town. But this came from like Houston, Texas where you think of you know everybody gets a gun. Cowboys and Walker, Texas Ranger. And that’s really awesome because they see the value in it even while still being tough on crime.

Gabe Howard: I couldn’t agree more Rachel and I’d be lying if I said that I wasn’t surprised too. And it’s nice to know that crisis intervention training exists. And I really like what officer Rebecca said when she said, “Look the role of police is not to enforce laws. The role of police is to keep people safe.” And I think that’s a message that really needs to get out there more because I think when we’re talking about misunderstandings and the general public the role of policing and the role of law enforcement might be misunderstood as well. And I think it does come to the detriment at people with mental illness and of people with schizophrenia. So I’m glad that she was here.

Rachel Star Withers: Yes. She was awesome. This has been inside schizophrenia. Thank you so much for listening to us. Like, share, subscribe, and thank you for tuning in.

Announcer: Inside Schizophrenia is presented by, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at Co-host Gabe Howard can be found online at For questions, or to provide feedback, please email The official web site for Inside Schizophrenia is Thank you for listening and please share widely.

Inside Schizophrenia: A Look into Possible Links Between Violence and Schizophrenia

Rachel Star Withers

Rachel Star Withers is the host of the Inside Schizophrenia podcast, and a mental health advocate who lives with schizophrenia. She creates comedic and mental health videos and has appeared in numerous TV shows.

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APA Reference
Withers, R. (2020). Inside Schizophrenia: A Look into Possible Links Between Violence and Schizophrenia. Psych Central. Retrieved on December 4, 2020, from
Scientifically Reviewed
Last updated: 20 Jun 2020 (Originally: 19 Jun 2019)
Last reviewed: By a member of our scientific advisory board on 20 Jun 2020
Published on Psych All rights reserved.