Crisis Intervention Team Training Dustin McKee & Gloria Walker NAMI Ohio & NAMI Greater Urban Cincinnati
National Alliance on Mental Illness • Founded in 1979 in Wisconsin • Original founders Harriet Shelter and Beverly Young • Largest grassroots movement in the nation with a focus on mental health • 40 local affiliates that cover most of Ohio’s 88 counties
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What is Crisis Intervention Team (CIT) Training? • A model for community policing • Brings together law enforcement (LE), mh providers, hospital emergency staff and people/families impacted by Mental Illness • Goal: To improve LE crisis response. • Improve communication, de-escalate person crisis & refer to treatment 3
PURPOSE To promote Crisis Intervention Teams (CIT) as an appropriate jail diversion alternative. To encourage working with communities To provide opportunities for trained CIT individuals to remain proficient in their skills. 4
WHAT IS CIT?? Collaboration between law enforcement, NAMI, MH consumers, & MH providers. Patrol officers receive 40 hours of training in MI & the local MH system. Focuses on providing practical techniques for de-escalating crises. Helps direct persons with MI into treatment instead of inappropriate incarceration. 5
Why train law enforcement in Crisis Intervention Team (CIT) Training? • Divert people with mental illness from incarceration to psychiatric treatment. – American Jails and prisons are the “new asylums”
• Provide new tools to ensure law enforcement & community safety • Better use of law enforcement resources by solving issues with people continuously encountered by law enforcement. 6
Today’s Agenda: Group Wisdom to Use In the Moment • NAMI Ohio: To improve the quality of life, ensure dignity and respect for persons with serious mental illness, and to support their families.
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What is mental illness? • Medical condition that disrupts thinking, feeling, mood, ability to relate to others, daily functioning • A disease of the brain, similar to other physical conditions like diabetes, thyroid, heart disease • May strike persons of any age, race, religion or income • Not the result of personal weakness, lack of character, poor upbringing, or moral failure • Treatable! Source: National Institute of Mental Health
Recent Research
Types of mental illness: • Bipolar disorder • Schizophrenia • Obsessive Compulsive Disorders (OCD) • Post-Traumatic Stress Disorder (PTSD) • Psychosis • Depression
Depression Symptoms include: • Suicidal thoughts or intention • Sleep disturbances, either not able to sleep well or sleeping too much) • Depressed mood such as feelings of sadness or emptiness • Feeling agitated or slowed down • Fatigue or loss of energy • Feeling worthless or excessive guilt • Difficulty with thinking, concentrating, or making decisions http://wallpaperswa.com/Art_Design
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Bipolar disorder Symptoms include: • Elevated or depressed mood (mania and depression) • Anxiety • Irritability • Intense imagination • Oppositional behavior • High activity • Hypersensitivity • Difficulties with sleep 12
Psychosis A mental state or symptom of mental illness in which some contact with reality is lost.
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Bipolar What Does a Manic Phase Look Like? Always on the go
Racing thoughts; talking very fast
Impulsive behavior
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Factors associated with high suicide risk: • • • • • •
Psychiatric diagnosis, esp. depression Feelings of depression & hopelessness Family history of suicide Previous attempt(s) Recently discharged from hospital Addiction disorders
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Suicide prevention • Are you having thoughts of suicide? OR • Are you thinking of killing yourself? • Do you have a plan? • Do you have the tools to implement the plan? • Do you have a timeframe? • At work, follow employer’s policy on assisting persons at immediate risk of suicide • In general, call Suicide Hotline: 800-273-8255 or 9-1-1
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Schizophrenia Two or more of the following symptoms occur persistently: • Hallucinations • Delusions • Disorganized way of thinking • Disorganized speech • Confusing or catatonic behavior • Lack of emotion/motivation Social/occupational dysfunction in: • Work or school • Interpersonal relations • Self care
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What brings about psychosis? It may occur with mental illness and/or substance use: – – – –
Schizophrenia Bipolar disorder Major depression Drug use
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Grandeur http://imgbuddy.com/hallucinations-schizophrenia-examples.asp
www.photobucket.com/user/shannymacsss/media/cat-mirror-lion
Schizophrenia
Paranoia
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Recognizing a person in crisis Behaviors • • • • •
Crying Exploding Verbalizing Withdrawing Displaying signs of a serious mental illness
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CIT guidelines for responding to a person you believe to be psychotic • • • • • • • •
Use short, clear, direct sentences Avoid multiple commands – give one statement or question at a time Do what you can to keep the “stimulation level” as low as possible Move to a quiet environment if possible If the person is withdrawn and uncommunicative, back off for a while Realize that a good deal of what you say will “fall through the cracks” Be pleasant (if possible) but firm Do not tell them their experience isn’t real; it’s very real to them
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“Ten Commandments” of De-escalation (Fishkind, 2002) 1. 2. 3. 4. 5. 6. 7. 8. 9.
