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Law Enforcement Academy Asheville-Buncombe Technical Community College Asheville, North Carolina Crisis Intervention Team Training September 27 – October 1, 2010

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Title: Law Enforcement Academy Asheville-Buncombe Technical Community College Asheville, North Carolina Crisis Intervention Team Training September 27 – October 1, 2010


1
Law Enforcement Academy Asheville-Buncombe
Technical Community College Asheville, North
Carolina Crisis Intervention Team
Training September 27 October 1, 2010
  • De-Escalation Skills

2
Overview
  • 1 ½ days (12 hours)
  • Lots of role-playing practice in small groups
  • Goal is for you to feel very confident in your
    ability to de-escalate
  • Model E-LEAP
  • E engage (wed. pm)
  • LEAP listen, empathize, affirm, partner (thur.
    am)
  • Specific strategies for consumers who are
    disoriented, intoxicated, suicidal, etc. (thur.
    pm)

3
Wednesday PM
  • What is de-escalation
  • Effective communication
  • Non-verbals
  • Behavioral crisis
  • Engagement

4
What is 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

5
Goals of Verbal De-escalation
  • Open up clear lines of communication
  • Build trust and validate the consumers situation
  • Get the consumer talking about his situation
  • Gathering the necessary information make a good
    resolution

6
What is De-Escalation
  • De-escalation is less like a recipe or formula
    and more like a flexible set of options.
  • No single set of de-escalation skills we have
    tried to put together a effective set of skills
    by borrowing from multiple approaches
  • De-escalation will not always work

7
What is de-escalation
  • Both officer and consumer safety always remain
    paramount concerns in a crisis involving a person
    with mental illness.
  • Once officers become skilled in de-escalation,
    they do not simply abandon all the training and
    experience that came before it.
  • De-escalation is another tool that officers have
    at their disposal to be judiciously applied in
    controlling a potentially volatile situation,
    rather than serving as a substitute for sound
    judgment and attentiveness to safety.

8
Effective Communication
  • 70 of communication misunderstood
  • Effective communication is defined as passing
    information between one person and another that
    is mutually understood

9
Effective Communication
  • Communication becomes more difficult when the
    persons ability to understand what you are
    saying and/or their ability to express their own
    thoughts or needs are compromised by their
    symptoms.
  • When they cant express their needs, they become
    more angry and frustrated more quickly and more
    frequently
  • Your ability to engage a consumer in conversation
    and successfully resolve a conflict often depends
    as much on how you say the words you choose as
    much as the words themselves.

10
Barriers to Effective Communication
  • Barriers to communication are the things that
    keep the meaning of what is being said from being
    heard
  • Pre-judging
  • Not listening
  • Criticizing
  • Name-calling
  • Engaging in power struggles
  • Ordering
  • Threatening
  • Minimizing
  • Arguing

11
Effective Communication
12
Non-Verbal
  • It is very important to be able to identify
    exactly what you are communicating to others
    non-verbally
  • You may be trying to de-escalate the situation by
    talking to the other person, but your body
    language may be saying something else. The
    consumer will react to want you are saying with
    your body language

13
Personal Space
  • Persons with mental illness often develop and
    altered sense of personal space. They require
    more space than usual to feel comfortable and
    feel intensely threatened when other people close
    in on them with no warning.
  • Invasion or encroachment of personal space tends
    to heighten or escalate anxiety
  • Personal space in American culture is about 3
    feet
  • Do not touch a hostile person they might
    interpret that as an aggressive action
  • Announce intention I need some space, so I am
    going to back up.

14
Eyes
  • One eyebrow raised sternness
  • Eyes wide open surprise
  • A hard stare threatening gesture
  • Closing eyes longer than normal I am not
    listening

15
Body Posture
  • Challenging postures that tend to threaten
    another person and escalate the situation
    include
  • Finger pointing may seem accusing or threatening
  • Shoulder shrugging may seem uncaring or unknowing
  • Rigid walking may seem unyielding or challenging
  • Use slow and deliberate movementsquick actions
    may surprise or scare the other person

16
Voice
  • Tone - Usually unconscious
  • Volume - A raised voice could create fear or
    challenges
  • Rate of speech - Speak slowly This is usually
    interpreted as soothing
  • Inflection of voice - I didnt say you were stupid

17
Face
  • Jaw set with clenched teeth shows that you are
    not open minded to listening to his or her side
    of the story
  • A natural smile is good. A fake smile can
    aggravate the situation

18
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19
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20
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21
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22
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
  • Unless the person obtains relief, the crisis has
    the potential to cause severe behavioral
    malfunctioning.

