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Law Enforcement Academy Asheville-Buncombe Technical Community College Asheville, North Carolina Crisis Intervention Team Training September 27 – October 1, 2010. De-Escalation Skills. Overview. 1 ½ days (12 hours) Lots of role-playing practice in small groups

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de escalation skills

Law Enforcement AcademyAsheville-Buncombe Technical Community CollegeAsheville, North CarolinaCrisis Intervention Team TrainingSeptember 27 – October 1, 2010

De-Escalation Skills

overview
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)
wednesday pm
Wednesday PM
  • What is de-escalation
  • Effective communication
  • Non-verbals
  • Behavioral crisis
  • Engagement
what is verbal de escalation
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
goals of verbal de escalation
Goals of Verbal De-escalation
  • Open up clear lines of communication
  • Build trust and validate the consumer’s situation
  • Get the consumer talking about his situation
  • Gathering the necessary information make a good resolution
what is de escalation
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
what is de escalation7
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.
effective communication
Effective Communication
  • 70% of communication misunderstood
  • Effective communication is defined as passing information between one person and another that is mutually understood
effective communication9
Effective Communication
  • Communication becomes more difficult when the person’s 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 can’t 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.
barriers to effective communication
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
non verbal
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
personal space
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.”
slide14
Eyes
  • One eyebrow raised = sternness
  • Eyes wide open = surprise
  • A hard stare = threatening gesture
  • Closing eyes longer than normal = I am not listening
body posture
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 movements—quick actions may surprise or scare the other person
voice
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 didn’t say you were stupid
slide17
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
what is a behavioral crisis
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.
behavioral crisis
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 what’s happening here and how!
behavioral crisis24
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
behavioral crisis25
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 consumer’s behavior is usually a result of his or her illness, rather than being criminally motivated
behavioral crisis28
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.
engagement
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.
engagement30
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
engagement31
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
engagement32
Engagement
  • “It is the wise officer who can, at times, conceal his or her combat-ready status.”

-Lt. Michael Woody

avoid
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.”)
avoid34
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.
avoid35
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
avoid36
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
avoid37
Avoid
  • Minimizing the consumer’s situation as a way to elicit conversation (“Things can’t be that bad, can they?”)
  • Suggesting that things will get better; they may not
  • Making promises that you may not be able to keep
avoid38
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.”
avoid39
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.
slide40
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
slide41
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
slide42
DO
  • Accept the consumer’s 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
hot buttons
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
hot buttons rationale detachment
Hot Buttons: Rationale Detachment
  • Staying in control of your emotions during a crisis situation
  • 3 steps
1 develop a plan
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
2 use positive self talk
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
3 recognize your limits
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.”
the logic of de escalation
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 consumer’s normal coping measures are not working at this time.
introduce yourself
Introduce Yourself
  • An introduction promotes communication
  • Hi, my name is Doug (or Deputy Smith). I am a CIT officer with the Sheriff’s Department.
  • Can you tell me your name?
  • State what you see/know (“I can see you’re 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)

