crisis intervention refresher training

7/28/2019 Crisis Intervention Refresher Training

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U.N.T Health Science Center P.D.


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To refresh Officers awareness of how to deal withand get help for subjects having a mental disorderepisode resulting in a crisis situation that must beresolved.

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UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER POLICE DEPARTMENT GENERAL ORDER: Number 301.03 EFFECTIVE DATE: 02/10/2005SUBJECT: Mentally Ill PersonsREVISION DATE: 04/13/2010 Approved: Chief Gary C.

Gailliard AMENDS/SUPERCEDES: SOP 301.03CALEA: 1.1.3, 1.2.4e, 41.2.7a-e, 74.2.1 REVIEW BY: Oddyears

I. POLICY It is the policy of the University of North Texas Health Science Center Police Department that officers shall adhere to

the Texas Health and Safety Code with dealing with mentally ill persons. The Departments primary concern shall be to

protect the mentally ill person and others. Execution of this process is civil in nature and shall be performed by swornofficers only. [74.2.1]

II. DEFINITIONS [41.2.7a] Mental Illness Mental illness as defined in the Mental Health Code does not include epilepsy, senility, alcoholism,

chemical dependency, or mental deficiency. However, no person who is mentally ill shall be barred from admission orcommitment to a mental health facility because he or she is also suffering one of these conditions. For purposes of thisGeneral Order, a person is deemed to be mentally ill if they are suffering from an illness that:

1. substantially impairs a persons thoughts, perception of reality, emotional process, or judgment; or 2. grossly impairs behavior as demonstrated by recent disturbed behavior. III. RESPONSE TO MENTALLY ILL PERSONS A. Non-violent Persons [1.1.3] mentally ill persons who present no substantial and imminent risk of serious harm to

self or others may be directed to one of the following facilities (Communications will keep an updated list of phonenumbers): [41.2.7b]

1. John Peter Smith Hospital; or 2. Tarrant County MHMR. B. Apprehension by Peace Officer without Warrant (Health & Safety Code Sect. 573.001) 1. A peace officer, without a warrant, may take a person into custody if the officer has reason to

believe and does believe that: [41.2.7a] a. the person is mentally ill;


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b. because of that mental illness there is a substantial risk of serious harm to the person or to others unless theperson is immediately restrained; and

i. A substantial risk of serious harm to the person or others under Section 573.001 may be demonstrated by: (a) the persons behavior; or (b) evidence of severe emotional distress and deterioration in the persons mental condition to the extent that the

person cannot remain at liberty. c. believes that there is not sufficient time to obtain a warrant before taking the person into custody. 2. The peace officer may form the belief that the person meets the criteria for apprehension: a. from a representation of a credible person; or b. on the basis of the conduct of the apprehended person or the circumstances under which the apprehended person

is found. 3. A peace officer who takes a person into custody under Sect. 573.001 shall immediately transport the apprehended

person to: a. the nearest appropriate inpatient mental health facility; or b. a mental health facility deemed suitable by the local mental health authority, if an appropriate inpatient mental

health facility is not available. c. A jail or s imilar detention facility may not be deemed suitable except in an extreme emergency.

d. A person detained in a jail or a nonmedical facility shall be kept separate from any person who is charged with orconvicted of a crime. 4. A peace officer shall immediately file an application for detention after transporting a person to a facility under

Section 573.001. The application for detention must contain: a. a statement that the officer has reason to believe and does believe that the person evidences mental illness; b. a statement that the officer has reason to believe and does believe that the person evidences a substantial risk of

serious harm to self or others; c. a specific description of the risk of harm; d. a statement that the officer has reason to believe and does believe that the risk of harm is imminent unless the

person is immediately restrained; e.a statement that the officers beliefs are derived from specific recent behavior, overt acts, attempts, or threats

that were observed by or reliably reported to the officer; f. a detailed description of the specific behavior, acts, attempts, or threats; and g. the name and relationship to the apprehended person of any person who reported or observed the behavior, acts,

attempts, or threats. C. Responding to an incident in which a mentally person is involved requires tact, patience, and understanding on

the part of the police officer. Incidents arising from activities of a mentally ill person may be extremely dangerous toofficers, bystanders, or the mentally ill person. The degree to which an officer can intervene in situations involving amentally ill


