Crisis Intervention Training for Dispatchers

LE & MH Services

Law Enforcement & Mental Health Services

• Are being called on to collaborate more than ever.

• According to the Treatment Advocacy Center - “Approximately one-third of individuals with severe mental illness have their first contact with mental health treatment through a law enforcement encounter.” –

• Many communities continue to face pervasive gaps in mental health services, especially crisis services, placing a heavy burden on law enforcement agencies and, in particular, officers.

• Without access to appropriate alternatives, officers are often left with a set of poor choices: leave people in potentially harmful situations, bring them to hospital emergency departments, or arrest them.”

Traditional Law Enforcement Training

Traditional law Enforcement Training

• Has had little information on Mental Health

• Officers have been left to manage on their own instincts.

• This may not go well for either the officer or the consumer.

Training for Mental Health Professionals

And Training for Mental Health professionals

• Has not included information needed for collaborating with law enforcement;

• This can leave both groups at a disadvantage,

• Acting on stereotyped ideas of how the other will be able to respond and engage in a crisis scenario.

CIT Training

CIT Training

• Helps to bridge the communication gap.

• Both “sides” can share their expertise to get better outcomes

• Crisis Intervention Team is -
• “An innovative, first-responder, model of police-based crisis intervention training”
• The purpose is to set up systems that promote access to treatment.
• Decrease the likelihood of people entering the criminal justice system solely due to illness-related behaviors.

What are the Core Elements of CIT?

• Partnerships

• Advocacy Community

• Mental health Community

• Stakeholders Meetings

• Statewide conference

• Law Enforcement Community

What’s the purpose of CIT Training?

• Give Law Enforcement a better understanding of mental health issues and symptoms.

• Introduce community services that they can use when responding to calls.

What is included in CIT Training at BHN?

• Six 40-hour sessions a year available to area Law Enforcement.

• Three-four 8-hour sessions a year for Dispatchers.

• Two 8-hour sessions a year focused on youth issues and targeted for SROs.

• As of July 2021, we have trained 963 officers in “regular” CIT (48 departments), 80 in Youth CIT (14 departments), and 172 Dispatchers (22 departments).

But, beyond training....

• The CIT approach has been shown to promote officer safety and the safety of the individual in crisis.

• CIT means collaboration and there are always new elements being added to the mix.

Beyond CIT...

So - why CIT for Dispatch?

So - why CIT for Dispatch?

• The information they gather, and pass on, can set expectations before the encounter begins.
• They must be able to paint the most accurate picture possible regarding each call
• This makes their involvement key to successful implementation of CIT in any department

Origins of CIT

Origins of CIT

Collaboration between MH & LE

Colloborationof MH/LE

• Gives officers alternatives when they respond to crises

• Helps us optimize outcomes for the individuals we serve

• Leads to creative problem-solving in the communities involved

Co-Occurring Disorders

What is Non-Suicidal Self-Injury

Non-Suicidal Self-Injury

Non-Suicidal Self-Injury

• What are some reasons people engage in non-suicidal self-injury?
• Discharge stress
• To penetrate numbness
• To punish themselves
• To achieve some other aim such as an adrenalin rush, control actions of others, express one’s self, or as a distraction.
• Slight contagion effect.

**For the most part, self-injurious acts are not

an attempt at suicide**

Non-suicidal self-injury: Signs and Symptoms

• Scares (burns cuts), fresh cuts, scratches, bruises or other

wounds,

• Keeping sharp objects on hand,
• Wearing long sleeves, pants even in hot weather,
• Claiming to have frequent accidents resulting in cuts/bruises,
• Hidden razors or other sharp objects,
• Often in need of first aid materials frequently.
• Broken bones

Possible Effects of Self-injury

Possible Effects of Self Injury

• Permanent scars
• Disfigurement
• Worsening feelings of shame, guilt, low self-esteem
• Depression regarding the inability to stop self-injuring despite the consequences
• Stress of providing many reasons for injuries
• Social isolation
• Stress of having to hide the self-abuse from others
• Infected wounds
• Substance use and abuse to self-medicate
• Failure to address reasons behind the self-injury

Statistics

• It’s estimated 1%-4% of adults self-injure

• Prevalence of chronic self-harm occurs in approximately 1% of the adult population.

• Self-harm rates in adolescents are especially high, with about 15% of adolescents reporting self-injury behavior.

• College students have the highest number of reported self-injury, ranging about 17%-35%.

• Those between the ages of 20-29 have the largest hospitalization rate for self-harm.

• Self-harm rates are almost equal among genders

What might be helpful?

