How Crisis Intervention Training Helps First Responders

  • Every day, first responders—police officers, firefighters, and paramedics—are called on to handle situations involving mental health crises. As a result, communities and industry groups have begun implementing training efforts to help emergency personnel better recognize mental health symptoms, relate to people experiencing a crisis, and access appropriate care or services for those in need.

    Why Are First Responders Encountering Mental Health Crises?

    In the United States, nearly 60% of adults and 50% of children experiencing mental health conditions did not receive treatment in the previous year, according to data from the National Alliance on Mental Illness (NAMI). The group estimates more than 40 million Americans have symptoms of anxiety, and more than 16 million live with major depression.

    Many people with mental health conditions go untreated, often in part because they lack adequate health coverage or reliable transportation options. As a result, many will call emergency services in times of need.

    Due to cuts in mental health services since the 1960s, first responders are encountering a rising number of mental health crises. Between 2009 and 2011, cuts to state mental health spending totaled $1.8 billion dollars, according to a 2011 NAMI report. Many blame these spending cuts for the increased number of mental health-related crises that first responders are called on to address. For the Berkeley Police Department in California, 35% of all police calls are related to mental health crises—a 43% increase in such calls over the past five years. In Medford, Oregon, calls specifically related to suicide increased by more than 33% since 2001.

    However, according to annual assessments by the Substance Abuse and Mental Health Services Administration (SAMHSA), recent years have not seen a dramatic increase in mental health diagnoses. Findings indicate a reduced percentage of serious mental health conditions from 2013 to 2014 in every adult age group except in those ages 18-25. Additionally, efforts in recent years to reduce the stigma associated with mental health issues may have led more people to openly seek treatment.
    Whether a friend or family member is requesting assistance due to an observance of a crisis or the person experiencing the crisis is calling, first responders need to know how to effectively deal with any type of situation they may face.

    Crisis Intervention Training for First Responders

    In many communities—especially smaller ones—proper training to deal with mental health-related dispatches is not always available to first responders. This can leave paramedics who are better accustomed to handling trauma response unsure when attempting to connect someone with appropriate services in the area.

    To deal with the rising number of mental health-related dispatches, efforts are underway to enhance training for first responders. One such program is Mental Health First Aid USA, which is active in most states and has trained more than 60,000 individuals. Three agencies—the Missouri Department of Mental Health, the Maryland Department of Health and Mental Hygiene, and the National Council for Community Behavioral Healthcare—cooperated in the development of the program.

    Detection of a variety of mental health conditions—from depression to schizophrenia—is emphasized in the training. The training programs encourage first responders to listen without judgment, offer reassurance alongside useful information, and encourage self-help strategies paired with professional care.

    Encounters with first responders can be upsetting to someone already experiencing a mental health crisis, potentially exacerbating anxiety or paranoia. The approaches taught in training can help defuse the uncertainty of a situation, both for first responders and the individual experiencing the crisis.

    Many U.S. police departments have also adopted the Crisis Intervention Team (CIT) model for officers, a common methodology rooted in dignity and compassion for those experiencing mental health issues. Instructor Dustin Wright of the Valley Community Services Board said the CIT method is all about communication and understanding. Wright’s agency supports several communities and counties in the Shenandoah Valley region of Virginia, and he has participated in training officers from several area police departments.

    One jail in his agency’s service area reports that roughly a quarter of its inmates are diagnosed with mental health conditions. Wright believes officers can help redirect that pattern on the front lines if they are trained to approach and assess such situations with an eye toward empathy and positive resolution.

    Wright says stigma has been a major barrier between police and those who might display signs of a mental health condition. Each, he says, tended to view the other as a potential threat, with many officers leery of the unknown while individuals with mental health issues might fear being jailed over misunderstood behavior.

    “Officers come to understand how utilizing their discretionary power to divert someone away from the criminal justice system and into treatment can lead to positive outcomes for these individuals and the community.”Wright adds that larger police departments benefit from CIT “multiple times daily,” and that the core component of CIT is improving communication skills. He says this can be beneficial no matter the scenario.

    “It doesn’t have to be pigeon-holed into a mental health realm,” Wright said. “It’s just the way in which we interact with another human.”

    Lisa Murray coordinates CIT training for law enforcement and 911 staffers, including officers with the Charlotte/Mecklenburg Police Department. As a trauma and justice clinician for Mecklenburg County, she stresses that CIT goes well beyond just recognizing signs and symptoms.

