10.30.2011

Analysis of the Changing Roles of Law Enforcement in Crisis Intervention

Institute of Mental Health 3, Nov 06Image via Wikipedia

by Elizabeth Hall

Introduction
The decision that Congress made in response to horrid reports of mistreatment in mental facilities, was mandated in 1963, by passing the Community Mental Health Centers Construction Act, resulting in the closing of all the facilities known as mental institutions, sanitariums, and specific hospitals that were designated for mental health care.  The results that followed automatically placed law enforcement in the front line of people who are supposed to respond to mental health crises in our communities.  Officers at this time were not fully trained, or prepared, to deal with crises involving mental health issues, and often viewed this as a disruption in performing “real police work”.  In this paper, we will discuss the evolution of the Crisis Intervention Team, along with a case involving Mary, who is having a current crisis.  This new role of law enforcement, in effect, happened without their consent, but effectively caused a new beginning to law enforcement training, planning, and intervention during crises in their communities. 
New Roles of Law Enforcement in Dealing with the Mentally Ill
According to Bird, Coffin, Hartley, and Lambert (2002), the Community Mental Health Centers Construction Act provided funding to communities to create centers specializing in services such as outpatient, inpatient, consultation, temporary hospitalization orders, crisis intervention services, and even emergency intervention services.  This was in response to the new plan to deinstitutionalize mental patients and attempt to return them to the communities instead of locking them away as was the previous practice.  Since these patients were now returning to the communities, law enforcement that previously was not responsible for such duties now were on the front lines when crises with mentally ill patients occur.  The law enforcement communities have come far in overcoming the idea that this is not real police work, which seemed to be a large problem when this change occurred notes Connor (2009).
 Since then the law enforcement network has since developed effective measures to deal with problems such as this, however not without some issues along the way.  One such issue is that not all departments of law enforcement are created equal, have different budgets, equipment, and local facilities.  Studies have shown that in the course of an officer’s career since the Act was passed in 1963, most officers have had at least one call if not several in which they are the first responders in a situation involving the mentally ill, called expressive crimes (James, 2008).  This absence of training and knowledge in areas of mental health according to Gil, Munetz, Ritter, and Teller (2006), has caused officers to seek more training in areas of this type of knowledge, and in the emergence of Crisis Intervention Teams (CIT) as an answer to the problems of untrained officers serving in community policing roles.   The role of the officer as the first responder is that he should attempt to diffuse the situation, and deliver the mentally ill person to other crisis workers, emergency rooms, hospitals, or other designated mental health facilities, which have aligned to aid police in these growing situations (James, 2008). 
Roles of the Crisis Intervention Team
The CIT is generally, made up of an alliance of networked professionals including law enforcement, Emergency Services, mental health professionals, and Emergency Rooms of local hospitals (James, 2008).  In short, the CIT is designed to bring professionals from all of these areas together in the community to effectively deal with the ongoing and growing numbers of mentally ill persons in the community, many of which are homeless and in plain sight of the public’s view.  These professionals network together and learn about each other’s profession in order to understand the problems caused when the mentally ill were put back into the communities and placed in line that makes officers the new first responders.  This helps them to formulate better training and plans to use when a crisis occurs (James, 2008). 
Training Needed to Fulfill these New Roles
The first model that happened when the need for training for law enforcement arose due to their new roles as first responders in crises was in Memphis, and involved agencies from the government, mental health facilities, and the law enforcement agencies of Memphis (James, 2008).  When the Memphis model began, they brought police into the world of mental health professionals in order for them to witness firsthand how things work in the field.  In turn, members of the mental health community also visited the law enforcement environment so they could see what they deal with on a daily basis, and effectively this forged better relationships between all sides involved by promoting respect and understanding of each other’s roles. It was after this that they developed training which would benefit everyone (James, 2008).
Out of these networking efforts, came the decision by law enforcement to use experienced officers as candidates for their CIT teams, to receive specialized training so they could serve in the positions of regular duty officers and CIT members concurrently (James, 2008).  The advantages of well-trained officers in mental health issues is priceless, because an officer that does not know how to approach situations involving people who are disturbed can make the situation worse.  What the Memphis Model did was to involve the upper rankings of law enforcement, and to make sure that trained CIT officers were assigned to every shift.  This was to ensure that in the case of a call involving a mentally disturbed person a trained CIT officer would be the one to respond to the call.  These officers received specialized training in many areas such as, multicultural awareness, drug and alcohol abuse, and the disorders that could be involved concurrently with this, debilitating developmental issues, resources for mental health and strategies for treatment in mental disorders, all legal aspects of crisis intervention, how to intervene in suicide instances, and what community resources and mobile mental health units are available.  They also are trained on what psychotropic drugs are used and the side effects caused by their use, personality disorders, and the viewpoints of family members of mentally ill patients, along with what the mentally ill really think about law enforcement.  The most critical training they receive is methods to de-escalate and defuse situations involving persons in crisis states (James, 2008). 
Effective Planning for Crises
According to Dunkel, Rollo, Zdziarski, and Associates (2007), the process of crisis management “requires an ongoing process of planning, prevention, recovery, and learning in a never ending cycle”.  When developing plans for crises that might occur, teams should evaluate and identify the types of crises that may arise, and the ramifications that could occur if the event happens.  Since one cannot plan for every type of event, it is critical to evaluate what types of incidents are the most likely to occur and what effects on the community the events may have.  If one considers the types of crises that could happen they may fall into three categories, which are environmental, facility incidents, and human incidents (Dunkel et al, 2007).
