9-1-1; What Is Your Emergency?

Thursday, April 2, 2009

Handling Crisis in Denver

Excerpts taken from Public Safety Communications Magazine February 2005
Written by Ernest Franssen Jr., he has been a Denver Police dispatcher for nine years.

Four years removed from an 11-year emergency calltaking and dispatching career in Denver's Combined Communication Center, Denver Police Officer Jamie Svalberg brings Crisis Intervention Team (CIT) training to 911 calltakers and dispatchers, who most often have the initial contact with people in crisis.

While more than 24 major police departments across the United Stated have some sort of CIT training for officers, Denver Police is only the second department (after Houston) to extend this training to its emergency telecommunicators.

The CIT program was founded in1987 by the Memphis (TN) Police Department (MPD). After an outcry from the community following the shooting of a mentally ill man in 1987, MPD teamed with the Memphis chapter of Alliance for the Mentally Ill to develop the ground-breaking CIT program. (The Memphis man was shot after he lunged at police officers with a knife he had used to cut himself more than 100 times. This incident was eerily similar to a shooting involving a Denver police officer and a mentally disabled teen in 2003.)

"You have individuals with a mental illness who are scared to death because they don't have control of their surroundings," said Sgt. Michael Anderson, Denver Police CIT coordinator and course director. "Now, as a police officer, you're there giving them commands and they don't know you from sunshine. You get frustrated and start to put your hands on them. The whole things goes to hell in a hand basket, when really a little space between you and that individual and a little conversation and reassurance would find out what's going to get both of your needs met."

During the first two years of CIT training, Denver officers reported 74 percent of the calls requiring the response of a CIT officer resulted in the contact being transported to a treatment facility. Only 4.6 percent of the calls resulted in arrest, and more than 98 percent resulted in no injury to the officer of the citizen.

"The idea of expanding it to calltakers and dispatchers was Jamie's," Sinclair said. "I also think it validates calltakers and dispatchers when they are included in this type of training."

After becoming CIT-certified in 2002, Svalberg sand the comm center training supervisor, Sgt. James Garret, sat down with the Colorado State Police and representatives from surrounding jurisdictions to create a CIT-training course for dispatchers and calltakers in the metropolitan area. Svalberg, who spent more than two years as a calltaker before beginning her nine-year stint as a dispatcher, believed calltakers and dispatchers were the first, and often the most important, contact with people in crisis. Anderson, who supported her in starting the training, agreed.

"You, as a calltaker or a dispatcher, have the opportunity to first escalate or de-escalate," Anderson said, "so when that officer gets there, he's either faced with having to start an immediate de-escalation, possibly with the use of force, or he's there in a situation that you've already de-escalated and it just makes his job easier."

During the last year, prior to the CIT training, the department had recognized a calltaker for talking a suspect down and keeping him at the scene after he reported stabbing his brother multiple times. Another dispatcher was given a local award and department recognition for talking a barricaded suspect, who at one time had a hostage, into turning himself over to the officers waiting outside the door of the apartment he had broken into.

In 1999, Dr. David Satcher, U.S. surgeon general from 1989-2002, said that one in five Americans is affected by mental illness each year. He explained that 15 percent of the U.S. adult population uses some sort of mental-health service.

The number of mentally ill Coloradoans is climbing, but budget allocations to deal with them, at all levels of government, are diminishing. According to a 2002 Population in Need study, the number of seriously mentally ill Coloradoans who lack treatment is more than 66,000. This leaves responding officers, calltakers and dispatchers as the first responders to people in crisis.

Svalberg has become all too familiar with these situations during her stint in the radio room and on the street. And these calls frame the telecommunicators' CIT course in Denver.

"The original intent was to include communications," Anderson said. "Because of the time and commitment to the CIT classes for officers, the state was never able to get it off the ground."

Undeterred, Svalberg (with Anderson's support) created a lesson plan for calltakers and dispatchers. After all the calltakers and dispatchers in Denver are certified in the modified 16-hour course, the department's goal is to extend the program to outside departments. Several have shown interest.

The course teaches calltakers and dispatchers the importance of the CIT program, the symptoms and types of mental illnesses officers and telecommunicators may face, and ways to communicate with and de-escalate people in crisis.

Calltakers and dispatcher witness role-play scenarios acted out by hired actors and actresses. Officers who have had their own experience in CIT situations provide testimonials.

Students are invited to have lunch with mentally ill citizens at a downtown facility. They can ask the patients any questions they want, ranging from what illness patients have and how it affect their lives, to the patients' thoughts and feelings about the CIT program. They also ask for advice in handling someone in crisis.

"It is important to get to know the other side," said Timothy Hall, chief executive officer of Laradon Hall, a facility officers visit during the classes. "Officers and our members get to see each other in a whole new light."