You shall respect personal space (2 arm lengths) You shall not be provocative You shall establish verbal contact You shall state things succinctly, and repeat them You shall identify wants/needs explicitly and calmly You shall listen; no retaliation if insulted You shall agree or agree to disagree You shall lay down the law: link behaviors to consequences You shall offer choices to diminish the assumption that the only two choices are fight or flee 10. You shall debrief with others http://www2.nami.org/Template.cfm?Section=cit2&template=/ContentManagement/ ContentDisplay.cfm&ContentID=63814
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“Ten Commandments” of De-escalation (Fishkind, 2002) 1. 2. 3. 4. 5. 6. 7. 8. 9.
You shall respect personal space (2 arm lengths) You shall not be provocative You shall establish verbal contact You shall state things succinctly, and repeat them You shall identify wants/needs explicitly and calmly You shall listen; no retaliation if insulted You shall agree or agree to disagree You shall lay down the law: link behaviors to consequences You shall offer choices to diminish the assumption that the only two choices are fight or flee 10. You shall debrief with others http://www2.nami.org/Template.cfm?Section=cit2&template=/ContentManagement/ ContentDisplay.cfm&ContentID=63814
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“Ten Commandments” of De-escalation (Fishkind, 2002) 1. 2. 3. 4. 5. 6. 7. 8. 9.
You shall respect personal space (2 arm lengths) You shall not be provocative You shall establish verbal contact You shall state things succinctly, and repeat them You shall identify wants/needs explicitly and calmly You shall listen; no retaliation if insulted You shall agree or agree to disagree You shall lay down the law: link behaviors to consequences You shall offer choices to diminish the assumption that the only two choices are fight or flee 10. You shall debrief with others http://www2.nami.org/Template.cfm?Section=cit2&template=/ContentManagement/ ContentDisplay.cfm&ContentID=63814
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Communication tools • Validation • “I” Statements
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Emotional Validation • • • • •
The first essential step is to accept the other person’s feelings. We allow them to share their feelings and thoughts in safety. We accept them after they have shared their feelings. We respect their perception of things at that moment. We help them feel heard, acknowledged, understood and accepted.
“Painful feelings that are expressed, acknowledged and validated will diminish. Painful feelings that are ignored will gain strength.” (SOURCE: http://core.eqi.org/index.htm)
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Emotional Validation • To validate is to acknowledge and accept one's unique identity and individuality. • MESSAGES: “I see you as a person.” “ I hear you.”
• Invalidation, therefore, is to reject, ignore, or judge their feelings, and hence, their identity. • MESSAGES: “You are invisible.” “You have no voice.”
(SOURCE: http://core.eqi.org/index.htm)
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“I” Statements • Used when you are in a conflict • Allows you to articulate your situation without escalating tensions • The “I” message is a way to state concerns, feelings, and needs in a manner that is easier for the listener to hear and understand • An “I-statement” focuses on your own feelings and experiences. • It does not focus on what the other person has done or failed to do. • MORE HELPFUL: "It seems that I am not being permitted to participate in investigations to the extent that others are.” • LESS HELPFUL: "You always let Marge take interesting cases, but you never ask me if I’m interested.”
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“I” Statements
If you can express your experience in a way that does not attack, criticize, or blame others, you are less likely to provoke defensiveness and hostility which tends to escalate conflicts, or have the other person shut-down or tune you out which tends to stifle communication. Ultimately, I-messages help create more opportunities for the resolution of conflict by creating more opportunities for constructive dialogue about the true sources of conflict. (SOURCE: http://www.bumc.bu.edu/facdev-medicine/files/2011/08/I-messages-handout.pdf)
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“I” Statement Examples 1. “You never listen to anyone, and you’re not really listening to me now.” versus “I feel that my concerns are not being heard.”
2. “I hate when you yell at kids playing in the ballpark.” versus “When you yell at the kids, I get angry because they need to be treated with respect. I’m asking you not to raise your voice or curse in their presence.” 3. “It’s rude of you to be late all the time. You screw up everyone’s schedule.” versus “When you are scheduled to be at your desk at 8:30 but don’t come in until 9, I feel disrespected/frustrated, because your being late means we can’t start on time. I would prefer that you arrive to work on time.”