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person is limited by law, but the officer must respond to take lawful action in order to: 1. protect the public from harm which may be caused by the mentally ill person; 2. protect the mentally ill person from harm which may be caused by others or himself; 3. provide a stabilizing force as to any conflict which may arise from the actions of the mentally ill person; and 4. aid in acquiring proper medical attention for the mentally ill person. D. Two officers shall be dispatched and assigned to all calls investigating a mentally ill person, when possible. At the

discretion of a single responding officer, additional assistance from the Fort Worth Police Department may be requested. E. In all cases, wherein officers believe that an emergency commitment should be conducted, a command staff

member shall be contacted immediately. 1. Officers shall interview the complainant and all available witnesses. 2. If, after conducting interviews, investigating officers determine that an emergency commitment is necessary, they

shall make an effort to then contact the subject that is to be committed. 3. If the subject can be located and taken into custody in a public place, this should be done without delay. 4. If the subject is not in a public place but is in their private residence and is not posing a threat to self or others,

forced entry will not be made into the residence without a warrant. This does not preclude officers from making aforcible entry in an emergency situation where the life of the subject or others is in immediate danger. [1.2.4e]

IV. INTERVIEWS, INTERROGATIONS AND ARRESTS [41.2.7c] A. Officers who find it necessary to interview or interrogate a person with a mental illness shall follow all laws and

procedures that would apply to any other interview or interrogation. Officers shall be particularly alert for officer safetyissues since a person with a mental illness may react unusually. When possible, two officers should be present during theinterview.

B. Officers shall not interrogate a person who exhibits a mental illness to the point that the officer believes a mentalcommitment would be warranted or if a magistrate has issued a mental health warrant for the person since the person

may not be able to knowingly waive their constitutional rights. C. Officers shall not arrest a person for criminal charges if the person exhibits a mental illness to the point that the

officer believes a mental commitment would be warranted or if a magistrate has issued a mental health warrant for theperson. The officer shall take the person into custody for the mental commitment or the mental warrant.

1. If the mental health facility determines that a warrantless mental commitment is not necessary, the person may bearrested for criminal charges if any are present.

2. If the mental health facility determines that a warrantless mental commitment is necessary or if the person is takeninto custody for a mental warrant, any criminal charges present shall be filed at large.


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V. TRAINING

A. Recruit officers will receive training onhandling mentally ill persons during the Field

Training Program. [41.2.7d] B. All officers will complete refresher training on

handling mentally ill persons at least every threeyears. Written documentation verifying therefresher training will be maintained in theirpersonnel files. [41.2.7e]


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Formulate a working mind set for recognizing thedifference between a subject in Crisis and how to

handle the situation as opposed to a subject with a

Mental Illness, is off their meds and how to handlethis totally different situation.

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Sudden, unexpected events that may overwhelman individuals ability to respond resiliently.

Extreme critical incidents may result in traumaticstressors, a personal crisis, or even Post TraumaticStress Disorder (PTSD).


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A temporary state of upset and disorganization,

characterized by an inability to cope with a particularsituation using customary methods of problemsolving, and by the potential for a radically positive ornegative outcome.

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When a person faces an obstacle to important life-long goals that is, for a time, insurmountable throughthe utilization of customary methods of problemsolving, a period of disorganization ensues, a periodof upset, during which many abortive attempts atsolutions are made. (Caplan)

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A crisis occurs when a stressful life eventoverwhelms a persons ability to cope effectively in

the face of a perceived challenge or threat.(Flannery)

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Identify behaviors that detect an individual in crisis

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Physical Emotional Psychological


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Discuss examples of personal experiencespertaining to situations you have had with people inCrisis.

Such as: Patient in Clinic upset because staff willnot give them a refill on a prescription.

Is this person necessarily Mentally Ill?


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How do these crisis behaviors differ if there is a pre-existing mental health issue?

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Articulate the technique of Crisis Intervention

Crisis Intervention techniques assist individuals in

returning to a level of functioning that enables themto gain some sense of behavioral control.

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The sooner the better

Intervention by first responders tends to greatly

reduce/prevent many crisis symptoms

A front-line officer has one critical qualification thata qualified practitioner does notthey are there.

(Hogan)

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Provide with sense of security and safety by:

Allowing them to ventilate

Validate

Give honest predictions

Prepare for situational outcome

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Defining the problem. ( if Criminal Take to jail )

Ensuring client safety.

Providing support. Refer to MHMR / JPS etc. )

Examine alternatives.

