Police learn to de-escalate crises involving the mentally ill

January 15, 2015


Yellowstone County Deputy Sherriff Matt McCave responded to a call in November on the outskirts of Billings, Mont., to assist a father in search of his adult daughter, who is severely bipolar and who was off her medication. In a situation that the father told McCave had played out repeatedly over the last dozen years, the daughter had vanished, and the father wanted to find her to get her some mental health help.

Crisis Intervention training
Yellowstone County, Mont., deputy Caleb Greenfield, left, attempts to calm Montana State University Billings theater student Sean Slaugh, portraying a man claiming he can fly with homemade wings. The role-playing is part of Crisis Intervention Team training supported by Billings' St. Vincent Healthcare.

McCave recalled, "Just the way I was able to talk to him, he was like, 'Oh, wow, you seem to kind of know about this'; and he seemed to appreciate that."

McCave credits Crisis Intervention Team training at Billings' Community Crisis Center for helping him to empathize with people in crisis — particularly those with mental illnesses — and their loved ones. (As Catholic Health World went to press, local authorities had not yet located the woman with bipolar disorder.)

Billings' Community Crisis Center has trained 319 police officers, emergency medical technicians, mental health care providers, 911 dispatchers and correctional facility workers since it began offering the course in 2007. It is adding a second course, on intervening with youth who are in crisis, this year.

Crisis intervention course attendees learn the signs of mental illness and techniques for handling volatile situations; they hear from a panel of experts including a family member of a person with a mental illness; and they tour the crisis center, an outpatient behavioral health center with 20 stabilization beds. The center, which is partially owned by St. Vincent Healthcare of Billings, is open and clinically staffed around the clock.

Calm body language
MarCee Neary, director of the Community Crisis Center, said, "We teach the specifics of how to deal with situations — what they would say, how to stand, how to use your voice and tone and cadence. It's a huge tool bag." She said the techniques are useful when working with anyone who is in crisis.

Tracy Neary, St. Vincent director of mission and community benefit (and MarCee Neary's sister-in-law), said officers learn to defuse situations involving a person with mental illness by keeping their stance in an open position, with their hands visible, using good eye contact, slowing their speech, and using empathy and listening skills. McCave added that participants learn breathing techniques in order to remain calm with people with a mental illness.

Tracy Neary added, "The police aren't there to diagnose, but to help," by getting people to the center, or the hospital for treatment, as appropriate. Importantly, Neary said, the Crisis Intervention Team training supports St. Vincent's "efforts around suicide prevention in a state that consistently tops the nation in suicide rates."

Someone cares
Course participants spend two days of the 40-hour course role-playing scenarios with theater students and talking through each interaction. McCave said officers commonly find the role-playing to be the most helpful part of the course.

MarCee Neary said the training makes officers on the street aware of alternatives to the emergency department and jail, for people with a mental illness, and gives law enforcement the skills to offer assistance instead of arresting people who would be better served in the mental health system.

McCave took the course about five years ago and has since become a trainer. He said Crisis Intervention Team training helps police practice compassion. "It's easy to be out on these calls and forget sometimes that this person that's completely out of control, ruining your afternoon … this is someone's family member, and someone cares about this person."

Attitude adjustment
The Memphis chapter of the National Alliance on Mental Illness, the University of Tennessee medical school and the University of Memphis developed in 1988 the crisis intervention training program now in use in Billings and 2,000 communities in 40 states. The National Alliance on Mental Illness syndicated the program as the Crisis Intervention Team and provides training on it. The Billings Community Crisis Center paid for several Billings officers to receive training in Memphis in 2006 and those Billings officers are among those who deliver the Crisis Intervention Team training curriculum in Billings.

According to information from the National Alliance on Mental Illness, crisis intervention programs that connect the law enforcement and mental health communities reduce officer injuries and reduce the amount of time officers spend responding to mental health calls.

McCave said that as a trainer, he hears many officers arriving for the course say, "'This is just a touchy-feely, hug-a-thug' program. But coming out of it, about 90 percent of them say, 'Wow, this was much better than I thought it would be.'"

Center offers immediate help to people with mental health issues
St. Vincent Healthcare of Billings, Mont., established the Community Crisis Center in 2006 as an outpatient mental health facility in partnership with the Billings Clinic, a hospital; local city and county health departments and a regional mental health care center.

The crisis center's staff of licensed mental health therapists, mental health technicians and registered nurses help people with mental illness and/or substance abuse disorders to complete a crisis management plan that covers steps the clients can take to address concerns they are facing, including getting long-term mental health and substance abuse treatment, medical care, housing and transportation and food and clean clothing. The center points the clients to providers and agencies with resources to assist them in meeting care plan goals.

In some cases, the center discharges clients to a lower level of care in other cases it transfers clients to a higher level of care. While the crisis center does not have a psychiatric emergency room, it can transfer patients to the Billings Clinic's locked psychiatric ward if necessary.

Tracy Neary, St. Vincent director of mission and community benefit, said the center "is a key part of our strategy of response to both mental health and substance abuse issues in our community health improvement plan."


Copyright © 2014 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2015 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.