Transcript Getting to the Emotional Truth: The Complex Connections

The Knee is Connected To
The Thigh Bone:
The Complex Connections
between Law Enforcement
and Mental Health
Darin Nelson LIMHP, LADC, IADC
Director of Crisis Response Services
Heartland Family Service
302 American Parkway, Papillion, NE. 68046
Phone: 402-552-7079
Fax: 402-339-4358
E-Mail: [email protected]
Website: heartlandfamilyservice.org
“Suicide is man's way of telling God, 'You can't
fire me - I quit!”
― Bill Maher
“Living is much harder than dying”
Ryan’s Story
Session Objectives
• Identify key concepts of MH/LE interactions.
• Understand individual and community
reactions
• Apply individual and LE intervention
strategies.
“They are coming to get me”
Susan’s Story
Law Enforcement Definition
Noun:
Ensuring obedience to the laws; enforcement - the act
of enforcing; ensuring observance of or obedience to
law, jurisprudence - the collection of rules imposed by
authority; "civilization presupposes respect for the
law"; "the great problem for jurisprudence to allow
freedom while enforcing order"
Mental Health Emergency Definition
A mental health emergency is when an individual's mental or
emotional condition results in behavior that constitutes an
imminent danger to that individual or to another person.
Emergencies require immediate attention. The following are
indications of a mental health emergency:
• (1) suicidal intentions, plans, or attempts;
• (2) homicidal intentions, plans, or actions;
• (3) loss of contact with reality, which may include
hallucinations, delusions, or extremely abnormal behavior
causing a campus disturbance or disruption;
• (4) disorientation, extreme confusion, unresponsiveness,
uncontrolled behavior, extremely irrational or incoherent
speech.
THE FINE LINE
How do two diametrically opposed professions
come together and work toward the best
interest of an individual?
CIT in the Omaha Area
In Omaha, a Crisis Intervention Team (CIT) model was
developed and adopted as a cooperative community
partnership involving law enforcement agencies, mental
health service providers, mental health consumers, family
members, and community funders.
Through participation in this program, CIT police officers
learn to recognize common forms of mental illness and to
utilize the most effective means of communicating with
people undergoing crisis. The officers are trained to deescalate the individuals in crisis and allow the consumer
to participate in the decision-making regarding their
treatment.
CIT in the Omaha Area
CIT officers must successfully complete 40 hours of
training to become certified. Training is provided by
consumers, family members, mental health providers,
law enforcement, and county attorneys and involves
not only classroom exercises but also panel
presentations, site visits, and scenario based training.
Participation on the CIT team is voluntary and officers
must apply to be chosen.
CIT in the Omaha Area
Since March of 2006 participants from the Omaha
Police Department, Douglas County Sheriff, County
Corrections, 911 Dispatch, Boys Town Police
Department, Papillion Police Department, Bellevue
Police Department, and Plattsmouth Police
Department have been trained and certified in the CIT
model. Citizens in need of assistance can request that
a CIT trained officer be dispatched when calling any of
the departments listed above. CIT officers are easily
identifiable to members of the mental health
community as they wear a distinctive CIT pin on the
right lapel of their uniform.
Our Story - History
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Baseline Statistics
Purpose
Funding
Philosophy
Goals
Infrastructure
Philosophy
Integrating mental health staff with Law
Enforcement personnel will optimize access to
appropriate resources and reduce stigma for
those seeking treatment, as well as reduce
unnecessary incarcerations and Emergency
Protective Custody situations. The service allows
for complimentary utilization of the strengths of
mental health, law enforcement and/or medical
professionals.
Multiple Agencies in the Omaha Area
Alegent
Brief Statistics
• In the last 4.5 years, over 2,000 individuals
have been assessed by the MH/LE teams.
• 95% did not have to be hospitalized.
• PRIOR TO THE PROGRAM, 100% would have
been hospitalized to “Liability” concerns
The Journey
How LE and MH teams combine skills
Common Utilization of
Crisis Response Teams
• An officer doubts the need for an EPC.
• An officer thinks there are alternatives to
EPC, but is unfamiliar with them.
• The individual does not qualify for an EPC,
but needs assistance.
• An officer wants a consultation on a possible
EPC.
Individual Reactions to Crisis
• Thoughts, feelings, dreams, and memories
associated with the event
• Grief and Sadness
• Fear and Anxiety
• Frustration, Anger, and Guilt
Community reactions to crisis
• Increase in preparedness activities
• Resurgence of media and political attention
• Community solidarity or discord
Law Enforcement Call Response
“getting there is the first step”
– Lt. Chris Whitted, Papillion Police Dept.
• Exigent Call
• Normal Call
• FOCUS – Timely/Safe Response
Mental Health Call Response
• Mobile crisis response to scene in the
community.
