Understanding Crisis Intervention

• People undergoing an acute crisis usually experience a distinct, short-term situation tied to a specific cause
• People in chronic crisis situations are usually candidates for a mental health system response, as opposed to a criminal justice response
• It's important to know and be able to access the mental health resources available in your community

The Crisis Cycle

• A crisis is time-limited, with individuals progressing through different stages

Stages of the Crisis Cycle

• Normal state: Emotional state and mental abilities are at normal levels
• Stimulation: An internal (physical illness, pain, emotional reaction, or mental illness) or external (something someone said or did, or an environmental factor) event causes the person to become excited, upset, active, or physically uncomfortable

Escalation

• The person shows obvious signs of distress, including observable physical changes and changes in behavior
• Reddening of the face may occur
• Muscles may tense (clenched jaw, clenched fists)
• Talking more or louder may occur
• Sometimes becoming quieter or more withdrawn

Crisis State

• The the person becomes temporarily out-of-control and possibly assaultive
• He or she may scream, yell or curse, or may wave arms or stamp feet

De-escalation

• The person remains tense but is more in control, with a gradual decrease in the crisis behaviors
• If provoked, the person can go back into crisis

Stabilization

• The person is back to normal behavior and is once again under control

Post-Crisis Drain or Depletion

• The person may drop below their normal level of stimulation, and is more likely if the crisis phase was prolonged and/or physical
• A person in this stage is quiet, tired, and/or withdrawn, and may express regret about his or her actions, including crying

Important Cycle Considerations

• Cycles vary in length, intensity, and individual reactions
• Not everyone escalates to a crisis state
• You may encounter a person at any phase
• A person’s ability to understand and respond varies greatly depending on the phase
• Crisis intervention strategies and techniques may have to vary, depending on assessment of the crisis cycle phase

Officer Safety/Tactical Considerations

• Two goals in managing a crisis are safety and control
• Apply concepts and skills from Arrest and Control Techniques training
• Emotionally disturbed persons (EDP) are potentially dangerous for a short period of time
• An EDP may be angry, upset, and not thinking clearly or rationally
• Some people with mental illness are violent or dangerous, particularly when under the influence of alcohol or drugs
• A good threat assessment is very important
• Take time to assess the situation
• Ask questions, listen carefully, and listen non-judgmentally to determine what is really going on with the subject(s)
• Try to identify the person’s problem, or perceived problem, as best as you can
• A crisis situation is always a matter of perception
• It is the the person’s perception of the situation and what it means to him or her, and not the apparent facts, that causes a person to feel that he or she is in crisis
• Never assume that something seemingly meaningless or insignificant is meaningless or insignificant to a subject
• Trivial things can be the triggering event that puts the person into a serious emotional or mental crisis, making the person emotionally disturbed
• Always assume that an EDP may be dangerous even if the subject has been dealt with in the past, and make your threat assessment accordingly

Early Warning Signs

• Watch out for early warning signs and pre-attack postures
• Conspicuously ignoring you
• Giving you excessive emotional attention
• Moving in an exaggerated way
• Ceasing all movement
• Having a known violent history

Specific Pre-Attack Postures

• Boxer stance
• Hand set/clenched fists
• Shoulder shift
• Target glance
• The “thousand-yard” stare

Important Reminders

• With people in crisis, you may not see any indicators of escalating tension before an attack
• Never take for granted a person’s “presumed compliance” because it is a form of complacency that puts officers at risk
• Remember this concept when dealing with any subject, and especially when dealing with a person in crisis
• When dealing with an EDP, you potentially wear a number of hats (medical first responder, therapist, and so on) but you are always a law enforcement officer first with officer safety and the safety of others being critical at all times
• Always stay alert, and never become complacent, especially if the subject seems low risk or low threat
• To presume that any person in crisis is not a potential threat, no matter how frail or disturbed, is to set yourself up for trouble
• The way in which you act with subjects during a crisis will affect the subject’s attitude and feelings toward you and other officers, both now and in the future
• Careful attention to follow-through may save another officer from a fight or injury the next time the subject has contact with law enforcement

