Searching for people with a psychiatric illness

Bushwalkers Search and Rescue is from time to time involved in searches for people with psychiatric or other medical conditions that can effect behaviour, who are missing in remote bush areas. Such conditions include schizophrenia, depression, autism and the intellectually impaired.

The elderly may also suffer from dementia, which can lead to varying degrees of confusion and memory loss. Confusion and disordered behaviour may result from many medical conditions. For example in epilepsy, the person may be confused in the period after a seizure (usually around 30-45 minutes). Diabetic patients, with low blood sugar level may become progressively more confused, and eventually lapse into coma.

Any person, particularly the elderly, who is unwell, not thinking clearly or confused, may be at increased risk of falls and the risk of head injury. In this way the primary condition the person suffers from, may be followed by secondary "insult". The medical conditions described above will be of significance in a search: The underlying condition may have directly contributed to the person becoming lost in the first place.

  • The underlying condition may lead to unpredictable or unusual behaviour by the lost person.
  • The search strategies will need to be varied accordingly.
  • The rescuing party may need to consider a flexible or tailored approach to the lost person when they are initially approached and in their subsequent care during rescue.

This article addresses the last point; how a search party can best support the lost person once found. The lost person may be extremely fearful. Confusion may lead to the person being fearful. Memory loss in the elderly may be a source of confusion and anxiety. Schizophrenia and some other psychiatric conditions may be associated with irrational beliefs and delusions. The exact nature of such beliefs varies enormously and should be sought from the family and doctors who know the lost person best.

Some beliefs may lead to paranoia and fear relating to specific persons or groups eg the "CIA", the "government", Police. The very actions of search parties; regimented movement through the bush, loud calling of a name, the wearing of uniforms or bright pack covers, the use of two way radios, an assertive style of leadership and conduct and typically with the helicopters overhead could well confirm the worst fears of a delusional individual. This may result in great distress, panic and fear.

Health professionals who deal with people who are confused, very fearful or delusional have well developed strategies designed to calm, reassure and achieve cooperation.

Any rescuing party should consider such strategies. In general, the rescue party's communication with and behaviour towards the lost person may need to be varied according to the particular circumstances. Searchers should be provided with some guidelines, which help them to cater for each situation. Examples of the ways searchers might modify their approach to the lost person include:

  1. Be aware that a paranoid or delusional person may view your actions with suspicion. A calm, reassuring, non-confrontational approach is required. Fearful people need to feel safe, and the way you conduct yourself and your communication may provide extra reassurance to the fearful person. Introduce yourself and greet them in a non-threatening manner. Allowing them to feel that they are still in control, and reassuring them that "I am only here to help" or "How can we help you?" may assist. Rapport may be best established between one member of the rescue party in particular, rather than the group.
  2. Buddy the person along, make them feel in control and part of the decision making. Have a drink of water, or eat some food, and say, "Would you like some?" "We are having a rest here, would you like to sit with us?" "We are thinking of walking up the hill to a track, how about you come with us?"
  3. Be non-threatening and calm. Avoid confrontational or threatening communication and similarly stay a distance from the person that is comfortable and safe for both them and you.
  4. Under advisement only, it may be appropriate to hide the accruements of search organisation and operation: radio operator keeps away, uniforms covered or pack covers off, request helicopters to keep away. Act like a group of friendly bushwalkers who just happen to be in the area.
  5. Bushwalkers Search and Rescue would not be asked to search where there was known to be the likelihood of violence. Nevertheless, searchers should be alert to the possibility of violence to themselves or others. If the lost person appears to be increasingly agitated, aggressive or utters threats to themselves or the search party, then "back off". Violence usually only occurs after warning signs of increasing agitation and aggression.

These notes demonstrate how the structures and processes of a search and the well meaning enthusiasm that inevitably accompany the finding of a lost person may need to be carefully tempered to take into account any medical conditions of the lost person.

Dr. Jenny Brookes Emergency Physician