23
Behavioral Crisis?
  • Crisis intervention is emotional first aid which
    is designed to assist the person in crisis to
    return to normal functioning.
  • The focus of crisis intervention is whats
    happening here and how!

24
Behavioral Crisis
  • 3 reasons that a consumer may be having a
    behavioral crisis
  • Medical condition
  • Substance use
  • Psychiatric condition 1) thought disorder 2)
    mood disorder 3) anxiety disorder 4)
    personality disorder

25
Behavioral Crisis
  • The majority of encounters that you will have
    with consumers are because the symptoms of their
    illness are not under control. Most commonly,
    this occurs at the initial onset of illness,
    during a relapse (that can result for a variety
    of reasons) and when the person s using
    substances.
  • The consumers behavior is usually a result of
    his or her illness, rather than being criminally
    motivated

26
Consumers typically will have one of 3 feelings
  • Anger
  • Fear
  • Sadness/depression

27
What you may be seeing . . .
28
Behavioral Crisis
  • Given the low likelihood that emotional people in
    crisis can succeed in rationalizing alternatives,
    law enforcement responses to emotional people in
    volatile situations cannot rely on convincing
    people by making a rational proposal to think
    differently. Rather, responders need to create a
    stable and respectful environment within which
    emotional individuals can take comfort and relief.

29
Engagement
  • Be aware of your setting personal safety first
  • Move to a safe place if necessary
  • Allow plenty of space
  • Persons with mental illnesses often can be
    expected to process information slowly and to
    have difficulty remembering things. This includes
    understanding and remembering instructions given
    by a police officer.

30
Engagement
  • Be aware that a uniform, gun, and handcuffs may
    frighten the person with mental illness so
    reassure consumer that no harm is intended.
  • Remain calm
  • You will likely have contact with the consumer
    again how you treat him will be important for
    establishing trust

31
Engagement
  • Know when to act A person may be acting
    dangerously, but not directly threatening any
    other person or himself/herself. If possible,
    give the consumer time to calm down. This
    requires patience and continuous safety
    evaluation.
  • Allow partner to de-escalate others on the scene
    as necessary

32
Engagement
  • It is the wise officer who can, at times,
    conceal his or her combat-ready status.
  • -Lt. Michael Woody

33
Avoid
  • Maintaining continuous eye contact
  • Crowding or cornering the consumer
  • Touching the consumer unless you ask first or it
    is essential for safety
  • Letting others interact simultaneously with the
    consumer
  • Negative thoughts (God, this is another one of
    those homeless people.)

34
Avoid
  • Expressing anger, impatience or irritation
  • Inflammatory language (You are acting crazy.)
  • Feeling as though you have to rush or feeling
    like you are stuck if it takes time to get the
    consumer talking
  • Intervening too quickly or trying too hard to
    control the interaction by interrupting or
    talking over the consumer.

35
Avoid
  • Saying You need to calm down.
  • Shouting or giving rapid commands
  • Arguing with the consumer
  • Taking the words or actions of the consumer
    personally (They are symptoms of mental illness.)
  • Lying, tricking, deceiving, threatening the
    consumer to get her to comply

36
Avoid
  • Asking why questions. Why questions are
    logic-based. Persons in crisis are not logical.
    Typically, what ever has worked in the past is
    not working now. Why questions put the consumer
    on the defensive. Ask open-ended questions.
  • Forcing discussion

37
Avoid
  • Minimizing the consumers situation as a way to
    elicit conversation (Things cant be that bad,
    can they?)
  • Suggesting that things will get better they may
    not
  • Making promises that you may not be able to keep

38
Avoid
  • Commands such as drop the knife, or Get down
    on the ground might seem to be straightforward
    and easy to understand. When dealing with people
    who live with mental illness, however, officers
    need to take into account the types of barriers
    to effective communication that the brain
    disorder might create.
  • Telling the consumer I know how you feel.

