Straight Talk
Helping Families Talk to Law
Enforcement in Times of Crisis
2014 NAMI NC Eastern Regional
Conference: Crisis Solutions
March 29, 2014
1
Helping Families Talk to Law
Enforcement in Times of Crisis
1. The Big Picture
2. The Picture in North Carolina – Kate Murphy,
CoastalCare
3. CIT & SROs in New Hanover County Schools –
Lt. Novella Frieslander, New Hanover County
4. How Families Can Help – Alice “Elaine” Slaton,
Slaton Associates
5. Questions & Answers
2
The National Perspective
Elaine F. Deck, Slaton Associates
THE BIG PICTURE
Elaine F. Deck
3
The Big Picture: The Problem
• U.S. Prisons have become our defacto mental health
system
• Police agencies have become a primary crisis resource for
persons experiencing mental/emotional crisis
• Law Enforcement Responses to mental health crisis
– Are time consuming
– Can be volatile situations risking safety for all involved
• Successful police responses to mental health crisis
– Require specialized training (funding & time)
– Are dependent on available community mental health resources
Elaine F. Deck
4
The Big Picture: Solutions
• Prevention, early intervention, and effective community
mental health services
• Specialized training for Law Enforcement and other
public service personnel
• Cross agency collaboration, including family-run, youthrun, and consumer-run organizations (keeping one
another informed with a real-time picture of where the
resources are and what challenges need to be addressed)
• Funding
• Educated decision makers (law makers)
Elaine F. Deck
5
The Big Picture: Sample Approaches
• Crisis Intervention Teams (CIT)
• Mental Health First Aid
• Law Enforcement and Mental Health CoResponder Teams -- Assertive Community
Treatment (ACT)
• Mental Health Consumer-Driven Services: e-CPR
• Jail and Prison Reentry Programs
From: The International Association of Chiefs of Police (IACP) 2010 National Policy
Summit Building Safer Communities: Improving Police Response to Persons with
Mental Illness-Recommendations and Models for Intervention
Elaine F. Deck
6
Kate Murphy, CoastalCare
THE PICTURE IN NORTH CAROLINA
Kate Murphy
7
What is Crisis Intervention Team?
• Crisis Intervention Team began in Memphis, TN in 1988
when the Memphis Police Department sought out
partnerships with the local affiliate of the National
Alliance on Mental Illness, mental health providers,
two local universities and consumers and family
members.
• A specialized unit consisting of volunteer officers who
have undergone additional training in mental health,
de-escalation and jail diversion was implemented.
• It has since become an international model, consisting
of volunteer officers from a variety of divisions within
law enforcement agencies. Aside from regular duties,
these members of the CIT are called upon to respond
to individuals experiencing a crisis.
Kate Murphy
8
Who is on the Crisis Intervention Team?
• Crisis Intervention Team is made up of
–
–
–
–
–
–
Law Enforcement
911 Telecommunicators
Magistrates
First Responders
Mental Health Professionals
Individuals and Family Members
• Crisis Intervention Team members can
– recognize signs and symptoms of mental illness, substance use, or
intellectual/developmental disabilities
– use verbal de-escalation techniques to assist a person experiencing
crisis
– connect that person with appropriate resources.
Kate Murphy
9
Crisis Intervention Team Training
40-hour, week-long training that is:
• Didactic
– Formal lectures on mental illness medications and
crisis intervention
• Interactive
– Dialogues with individuals and family members
reduce stigma and help officers see people with
mental illness as similar to them
• Experiential
– Use of role plays, practicing skills at de-escalation.
Kate Murphy
10
Crisis Intervention Team Training
• Crisis Intervention Team Training requires collaboration across
the team.
• Subject-matter experts give individual presentations.
Curriculum includes:
• Introduction/orientation to CIT
•
and the CIT partnership
• An overview of the mental health
•
system
•
• Signs and symptoms of severe
•
mental illness
• Medications for treatment of
•
mental illness
• Personality disorders
•
• Co-occurring diagnoses
• Intellectual/developmental
disabilities
• Dementia and aging
Kate Murphy
Children/adolescent mental
health
Suicide intervention
Trauma/PTSD
Community resources & crisis
services continuum
Crisis intervention / de-escalation
skills training
Use of force continuum including
when to use and not use less
lethal weapons
11
CIT in North Carolina
As of January 1, 2014:
•5,910 law enforcement officers CIT
certified
•331 law enforcement agencies
participating in CIT
•682 911 Telecommunicators
(dispatchers) trained in CIT
•687 *other professionals trained in
CIT
*other referring to other first responders i.e. fire fighters, paramedics, magistrates, private security guards, etc.
Kate Murphy
12
CIT in Action
• When 911 is called for a crisis due to a mental
illness, substance use disorder or
intellectual/developmental disability, a CIT
officer should be requested.