When looking at possible scenarios one should consider that if the end result of the incident happening equals disaster, but may be unlikely to happen, the incident should remain on the preparedness plan simply for the ramifications that would follow to the community (Dunkel et al, 2007).  Once the team determines the types of incidents that must be included on the list of potential incidents, they should examine the availability of any resources needed to manage the crisis and what groups within the CIT are best suited to respond to individual details of the incident.  Another item that needs to be constantly updated is the staff changes that happen to every organization as people change jobs, move, etc.  The middle of an incident is not the time to discover that the person that was supposed to respond to certain criteria no longer works for the entity involved (Dunkel et al, 2007)
The Steps that need to be Taken
The first step that a crisis interventionist should take is to define the current crisis, along with the nature and scope of the incident according to James (2008), when using the six-step model of crisis intervention.  The second step in this model involves assessing and securing the safety of the scene, the individual in crisis, and anyone else around the incident including but not limited to any officers involved in the resolution of the incident.  This includes ascertaining any likelihood that the client poses a danger to themselves or others.  The third step in this model is that the crisis worker must actively listen and provide support for the client in crisis.
  When the crisis interventionist believes that that there are safety concerns for the client or others around the incident, they are required to act immediately on the situation.  The process of actively listening can begin.  The fourth step that should be performed is to examine any alternatives other than the current crises that the client can utilize.   The fifth step in the model involves making definitive plans with the client to follow with definite time limits established.  The final step is to obtain a commitment from the client to the plans that have been established (James, 2008). 
Case Scenario
“Dispatch to Unit 203B” crackles my radio.  “203B here, what do you need” is my reply to dispatch.  The radio crackles again, “I need you to respond to a priority alert advising that we have a woman in the middle of the street on Broadway in the 1500 block displaying disorderly behavior, ranting at vehicles and disrupting traffic”.  I immediately head in the direction of Broadway, wondering what could be going on.  Upon arrival at the scene, I see traffic backed up for blocks, pedestrians gawking, motorists honking and yelling, and, a woman in her early thirties clawing at her shirt yelling that “the devil is in her shirt”.  This is a busy street, and she is directly in the middle of the two lanes of traffic.
Most Effective Response for Case Discussed
In following the six-step model, my first priority is to assess the situation, and what I see is that traffic must be dealt with,   I need to call an ambulance in order to get this woman to the emergency room so she can be evaluated for any medical reasons that may be causing her to react in this manner.  After calling for emergency services (an ambulance), my first priority is to get the woman out of the street and get traffic moving again to ensure the safety of the scene.  I approach the woman with caution and tell her that I am here to assist her. 
I figure that the best way to calm her is to see if I can get her to my car and let her take off the offensive shirt.  I suggest to her that I have a jacket in my car that she can wear instead of the shirt, and she agrees to leave the middle of the street and accompany me to the cruiser.  Upon arrival at the cruiser, I advise her to get in the back as I retrieve the jacket from my trunk.  I give her the jacket and block the view with my body so she can change, putting the “offensive shirt” in an evidence bag so I can send it with the ambulance.
 Meanwhile, the ambulance arrives, and since the “evil shirt” has been removed, the woman has calmed down considerably.  The next issue will be getting her to get in the ambulance.  I consider my options, and decide that the best alternative is to tell her that the hospital will be able to check and see if there was anything wrong that the shirt has caused.  She considers this carefully, and decides that it may be a good idea and walks with me to the ambulance.  Once I deliver her to the ambulance she will be transported to the emergency room, evaluated for medical and psychological causes for her public outburst, and directed to the proper resources to assist her with issues she may be having.
Conclusion
Because of the decision by Congress to deinstitutionalize mental patients by passing the Community Mental Health Centers Construction Act in 1963  law enforcement was suddenly thrust in the role of first responders when issues involving the mentally ill come up in their communities (James, 2008).  This has resulted in the invention of the Crisis Intervention Team as a specific response to aid law enforcement in training and preparing for incidents of this nature.  Since then, law enforcement, mental health professionals, local government officials, and other emergency workers have developed specific plans to effectively deal with the influx of mentally ill patients that have returned to our communities.  These plans have included developing models to deal with crises such as the six-step model, and developing networks comprised of all mental health services, law enforcement, and emergency services working together to resolve crisis incidents with the best possible solutions.  The end result, is that while these new roles in law enforcement were thrust upon them, they have risen to the challenge by working with other professionals involved with mental health and emergencies developing sound  plans to keep our communities and streets safe for the people who live in them whether they have mental illnesses or not (James, 2008).





References:
Bird D. C. Ph.D., Coffin J., MS, Hartley D. Ph.D., MHA, and Lambert, D., Ph.D. (2002).  The Role of Community Mental Health Centers as Rural Safety Net Providers.  Retrieved From: http://muskie.usm.maine.edu/Publications/rural/wp30.pdf
Connor, M.G., Psy.D.  (2009). Use of Police and 911 for Mental Health and Psychological Emergencies.  Retrieved From: http://www.crisiscounseling.com/crisis/Police911.htm
Dunkel, N.W.  Rollo, J.W., Zdziarski II, E.L., and Associates, (2007).  Campus Crisis Management: A Comprehensive Guide to Planning, Prevention, Response, and Recovery.  Josey-Bass.  San Fransisco.
Gil, K.M., Ph.D, Munetz, M.R., M.D., Ritter, C., Ph.D., and Teller, J.L.S., Ph.D., (2006).  Crisis Intervention Team Training for Police Officers Responding to Mental Disturbance Calls.  Retrieved From: http://psychservices.psychiatryonline.org/cgi/content/full/57/2/232
James, R.K. (2008).  Crisis Intervention Strategies, Sixth Edition.  Cengage Learning.  United States

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