Austin Police Department

Austin Police Department

Austin Police Department Senior Police Officer James Turner 10 ½ years with Austin Police Department 5 ½ years with the Crisis Intervention Team Unit Recipient of the Austin Police Department s Superior Service Citation Award (10/13) for services rendered with the CIT Unit. Bachelor of Science-Criminal Justice from the Texas State University

This training was created to briefly familiarize you on: Aspects of Crisis Intervention Mental Illness Facts Personal safety Safety Concerns, at the office or at a residence De-escalation and Communication Techniques Know your resources Community Collaboration Positive outcomes

What is Crisis Intervention?

Crisis Intervention Crisis Intervention is emergency psychological care aimed at assisting individuals in a crisis situation to assist in restoring them to their equilibrium. Many people are involved in crisis intervention: Family and Friends Crisis Hotline Counselors Law Enforcement Hospital: Emergency Room or Psychiatric Social Workers and Counselors Psychiatrist and other Physicians Officers of the Court: Judges, lawyers, etc.

What does a mental health crisis look like? ANYTHING

Examples of possibly crisis: being locked out of the house losing a job being a victim of a crime visited by your probation officer large crowds waiting in line public settings family arguments cell phone issues Anyone can suffer from a crisis and its effects can vary with time, place, and person.

4 parts of a Mental Health Crisis

4 Parts of a Mental Health Crisis 1. A situation that is stressful, disturbing or alarming. 2. Observable signs of a possible Mental Illness or other conditions that affect the mind (ie, Autism, Dementia, etc) 3. A possible Safety concern of some type(harm to self/others or deterioration) 4. Need for some form of Intervention (counseling, arrest, forced psychiatric treatment, referral to out patient treatment) 9

Crisis Incidents Most often people are not prepared or understand what to do in these situations Crisis incidents are exciting, alarming, confusing, and could be out of control. In crisis, reason takes a back seat to emotion, even when one does not have a mental illness

What is considered a Mental Illness?

Legal Term; Texas Health and Safety Code 571.003 (14) "Mental illness" means an illness, disease, or condition, other than epilepsy, dementia, substance abuse, or intellectual disability, that: (A) substantially impairs a person's thought, perception of reality, emotional process, or judgment; or (B) grossly impairs behavior as demonstrated by recent disturbed behavior.

Professional Definition of Mental Illness: Mental illness is diagnosed based on behaviors and thinking as evaluated by a psychiatrist, psychologist, licensed professional counselor, licensed social worker, or other qualified professionals using a tool known as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, most commonly called the DSM-V. 13

Common Conditions that Affect the Mind Encountered in a crisis Mental Illnesses: Schizophrenia, Bi-Polar Syndrome, Anxiety Disorders, PTSD, OCD, Depression, Mood Disorders, Personality Disorders, Etc Other Conditions That Affect The Mind: Autism, Development Disorders, Dementia, Alzheimer s, Substance Abuse factors, Excited Delirium Syndrome

What Does Mental Illness Look Like? 15

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Are there Visible signs that a person has a mental illness?

Visible Signs Mental illness usually can not be detected by the human senses; seeing, hearing, smelling, tasting, feeling. But in rare and serious cases there may be clues or hints that a person is having a mental health crisis.

Possible Signs or Symptoms

Possible Signs or Symptoms Visible Anguish: crying, sobbing Anxious, unreasonably nervous: twitching, jumpy, startling easily, Difficulty concentrating or making decisions Paranoid statements or beliefs Talking to oneself Looking from side to side Abnormally high, low or irritated mood More talkative than normal Inappropriate or bizarre dress Flight of ideas or feeling of thoughts racing

Possible Signs or Symptoms Body movements are lethargic or sluggish Impulsive or repetitious body movements Responding to hallucinations Thoughts of hurting oneself or others Home environment: strange decorations pictures turned over waste matter/trash on floors and walls Lack of interest Low energy Excessive risk-taking

Visible Signs or Symptoms Remember: Individuals having such visible signs are the exception and not the norm Most people who have a diagnosed mental illness manage their condition without having a crisis or need for intervention Its recommended to continually educate yourself on other aspects and information pertaining to mental illness

How does the media portray the mentally ill?