Crisis Intervention Techniques (POST B)

• If the person is very upset or angry, depressed, irrational, unusually confused, very withdrawn or frightened, possibly mentally ill, or under the influence of alcohol or other drugs, using the techniques described in this section will help you manage the situation effectively
• Such situations are often difficult and/or volatile, so you will be dealing with unpredictable or even potentially violent subjects
• Usual communication skills may not work well

Pre-Intervention Preparation

• Calm yourself
• Center yourself and get focused
• Develop a strategy for the intervention

Intervention Guidelines

• Try to get the person’s attention
• Check on the person’s perception of reality
• Try to establish rapport with the person
• Explain your perception of reality
• Move toward resolution of the situation

Professionalism

• Think of how you would want to be treated by law enforcement
• Your professional presence and your effective use of dialogue are critically important
• Presence and dialogue helps you get voluntary compliance and avoid using physical force

Getting the Person's Attention

• You cannot make progress with a person in crisis unless he or she is paying adequate attention to you
• A person in crisis is more likely to see you rather than to hear you, at least initially
• The subject will see you and gain an impression of you from what he or she sees

Positioning and Body Language

• Move to where the subject can see you and use an open stance. An open stance, with your body slightly bladed and hands visible with palms up appears non-confrontational to the person in crisis while also allowing you to react quickly if need be
• If dealing with a child or a short adult or seated person, you may wish to lower yourself. By kneeling or stooping or sitting, you may appear less threatening. However, only do this if you feel it is safe because people in crisis are unpredictable
• Avoid crowding the subject to the extent possible
• If you crowd the person, you may appear threatening or may appear as though you are blocking the person’s “escape” route, as they are likely to have expanded “intimate” zones
• If you get too close, they may feel threatened or upset or lash out and how close is too close varies with the individual and may change during an encounter
• Always try to pay attention to the person’s body language, posturing, facial expressions, and so on
• Control distance and maintain bailout routes
• Because EDP’s can be dangerous and unpredictable, maintain an appropriate distance for officer safety
• Be aware of your escape routes should you suddenly need to disengage
• Remain alert, but try not to appear tense
• Instead, try to project that you are calm
• Speak in a low, calm tone of voice and keep your body relaxed
• Try to maintain a neutral but interested facial expression, and keep your palms open, not closed
• Remember that your calm appearance may help the subject to feel safer and calmer, because he or she will perceive that you are in control of the situation

Verbal Interaction

• Use your given name, rather than a title. This will make the encounter seem less formal, and thus be less frightening to the subject. It makes you seem like a person first. Example: “Good morning, I’m Bill Smith.”
• You can add your title after you’ve given your name, if you wish to do so
• Learn and use the individual’s name. Often using the person’s first name helps establish a bond, but it is a good idea to ask permission first, particularly if you are a younger officer dealing with an older subject. In that case, it might be better to use “Mr.” Or “Mrs.” Example: “Is it okay if I call you Bill?”
• Ask the subject to look at you. But do not order him or her to do so
• Be polite. If needed, wave your hands slowly to get the other person’s attention. Examples: “Joe, please look at me.” “Susan, can I get you to look at me?”
• Get the subject to focus on you, not at you. Talk softly and slowly
• Use simple commands, using the subject’s first name if you know it
• Remember, a person in crisis has a diminished ability to think rationally
• Keep your commands as simple as possible and be polite. This is a sign of basic respect, and is likely (though not guaranteed) to make the encounter go more smoothly
• Avoid using words or phrases that the subject may not understand, or may be frightened or confused by
• Do not use ten-codes or other police jargon
• Always give as much time as you can so that the subject will calm down, focus on you, and be compliant because the longer you can keep things in a verbal mode, the less likely it is that you will have to escalate to physical intervention and you will have to wait the person out, if you can do that