39
Avoid
  • Asking a lot of questions of the consumer in the
    beginning. This is a natural tendency, however,
    this is generally not a good idea, especially
    early in the interaction. In de-escalation,
    encouraging the consumer to continue talking is
    more effective than asking a lot of questions. It
    will help continue the dialogue and will provide
    the consumer with opportunities to give
    information that will help to resolve the crisis.

40
DO
  • Speak in a calm, slow, clear voice
  • You may need to repeat the consumer may be
    distracted
  • Be patient give the situation time time is on
    your side
  • Try to reduce background noise and distractions
  • Use and instead of but
  • Obtain relevant information from informants

41
DO
  • Allow the consumer to ventilate (Tell me some
    more about that.
  • Use please and thank you often
  • Remain friendly but firm
  • Ask the consumer if she needs something
  • Offer a cigarette, nutrition bar, warm clothing
  • Forecast Announce your actions and movements

42
DO
  • Accept the consumers feelings, thoughts and
    behavioral acceptance is not easy when a
    consumer is behaving in a bizarre or hostile
    manner
  • Respect the dignity of the consumer without
    regard to sex, race, age, sexual orientation

43
Hot Buttons
  • Consumers will sometimes push a hot button
  • We all have them
  • Example The consumer calls you a pig or swears
    at you.
  • This is NOT the time to demand respect

44
Hot Buttons Rationale Detachment
  • Staying in control of your emotions during a
    crisis situation
  • 3 steps

45
1. Develop a Plan
  • Decisions made ahead of time are more likely to
    be rationale
  • Identify your hot buttons
  • Strategic visualization practice what you would
    do
  • Helps you gain confidence

46
2. Use Positive Self-Talk
  • You are not the target of the outburst
  • Never take anything personally
  • Remember that most of us have been irrational and
    said inappropriate things when we are under
    extreme stress

47
3. Recognize Your Limits
  • Let someone else take over if necessary
  • Set a limit with the person use an I
    statement I really want to help you but I find
    it difficult because of your name-calling could
    you help me and stop the cursing so that I can
    work on helping you. Thanks, I would appreciate
    it if you try.

48
The Logic of De-Escalation
  • If you take a LESS authoritative, LESS
    controlling, LESS confrontational approach, you
    actually will have MORE control.
  • You are trying to give the consumer a sense that
    he or she is in control.
  • Why? Because he or she is in a crisis, which by
    definition means the consumer is feeling out of
    control. The consumers normal coping measures
    are not working at this time.

49
Introduce Yourself
  • An introduction promotes communication
  • Hi, my name is Doug (or Deputy Smith). I am a CIT
    officer with the Sheriffs Department.
  • Can you tell me your name?
  • State what you see/know (I can see youre
    upset.)
  • State or convey that you are there to help.
  • Be prepared to explain the reason you are there
  • (e.g., a neighbor called to say someone is upset)

50
Introduce Yourself
  • How many of you can have someone tell you her
    name, and within a few seconds you have already
    forgotten it
  • Make a point of immediately starting to use the
    consumers name that will help you remember it
  • Use the consumers name often

51
Introduce Yourself
  • Get out of here you damn cop!
  • Dont take the bait and turn confrontational

52
Role-playing Scenarios
  • Role-playing is a learning tool
  • Allows us to try out new approaches
  • Expect mistakes they are an opportunity to learn
  • You can rewind and try again

53
Role-playing Scenarios
  • Everyone feels uncomfortable in role play
  • Feedback will be constructive
  • Scenarios are derived from real-life experiences
  • We will be working as a team to assist one
    another in skill development
  • Small groups 3 rolesLaw enforcement, consumer,
    observer

54
Thursday AM
  • Listen
  • Empathize
  • Affirm
  • Partner
  • What Ifs
  • 5 special strategies

55
L Listen
  • Silent and listen are spelled with the same
    letters
  • Listen twice as much as you talk thats why you
    have 2 ears and 1 mouth
  • What is the difference between listening and
    hearing?

