Crisis Intervention Teams & Police Interactions with People with Mental Illness: Evolving Tactics That Make a Difference

It was a crisis call that may well have ended in tragedy. Police responded to an incident at a group home and a group home worker answered the door with a knife in hand. Police reached for their guns.

"Once guns are drawn, things happen fast," Cops understand this very well!

Due to sound judgment by the responding officer(s), and the full cooperation of the group home worker, who quickly realized that grabbing the knife of the counter in an effort to keep it away from the person in crisis may have led to tragic unintended consequences, no one was hurt in this incident, but it served as a catalyst to change the way this police department respond to mental health crisis calls.

Beyond group homes, mental illness impacts people throughout the community, from youth to the elderly.” Police respond to mental health calls every day and they need to know what's out there for resources. One of the those resources is The National Alliance on Mental Illness (NAMI), which, I learned about several years ago while taking a crisis intervention training class with the Taunton Community Crisis Intervention Team. Taunton’s team has been involved in crisis intervention teams and collaborations for more than 20 years. About 3 years ago they and NAMI Massachusetts launched a program called the Community-to-Community Mentoring Initiative (CCMI). The program helps towns and cities bring together local agencies and develop a coordinated and comprehensive response to mental health crisis calls.

Taunton Crisis Intervention Team put us through a SWOT Analysis. The SWOT Technique is a method of analysis that integrates four factors that make up the acronym; strengths, weaknesses, opportunities and threats. Strengths and weaknesses are inward looking and normally focused on the response organization itself. Opportunities and threats are outward looking and attempt to identify factors, influences and opportunities that result from environmental factors and adversary errors.

It was through this program that Walpole formed its own Community Crisis Intervention Team (CCIT). One of the group's main goals is to avoid the unnecessary arrest and incarceration of people with mental illness. About 80% of crises, communities respond to involve some type of mental health, substance abuse or a combination of both as an initiating factor. The idea:

If we make an arrest and ignore mental health or substance abuse issues, we're just sending that person back into the criminal justice system. "They revolve back in and out and we're dealing with the same people. We want to give them the right help and this help at the same time helps remedy the problem.

For example: in the community I worked for 30 years (I am now retired) Walpole Massachusetts we had several success stories involving people of all ages who struggled with mental illness and due to the assistance they received and their own efforts to evolve, became healthy and productive people in the community. Once the stakeholders were identified all of them responded robustly in their efforts to make the team successful. Among those stakeholders who participated in the Walpole Community Crisis Intervention Team, were representatives from Massachusetts Department of Mental Health, Riverside Community Care, a local behavioral healthcare and human services center, group home workers, public school mental health workers, first responders, a probation officer, the District Attorney’s office, defense attorneys and the parents of children and adult children who struggle with mental illness.

"When somebody is mentally ill, they live in world of fear," a mother once explained to me. She says the way police approach a person in crisis can make the situation worse, or better. . "Just knowing that my son can shake someone's hand and feel comfortable goes a long way."

This lady had remarkable character and came to every CCIT meeting and we met 10 months a year, for now going on 3 years. Her main goal in participating in the Crisis intervention Team meetings was to help other parents in similar situations and to help the police understand how to better respond to people with mental illness and how mental illness affects the families.

The focus of effort of the Crisis Intervention Team was to firstly to build relationships among all the stakeholders. In my view getting to know people was the key to success of these groups. The relationship established are built on trust and don’t be fooled that trust must be earned. Once earned my experience has been that all stakeholders from vast areas of expertise progressively learn to work together on individual cases in hopes of finding treatment options that will keep people out of jail. I describe this as “connecting the dots” among agencies that have long worked independently of one another. It’s a systems approach to solving community problems involving mental health related issues.

Secondly the focus of effort was to improve police response to people with mental illness and emotional distress. Obviously at times police interaction with people struggling with mental illness will occur. The way the crisis is handled and the respect shown or not shown during today’s interaction can help with tomorrows. Training police officers on mental illness can help reduce injuries with the people in crisis and the police responding to deal with that crisis. It only makes sense that police are often the first people to interact with person with mental illness while they are in crisis, so a better understanding of crisis will enhance the skills of officers and give them addition options to deal with the current situation.

What does this mean for police officers, how they train and respond? Obviously in today’s times when ambushes and killings of police are up and continuing a big question that I had to answer to numerous street cops while teaching these ideas and methods is how do we police do this and maintain everyone’s safety? Yes we have to handle the crisis situation but sometimes there is no time for de-escalation? Great question that I will answer coming at it from a tactical perspective. It is important to understand that studies of risk and violence associated with mental illness have shown that people with mental illness without substance abuse were no more violent than comparison community samples without substance abuse. However co-occurring substance abuse combined with mental illness was a risk factor for violence. So we may encounter a small subset of individuals who have a mental illness and exhibit violent behavior, many of whom may be using substances. Having said this it is also important to be reminded that people with mental illness are more likely to be victims of violence than perpetrators of violence. The key is that police officers responding to and dealing with people with mental illness in crisis continually observe, orient, decide and act based on the unfolding conditions.