• Have a conversation about the relief it really provides.

• How long does it last? What if there were other things that could provide similar stress relief?

• Harm Reduction

• What techniques are available to reduce harm?

• You cannot stop the behavior – so do not try! It is a means of coping that is probably well established and needs a replacement before it can be stopped.

• Any good you can identify in self-harming?

What might be helpful:

Suicide

Throughout our discussion please keep these realities of suicide in mind:

• It is the outcome of an individual crisis and it causes crisis in others.
• It produces trauma in all those who experience it in any way.
• It happens in families and not in a vacuum.
• It is one of the most abnormal forms of death.
• It is always a premature death.
• It is preventable.

Suicide

Suicide Statistics - MA

Suicide Statistics

Statistics Continued

National Suicide Statistics Cont'd

• Firearms remain the most commonly utilized.

• Method of completing suicide by essentially all groups. About one-half (51.5% of the individuals who took their own lives in 2013 used this method. Males used firearms more often than females.

• The most common method of suicide for all females was poisoning. In fact, poisoning has surpassed firearms as the most common method used in female suicides since 2001.

• Caucasians have higher rates of completed suicides than any other group.

• Suicide rates have traditionally decreased in times of war and increased in times of economic crises.

• Suicide rates are the highest among the divorced, separated, and widowed and lowest among the married.

* www.suicidology.org

Risk and Protective Factors - Suicide

• Risk factors are variables strongly associated with suicide. Risk factors do not cause suicide.

• Protective factors are behaviors, characteristics, and other variables found to offset risk factors of suicide and precipitants of suicidal behavior. They contribute to feeling that life is worth living.

Suicide Model - Thomas Joiner

Suicide Model

Danger/Warning Signs IS PATH WARM

Warning Signs

• I Ideation
• S Substance Abuse

• P Purposelessness
• A Anxiety
• T Trapped
• H Hopelessness

• W Withdrawal
• A Anger
• R Recklessness
• M Mood Change

Screening Questions

• Screening is the basic technique for finding suicide risk factors. It involves simple direct questioning. It requires training but not clinical skill or judgment. It does not evaluate or estimate an individual’s level of suicide risk.

• Screening questions must be direct:

• Have you ever thought about killing yourself?
• Are you thinking about it right now?
• Do you have a plan on how to kill yourself?
• Do you have the means to carry out this plan?
• Have you tried out or rehearsed your plan?
• Have you ever attempted suicide?

Asking the tough Questions

What impacts communication?

Barriers to Com-munication

• Development of emotions/responses

• Anxiety, defensiveness, actions, calming

• Nonverbal and paraverbal communication

• Personal space, body language, tone, volume, cadence

• Integrated experience – understanding our own anxiety, frustration, counter transference

Discussion

Barriers to Treatment

Why people do not get treatment.

Connecting with Crisis

Final Thoughts - Open Forum

Resources

• American Association of Suicidology
• Center for Disease Control and Prevention (CDC).
• Joiner, Thomas (2006). Why people die by suicide.
• Massachusetts Department of Public Health
• www.mass.gov
• Substance Abuse and Mental Health Services Administration.

Resources

What is De-Escalation

Verbal De-Escalation

Verbal de-escalation is used during potentially dangerous, or threatening, situation in an attempt to prevent persons from causing harm to us, themselves, or others

What is Verbal De-Escalation?

Goals of Verbal De-Escalation

Goals of Verbal De-Escalation

Logics of De-Escalation

Logics of De-Escalation

What is a Behavioral Crisis?

A crisis is a perception of an event or situation as an intolerable difficulty that exceeds the resources and coping mechanisms of the person

Behavioral Crisis

What does a Crisis look like?

Crisis

Initial Presentation

Initial Presentation

• Be cognizant of all possible precipitants, life stressors, or other reasons for negative behaviors.

• What is the reason for the call?

• How is the individual behaving?

What is the story?

The Story

• Frustration
• Unrealistic Expectations
• Family/Social Difficulties
• Mental Disorder
• Pain
• Medical Condition
• TBI
• Substance Use
• Past Trauma

Empathy

• Direct identification with, understanding of, and vicarious experience of another person's situation, feelings, and motives.

• “To my mind, empathy is in itself a healing agent . . . because it releases, it confirms, it brings even the most frightened person into the human race. If a person is understood, he or she belongs.” – Carl Rogers

Empathy

Non-judgemetal

Non-judgemental

Active Listening

Questions to Ask When Appropriate

Approriate Questions

• Does the individual need something (e.g., hungry, thirsty)?