56
The Chinese symbol for listen eyes, ear, heart
57
Listen
  • Listen for the total meaning
  • Focus on what the consumer is telling you
  • Block out distractions

58
Listen
  • It is important understand and remember that what
    the consumer is saying or believing may be real
    or imagined. Since mental illness is a brain
    disease, thinking is what is most affected by
    mental illness. Sometimes their thoughts are
    disconnected and youll hear this in their
    speech, which can be difficult to follow and make
    sense of.

59
Techniques that Show You Are Listening
  • Minimal encouragers
  • Reflecting
  • Ask open-ended questions (Can you tell me more
    about that.

60
Minimal Encouragers
  • Minimal encouragers are brief statements that can
    be either nonverbal, such as a positive nod of
    the head, or simple verbal responses such as
    Okay, Uh-huh, I see, I am listening.
  • Minimal encouragers demonstrate to the consumer
    that you are listening and paying attention,
    without stalling the dialogue or creating an
    undue interruption. Especially early in the
    encounter, consumers need these types of
    encouragers to feel that the officer is really
    attending to them and listening to what they are
    saying.

61
Reflecting
  • Whereas minimal encouragers provide initial
    confirmation that you are listening, reflecting
    adds another dimension to the communication.
    Here, you provide the consumer with evidence that
    you are listening by actually repeating what he
    or she has said. Often the reflecting response
    will simply consist of the last few words the
    consumer says. These statements should be brief
    and used in such a way as not to interrupt the
    consumer.

62
Reflecting
  • Repeat the last few words that the consumer said
  • Example I am tired of everyone not listening to
    me and it make me angry.
  • Jim, it makes you angry.

63
Open-Ended Questions
  • Open ended questions allow you to get more
    information
  • Open ended questions enable us to assess the
    consumers level of dangerousness
  • Open ended questions allow you to assess whether
    the consumer is in touch with reality

64
Specific Questions That You May Want You Ask,
When Appropriate
  • Does the consumer need something (e.g., hungry,
    thirsty)
  • Is the consumer receiving services
  • Where is the consumer receiving services
  • Does the consumer have a case manager
  • Is the consumer taking medication
  • When did the consumer last take his or her
    medication

65
Medication
  • Mentioning medication must be given careful
    thought.
  • In some cases, the topic is best left to mental
    healthcare providers after the consumer has
    calmed down.
  • In other situations, the consumer may want to
    talk about his or her medication.
  • Also, many consumers have had negative
    experiences with therapists and dont want to
    talk about it their counselor.

66
E Empathy
  • Emotion labeling
  • Paraphrasing

67
Empathy
  • What is the difference between empathy and
    sympathy?
  • Feeling sorry versus trying to understand what it
    is like to be in their shoes.
  • Being sincere and real will convey understanding
  • 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)
  • Its hard to stay angry and aroused when someone
    empathizes

68
Emotional Labeling
  • In emotional labeling, you again take listening
    to a higher level by trying to help the consumer
    identify feelings.
  • This is different from telling the consumer
    what he or she is feeling because your statement
    is based on what the consumer has been
    communicating through his or her words and
    behavior.
  • If you have used your listening skills well, it
    will often be rather easy to provide an emotional
    label to assist the consumer.

69
Emotional Labeling Examples
  • You seem to be . . . .
  • It seems to me like you feel . . . .
  • If I were in your situation, I think Id feel . .
    .

70
Paraphrasing
  • Paraphrasing is similar to reflecting except that
    now you begin to communicate that you are trying
    to understand the consumers entire message by
    putting what the consumer has said into your own
    words.

71
Paraphrasing
  • Builds rapport between officer and consumer
  • Helps the officer refine the assessment of the
    crisis
  • Provides information that lays the groundwork for
    an eventual resolution of the crisis
  • Communicates that you are listening and
    understanding

72
Paraphrasing Examples
  • Consumer I dont know what I am going to do. My
    family doesnt want me here.
  • CIT Officer Youre not sure where you can stay
    for awhile, but home doesnt seem like the best
    place right now.

73
Paraphrasing Examples
  • What I hear you saying is . . . .
  • If I am hearing you right . . . .
  • Let me see if I understand what you are saying .
    . .
  • These types of statements also summarize what has
    been said in the communication.

