It's 3 a.m. and you've been dispatched to a weapons call involving a man with a knife acting strangely in the lobby of a local area hotel. You're the first officer on scene and are trying to assess the situation.
As you approach the lobby, you see the man pacing back and forth talking to someone yet there's no one around. You wonder why he's acting this way. What's his intent? Is he in crisis? How do you get him into custody? These are all very important questions going through the mind of any first responder in a similar situation.
Front-line officers must have the knowledge, skills and abilities to deal with these kinds of situations.
In 2010, the Training and Education Bureau of York Regional Police (YRP) in Ontario recognized a need to offer more training to its front-line officers who respond to emotionally disturbed persons who are in crisis. As a result, YRP introduced a Crisis Intervention Training (CIT) course.
According to the Canadian Mental Health Association, mental illness will indirectly affect all Canadians at some point in their lives either through a family member, friend or colleague. The centre also suggests that one in five Canadians will personally experience a clinical mental illness while many others struggle with stress and grief on an ongoing basis.
Most often, when someone is in crisis, it's a police officer, paramedic or firefighter who will respond to the call.
Crisis or criminal?
Traditional police training teaches officers to respond to behaviours and perceived actions. But a person in crisis can often exhibit the same types of behaviours and actions as someone intent on committing a criminal act.
- Consider eliminating the use of emergency lighting and sound equipment, and keep the volume of portable radio transmissions low. The added sensory stimulus can elevate a person's already agitated state and make communication and establishing rapport with them more difficult.
- Speak calmly and slowly, and keep instructions simple and direct. Elevated voices and rapid speech cadence can elevate tensions in your interactions with the person in crisis. Complicated instructions lead to confusion and elevated anxiety.
- Give them space. Respecting the personal space of the person in crisis is essential to reducing their tension.
- Let them talk. This can be a hard concept for first responders to encourage while attempting to control a situation. However, it can reduce anxiety and tension, and have a positive impact on the overall outcome of the incident.
- Share in the control. Whenever possible, allow the person in crisis to feel that they have some control in decisions that are being made. Create understanding about your reason for being there to allow them the opportunity to offer their input about the solution.
- Create a positive experience. The way that you handle this incident will have an impact on future incidents. A good outcome will have a positive effect on future interactions between the emotionally disturbed person and first responders.
One example of this kind of behaviour is damaging property. Someone may intend to damage or destroy another person's belongings or their actions may be the direct result of an illness that prevents them from communicating with others.
Another example is a man armed with a knife who may have the intent to hurt others or he may be protecting himself as the result of a paranoid delusional thought he's experiencing.
Knowing how to differentiate between the two is critical. Education and understanding can teach police officers how to recognize the signs and symptoms of a person in crisis and set them apart from the behaviour of a person whose actions are deliberate and calculated, and not caused by an overwhelming emotional state.
For the man described in the introduction who was pacing and talking to himself, training can help identify whether he might be experiencing paranoid delusional thoughts, which are often associated with schizophrenia.
Understanding behavioural cues associated with schizophrenia and other mental illnesses can have a profound effect on how a police officer analyzes, perceives and reacts to that person.
CIT helps create a better understanding of the symptoms of a person in crisis and allows officers to formulate better decisions when determining a plan of action.
Based on the Memphis Model, which is a pre-arrest jail diversion program developed in the United States at the University of Memphis, CIT is more than just mental health awareness training. It not only educates officers about mental illnesses, but teaches them communication and de-escalation strategies when responding to crisis calls involving the mentally ill.
The key to preventing a use-of-force encounter is to calm down the situation, and this can often be achieved through effective communication with the individual in crisis. Stress, anxiety, fear, tension and anger must be reduced to make this possible.
Effective communication can be better accomplished when the officer relates and responds to the underlying emotions rather than the associated behaviours.
The 40-hour training involves community partners in delivering the program. Officers receive first-hand information from mental health professionals as well as the patients themselves.
Education on major psychiatric illnesses, autism spectrum disorder, psychotropic medications and their side effects, the stages of crisis development, de-escalation and communication strategies, suicide prevention and post-traumatic stress disorder are all covered during the week.
Course participants have an opportunity to visit local area hospitals and mental health facilities to observe and interact with professionals and patients in a controlled clinical setting.
These visits are a unique opportunity for officers to interact with patients when they're well and participate in open forum discussion groups where they receive valuable feedback from the patients. Past interactions with police during crisis events are discussed, including which strategies worked and which did not.
Learning assessments are made at the end of the week when officers take part in controlled simulated scenarios.
To date, all sworn members of York Regional Police have received a four-hour condensed version of the 40-hour curriculum with the goal of providing the full 40-hour curriculum to all front-line uniformed members. Currently, 200 frontline officers – 13 per cent of the York Regional Police – have received the complete training.
Putting training into action
Those who have received the training have provided positive feedback about how it has helped them perform calls for service involving the mentally ill. A recent hire of YRP who just completed the training wrote the following:
"The training has had a positive effect on the way I've been able to deal with EDPs (emotionally disturbed persons). My first EDP call was at 3 a.m. on my first night shift. The man had left his house and wanted to catch the bus to the Markville mall because he had left his truck there. His family advised the truck wasn't there and that this behaviour was unusual. My coach and I found the man at the bus stop and I used my training to talk him into going home. We kept back to ensure he felt safe. I spoke calmly and kept him talking, and we were able to build a rapport with him so that we could walk him back home. Without the training, I would have made mistakes that would have frightened him into not trusting me."
A member of YPR's communication staff who attended the training had this to say:
"Tonight, on my first night shift since the course, I was able to actually use some of the knowledge that the guest speakers taught. At about 11:30 p.m., I received a 911 call from a schizophrenic man, who had told me he was in a bus shelter behind Hillcrest Mall, stopped taking his meds, was hearing voices and wanted the police to do something to help him. I spent 20 minutes speaking to this man on the phone before the first unit arrived, and the information I received in the course was very helpful. Firstly, what I learned about the horrible side effects of some medications helped me to understand what this individual was experiencing. Secondly, I learned that sometimes we should listen rather than talk all the time. I did this for a good part of the call, paraphrasing what the caller was saying or saying nothing at all. Despite his anxiety, he continued to talk to me. I believe that we established a good rapport during the 20-minute call and I credit what I learned in crisis intervention training with being able to do this."
EDP calls are common in today's world of policing. As many organizations try to erase the stigma associated with mental illness, police agencies must follow their lead.
Training and education creates understanding, leads to higher-quality service for the community and helps reduce the stigma in our own professional culture. CIT is the start of that education.
York Regional Police (YRP) serves more than 1.1 million residents within the Region of York in Ontario, Canada. The service has more than 1,500 sworn members and 500 civilian staff.