• Is the individual receiving services; and if so where?

• Is the individual taking medication?

• When did the individual last take his or her medication?

Mistakes

A day in the life of .....

A Day in the Life

As a Dispatcher:

• You have to be constantly ready to respond
• Your brain and body are experiencing frequent repeated “rushes” of stress hormones (ACTH and Cortisol)
• These are intended to help you deal with the immediate situation BUT over the long haul they can leave you

Ready to Snap?

Ready to Snap

Lets talk:

Self-Care

• Self Care is not an acknowledgment of weakness.
• It’s a way of drawing on, and building, your inner strength.

Compassion Fatigue

• 16% of dispatchers report symptoms consistent with Compassion fatigue

• Compassion Fatigue: (Figley, 1995) The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events.

Compassion Fatigue

The Relaxation Response

Relaxation Response

• The relaxation response can be induced through techniques that relax your body or your mind.

• What are the most common techniques?

Emotional Symptoms Include

Emotional Symptoms

• Hypervigilance – “I can’t relax”
• Hopelessness – “I give up”
• Guilt – “I should have done better”

Which can lead to :

• Impaired self-esteem – “I’m not good enough”
• Desensitization, cynicism – “your trauma is no big deal to me”
• Disconnection – “I really don’t care how this turns out”

Physical Symptoms

• Decreased Immunity
• Appetite disturbance, weight gain or loss
• Chronic indigestion, ulcers
• Physical problems – headache, back pain
• Sleep problems “I’m always exhausted”; “I wake up in the middle of the night thinking about work”

Physical Symptoms

Manage your expectations

Self Management

"The bigger the gap between your expectations and reality, the greater the stress” – Adam Timm

What’s the bottom line?

Bottom Line

References

• Journal of Emergency Dispatch July/August 2016 – “Coming Together on the 911 Stress Front”
• Adam Timm & Joe Serio, Dispatcher Stress:50 Lessons on Beathing the Burnout. LED ( Law Enforcement Development) Training Publications. 2015

References

StatisticsMap

Statistics

What is Mental Illness?

What is Mental Illness?

Substantial disorder of:

• Thought
• Mood
• Perception
• Memory

Can significantly impair judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands of life.

Types of Mental Illnesses

Types of Mental Illness

• Mood Disorders
• Anxiety Disorders, Depressive Disorders, Bipolar Disorder
• Psychotic Disorders
• Personality Disorders
• Substance Use Disorders
• Stress & Trauma-Related DisordersDissociative Disorders
• Dissociative Disorders
• Alzheimers/Dementia

Causes

Biological Factors

• Biochemical Disturbances
• Genetics
• Infections- can cause brain damage
• Brain defects or injury
• Prenatal damage
• Poor nutrition, exposure to toxins

Biological Factors

Social/Environmental Factors

Social/Environ-mental Factors

• Significant life events: Death, divorce, changing jobs/school
• Significant local/world events
• Disasters
• A dysfunctional family life, including domestic violence
• Living in an unsafe environment
• Living in poverty
• Feelings of inadequacy, low self-esteem, or loneliness
• Social or cultural expectations
• Substance abuse

Psychological Factors

• Severe psychological childhood trauma, such as emotional, physical or sexual abuse
• An important early loss, such as the loss of a parent
• Neglect
• Poor ability to relate to others

Why someone may call 911 for assistance

Why someone may call 911?

Sympstoms of:

• Bipolar
• Depression (Situational, clinical, bipolar, bereavement, psychotic)
• Anxiety Disorders
• Personality Disorders
• Schizophrenia Spectrum and Other Psychotic Disorders (Hallucinations and delusions, negative symptoms)

How are Childhood Disorders Diagnosed

Parents might call 911 about kids when:

• They run out of school, or away from home
• They act out in school or at home, and become physically aggressive or destructive of property
• They are involved in impulsive crimes, like shoplifting – they may tend to be followers rather than leaders

Why?

• Problems with attention, focus and follow-though –
• Poor planning skills – not anticipating consequences
• Low frustration tolerance
• Social difficulties – speaking or acting without thinking can alienate their peers

Parents and 911

Contact

NAMI- MA

NAMI- MA Programs

Community Eductaion and Outreach Team

Criminal Justice Diversion Initiative

Philosophy of Diversion

Methodlogy: Sequential Intercept Model

CJDI

Current Focus of the Initiative

MA Behavioral Health Response System

ER - Commun-ication/MH Response

A Compre-hensive Approach

MH ER-Communic-ation Integration

Results

Funding

Questions