74
A Affirm
  • You need to know what the consumer is upset about
  • You may have a tendency to go to the solution
    step without really identifying what the issue is
    with the consumer. You should not assume that you
    know why the consumer is upset. You should ask
    and let the consumer tell you what the problem is
    before looking at possible solutions.
  • After getting the information that you need,
    steer the conversation toward a resolution by
    affirming the consumers situation

75
Affirm Example
  • Okay, let me make sure I understand you, Youve
    told me that people are bothering you and that
    your case manager is not helping you. That your
    meds are hurting you because they make you feel
    sick. Did I understand you correctly.

76
P Partner
  • Also plan, problem-solve
  • Goal is to find a resolution and return to
    pre-crisis state.
  • You are looking to find the combination that will
    unlock the crisis.

77
Partner
  • You can ask the consumer what she thinks will
    resolve the problem
  • Look for alternatives with the consumer
  • Try to have 2 or more options
  • Empower the consumer to choose
  • If one approach doesnt work, throw another
    lure

78
Partner
  • Putting yourself in the consumers shoes will
    help you find a solution
  • Dont force particular points of discussion
  • Try to get agreement on a course of action.
    Repeat what the plan is and what is expected.
  • Meet reasonable demands when possible
  • Reach for small concrete goals
  • Its never too late to reassess and change a plan

79
Partner
  • If repeated attempts fail, set firm limits and
    tell the consumer that you are worried about his
    safely and you want to help him.
  • Ask if there is a family member you could talk
    to.
  • State your expectations by linking to safety
    issue I need to make sure that everyone stays
    safe.

80
Partner
  • In your attempts to resolve an escalating
    situation you may be tempted to use bargaining,
    deal-making, or saying/promising anything to gain
    compliance.
  • They are not recommended as they ultimately
    violate trustwhich is important in your repeated
    encounters with people.

81
Resolution
  • Can it be informally resolved?
  • Is an evaluation needed?
  • Are commitment criteria met?
  • Was a crime committed?

82
What Ifs
  • What if the consumer asks you a long-term
    question?
  • Say that you dont know the answer but that you
    and the consumer can handle the immediate
    situation

83
What If
  • The consumer says that theres nothing you can do
    to help?
  • Say that youre not sure what you can do, but
    that you want to work with the consumer to figure
    out something

84
What If
  • The consumer will not engage problem-solving and
    is distracted?
  • Say Stay with me, Frank. Lets work on this
    together. Id like for you to stop for a minute
    and take a deep breath with me. Like this. Thats
    good. Thank you, Frank.

85
What If
  • The consumers moves too close you?
  • Say I need some space, Jim, so I am going to
    back up.

86
What If
  • The consumer is talking so loudly it is
    disruptive?
  • Drop the volume in your own voice and say, Jim,
    I am having a hard time understanding you because
    of how loud your voice is.

87
What If
  • You think the consumer might become aggressive?
  • If possible, bring in another trained person.
  • There is less chance of aggression if two people
    are talking to one person.

88
What If
  • The consumer will only respond non-verbally, like
    with a head nod
  • Respond positively

89
What If
  • The consumer remains unresponsive?
  • Simply validate the consumer by stating what you
    observe about their situation
  • You look really sad you must be really hurting
    right now.

90
Five Special Strategies
  • Assertive Intervention
  • Corrective Action
  • Reducing Stimuli
  • Reducing Arousal
  • Pro-active (as opposed to reactive) engagement of
    consumers

91
1. Assertive Intervention
  • Can be used when
  • The consumer is uncooperative or unresponsive to
    directives that they are expected to follow.
  • The consumer is violating rules which serve to
    maintain security

92
Three Step Assertive Intervention
  • Empathy statement A statement that lets the
    consumer know that you understand where he or she
    is coming from and how he or she likely feels.
  • Conflict statement A statement that describes to
    the consumer that you have a conflict that needs
    to be addressed.
  • Action statement A statement that lets the
    consumer know what you want him or her to do.
    This statement can be in the form of a request.

93
Examples
  • Jack, I understand that you are upset and that
    you feel like no one is listening to you or doing
    enough to help you. But you and I need to let
    these people get back to work here, so we are
    going to have to get out of this waiting room.
    Id like you to walk with me down the hallway to
    an empty room so you and I can talk.
  • It looks to me like you are pretty upset, and
    Im here to help you. But I am afraid someone is
    going to get hurt by those stones. So Id like
    you to stop tossing them and step up here on the
    curb so I can talk to you and try to understand
    what is going on with you today.