Making Plans. (Ours and theirs )

Obtaining commitment. (From the person and the family)


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Stabilization, an interruption in crisis escalationbehavior, identification of any risk of harm tothemselves and others

Reduction in the acute signs of distress

Restore independent functioning or, if needed,

referral to higher level of care forassessment/evaluation

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A successful crisis intervention model iscomprehensive enough to be implemented by thosewith little training and flexible enough to be used by

those that are trained.

As law enforcement officerscrisis intervention techniques are used to

alleviate immediate symptoms only, followed by areferral to qualified help as appropriate.

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Primary tool

Ventilation

Do not take risks

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Identification Problem areas Issues needed addressing

Questioning Process Narrow options List alternatives Best solution

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Incorporate the technique of Crisis Intervention intoOfficer Safety.

Keep in mind that you are making a Legal decisionnot a Medical diagnosis.

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Illness, disease, or condition that eithersubstantially impacts a persons thought, perceptionof reality, emotional process, or judgment, or

grossly impairs a persons behavior, as manifestedby recent disturbance behavior.


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HSC 573.001Apprehension by a Peace Officerwithout a Warrant.

a. A Peace Officer as defined per CCP 2.12 ..

b. who has reason (singular1 reason) to believe anddoes believe..

c. the person to be detained is mentally ill andbecause of such mental illness represents a substantialrisk of serious harm

d. to himself or others

e. unless immediately restrained..

f. and there is not time to obtain a warrant..

g. the Police Officer shall immediately transport theperson..

h. to a facility deemed suitable by local MH Authorityand file an Application for Detention.


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The following are but a few of the laws allowing

( and in some cases REQUIRING ) Officer to takethe actions he deems necessary to handle thesituation.


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P.C. 9.21 Public Duty

P.C. 9.22 Necessity

P.C. 9.31 Self Defense

P.C. 9.32 Deadly Force in Defense of Person

(3rd. Party)

P.C. 9.34 Protection of Life or Health P.C. 9.51 Arrest and Search


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1. CCP 2.13 - Duty and Powers

2. CCP 6.05 Duty of Peace Officer as to Threats

3. CCP 6.06 Peace Officer to Prevent Injury


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A person May truly be mentally ill, but that does notAlways negate his legal culpability for his actions.

When taking a mentally ill person into custody do notalways assume that he has to be transported to a mentalfacility at that time.

He may be taken to jail and then referred from there toget the help that he needs.

If you automatically apply to detain a person, who hascommitted a crime, to a mental facility you may lose allpossibility of filing a case later.


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Questions about what we have covered and/orDiscuss examples of situations you have had withpeople with a Mental Illness.

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The essential difference between suspect encountertrainingand how to approach the mentally ill is theneed to be non-confrontationalto shift

gearsopposed to the way officers are routinelyexpected to control conflict (Police Magazine)

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Critique intervention techniques for their proactiveabilities

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Proactive Interventions:Address needs prior to a problem or action

Reactive Intervention:Already escalated behavior

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Apply knowledge of cultural background to crisisbehavior

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but crisis response varies.

Consider:

How culture impacts ones perspective of trauma Perception or interpretation of a threats meaning Cultures nature of expression

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Compile general categories of the most prominentmental disorders and the mental illnesses thatpopulate these categories

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Most common:

Depression

Bipolar Disorder

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Most Common:

Organic Brain Disorders

Pain Syndromes Drug Withdrawal

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Most Common:

Panic Attacks

Phobias Obsessive-Compulsive Disorder Post Traumatic Stress Disorder (PTSD)

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Most Common:

Alzheimers Disease

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Most common:

Stimulants

Alcohol Heroin

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Most Common:

Paranoid

Antisocial Borderline

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Develop an increased understanding of the legalprocess; evaluation and techniques forappropriateness of apprehension

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Analyze the law enforcement decision-making processutilizing the concept of discretion

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Dependent on:

Severity

Resources

Major Areas of Disposition:

Emergency Psychiatric Apprehension Informal Disposition

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Appraise the legalities and ethical considerations ofconsumer rights

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Competency Age Criminal

Residency Court Orders Orders of Protective Custody

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Illustrate the reasoning of arresting to manage

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Exceeds community tolerance Person will continue to cause problem Behavior not severe enough

Too dangerous Rejected for treatment

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Give examples of the types of mentally ill consumersthat are handled in an informal manner by lawenforcement

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Neighborhood Characters Troublemakers Quiet Consumers

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Compile a list of mental health referrals/resources inthe community.

1. JPS2. Tarrant Co. MHMR

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crisis intervention refresher training

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