    “CIT supports efforts to reduce stigma and teaches officers about recovery and the role that they can play in offering encouragement and hope in times of crisis,” she said.

    Murray cites CIT as a nationally accepted “pre-arrest jail diversion model” in which trainees get a chance to interact with local mental health groups and those they serve.

    “Through a strong partnership with our local chapter of the National Alliance on Mental Illness (NAMI), officers have an opportunity to hear the stories of individuals with behavioral health disorders and to see first-hand that beyond the crises they often respond to, these individuals are people first,” Murray said. “They learn that with the right treatment and support, recovery is possible. Officers come to understand how utilizing their discretionary power to divert someone away from the criminal justice system and into treatment can lead to positive outcomes for these individuals and the community.”

    In many communities, the demand for crisis intervention training only arrives following a tragedy. Such was the case with the nation’s first CIT program in Memphis, after a young man with a history of mental health conditions was shot and killed by police in 1987. Officers at the scene had perceived the knife he was cutting himself with to be a threat. The incident would bring about serious reviews of policies and methodology in an effort that would soon begin spreading to police agencies nationwide.

    Now nearly 30 years later, the department’s evolution and self-evaluation has served as a model (known as “the Memphis Model”) for law enforcement agencies worldwide. Within the Memphis Police Department today, just over a tenth of the more than 2,000 officers are trained and designated for CIT dispatches. This ensures appropriate coverage is available for any crises that arise at any hour of the day.

    According to the CIT Center at the University of Memphis, there are now roughly 3,000 local and regional CIT programs active in the U.S.

    When Crisis Occurs

    If a person is experiencing a mental health crisis, seek out support and assistance from a trusted friend or family member whenever possible. Also, make contact with a mental health professional or visit the nearest emergency room if no immediate treatment or services are available.

    Developing a plan of action is also recommended for those who believe they might experience a mental health crisis again. This can include having relaxation techniques in place to calm the situation and keeping resources like relevant names and phone numbers handy, along with a list of all current medications. Determine ahead of time the type of treatment that is preferable, and re-evaluate the plan of action for effectiveness following a crisis.

    References:

    Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. (2015, September). Retrieved from http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
    Booth, B. (n.d.). Training for Mental Health Response. Retrieved from http://theinteractgroup.com/blog/training-for-mental-health-response/
    Canadian Mental Health Association. (n.d.). Coping with mental health crises and emergencies. Retrieved from http://www.heretohelp.bc.ca/factsheet/coping-with-mental-health-crises-and-emergencies
    Dinkelspiel, F. (2015, April 16). Mental health calls #1 drain on Berkeley police resources. Retrieved from http://www.berkeleyside.com/2015/04/16/mental-health-calls-are-1-drain-on-berkeley-police-resources/
    First responders learn how to handle mental health crises. (2016, May 22). Retrieved from http://www.nbc29.com/story/32036507/first-responders-learn-how-to-handle-mental-health-crises
    Honberg, R., Diehl, S., Kimball, A., Gruttadaro, D., & Fitzpatrick, M. (2011, March). State mental health cuts: A national crisis. Retrieved from https://www2.nami.org/ContentManagement/ContentDisplay.cfm?ContentFileID=125018
    Memphis Police Dept. (n.d.). Memphis PD Initiatives. Retrieved from http://www.memphispolice.org/initiatives.asp
    National Alliance on Mental Illness. (n.d.). Mental Health Facts in America. Retrieved from https://www.nami.org/NAMI/media/NAMI-Media/Infographics/GeneralMHFacts.pdf
    Pauly, M. (2013, October 11). How police officers are (or aren’t) trained in mental health. Retrieved from http://www.theatlantic.com/health/archive/2013/10/how-police-officers-are-or-aren-t-trained-in-mental-health/280485/
    Responding to mental health crisis calls – Oregon Knowledge Bank. (2012). Retrieved from http://okb.oregon.gov/portfolio-item/crisis-calls/
    Santos, F., & Goode, E. (2014, April 1). Police Confront Rising Number of Mentally Ill Suspects. Retrieved from http://www.nytimes.com/2014/04/02/us/police-shootings-of-mentally-ill-suspects-are-on-the-upswing.html
    Vickers, B. (n.d.). Memphis, Tennessee, Police Department’s Crisis Intervention Team. Retrieved from https://www.ncjrs.gov/pdffiles1/bja/182501.pdf
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