94
Choice
  • If possible, offer a choice
  • Joe, I want you to stop throwing the stones or,
    if you prefer, step over here with me on the
    grass and throw them in the grass while we talk.
    What is best for you?
  • This helps the consumer save face.
  • Everyone reacts better to a choice versus being
    told what to do.

95
2. Corrective Action AAA
  • If you make a mistake (and you will) and the
    consumer escalates
  • Acknowledge Jim, I can see that mentioning your
    medication is a real sore point.
  • Apologize Im sorry to have upset you. I didnt
    mean to.
  • Try Again I want to help, not upset you, so
    lets try something else.

96
3. Reducing Stimuli
  • Remove the audience or move the consumer to a
    private space
  • Turn off flashing lights

97
4. Reducing Arousal
  • Encourage the consumer to take 3 deep breaths
    you can do this with the consumer. Lets take 3
    deep breaths like this then demonstrate and do
    it with the consumer.

98
5. Pro-active Engagement of Consumers
  • Many of you will interact with the same consumer
    on repeated occasions so you will get to know him
    or her. If you talk to a repeat consumer on a
    good day, you will have much better information
    to base an assessment come the bad day. That
    information will provide greater options for
    resolving conflicts.

99
Pro-active Engagement of Consumers
  • Drop by the consumers residence. Ask if there is
    anything you can do to help. (e.g. call the case
    manager to try to access a resource for the
    consumer.)
  • If you see the consumer in the community,
    acknowledge him or her. Stop to say hello if it
    would not embarrass the consumer.
  • Get to know some of the providers (e.g., case
    managers) who serve your consumers.

100
Thursday PM
  • Verbal Intervention Strategies for People who are
    Suicidal, Homeless, Delusional, Hallucinating,
    Confused, Agitated, Intoxicated, Having
    Flashbacks, Manic

101
Review of Terms
  • Thought Disorder usually a reference to a
    psychotic disorder
  • Psychotic out of touch with reality often
    experiencing delusions or hallucinations
  • Delusion false belief
  • Hallucination false sensory perception (most
    common is auditory)
  • Mania A manifestation of bipolar disorder
    (manic depression), characterized by profuse and
    rapidly changing ideas, exaggerated sexuality,
    gaiety, or irritability, and decreased sleep

102
Suicide
  • Asking about suicide Sometimes when people have
    been feeling down for a long time, they begin
    having thoughts that they would rather be dead,
    are you having any feelings like that?
  • Have you ever tried to hurt yourself before?
  • When and what did you do?
  • Do you have a plan now?
  • Do you have any weapons that you could use to
    hurt yourself?
  • Show support and interest
  • Be non-judgmental and accepting
  • Offer help that is available
  • Assess availability of supports

103
Suicide Threatening Harm
  • Focus on the anger or fear that is causing the
    threats
  • Repeat that you are here to help and keep
    everybody safe
  • Get the names of significant others (even pets),
    as a way to make a personal connection and keep
    the consumer grounded

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Suicide Attempt
  • Verbal communications should focus on providing
    hope for the consumer during a time when he is
    feeling hopeless.
  • Generally, helpful comments to make during
    questioning include These feelings will not last
    forever, even though it may seem like it now.
    There is help available. Many other people have
    felt this way and have gotten better.

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Suicide Attempt
  • Unhelpful comments include clichés such as,
    Theres a silver lining in every cloud, or
    comments about all that they have, You have a
    nice home, family who loves you, who will take
    care of your kids. And finally comments about
    yourself, I felt the same way once or a friend of
    mine felt this way once. These types of unhelpful
    comments only elicit more profound feelings

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Homelessness
  • 40 of homeless persons have a mental illness
  • The ways in which homeless people dress may seen
    bizarre to other people
  • Mental health professionals may refer to a
    homeless persons choice not to take medications
    as noncompliance, but to a homeless person the
    decision not to take sedating psychiatric
    medications may make good sense.

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Thought Disorder
  • The 3 possible responses to a person who loses
    contact with reality, and are either
    hallucinating or delusional, are
  • Agree with them
  • Dispute them, or
  • Defer the issue
  • Which is the appropriate response A, B or C?

