9-1-1; What Is Your Emergency?

Saturday, August 11, 2012

CIT Training: Telecommunicators Need it Now

Taken from Public Safety Communications Magazine, August 2012
Written by Kelly M. Sharp, 9-1-1 training officer and dispatcher for 18 years.  She holds a master's degree in education and is on the part-time faculty at Portland Community College's Emergency Telecommunicator/911 Dispatcher program

No matter how good a calltaker you are, dealing with a mentally ill caller can be frustrating.  How do you help people when you have no idea how to relate to them?  What do you say to someone who believes he lives on a different planet, where the sky is purple and the grass is orange?  What do you tell the family member who is begging for her mentally ill child to be "sent somewhere safe?"  What about the caller who isn't necessarily suicidal but feels life just isn't worth living?

According to the National Alliance on Mental Illness, one in four people has some kind of mental disorder.  These are the people at the grocery store, school, across the street or sitting next to you.  For most, mental illness is no different than any medical problem.  Sufferers follow a treatment plan, take their medications and function just fine.  They have good jobs, great home lives and happy families.  Some, however, have no access to care or can't follow a treatment plan.  They are the ones who can complicate the job of emergency services.

Once upon a time, those who were severely mentally ill were rounded up and dumped into institutions.  Obviously, this was not the best or most compassionate option.  In the 1960s, society demanded that the mentally ill be treated more humanely, and the focus changed to providing a community-based setting where the mentally ill could be offered both their freedom and the care they needed.

At first, it seemed like a great idea and mental hospital admittance dropped 35% within five years.  The problem was that funding for this grand idea came from the government.  When the money ran out, the institutions were closed and the patients were either sent home to families who had no idea how to care for them or cast off onto the street.  For many, 9-1-1 became the only option for help.

Often, callers are looking for guidance rather than solutions.  The dad who has a bipolar daughter doesn't want you to cure her mental illness.  He may just want suggestions on who he can contact to get her into some kind of program.  The chronically depressed man who has called 11 times today may not want to go to the hospital again; he just wants someone he can talk to about how he's feeling.  The wife of the man suffering from PTSD may be more afraid of how the police will treat her husband when they arrive than if he will hurt her.

The challenge for calltakers is that 9-1-1 training usually revolves around handling calls that need police, fire or medical -- not counseling.  The focus is on responder and citizen safety, not on talking with someone who has a green Martian in her living room.  When those calls come in, even the best calltaker can struggle with what they should do next.

Law enforcement agencies have come up with a possible solution, Crisis Intervention Teams (CIT), and CIT training is popping up across the nation.

CIT training is designed to help officers understand the unique challenges that come with mental illness.  A week-long class, the program focuses on understanding what mental illness is and how it affects individuals and their families, and introduces them to available resources.  Presentations by those who suffer from mental illness, have a loved one who does or are in the business of treating the mentally ill help demystify the disease.  Through role-playing and scenarios, students are taught to de-escalate situations with those who are agitated, reason with those who cannot understand and work with those who feel life is nothing but pain.  Officers finish the program with discussions of legal issues and officer safety.  Those who attend the class say it completely changes how they interact with people with mental illnesses.

Most CIT programs are designed primarily for law enforcement officers who arrive long after the call begins.  Wouldn't it make sense to provide that type of training to those who are a part of the conversation from the beginning?  How the calltaker handles the 9-1-1 call can set the stage for how the mentally ill person reacts when police arrive.  Providing calltakers with training helps create a safer environment for responders and could possibly lead to a solution so a response is not required at all.

Former dispatcher Courtney Janes, now a mental health provider with the Law Liaison Project in Tarrant County, Texas, is a CIT instructor for law enforcement and telecommunicators.  She says that often, the mentally ill are looking for help not for police or rescue.  "Most of them don't want the police to come," Janes says.  "Most of them are calling because this is the only number they know where they will get a live person who has to talk to them.  They want to be heard."

Janes acknowledges that asking for dispatchers to attend yet another training class may be a hard sell.  But she points out that by attending CIT training, calltakers can learn how to more effectively handle these callers, get them off the phone faster and possibly keep them from calling again.  "They can be the most difficult calls to take, especially if you don't have a background in mental health," she says.  "It's going to help you assess the risk [and] the mental health issue and [determine] the best course of action."

Telecommunicators trained in the unique challenges of dealing with the mentally ill provide a huge officer safety benefit.  Without CIT training, telecommunicators must guess the level of threat the caller poses.  Does she just want to vent about the armed green Martians in the living room, or does she want to shoot her roommate for letting the green Martians into the living room in the first place?  Is this going to be a welfare check or a potential homicide?

Although both scenarios will require a police response, only one may need it code three.  Do you know how to reason with someone raving about green Martians?  With CIT training, "you can defuse the crisis so the officer is less likely to get hurt," Janes says.

"To me, [training is] a huge officer safety issue," says Janes.  "As a dispatcher I need to recognize the symptoms of [a mental health crisis].  I need to know what somebody sounds like when they're manic.  I need to know what somebody sounds like when they are psychotic.  I need to know what somebody sounds like when they are depressed.  And I need to be able to talk to them to get the best information possible."

Getting good information and using it to defuse the situation are the main points of CIT training.  If you can get the caller to calm down long enough to talk, then you can provide first responders with an accurate picture of what's happening on scene.  If officers know they are responding to a bipolar female who is alternately crying and raging while she is screaming at her roommate for letting in the Martians, they may use a different set of tactics than they would for another disturbance.

Handling calls from those in the throes of a mental illness can also be frustrating because it can be difficult to get them to cooperate.  Are they intentionally ignoring you or are you being drowned out by all the other voices?  What do you do with someone who is hallucinating?  How do you calm someone who is paranoid?  CIT training can teach how to look for signs and symptoms to choose the best course of action to communicate effectively.

Sometimes it's as simple as finding a different way to ask questions.  Take the caller who is severely depressed and won't answer you.  It could be that instead of being uncooperative, he is just overwhelmed by the rapid-fire questioning techniques used by many calltakers.  A CIT-trained calltaker can adapt their questioning techniques to get the necessary answers and provide a clearer picture to the officer.  This, in turn, can lead to a better outcome for everyone.

As the benefits of CIT training become better known, more families and people with mental illnesses are asking specifically for CIT officers to respond -- and the results have been encouraging.  But those on the front lines also need the training so they can set the tone from the minute they pick up the phone for what the officers will find when they arrive on scene.

Local law enforcement agencies already provide CIT training to their officers.  Telecommunicators may not need the entire 40-hour police program but could attend the sections that apply to both law enforcement and 9-1-1.

No local training in  your area?  No problem.  The National Alliance on Mental Illness website offers a CIT Advocacy Toolkit designed to help NAMI state organizations and affiliates, law enforcement agencies and mental health providers advocate for CIT in their communities.  This site contains information on everything from how to start a program to where to find grants to fund it.

Look for a trainer who charges a set rate for a class rather than by the number of attendees.  You may be able to recoup some of the costs by hosting the training for other local agencies to attend.

Janes says, "My job is to keep the officer safe.  So that's why I want to go to as much training as I can so I know what I am dealing with."  Offering CIT training to all calltakers and dispatchers can help make that happen.

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