• FOCUS – Timely Safe Response
Law Enforcement Initial Assessment
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Can I get in
Are there any weapons
Is individual alone or not
Is their agitation or not
Any suicide by cop
Who are the players involved
Where is the best place to talk
FOCUS – Community Safety
Mental Health Initial Assessment
Mental health assessment is a process that involves
the integration of information from multiple sources,
such as personal and medical history, description of
current symptoms and problems, and sometimes
other information such as psychological test results.
All mental health professionals do some level of
assessment when providing services to clients, and
may use checklists or inventories to assess traits or
symptoms.
Mental Health Initial Assessment
The interview during the first meeting with a mental
health professional is structured to gain information
used for assessment. Assessment is also an ongoing
process. The aims of assessment are to provide a
diagnosis, to determine an individual's level of
function or disability, to help plan and direct the
appropriate services, and to measure the outcome of
the services or treatment intervention.
FOCUS – Individual safety
Law Enforcement – Processing Situation
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Behavior
Suicide attempt in progress
Weapons involved
Statement of suicide to dispatcher.
• FOCUS – Community Safety
Mental Health – Processing Situation
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Behavior
Mental Health
Suicide/Homicide Ideation
Risk Factors
Protective Factors
FOCUS – Needs of person in crisis
“Fence Walkers”
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Refusal to speak
Drugs/Alcohol involved
Depression verging on suicidal
Bizarre behavior
Statements of family regarding unseen
behavior
• Others
Performing the Assessment
• Conducting the Interview
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History: personal & familial at risk behavior
Predisposing vulnerabilities
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Depression; substance use; other mental health
diagnoses
Any means & plans the client may have about
carrying out the risk behavior
Controls: internal & external that are stopping the
client from undertaking the risk behavior
Precipitating factors
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Conflict; break-up of relationship; health crisis
Performing the Assessment (cont’d)
• Observations during the Interview:
• Level of anxiety; desperation; despair; sense of
hopelessness; contact with reality
• Appearance & behavior (neat/dirty, attitude
toward officer, nervous mannerisms)
• Thought Content (preoccupations, delusions,
suspicions, paranoia, nonsensical thought)
• Manner of speech (easy, reluctant, silent,
confused, pressured)
Performing the Assessment (cont’d)
• Observations (cont’d):
• Perceptual abnormalities (visual, mental, tactile,
auditory or olfactory hallucinations;
depersonalized or perceptual realities)
• Affect-prevailing emotional tone (happiness,
sadness, anxiety, flat affect, suspicion)
• Concentration
• Cognitive-intellectual functions (alert, drowsy,
confused)
Performing the Assessment (cont’d)
• Protective Factors (or contraindications)
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Coping skills; hopeful attitude toward the future;
strong social support or connectedness
• Focusing is the most essential skill & technique at this
stage, while allowing the client to express the
overwhelming flood of emotions.
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Focusing technique can elicit more coherent
information for assessment, as well as, help the client
pull themselves together cognitively and emotionally.
A focused interview can serve as a instrument of both
assessment and intervention.
“If I had no sense of humor, I would long ago
have committed suicide.”
― Mahatma Gandhi
Gather Baseline Statistics
Sarpy County Nebraska:
– From 2006 through 2008 there was a 400%
increase in Emergency Protective Custody.
– All were hospitalized.
This was the result of very involved policing with
concern for obtaining assistance for citizens in
need.
Define Program Purpose
• Assist Law Enforcement in assessing the
needs of a citizen immediately
following/during crisis event.
• Assist in supporting needs of the citizen and
Law Enforcement immediately following crisis
event.
• Assist in providing crucial referral information
& 24 hour follow up support to the citizen.
Goals of Crisis Response Teams
• To respond to individuals in their community,
and provide immediate crisis response.
• To utilize the least intrusive, most effective
intervention to provide immediate support,
information and referrals, and facilitate
problem-solving to assist in the alleviation of
a mental health or psychiatric crisis.
Program Implementation
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Law Enforcement Engagement
External Training
Internal Training
Challenges
Successes
Engaging Law Enforcement
• Law Enforcement Professionals provide up to
1/3 of all emergency mental health referrals.
• They interact with more persons with mental
illness than any other occupational group
outside of the mental health field.
• They are often the first to respond to a
mentally ill person in crisis, yet, in general,
their training in mental illness is limited.
Law Enforcement:
The Biggest Stakeholder
Address their concerns to ensure buy-in.
• Liability regarding safety of person in crisis.
• Response time – time saved by Crisis
Response Team.
HFS Crisis Response Teams provide 4 hour
trainings to all Law Enforcement Agencies in
the counties served.
External Training
• Trainings offered to referring agencies to
provide general information about working
with those with mental illness.