introduce yourself50
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 consumer’s name; that will help you remember it
  • Use the consumer’s name often
introduce yourself51
Introduce Yourself
  • “Get out of here you damn cop!”
  • Don’t take the bait and turn confrontational
role playing scenarios
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
role playing scenarios53
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 roles—Law enforcement, consumer, observer
thursday am
Thursday AM
  • Listen
  • Empathize
  • Affirm
  • Partner
  • What Ifs
  • 5 special strategies
l listen
L = Listen
  • Silent and listen are spelled with the same letters
  • Listen twice as much as you talk; that’s why you have 2 ears and 1 mouth
  • What is the difference between listening and hearing?
listen
Listen
  • Listen for the total meaning
  • Focus on what the consumer is telling you
  • Block out distractions
listen58
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 you’ll hear this in their speech, which can be difficult to follow and make sense of.
techniques that show you are listening
Techniques that Show You Are Listening
  • Minimal encouragers
  • Reflecting
  • Ask open-ended questions (“Can you tell me more about that.”
minimal encouragers
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.
reflecting
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.
reflecting62
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.”
open ended questions
Open-Ended Questions
  • Open ended questions allow you to get more information
  • Open ended questions enable us to assess the consumer’s level of dangerousness
  • Open ended questions allow you to assess whether the consumer is in touch with reality
specific questions that you may want you ask when appropriate
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
medication
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 don’t want to talk about it their counselor.
e empathy
E = Empathy
  • Emotion labeling
  • Paraphrasing
empathy
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)
  • It’s hard to stay angry and aroused when someone empathizes
emotional labeling
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.
emotional labeling examples
Emotional Labeling Examples
  • You seem to be . . . .
  • It seems to me like you feel . . . .
  • If I were in your situation, I think I’d feel . . .
paraphrasing
Paraphrasing
  • Paraphrasing is similar to reflecting except that now you begin to communicate that you are trying to understand the consumer’s entire message by putting what the consumer has said into your own words.
paraphrasing71
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
paraphrasing examples
Paraphrasing Examples
  • Consumer: I don’t know what I am going to do. My family doesn’t want me here.
  • CIT Officer: You’re not sure where you can stay for awhile, but home doesn’t seem like the best place right now.
paraphrasing examples73
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.
a affirm
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 consumer’s situation
affirm example
Affirm Example
  • “Okay, let me make sure I understand you, You’ve 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.”
p partner
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.
partner
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 doesn’t work, “throw another lure”
partner78
Partner
  • Putting yourself in the consumer’s shoes will help you find a solution
  • Don’t 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
  • It’s never too late to reassess and change a plan
partner79
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.
partner80
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 trust—which is important in your repeated encounters with people.
resolution
Resolution
  • Can it be informally resolved?
  • Is an evaluation needed?
  • Are commitment criteria met?
  • Was a crime committed?
what ifs
What Ifs
  • What if the consumer asks you a long-term question?
  • Say that you don’t know the answer but that you and the consumer can handle the immediate situation
what if
What If
  • The consumer says that there’s nothing you can do to help?
  • Say that you’re not sure what you can do, but that you want to work with the consumer to figure out something
what if84
What If
  • The consumer will not engage problem-solving and is distracted?
  • Say “Stay with me, Frank. Let’s work on this together. I’d like for you to stop for a minute and take a deep breath with me. Like this. That’s good. Thank you, Frank.”
what if85
What If
  • The consumers moves too close you?
  • Say “I need some space, Jim, so I am going to back up.”
what if86
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.”
what if87
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.
what if88
What If
  • The consumer will only respond non-verbally, like with a head nod
  • Respond positively
what if89
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.”
five special strategies
Five Special Strategies
  • Assertive Intervention
  • Corrective Action
  • Reducing Stimuli
  • Reducing Arousal
  • Pro-active (as opposed to reactive) engagement of consumers
1 assertive intervention
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
three step assertive intervention
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.
examples
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. I’d 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 I’m here to help you. But I am afraid someone is going to get hurt by those stones. So I’d 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.”
choice
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.
2 corrective action aaa
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: “I’m sorry to have upset you. I didn’t mean to.”
  • Try Again: “I want to help, not upset you, so let’s try something else.”
3 reducing stimuli
3. Reducing Stimuli
  • Remove the audience or move the consumer to a private space
  • Turn off flashing lights
4 reducing arousal
4. Reducing Arousal
  • Encourage the consumer to take 3 deep breaths; you can do this with the consumer. “Let’s take 3 deep breaths like this”; then demonstrate and do it with the consumer.
5 pro active engagement of consumers
5. Pro-active Engagementof 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.
pro active engagement of consumers
Pro-active Engagement of Consumers
  • Drop by the consumer’s 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.
thursday pm
Thursday PM
  • Verbal Intervention Strategies for People who are Suicidal, Homeless, Delusional, Hallucinating, Confused, Agitated, Intoxicated, Having Flashbacks, Manic
review of terms
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
suicide
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
suicide threatening harm
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
suicide attempt
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.
suicide attempt105
Suicide Attempt
  • Unhelpful comments include clichés such as, There’s 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
homelessness
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 person’s choice not to take medications as noncompliance, but to a homeless person the decision not to take sedating psychiatric medications may make good sense.
thought disorder
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?

thought disorder108
Thought Disorder
  • The engagement goal is to validate the consumer’s 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.
delusions
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 one’s thoughts are controlled by external forces.
  • Convey your acceptance—but 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 don’t know of anyone who is trying to hurt you . . . I’m here to keep you safe.”
  • Don’t argue about the delusion—no one will win this argument
hallucinations
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
hallucinations111
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: I’m here to help; I am not going to hurt you.
hallucinations112
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.
confused disorganized speech
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
confused disorganized speech114
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.”
agitation anxiety fears
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
people who are intoxicated
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
ptsd flashbacks
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), it’s our job to keep you safe
  • Provide simple directives and reassurance softly and slowly
rapid speech mania
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. Let’s take some deep breaths together.”
acknowledgements
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