All this work and preparation is done with one simple idea in mind: getting as much information as possible about a person in crisis to de-escalate the situation so everyone involved can go home at the end of the day."

"I want to go home,"Svalberg said. "If that means taking the extra moment to ask the extra question that will help us calm that person down without injury to me or to them, than that's what we need to do."

Anderson says the goal of the CIT program is to avoid jailing or hospitalizing the mentally ill. Before CIT, police officers and telecommunicators had limited avenues to help the mentally ill and others in crisis.

"Our officers have always had the ability to talk to and deal with the mentally ill," Anderson said. "This program will give them the resources they need to help them."

Anderson said the CIT program is directed toward the mentally ill, but it teaches communication skills that can be used to de-escalate many situations. These skills can be used to calm a suicidal party, a frantic parent, a domestic-violence victim, drunk people or anyone in crisis.

"It isn't just mental illness," Sinclair said. "It started with mental illness, but there are other people down on their luck who can't seem to get back to stability."

Anderson is reminded of the days when calltakers would hang up on callers if they didn't like what they were saying or how they were being talked to. Doing this escalates a situation, putting police officers in contact with people who are now angry, not only with the crisis element, but at the police department as well.

"When people call the police, they think they are talking to a police officer," Svalberg said. "They react to the officer on the street based on the outcome of the interaction they've had with the person they think was an officer on the phone."

Fewer than one percent of the calls handled by the Denver Police falls into the "person in crisis" category. The department's policies and training still stress brevity, clarity and getting as much information as quickly as possible to officers. But despite the low number of "crisis" calls, the department is teaching the C"IT skills to avoid the "wing it" mentality.

A large part of the training is helping calltakers and dispatcher identify people who might be off their required medications, having hallucinations that make them fear authority, or are suicidal and seeking help.

Sinclair admitted they teach a lot of terms and technical jargon in the class. She said it isn't important to remember the diagnostic criteria, but rather for communicators to be able to identify someone in crisis, based on the training. The training is useful even to veteral communicators.

"In my 12 years of being here as a calltaker, dispatcher and lead dispatcher, I've never been taught how to talk to a suicidal party unitl now," said Lead Dispatcher Carolyn Miller.

Denver's communicators are being trained to ask questions about medications, hallucinations, family, suicidal history, weapons, injuries and other people who are with the person in crisis at the time of the call.

It doesn't end there. Much of the training teaches telecommunicators active-listening skills. Calltakers or dispatchers can be distracted by issues in their personal lives, activities in the radio room: the idea that certain questions have to be answered in a certain order, the need to get off the line to answer another call on hold, pressures from local media reports, etc. Despite these issues, active listening can be the key to building rapport with the caller.

"Sometimes your best tool is to be quiet and just listen," Anderson said. "Just listen and take notes as to what's happening and just ask confirming questions. Gather data so when information is passed on to officers, it is useful."

Sinclair said the way to earn callers' trust is to pick up on things they say, like their names, and then use those details to build a relationship. Sometimes people perceive interrupting as not listening. Sinclair admitted the technique requires patience and can be difficult for telecommunicators who need to get information fast. Sinclair also doesn't believe the answer is tip-toeing around the caller. It does a disservice to the caller and to the job the communicator must do.

"I think people know whether you genuinely value them. Your tone of voice and your demeanor on the phone can turn that person and calm them down," Sinclair said. "There's a certain subtle gentleness that lets them know you care about what their predicament is."

Other techniques also are taught, such as keeping the emergency communicators' emotions in check, which can be hard when dealing with someone who is yelling or cursing at them or when callers sound like they're in danger. In addition, the course teaches telecommunicators how to avoid arguments, the difference between open-and closed-ended questions and how to keep a caller calm and focused.

Examples of what to say and what not to say are given. This segment of the class covers whether telecommunicators should ask callers if they plan to commit suicide. Often dispatchers and calltakers are taught not to ask this questioin, yet pshychologists from Nicoletti-Flater Associates, the department's psychology office, teach that this question can help callers realize the implications of what they plan to do. Sometimes that realization can open up the lines of communication.

Some things should be avoided, however. Telecommunicators are taught not to tell callers they know what the callers are going through, not to tell them to calm down, not to use jargon. They should avoid multiple questions and insensitive comments. They should not interrupt.

Sinclair said if communicators can connect with callers, they are more likely to get the informatioin they need. This is important because everyone, including the mentally ill, is looking for a connection.

"There is not failure to this training," Anderson said, "because even officers who don't accept the idea of CIT training reap the benefits from the officers who do."

Anderson referred to the policy where dispatchers send C"IT-certified officers to calls involving people in crisis. She said the overall success will occur with increased public confidence in the department. The process of gaining the public's confidence begins when they make a 911 call.

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