• Basic assessment skills are taught to
recognize warning signs of suicide.
• Dispel myths and familiarize front line
workers with issues surrounding crisis
intervention and mental illness.
Program Assessments
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Define Crisis and Crisis Theory
Define Crisis Intervention
Assessment
Evaluating Risk
Suicide Assessment
Common Situations Encountered
• A family member, friend or other concerned person
calls the police for help during a psychiatric
emergency.
• A person with mental illness feels suicidal and calls the
police as a cry for help.
• Police Officers encounter a person with mental illness
behaving inappropriately in public.
• Citizens call the police because they feel threatened
by the unusual behavior or the mere presence of a
person with mental illness.
• A person with mental illness calls the police for help
because of imagined threats.
Crisis Intervention Approaches
The exact nature of the intervention will depend on
the client’s pre-existing strengths & supports.
• Affective:
• Expression and management of feelings
involving techniques of ventilation,
psychological support and emotional catharsis.
• Cognitive:
• Helping the client understand the connections
between the stressor event and their response.
Crisis Intervention Approaches
• Cognitive (cont’d):
• Techniques include clarifying the problem,
identifying and isolating the factors involved,
helping the client gain an intellectual
understanding of the crisis.
• Also involves giving information, discussing
alternative coping strategies and changing
perceptions.
Crisis Intervention Approaches
• Environmental Modification:
• Pulling together needed external,
environmental resources (either familial or
formal helping agencies).
Any and all 3 approaches may be used at any
time, depending where the client is emotionally
and cognitively.
Suicide Assessment
• Components of Suicide Assessment:
• Appreciate the complexity of suicide – multiple
contributing factors.
• Conduct a thorough psychiatric examination,
identifying risk & protective factors and
distinguishing between risk factors that can be
modified and those that cannot.
• Ask directly about suicide.
Protection Against Suicide
Green Light…Good to Go!
• Protective Factors – Factors that make it less
likely that someone will commit suicide.
• Getting help for mental, physical and substance
abuse disorders – especially depression
• Restricted access to highly lethal methods of
suicide – especially firearms
• Family and community support
• An established relationship with a doctor,
clergy, teacher, counselor, or other professional
who can help
Suicide Risk Factors
Yellow Light…Proceed with Caution
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Psychiatric Disorders
Past History of Attempted Suicide
Genetic Predisposition
Impulsivity
Demographics:
• Sex: Males are three to five times more likely
to commit suicide than female.
• Age: Elderly Caucasian males have the highest
suicide rates.
Suicide Warning Signs
Red Light…Stop the Suicide!
• Talking, reading, or writing about suicide or
death.
• Talking about feeling worthless and helpless.
• Saying things like, “I’m going kill myself,” “I wish I
was dead,” or “I shouldn’t have been born.”
• Visiting or calling people to say goodbye.
• Giving things away or returning borrowed items.
• Self destructive or reckless behavior.
• Significant change in behavior.
Challenges Faced by
Crisis Response Team
• Assessing clients under unusual circumstances (i.e. in
jail, with officer in room, on the side of highway).
• Changing Police Procedures.
• Criminal Justice Mindset vs. Therapeutic Intervention.
• Dangerousness of Scene – when assessing and
responding to non-law enforcement agencies.
• Educating Law Enforcement about those appropriate
for Emergency Protective Custody due to mental
health deterioration.
Challenges of Growth
Heartland Family Service Crisis Response Teams respond
to:
• Law Enforcement at crisis scene
• Casinos
• County Jails
• Homeless Shelters
• Heartland Family Service
• Juvenile Justice/Detention Center
• Juvenile Court Services
• Public Schools
• Residential Correctional Facility
Successes
• The Program began in 1 county and is now
serving 3 counties.
• The Program originally employed 1 FTE and 6 oncall staff. Currently there are 3 FTE and 11 oncall staff.
• The program has expanded from 5 law
enforcement agencies at the beginning to now
responding to 11 Law Enforcement agencies, 2
juvenile detention centers, 3 county jails, 131
schools, and 1 post-prison release residential
center.
Successes (cont’d)
• In June 2012, the Crisis Response Team
responded to its 2000th assessment call.
• 95% of the individuals that were assessed were
found to not to be in need of hospitalization.
• The estimated cost of serving those 95% of
people in a minimum 3-day forced
hospitalization would be 6 million dollars. This is
a substantial savings to the county and state. It
also is a reduction of further trauma to the
person in crisis.
Why the Program Grew so Quickly
• Increased safety to the person in crisis.
• Decreased trauma to the person in crisis.
• Increased information available to Law
Enforcement to make decision regarding
EPC’s.
• Decreased amount of money the county and
state are paying for hospitalizations.
Thank You!
Questions & Answers