Reality Perception

• May or may not perceive reality accurately, especially if experiencing a mental disorder, under the influence, or in a temporary crisis
• Ask basic questions like, “Who are you?” or “Where are you?”
• See if the person is oriented to time by asking, “What time is it?” or “What is the date today?”
• Ask the person what he or she is seeing may assist you in figuring out what the person is experiencing
• If the person does not answer, tell him or her that you cannot hear what he or she is thinking because some EDP’s—particularly individuals with mental disorders—may believe that other people can hear or read what they are thinking, and therefore do not verbalize all of their thoughts, known as “thought broadcasting.”
• Recognize that the person may feel the need to touch you to determine if you are real and your choice of how to respond will depend upon your assessment of the situation
• Some options include:
  • Allow it to happen, as a calculated risk—remembering that you are putting your safety at risk. -Do not allow the person to touch you. Step back. -While verbalizing that you are real, establish the physical contact yourself

Establishing Rapport

• To try to alleviate the person’s fears and to get him or her to trust you, there are certain things that you can and should say to a person in crisis Tell the person directly that you are here to help and to protect him or her. Use positive words and keep it simple
• Listen to the person, using your active listening skills
• Use the pronoun “I” as frequently as possible. Just like using your name when you introduce yourself, this helps make the encounter more personal, and helps the subject see you as a human being
• Acknowledge the person’s sensory or emotional experience
• Acknowledge that you too would feel upset if the same thing were happening to you
• Sometimes establishing physical contact with a person can help establish rapport
• Use a gentle, firm touch and maintain the contact for a little while but at the same time, remember that touching can sometimes be threatening to EDP’s and always ask for permission before touching a person in crisis
• Explore ways to help the person calm down
• Just the idea of taking a medication can help calm a person

Explaining Reality

• Explain your perception of reality so other person can distinguish between what he or she is experiencing and what you are experiencing
• Some people in a crisis are uncertain as to what is “real” or not and a “reality check” from another person may be useful
• Tell the other person directly what you are seeing, and that you are not seeing, hearing, or smelling what they say they are perceiving
• According to mental health experts, you should avoid telling an EDP that what he or she is experiencing is not real, because doing so undermines the person’s ability to believe you and trust you

Resolution

• You need to try to move toward achieving a resolution of the situation
• What that resolution is depends on the reason that you are there and to make the right decision and achieve resolution requires you to:
• Keep the subject as calm as possible
• Find out as much as you can about the situation
• Use available resources to help with resolution
• Remain realistic and honest in your dealing with the subject

Resolution Techniques

• Separate the person in crisis and his or her “audience” to prevent “grandstanding” and embarrassment and it is easier when you can work just with the person
• Try to allow the person to “save face”
• Don’t make statements that will embarrass or demean the other person, should add to the stigma of mental illness
• Do not label someone as mentally ill
• Try to get the person to voluntarily agree to move to a different location
• Find out as much as you can about the situation, including any history of crisis, by asking open-ended questions
• If it seems to be a mental health crisis, also try to find out information about the person’s treatment history and care providers
• Sometimes the person in crisis may be able to help reach a resolution and an excellent technique is to ask a person directly: “What would you like me to do?” or “What can I do to help you?” or “How can I help you?”
• Be careful about what you agree to or promise
• In many cases, enlisting the subject’s help in finding resolution will help achieve voluntary compliance
• Often a subject’s family or friends can be very helpful unless they agitating the subject
• You must use your judgment, on a case-by-case basis, about involvement of other people
• Remain realistic and honest in your dealing with the subject because establishing your credibility with the subject and maintaining that credibility is crucial to achieving a positive resolution

Honesty

• Work toward small, concrete goals because it is unrealistic in most cases to expect immediate resolution of a complex situation
• Avoid making promises that you cannot keep, do not intend to keep, or do not have the authority to follow-up on
• Use the technique of “creative confusion” to move toward resolution. With this technique, you appear as though you do not understand something and ask the other person to help you understand
• In some cases, a person may be trying to manipulate you and/or the system, and you can use this technique to try to reveal that manipulation attempt
• Whenever possible, get the person’s agreement as to what will happen which is a form of voluntary compliance