Reality

Destigmatizing Mental Illness People with mental illness are more likely to be victims than perpetrators of violence - National Institute of Justice Only make up 4-13% are perpetrators of crime They are 140 times more likely to be victim of theft 3 million are estimated to be victimized each year There is an 11-times-higher risk for them than for the general population to be victimized 33

Destigmatizing Mental Illness The public tends to be surprised by these findings, due to the stereotype that people with a mental illness are dangerous. Violence among this population is caused by many of the same factors that produce violence in the rest of us. People become violent when they feel threatened, when they feel out of control, or with the excessive usage of mind-altering substances. 34

Mental Illness: Growing concern In our community

Growing Concern In our Community

Growing Concern In our Community

Crisis Incidents can have Safety Concerns

Personal Safety

Personal Safety Know your department s policies and training: Many organizations require that their employees never be involved in a physical altercation and even reprimand those who do. Walk away policy Speak with a supervisor or your Human Resources representative if not clear on your companies policy

Personal Safety Put the situation into perspective: Why are you there? Is there an emergency? Is your presence causing the crisis? Do you need assistance? What are your authorities? Can your contact be delayed to another day? Does the person understand you? Do not escalate the situation with your actions.

Personal Safety REMEMBER YOUR SAFETY COMES FIRST! You can not do your job properly if you get injured If someone is in a mental health crisis they may not be aware of the actions or the repercussions of their decisions. When in doubt WALK AWAY AND CALL FOR HELP!

Personal Safety When in doubt CALL 911 EMS, law enforcement and mental health personnel are often better equipped to intervene in these incidents.

Remember Know your department policies and procedures for personal safety Take the situation into perspective When in doubt: Walk Away and Call for Help

Crisis Scenes, Environment Hazards

What are some possible hazards found in homes?

Look for Clues for personal safety Be observant: What signs or indications are there that the subject may be suffering from a mental illness Writings or books; Final Exit Condition of the home Where in the house are you making contact with your client? (Kitchen, garage, bedroom, etc)

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Look for Clues for personal safety Are there observable weapons in the residence: Guns Knives Razor blades Bats and clubs (golf clubs) Tools

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Look for Clues for personal safety Weapons: Don t be afraid to ask; Do you have any weapons? Could you put them away from me? Express your desire for a safe setting for you to speak and if you have concerns explain it to the person Express your feelings: I don t feel safe with your weapon in the room You are making me feel nervous. Can we move our conversation to another location of the residence or speak outside? When in doubt: WALK AWAY AND CALL FOR HELP

Look for Clues for personal safety Know your environment: Pad locked doors around the residence Bug infestations Hoarders Covered windows Other bizarre or out of the ordinary decorations or items

What are some possible hazards found in your office?

Office Hazards Crowds: Persons experiencing a mental health crisis may not react well to crowded areas Possible signs: Nervousness Sweating Agitation Difficulty answering questions

Office Hazards Know your Environment: Be aware of exits Remove items that could be used as a weapon Development procedures and plans with other co-workers in case of an emergency Know your resources and services in the community for this population Always have a plan for when a crisis occurs

De-escalation and Communication Techniques

The Crisis Cycle

The Cycle of Crisis Behavior A person can suffer from a temporary breakdown in coping skills that includes perception, decisionmaking and problem solving abilities Different depending on individual response. Anyone can suffer from a crisis and its effects can vary with time, place and person As an individual enters into a crisis situation, their response enters into fairly predictable stages.

The Crisis Cycle 1. Onset: An incident or occurrence causing a person to become excited, active, upset or physically uncomfortable. Cause or stimulus could be: External: Words or behavior of another person The environment (crowded, cold/hot) Internal: Physical illness or pain Emotional upset Mental illness (internal stimuli)

The Crisis Cycle 2. Escalation and Anger: Obvious signs of distress and observable changes (physically and behaviorally) begin to occur Red face Tense muscles (tight face, clenched fists) Talking more and/or louder or quiet and withdrawn Increased activity (pacing, rocking, etc.)

