Straight Talk

1. Straight Talk Helping Families Talk to Law Enforcement in Times of Crisis 2014 NAMI NC Eastern Regional Conference: Crisis Solutions March 29, 2014

2. Helping Families Talk to Law Enforcement in Times of Crisis • The Big Picture • The Picture in North Carolina – Kate Murphy, CoastalCare • CIT & SROs in New Hanover County Schools – Lt. Novella Frieslander, New Hanover County • How Families Can Help – Alice “Elaine” Slaton, Slaton Associates • Questions & Answers

3. The National Perspective Elaine F. Deck, Slaton Associates The Big Picture Elaine F. Deck

4. The Big Picture: The Problem • U.S. Prisons have become our defacto mental health system • Police agencies have become a primary crisis resource for persons experiencing mental/emotional crisis • Law Enforcement Responses to mental health crisis • Are time consuming • Can be volatile situations risking safety for all involved • Successful police responses to mental health crisis • Require specialized training (funding & time) • Are dependent on available community mental health resources Elaine F. Deck

5. The Big Picture: Solutions • Prevention, early intervention, and effective community mental health services • Specialized training for Law Enforcement and other public service personnel • Cross agency collaboration, including family-run, youth-run, and consumer-run organizations (keeping one another informed with a real-time picture of where the resources are and what challenges need to be addressed) • Funding • Educated decision makers (law makers) Elaine F. Deck

6. The Big Picture: Sample Approaches • Crisis Intervention Teams (CIT) • Mental Health First Aid • Law Enforcement and Mental Health Co-Responder Teams -- Assertive Community Treatment (ACT) • Mental Health Consumer-Driven Services: e-CPR • Jail and Prison Reentry Programs From: The International Association of Chiefs of Police (IACP) 2010 National Policy Summit Building Safer Communities: Improving Police Response to Persons with Mental Illness-Recommendations and Models for Intervention Elaine F. Deck

7. Kate Murphy, CoastalCare The Picture in North Carolina Kate Murphy

8. What is Crisis Intervention Team? • Crisis Intervention Team began in Memphis, TN in 1988 when the Memphis Police Department sought out partnerships with the local affiliate of the National Alliance on Mental Illness, mental health providers, two local universities and consumers and family members. • A specialized unit consisting of volunteer officers who have undergone additional training in mental health, de-escalation and jail diversion was implemented. • It has since become an international model, consisting of volunteer officers from a variety of divisions within law enforcement agencies. Aside from regular duties, these members of the CIT are called upon to respond to individuals experiencing a crisis. Kate Murphy

9. Who is on the Crisis Intervention Team? • Crisis Intervention Team is made up of • Law Enforcement • 911 Telecommunicators • Magistrates • First Responders • Mental Health Professionals • Individuals and Family Members • Crisis Intervention Team members can • recognize signs and symptoms of mental illness, substance use, or intellectual/developmental disabilities • use verbal de-escalation techniques to assist a person experiencing crisis • connect that person with appropriate resources. Kate Murphy

10. Crisis Intervention Team Training 40-hour, week-long training that is: • Didactic • Formal lectures on mental illness medications and crisis intervention • Interactive • Dialogues with individuals and family members reduce stigma and help officers see people with mental illness as similar to them • Experiential • Use of role plays, practicing skills at de-escalation. Kate Murphy

11. Crisis Intervention Team Training • Crisis Intervention Team Training requires collaboration across the team. • Subject-matter experts give individual presentations. Curriculum includes: • Introduction/orientation to CIT and the CIT partnership • An overview of the mental health system • Signs and symptoms of severe mental illness • Medications for treatment of mental illness • Personality disorders • Co-occurring diagnoses • Intellectual/developmental disabilities • Dementia and aging • Children/adolescent mental health • Suicide intervention • Trauma/PTSD • Community resources & crisis services continuum • Crisis intervention / de-escalation skills training • Use of force continuum including when to use and not use less lethal weapons Kate Murphy

12. CIT in North Carolina • As of January 1, 2014: • 5,910 law enforcement officers CIT certified • 331 law enforcement agencies participating in CIT • 682 911 Telecommunicators (dispatchers) trained in CIT • 687 *other professionals trained in CIT *other referring to other first responders i.e. fire fighters, paramedics, magistrates, private security guards, etc. Kate Murphy

13. CIT in Action • When 911 is called for a crisis due to a mental illness, substance use disorder or intellectual/developmental disability, a CIT officer should be requested. • The CIT officer can: • Use verbal de-escalation techniques • Divert the individual from incarceration or involuntary commitment (if appropriate) • Connect the individual to community-based crisis services Kate Murphy