• The CIT officer can:
– Use verbal de-escalation techniques
– Divert the individual from incarceration or
involuntary commitment (if appropriate)
– Connect the individual to community-based crisis
services
Kate Murphy
13
Crisis Services
• CIT officers have a number of resources available
to them:
– Provider first responder
– Mobile Crisis Clinicians
– Walk-in services (Crisis Response Centers, Drop-in
Centers, Walk-in clinics etc.)
• Provides triage, evaluation, assessment and
interventions, including medication management
• Is available to all individuals in crisis regardless of
insurance type or ability to pay
Kate Murphy
14
When law enforcement responds to calls
for people with mental illness...
• The arrest rate is 20% when no specialized
response exists
• The arrest rate is 7% when some form of
specialized response exists
• The arrest rate for the Memphis CIT program is
just 2%
– Percent of incidents resolved on scene = 23%
– Percent of incidents resulting in the person being
transported to a crisis unit = 75%
Kate Murphy
15
Accessing Crisis Services
• 911 is NOT necessary to access crisis services
• Individual OR third party can call in times of
crisis.
• Access to crisis services is available by calling
your local Local Management Entity/Managed
Care Organization
Kate Murphy
16
Accessing Crisis Services
• Alliance Behavioral Healthcare-800-510-9132
– Durham, Johnston, Wake
• CoastalCare-866-875-1757
– Brunswick, Carteret, New Hanover, Onslow, Pender
• East Carolina Behavioral Health-877-685-2415
– Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dar,
Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico,
Pasquotank, Perquimans, Pitt, Tyrell, Washington
• Eastpoint-800-819-5112
– Bladen, Columbus, Duplin, Edgecombe, Greene, Lenoir, Nash,
Robeson, Sampson, Scotland, Wayne, Wilson
Kate Murphy
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Lt. Novella Frieslander, New Hanover Co. Sherriff’s Office
CIT & SROS IN NEW HANOVER
SCHOOLS
Novella Frieslander
18
CIT and SROs
• An alarming number of youth with serious
mental health issues become involved with
law enforcement and the juvenile justice
system while in school.
• CIT is a tool we use to try to divert these
youth and get them the help they need.
Lt. Novella Frieslander
19
CIT and SROs
• New Hanover County Sheriff’s Office expands the SRO Unit
thanks to the Board of Education and a grant!
• Currently have 34 NHSO SROs, 4 WPD SROs and 1 CBPD SRO
– 2 SROs at Ashley/Laney High Schools/Mary Mosley
Academy; 3 at Hanover and Hoggard High Schools
– 1 in each Middle School (2 at Williston and Holly Shelter
Middle Schools
– 3 teaching G.R.E.A.T. in Elementary Schools
(Gang Resistance Education and Training)
– 11 additional deputies (2 supervisors and 9 officers to float
the Elementary Schools-3 schools each)
Lt. Novella Frieslander
20
CIT and SROs
• We are partners with Wilmington and Carolina
Beach Police Departments
– Wilmington PD provides
•
•
•
•
1 officer for New Hanover High School
1 Officer for John T. Hoggard High School
1 Officer at Mary Mosley Academy
1 Officer at Williston Middle School
– Carolina Beach PD provides
• 1 officer at Carolina Beach Elementary School
Lt. Novella Frieslander
21
CIT and SROs
• All SROs in NHC, WPD and CBPD are or
will be CIT certified
• Conduct a special CIT class covering
issues with children in schools
Lt. Novella Frieslander
22
CIT and SROs
• Schools have a variety of students.
– AG (academically gifted)
– LD (learning disabled)
– BEH (behavior/emotionally handicapped)
– OHI (other health impaired)
– Autistic
– Mentally disabled
– Traumatic Brain Injury
Any of which can have a need for a CIT officer.
Lt. Novella Frieslander
23
CIT and SROs
• Helps the SRO differentiate between different
mental illnesses and the best way to deal with
them
• Increases officer safety
• Reduces the amount of force
• Helps reduce referrals to juvenile services
• Helps reduce suspensions
Lt. Novella Frieslander
24
CIT and SROs
• Helps reduce unnecessary escalation of
psychiatric crises in schools
• Helps get students with needs for mental
illness treatment, effective services
• Minimizes trauma to all involved
• Helps to positively impact the relationship
built between the student, the SRO and the
parent or caregiver.
Lt. Novella Frieslander
25
CIT and SROs
• Encourage school personnel to take CIT:
– Counselors
– Social workers
– Psychologist
– Administrators
– Teachers
Lt. Novella Frieslander
26
CIT and SROs
• NAMI’s Parents and Teachers as Allies
program
– Compliments CIT programs for youth by
educating school staff on how mental health
impacts students’ behavior and learning.