The Crisis Cycle 3. Out of control behavior: Aggression Screaming and yelling Throw or hit things Assaultive actions Does not have to be violence

The Crisis Cycle Important: Interruption in the cycle can occur at any stage. However, when they begin to de-escalate, their comprehension remains impaired. If they are provoked, they can quickly re-escalate to the crisis stage.

Communication is Key During a Crisis

L.E.A.P.S. Listen, empathize, ask, paraphrase and summarize ( L-E-A-P-S ) 85

Strategies for Communicating

Strategies for Communicating in a Crisis Situation Stay calm - breathe deeply to become calmer Be patient - avoid crowding the individual, give them time to calm down Double-check information by restating what you hear Use the individual s name in talking to them 87

Strategies for Communicating in a Crisis Situation Give instructions or directives one at a time, and allow time for the person to comply The size and age of a person with mental illness has little to do with whether or not a person can become a safety concern for all involved Remember that a person with a mental illness may exhibit extraordinary strength 88

Strategies for Communicating in a Crisis Situation Engagement is pivotal - keep trying Don t underestimate the power of hallucinations or delusions - they are real from the individual s point of view and can be very frightening, so try to be understanding Never argue about a delusion, since arguing only solidifies the conviction - simply accept and move on 89

Strategies for Communicating in a Crisis Situation Ask about treatment in the past - sometimes that can help with offering potential solutions to the current situation Remember that psychiatric medications have side effects that make them hard to take Don t express disapproval Persons in mental health crisis need more personal space - watch for cues 90

Four Effective Communication Skills When Interacting With Persons With A Mental Illness 91

Four Effective Communication Skills When Interacting With Persons With A Mental Illness 1. Safety - Your personal safety comes first. Control the surroundings. Remove harmful obstacles from the surroundings if possible. 92

Four Effective Communication Skills When Interacting With Persons With A Mental Illness 2. Crisis facts - The person in distress is usually excited, alarmed, or confused. Control is very important to persons in crisis. When people feel cornered, which translates to lack of control, they may respond with sudden violence. 93

Four Effective Communication Skills 3. Language: Use the person s name. Talk quietly. Speak firmly. Use a calm tone of voice. Avoid direct confrontation. Avoid labels and acronyms. Limit the number of instructions, and give them one at a time. Be patient and consistent. Reactions and verbal responses may be slower than you expect. 94

Four Effective Communication Skills When Interacting With Persons With A Mental Illness 4. Movements - Be aware of body movements. People in crisis often need more physical space. If possible, position yourself at or below the individual s eye level. Keep all movements slow and deliberate. 95

Helpful Hints: Ask the person about available supports, e.g. clergy, family, therapist, doctor. Don t be afraid to reveal your own emotions, e.g. Mr. Smith, you re making me nervous. Introduce yourself clearly. You may need to re-introduce yourself, as well. Try to find ways to establish trust. Keep your own emotions under control. Allow ventilation. Reassure, but be realistic, don t lie. Listen actively. 96

The scene is safe.. now what do you do?

Know your Resources

Resources There is help out there for you in the community No one can do it all on their own. Collaboration and resources can assist you.

Resources Who is your local mental health authority? Find your local mental health authority and inquire about resources they have in your community that can be utilized by you (ie clinicians, counselors, doctors, outreach teams, treatment options, etc)

Resources Who is your local law enforcement agency? Does your local law enforcement agency have a Crisis Intervention Team/Mental Health Program? Do you have a relationship with them? What are their authorities and procedures to assist you? When in doubt call 911.

Community Collaboration

Community Collaboration Collaborations improve your employees response to a crisis Builds bridges between different organization s resources and duties Assist you with your clients (treatment options) Greater level of care for those suffering form mental illness

Positive Outcomes

Positive Outcomes Working together with resources in the community will create better outcomes for the population you service Other Organizations could assist with training your personnel: Mental Health Safety Training De-escalation Referrals

Building Bridges Constructing relationships builds bridges of understanding and cooperation Speak with your department leaders and inquire about what can be done to better you and your organization

Lets Review

Remember We all have the possibility of encountering a person in a mental health crisis Relay on your training and department policy Stay calm and utilize de-escalation techniques like those discussed in this training Help those in need: refer or request help

Questions? APD CIT Unit 512-854-3450