14. Crisis Services • CIT officers have a number of resources available to them: • Provider first responder • Mobile Crisis Clinicians • Walk-in services (Crisis Response Centers, Drop-in Centers, Walk-in clinics etc.) • Provides triage, evaluation, assessment and interventions, including medication management • Is available to all individuals in crisis regardless of insurance type or ability to pay Kate Murphy

15. When law enforcement responds to calls for people with mental illness... • The arrest rate is 20% when no specialized response exists • The arrest rate is 7% when some form of specialized response exists • The arrest rate for the Memphis CIT program is just 2% • Percent of incidents resolved on scene = 23% • Percent of incidents resulting in the person being transported to a crisis unit = 75% Kate Murphy

16. Accessing Crisis Services • 911 is NOT necessary to access crisis services • Individual OR third party can call in times of crisis. • Access to crisis services is available by calling your local Local Management Entity/Managed Care Organization Kate Murphy

17. Accessing Crisis Services • Alliance Behavioral Healthcare-800-510-9132 • Durham, Johnston, Wake • CoastalCare-866-875-1757 • Brunswick, Carteret, New Hanover, Onslow, Pender • East Carolina Behavioral Health-877-685-2415 • Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dar, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrell, Washington • Eastpoint-800-819-5112 • Bladen, Columbus, Duplin, Edgecombe, Greene, Lenoir, Nash, Robeson, Sampson, Scotland, Wayne, Wilson Kate Murphy

18. Lt. Novella Frieslander, New Hanover Co. Sherriff’s Office CIT & SROs in New Hanover Schools Novella Frieslander

19. CIT and SROs • An alarming number of youth with serious mental health issues become involved with law enforcement and the juvenile justice system while in school. • CIT is a tool we use to try to divert these youth and get them the help they need. Lt. Novella Frieslander

20. CIT and SROs • New Hanover County Sheriff’s Office expands the SRO Unit thanks to the Board of Education and a grant! • Currently have 34 NHSO SROs, 4 WPD SROs and 1 CBPD SRO • 2 SROs at Ashley/Laney High Schools/Mary Mosley Academy; 3 at Hanover and Hoggard High Schools • 1 in each Middle School (2 at Williston and Holly Shelter Middle Schools • 3 teaching G.R.E.A.T. in Elementary Schools (Gang Resistance Education and Training) • 11 additional deputies (2 supervisors and 9 officers to float the Elementary Schools-3 schools each) Lt. Novella Frieslander

21. CIT and SROs • We are partners with Wilmington and Carolina Beach Police Departments • Wilmington PD provides • 1 officer for New Hanover High School • 1 Officer for John T. Hoggard High School • 1 Officer at Mary Mosley Academy • 1 Officer at Williston Middle School • Carolina Beach PD provides • 1 officer at Carolina Beach Elementary School Lt. Novella Frieslander

22. CIT and SROs • All SROs in NHC, WPD and CBPD are or will be CIT certified • Conduct a special CIT class covering issues with children in schools Lt. Novella Frieslander

23. CIT and SROs • Schools have a variety of students. • AG (academically gifted) • LD (learning disabled) • BEH (behavior/emotionally handicapped) • OHI (other health impaired) • Autistic • Mentally disabled • Traumatic Brain Injury Any of which can have a need for a CIT officer. Lt. Novella Frieslander

24. CIT and SROs • Helps the SRO differentiate between different mental illnesses and the best way to deal with them • Increases officer safety • Reduces the amount of force • Helps reduce referrals to juvenile services • Helps reduce suspensions Lt. Novella Frieslander

25. CIT and SROs • Helps reduce unnecessary escalation of psychiatric crises in schools • Helps get students with needs for mental illness treatment, effective services • Minimizes trauma to all involved • Helps to positively impact the relationship built between the student, the SRO and the parent or caregiver. Lt. Novella Frieslander

26. CIT and SROs • Encourage school personnel to take CIT: • Counselors • Social workers • Psychologist • Administrators • Teachers Lt. Novella Frieslander

27. CIT and SROs • NAMI’s Parents and Teachers as Allies program • Compliments CIT programs for youth by educating school staff on how mental health impacts students’ behavior and learning. Lt. Novella Frieslander

28. Alice “Elaine” Slaton, Slaton Associates Helping Families Talk to Law Enforcement in Times of Crisis Alice "Elaine" Slaton