Lt. Novella Frieslander
27
Alice “Elaine” Slaton, Slaton Associates
HELPING FAMILIES TALK TO LAW
ENFORCEMENT IN TIMES OF CRISIS
Alice "Elaine" Slaton
28
Before a Crisis Occurs
• Prevention is KEY
– Recurring crises may signal problems in assessment or care
• Crisis Planning
– #1 Have a plan
– #2 Have strategies beyond “call 911”
– Engage your family member in developing this plan; affirm
his/her role in prevention and resolution
– Ensure the plan is strengths-based, building upon his/her
capabilities, & focused in helping him/her regain control
– If your family member is a student, include their SRO in IEP
meetings and crisis planning
Alice "Elaine" Slaton
29
Sample Crisis Plan/ Advance Directives
• Name and age
• Emergency contact information (parent or
legal/guardian. in the case of youth)
• Health care providers contact information
• Diagnoses, medications & doses, known allergies
• Known triggers
• Strategies for calming and regaining a sense
of control
Alice "Elaine" Slaton
30
Helping Families Talk to Law
Enforcement in Times of Crisis
Speaking to the dispatcher (911)
• Be specific, clear and calm: what is happening
and what you are asking for
• Ask for a CIT trained officer
• Provide facts, including known weapons in the
vicinity
• Provide known triggers and calming strategies
Alice "Elaine" Slaton
31
Telling “911” what is happening:
Not:
• She is doing real bad
again
• His sister is scared to
death
• He is out of control
• We don’t know what to
do with her
• You need to come get her
More clear and specific:
• He has {diagnosis} and
has locked himself in the
garage. He has a knife and
says he will hurt himself.
• He chased his sister and
said he will “bash her
head in”. She is locked in
the car now, but he is
pounding his fists on the
outside of the car. They
are in the driveway.
Alice "Elaine" Slaton
32
Telling “911” triggers & known
strategies:
• His illness makes him jittery, please do now expect
him to be still.
• He is terrified of being locked up, please reassure
him you want to help him figure this out.
• If he sees a gun, he may run away from you.
• Please tell him Joe will meet him at the hospital
and help him figure this out.
• Remind him “X” worked last time he felt this way.
Alice "Elaine" Slaton
33
Helping Families Talk to Law
Enforcement in Times of Crisis
When officers are on the scene
• The law enforcement officer is now in charge
• The officer’s task is to observe -- assess risk -resolve
• Your primary task now is to provide information
– Clear, calm, specific
– Stay physically neutral – DO NOT try to physically
intervene
– Answer questions
– Give information about triggers, strategies &
resources
Alice "Elaine" Slaton
34
Helping Families Talk to Law
Enforcement in Times of Crisis
What next?
• Debrief & re-assess & re-plan & focus on
prevention
• Advocate for resources & services
• Develop meaningful collaboration between
family-run, youth-run, peer-run organizations
and law enforcement
Alice "Elaine" Slaton
35
“While behaviors that represent an imminent danger certainly
indicate the need for some sort of an emergency response, these
behaviors may well be the culmination of a crisis episode, rather than the
episode in its entirety. Situations involving mental health crisis may
follow trajectories that include intense feelings of personal distress (e.g.,
anxiety, depression, anger, panic, hopelessness), obvious changes in
functioning (e.g., neglect of personal hygiene, unusual behavior) or
catastrophic life events (e.g., disruptions in personal relationships,
support systems or living arrangements; loss of autonomy or parental
rights; victimization or natural disasters).”
“Because only a portion of real-life crises may actually result in
serious harm to self or others, a response that is activated only when
physical safety becomes an issue is often too little, too late or no help at
all in addressing the root of the crisis. And a response that does not
meaningfully address the actual issues underlying a crisis may do more
harm than good.”
Practice Guidelines: Core Elements in Responding to Mental Health Crises. HHS Pub No.
SMA-09-4427. Rockville, MD: Substance Abuse and Mental Health Services
Administration, 2009.
Alice "Elaine" Slaton
36
Additional Resources
• Emotional CPR (eCPR) – a public education program designed to
teach people to assist others through an emotional crisis
www.emotional-CPR.org
• Mental Health First Aide – a national program to teach the skills to
respond to signs of mental illness and substance abuse
www.mentalhealtfirstaid.org
• Statewide Law Enforcement/Mental Health Efforts: Strategies to
Support and Sustain Local Initiatives: 2013; BJA/Council of State
Governments - www.bja.gov/Publications/CSG_StatewideLEMH.pdf
• Improving Police Response to Persons with Mental IllnessRecommendations and Models for Intervention. 2010 The
International Association of Chiefs of Police (IACP) National Policy
Summit Building Safer Communities
Alice "Elaine" Slaton
37
CONTACT US
• Elaine F. Deck
Senior Associate and Co-owner, Slaton Associates
edeck334@gmail.com
704/929-9927
• Kate Murphy
Member Communication Specialist, CoastalCare
Kate.Murphy@coastalcarenc.org
910/550-2552
• Novella Frieslander
Deputy Sheriff, Lt., SRO Commander
New Hanover County
nfrieslander@nhcgov.com
910/798-4226
• Alice “Elaine” Slaton
Owner/Manager, Slaton Associates
a.elaine.slaton@gmail.com
703/919-7019
38