(SOURCE: http://www.bumc.bu.edu/facdev-medicine/files/2011/08/I-messages-handout.pdf)
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• • • • •
Peer & family support Therapy/professional help Medication Exercise and self care Hope and a sense of purpose
“A process of change through which individuals improve their health and wellness, live a selfdirected life, and strive to reach their full potential.” -Substance Abuse & Mental Health Services Administration
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PERFORMANCE MEASURES DELIVERABLE
FY 09
FY 10
FY 11 (projected)
New community CIT Training
7
2
2
Intensive mentoring for CIT program in need
0 (not an objective)
3
1 mentor, 3 peer reviews
Present CIT “teasers” in communities w/ no CIT
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5
6
Provide technical assistance
7
2
3
Provide statewide advanced CIT training conf.
100 officers
30 officers
30 officers
Focus groups
1
1
2
Increase # of CIT trained officers
3480
4001
4201
Increase # of campus police w/ CIT training
225
265
290
Increase # of campuses w/ CIT
45
49
54
Maintain collaborative relationships w/ partners
5 mtgs
7 mtgs
4 mtgs
Attendance at conferences
6
2
2
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STAKEHOLDER IMPACT HOW IT WAS EVALUATED Consumer Impact – focus groups w/ consumers & family members Critical of the police forces, particularly non-CIT officers. Believed that CIT training could and should be expanded. Believed that there was not enough awareness in the community about CIT. Praised the work that CIT trained officers in the area perform. 34
STAKEHOLDER IMPACT HOW IT WAS EVALUATED CIT OFFICERS impact - conducted a survey to a convenience sample of CIT officers at the Advanced CIT conference. Goal: Assess the impact that CIT has had on the officers’ job and perceptions of mental illness. Assess opinions about CIT within their department Assess the impact of CIT on their ability to respond appropriately to individuals with MI
Data analysis and results are pending 35
STAKEHOLDER IMPACT HOW IT WAS EVALUATED MH system
9 focus groups with consumer advocates, MH professionals, CJ system personnel & stakeholders Purpose: Assess the needs of the community regarding jail diversion & CIT. Gauge stakeholder perception of CIT & the CJ CCOE. Findings: Important to keep people with MI out of the CJ system. Important to implement programming using available community resources that best meets the needs of its citizens. Important for cross-system collaboration & open & frequent communication. 36
STAKEHOLDER IMPACT HOW IT WAS EVALUATED
MH System Continue
75 counties have CIT trained officers. 4000+ officers trained. 47 campuses have trained personnel. Consumers are part of the instructional plan. Classes have reflected the communities in regards to diversity. 37
STAKEHOLDER IMPACT HOW IT WAS EVALUATED
Research – Trying to get to “true” outcomes Multi-site (5 sites) study assessing CIT before and after implementation. Current stage of collecting data. Reviewing dispositions of calls: CIT officers vs. non-CIT officers.
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INCORPORATION OF LAST YEAR’S RECOMMENDATIONS 6. Require MH agencies to report CIT utilization. 7. Report frequency of use & outcomes. 8. Track cultural diversity of officers –
Efforts to increase diversity among participants.
Plans to connect to Black Law Enforcement Officers groups. NAMI plans to connect to inner city & minority groups.
9. Expand to other types of diversion. 39
FUNDING OUTCOME
COST EFFECTIVENESS
COMMENTS
New Community CIT Training
$1,016 per training
Leverage dollars by some cost being borne by the local community.
Intensive mentoring for CIT programs in need
$896 per program
Assists in assuring fidelity to the model & programs feel supported.
CIT Teasers in communities that do not have CIT
$575 per community
Way of introducing CIT & getting communities interested.
Technical Assistance
$1,420 per county/program
Provides support to programs.
Statewide CIT Conference $81 per participant
130 total participants, 100 were law enforcement. 40
FUNDING OUTCOME
COST EFFECTIVENESS
COMMENTS
Focus Groups
$5,700
Includes travel.
Increase the number of CIT trained officers
$114 cost per training
Provides resources – leverage dollars from the local level.
Increase the number of campus police who are CIT trained
$61 per officer
Dollars are leveraged from the local level.
Increase the number of college campuses with CIT officers
$152 per campus
Dollars are leveraged from the local level. 41
FUNDING Leveraging other funds In-kind – volunteer time for training, space, resources etc. Each community utilizes a variety of resources. Additional resources from AG’s office, OCJS & NEOUCOM.
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CHALLENGES Difficulty sustaining CIT programs over time.
Must provide ongoing support, mentoring, follow-up & resources
Funding – has been reduced in several areas NAMI lost funding Law Enforcement agencies have lost funding
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QUESTIONS THANK YOU!!
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Questions?
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