29. Before a Crisis Occurs • Prevention is KEY • Recurring crises may signal problems in assessment or care • Crisis Planning • #1 Have a plan • #2 Have strategies beyond “call 911” • Engage your family member in developing this plan; affirm his/her role in prevention and resolution • Ensure the plan is strengths-based, building upon his/her capabilities, & focused in helping him/her regain control • If your family member is a student, include their SRO in IEP meetings and crisis planning Alice "Elaine" Slaton

30. Sample Crisis Plan/ Advance Directives • Name and age • Emergency contact information (parent or legal/guardian. in the case of youth) • Health care providers contact information • Diagnoses, medications & doses, known allergies • Known triggers • Strategies for calming and regaining a sense of control Alice "Elaine" Slaton

31. Helping Families Talk to Law Enforcement in Times of Crisis Speaking to the dispatcher (911) • Be specific, clear and calm: what is happening and what you are asking for • Ask for a CIT trained officer • Provide facts, including known weapons in the vicinity • Provide known triggers and calming strategies Alice "Elaine" Slaton

32. Telling “911” what is happening: Not: • She is doing real bad again • His sister is scared to death • He is out of control • We don’t know what to do with her • You need to come get her More clear and specific: • He has {diagnosis} and has locked himself in the garage. He has a knife and says he will hurt himself. • He chased his sister and said he will “bash her head in”. She is locked in the car now, but he is pounding his fists on the outside of the car. They are in the driveway. Alice "Elaine" Slaton

33. Telling “911” triggers & known strategies: • His illness makes him jittery, please do now expect him to be still. • He is terrified of being locked up, please reassure him you want to help him figure this out. • If he sees a gun, he may run away from you. • Please tell him Joe will meet him at the hospital and help him figure this out. • Remind him “X” worked last time he felt this way. Alice "Elaine" Slaton

34. Helping Families Talk to Law Enforcement in Times of Crisis When officers are on the scene • The law enforcement officer is now in charge • The officer’s task is to observe -- assess risk -- resolve • Your primary task now is to provide information • Clear, calm, specific • Stay physically neutral – DO NOT try to physically intervene • Answer questions • Give information about triggers, strategies & resources Alice "Elaine" Slaton

35. Helping Families Talk to Law Enforcement in Times of Crisis What next? • Debrief & re-assess & re-plan & focus on prevention • Advocate for resources& services • Develop meaningful collaboration between family-run, youth-run, peer-run organizations and law enforcement Alice "Elaine" Slaton

36. “While behaviors that represent an imminent danger certainly indicate the need for some sort of an emergency response, these behaviors may well be the culmination of a crisis episode, rather than the episode in its entirety. Situations involving mental health crisis may follow trajectories that include intense feelings of personal distress (e.g., anxiety, depression, anger, panic, hopelessness), obvious changes in functioning (e.g., neglect of personal hygiene, unusual behavior) or catastrophic life events (e.g., disruptions in personal relationships, support systems or living arrangements; loss of autonomy or parental rights; victimization or natural disasters).” “Because only a portion of real-life crises may actually result in serious harm to self or others, a response that is activated only when physical safety becomes an issue is often too little, too late or no help at all in addressing the root of the crisis. And a response that does not meaningfully address the actual issues underlying a crisis may do more harm than good.” Practice Guidelines: Core Elements in Responding to Mental Health Crises. HHS Pub No. SMA-09-4427. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009. Alice "Elaine" Slaton

37. Additional Resources • Emotional CPR (eCPR) – a public education program designed to teach people to assist others through an emotional crisis www.emotional-CPR.org • Mental Health First Aide – a national program to teach the skills to respond to signs of mental illness and substance abuse www.mentalhealtfirstaid.org • Statewide Law Enforcement/Mental Health Efforts: Strategies to Support and Sustain Local Initiatives: 2013; BJA/Council of State Governments - www.bja.gov/Publications/CSG_StatewideLEMH.pdf • Improving Police Response to Persons with Mental Illness-Recommendations and Models for Intervention. 2010 The International Association of Chiefs of Police (IACP) National Policy Summit Building Safer Communities Alice "Elaine" Slaton

38. CONTACT US • Elaine F. Deck Senior Associate and Co-owner, Slaton Associates edeck334@gmail.com 704/929-9927 • Kate Murphy Member Communication Specialist, CoastalCare Kate.Murphy@coastalcarenc.org 910/550-2552 • Novella Frieslander Deputy Sheriff, Lt., SRO Commander New Hanover County nfrieslander@nhcgov.com 910/798-4226 • Alice “Elaine” Slaton Owner/Manager, Slaton Associates a.elaine.slaton@gmail.com 703/919-7019