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Thought Disorder
  • The engagement goal is to validate the consumers
    situation and how frightened and anxious he must
    feel without agreeing with their
    hallucinatory/delusional experience.
  • It is OK to indicate that you do not hear or see
    what he is seeing/hearing but that you believe he
    does.
  • Persons who are psychotic develop an altered
    sense of personal space and require more space
    than usual to feel safe.
  • Remember to maintain a safe reactionary
    distance of from the consumer.
  • Use friends and family members to get information
    if they are available and their presence is not
    escalating the consumer.

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Delusions
  • Paranoid delusions can lead to dangerous behavior
    because they cause a great amount of fear. This
    is especially true if the delusion includes a
    belief that ones thoughts are controlled by
    external forces.
  • Convey your acceptancebut let the consumer know
    that you are not experiencing it and reinforce
    reality.
  • I can see that you are scared that someone is
    out to get you, but I dont know of anyone who is
    trying to hurt you . . . Im here to keep you
    safe.
  • Dont argue about the delusionno one will win
    this argument

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Hallucinations
  • Ask if they are hearing voices When people are
    stressed or scared, they may hear or see things,
    is that happening to you.
  • Ask, are the voices telling you to do something,
    what?
  • People who are abusing substances or are in
    withdrawal may see things or feel things crawling
    on them

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Hallucinations
  • Indicate that you understand that those
    experiences are real and frightening for the
    consumer.
  • You can attempt to calm the person by letting
    them know that voices may quiet if you can help
    the consumer lessen their stress and get help.
  • You may have to repeat a reassuring message many
    times before the consumer can respond to it.
    Repeat Im here to help I am not going to hurt
    you.

112
Hallucinations
  • Hallucinations/voices that are command oriented
    involving religion, good versus evil, or are
    declaring self-harm are higher-risk than
    non-religious, non-confrontational
    hallucinations.
  • This can lead to dangerous behavior because many
    persons will obey the command.

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Confused/Disorganized Speech
  • People with a variety of mental illnesses may
    experience confusion schizophrenia, bipolar,
    neurological disorders, traumatic brain injury,
    people who are actively using or withdrawing from
    substances
  • Keep interactions brief and to the point

114
Confused/Disorganized Speech
  • When it is difficult to understand the consumer,
    say so and ask for clarification. If the consumer
    is rambling nonsensically, comment periodically
    that you realize that he must be frightened and
    that you are there to help.
  • Drop the volume in your speech and say, I am
    having a hard time understanding you because of
    how loud your voice is.

115
Agitation, Anxiety, Fears
  • Encourage 3 slow deep breaths
  • If this is difficult for the consumer, ask him to
    look at you and do it with you
  • Reassure and converse calmly

116
People Who Are Intoxicated
  • Remember, substance use, especially alcohol is a
    significant risk factor associated with violence.
    Do not let your guard down (She is only drunk.)
  • Keep statements brief and to the point
  • Avoid engaging in arguments
  • Point out that it is difficult to understand what
    is being said

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PTSD Flashbacks
  • Some people with post traumatic stress disorder
    experience flashbacks. During a flashback, the
    person is experiencing the traumatic event. So
    all the senses and thoughts are in the moment. It
    is really important to maintain personal space
    and avoid touch during a flashback.
  • Orient and ground My name is . . . today is . .
    . you are (describe where), its our job to keep
    you safe
  • Provide simple directives and reassurance softly
    and slowly

118
Rapid Speech / Mania
  • Some people talk rapidly when they are stressed
    or scared. People who are manic often talk very
    rapidly
  • Encourage the person to slow down, take deep
    breathes.
  • I want to understand what you are saying, but
    you are talking really fast. Lets take some deep
    breaths together.

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Acknowledgements
  • This material was adapted from numerous sources,
    including
  • Memphis CIT Curriculum
  • Sam Cochran
  • Randy Dupont
  • Georgia CIT Curriculum
  • Responding to Individuals with Mental Illness by
    Michael Compton and Raymond Kotwicki
  • Connecticut State Department of Mental Health and
    Addiction Services
  • Findlay/Hancock County CIT

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Thank you for going the extra mile to help people
with mental illness!
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