The next important thing to know is that no one would ever ask a police officer to recklessly react to a crisis situation. We do ask and what most all of us have done over our years of service to our communities is to take calculated risks. This is what tactics and tactical responses are all about. Maneuver refers to the movement of troops and equipment to gain an advantage. Tactics are the methods and concepts used to accomplish particular missions. When we maneuver tactically the affect of this is we are better able to make a situation assessment which is any analysis that attempts to identify the various elements and dynamics at play in an unfolding situation, especially those that may influence a favorable outcome.

Our situational assessments lead to situational awareness which is c concept that describes a person's knowledge and understanding of the circumstances, surroundings, and influences with regard to an unfolding situation. It also includes everything that is known about the situation leading up to the current episode, as well as the impact it might have on other incidents. This includes a better understanding of mental illness and its effects on people and their coping skills in crisis situations. This also means as we interact our goal should be less effort in controlling and more effort on reshaping the circumstances. These means having a working knowledge of the escalation/de-escalation principles and that you have mastered your social skills. This simply is balancing persuasion and force or as Sun Tzu, “Knowing when to fight and when not to fight.”

An empathetic presence, genuineness, acceptance along with communication and social skills that include non-verbal signs and signals and the art of listening that leads to understanding, a person in a mental health crisis may be fearful and emotional. This means attention spans and critical thinking are in short supply as the survival stress response takes hold. I will state again, it is about observing, orienting deciding and acting throughout the interaction in an effort to gain voluntary compliance (to win without fighting) if at all possible. Yes! There will still be those we encounter who struggle with mental illness that we will have to arrest and have to transport to hospitals for evaluation. At times this will require police use of force which we all know is very rare, about 1.4% of all contacts police make (60-70 million per year) police use force. So we do a pretty damn good job at this anyhow but there is always room to continually improve. This won’t just keep the folks in crisis safer; it will keep police safer as well.

There's no IPhone app to fix this problem. When it comes to Crisis Intervention Teams we need to take our time and to build trust among the various stakeholders. This I cannot stress enough, building these teams take time. If mutual trust and the spirit of working together don’t exist, then community problems do not get solved affectively.

Is there any evidence that these crisis intervention teams are making difference? The answer is yes. An example that comes to my mind was the circumstances I opened this piece with; a knife in hand, police officer gun drawn crisis response. Walpole police responded 66 times to mental health crisis calls involving the same individual at this location. Within a year of forming the crisis intervention team, the number of calls involving that person has dropped to 15, the next year about half that number. In some instances police were able to resolve the issue over the phone. Yes over the phone!!! We were able to do this because of the relationships formed and with a better understanding of how to deal with people with mental illness and emotional distress we realized not every call required a full scaled response and transport to the hospital. We relied on the crisis intervention team to come up with new ways of dealing with these types of problems which led to new policies and procedures developed by the group homes and first responders working together and coming up with new solutions. For example the resources of a mobile crisis team provided by the local health care providers in our area it was Riverside Community Care. We were able to have those teams respond and resolve situations in the home or on the street.

Obviously situations matter and safety is always considered but when the option was viable and workable these teams were used along with the police and other first responders to resolve issues peacefully and more effectively. And problems were remedied for a longer term. Police were not responding to the same calls over and over. The revolving door responses of respond-transport or arrest-evaluation-release; became less and less frequent and in many cases police and first responders have not been back to the same old locations for the same problems at all.

The thoughtful approach being employed with Crisis Intervention Teams is making a difference in the lives of not only families touched by mental illness, but the community as a whole. This coordinated response will improve the safety and quality of life for all members of the community.

I am retired but (Not Expired) and I have been recently honored with an appointment to a Massachusetts Department of Mental Health Site Board Member for a three year term as a volunteer advisor. The Site board is committed to developing a system that reflects local needs and meets high standards of care. Advances in care and treatment for individuals with mental illness, together with recognition of the need to partner with people to sustain their recovery in less restrictive environments have shifted the focus of treatment to the community. The Department of Mental Health’s Community First vision is one that is aligned with people with mental illness choice and the DMH public mental health system has transformed to empower people and their families. Overwhelmingly, their choice to achieve their recovery is living independently with the right supports in the community of their preference.

The effort of the Site Board which I am honored to be actively involved in is critical to the success of the DMH mission and the Community First Initiative which is to empower and support people with disabilities and elders to live with dignity and independence in the community by expanding, strengthening, and integrating systems of community-based long-term supports that are person-centered, high in quality and provide optimal choice. Police Departments and other first responders and stakeholders in the form of Crisis Intervention Teams have been influential in meaningful and lasting change in these efforts. My goal will be to keep the forward momentum and to get more police departments involved.

Different agencies, one community - the goal now is to better respond to a problem any family could face. Including one of our own!

Stay oriented!

Fred