An Interview With Rafael about CIT -- National Mental Health Awareness Week -- Volume Four

It's still National Mental Health Awareness Week . I've done posts every day and I'm trying to talk about various aspects of mental illness and various segments of society in relation to it.

I came across this article on Gawker -- "Police Shoot, Kill Man in Urgent Need of Medical Assistance." Now, Gawker is known for their gossip and sensationalism, and that's why we read them, right? Right. But I have noticed a disturbing trend of stories from all over -- Gawker, Alternet, the Occupy folks, and a smattering of other sources that seem to indicate that something is going wrong with our police forces and how they are interacting with the public.

Some say they are becoming militarized. I won't lie; I tend toward that theory myself. But there's got to be something that can be done in situations where there are sick people involved. In the aforementioned Gawker story, commenters point out there are probably two very different sides to what happened; that how the woman describes what went down seems implausible. I say that there's something to that -- that there's this side, that side, and the truth. But what piqued my interest about the story was that they were called there on a suicide threat. I know that there is training available for officers, Crisis Intervention Training (CIT), that if taken advantage of can make all the difference between handling a scary and volatile situation and seeing it end well or knowing nothing about mental illness and how it manifests and having it go very badly for everyone involved.

I have a friend, Rafael, who I met through blogging years ago. He lives in Anchorage, Alaska, and I know he has expertise in CIT, so I wrote him and asked him to answer some questions for the blog for National Mental Health Awareness Week.

First an intro from Rafael:

I cannot be a spokesman for my department (by policy). The opinions expressed are mine and do not reflect the opinions of any police agency. My personal, definitely not vetted by my agency, opinion: Use of force is a huge issue, as well it should be. No officer that I have met wants to shoot anyone. Less lethal options like Tasers, bean bag rounds, etc., are fantastic for many situations, but if someone comes at an officer with a deadly weapon, everyone needs to expect the officer to shoot that subject. Also: officers shoot at center mass. No one should ever expect an officer to shoot a subject in the leg or try to shoot a weapon out of someone’s hand. CIT is designed to reduce the need for an officer involved shooting of a mental health consumer but sometimes lethal force is necessary.

JG: What's your background with the police department?

R: In January I’ll have been a police dispatcher for 18 years.

JG: How did you get involved there -- you do 911? Are you a police officer?

R: I am not a police officer. During my 12 hour shift I am a dispatcher monitoring a radio 4-6 hours and a calltaker the rest of the time. Most of the CIT skills are used on the phones. When someone calls 911 in my jurisdiction, the call goes to my emergency communication center and is answered by a calltaker. If the problem is primarily a medical or fire issue we will transfer the caller to the fire department dispatch center who will have their own series of questions and will dispatcher fire and medical equipment. Police often go to medic calls also (since they can get there faster in some cases and provide first aid until a medic rig gets there) so we monitor the calls we transfer to the medics.

If the caller is reporting something that requires police response the calltaker will take the information and create a “call for service” in our dispatching computer. News you can use: The calltaker is going to ask you a lot of questions. Callers will often say “stop asking questions, just get here.” Since the dispatching is handled by a different person, the calltaker’s questions will not delay any response. Calls that have things going on “in progress” are usually entered into the computer in several parts. The dispatcher doesn’t have to wait until all the information is there to get officers started to the call.

The dispatcher will read all the calls for service and dispatch the appropriate amount of resources to each call in order of priority. Shootings, injury accidents, deaths, etc. go first; parking problems and loud music calls go last. Since there are usually more calls holding than officers available, dispatching is a different kind of challenge than calltaking. Both can be quite stressful.

JG: What is CIT?

R: The Crisis Intervention Team is a group of officers and dispatchers who receive extra training so that we can better serve the needs of mental health consumers in crisis. The goal of CIT is to respond to a consumer in crisis with as little force as possible (ideally none), provide help BEFORE the consumer commits a crime (since jail is a sorry substitute for mental health care), and allow consumers to keep their dignity.

The CIT academy is a 40 hour training course consisting of learning the basics of the different diagnoses and medications; an in-depth review of what resources exist for treatment, housing, etc.; review of the laws involving involuntary commitment and the laws regarding police order for mental evaluation; training in active listening, de-escalation techniques, etc. The academy is taught by police officers, mental health clinicians, and most importantly, mental health consumers. NAMI is a big part of the CIT program. Talking to people with serious mental illnesses gives CIT members more insight into what it might be like to live with such a difficult situation.

In my experience, it has turned the notion of the “frequent flyer” mentally ill caller from just a nuisance to a real person with real problems. It’s helpful to be reminded that no one asks to be mentally ill and a lot of bad behavior is symptomatic of an illness and not a character defect. Jimmy Schizophrenic isn’t being an asshole, he’s hallucinating and his world is chaotic and scary at the moment. It’s also worth remembering that the people who need most to take their medication regularly are sometimes the least able to do so by very definition of their illness. That certainly makes me less judgmental when I get the call that “Jenny is off her meds.”

At my agency CIT officers work a normal patrol shift and are sent to “CIT calls” as needed. Like other specialty teams (SWAT for instance) an officer or dispatcher has to apply to be a member of CIT. You have to have both passion and compassion. Unlike some other teams there is no extra pay involved. That’s on purpose also: if you are in it for the money, you are in it for the wrong reason.

JG: When did you add that to your repertoire?

R: I attended the 40 hour CIT academy in 2006. Since then I’ve had the opportunity to attend the national CIT conference in 2009 and to take other training classes to add to my knowledge base and to pass that information along to my fellow CIT members. We try to do some kind of advanced CIT training every year.

Worth pointing out: I am fortunate to work for an agency that allows dispatchers to attend the full 40 hour academy. Most agencies with CIT give their dispatchers 4-8 hours training. Part of what I was doing at the CIT International conference in Atlanta in 2009 was trying to sell the idea of giving dispatchers in every agency the entire CIT training since every part of the training applies.

JG: You live in Alaska ... i've heard that there is a lot more alcoholism/addiction/mental illness there -- do you see that manifest in your job?

R: Statistically, Alaska has a huge alcohol and drug problem. Since we have a comparatively small population, our per capita numbers are liable to be higher anyway, but it’s an undeniable problem. Add that to our huge domestic violence and sexual assault problem, and we have plenty of calls for service. Things go hand in hand too. Drugs and alcohol make people more vulnerable to being victimized in all sorts of ways. As far as mental illness, I think Anchorage is about average. The extra challenges are in rural areas where the clinical resources are few and far between. Average is terrible though. We have a broken system in this country.

JG: What sorts of extra training do you have in CIT?

R: In addition to the regular CIT training, I have attended training in self-injury, brain development in children and adolescents, autism spectrum disorder, PTSD, veteran’s issues, traumatic brain injury, and suicide.

JG: How do you use that in your job?

R: My job is to keep my officers safe and to keep my callers safe. For a CIT call, I prepare a caller for the police arriving and to make them as calm as possible and therefore less dangerous for the officers I’m sending. A call taker with a bad attitude or low level of skill can make a situation more volatile and dangerous for both the citizens and the officers. It reflects poorly on the police department and makes every encounter with that subject more difficult. A CIT call taker can deescalate a situation and provide reassurance that we are there to help.

Just being able to speak the language of mental illness goes a long way in calltaking. The relief I hear in a parent’s voice when I can correctly pronounce their children’s illness is dramatic. The ability to collect information in a non-confrontational and non-judgmental way makes the call go much more smoothly. A lot of it is basic customer service stuff: just because I’m trained to take control of a difficult caller and squeeze them like a rotten peach for information doesn’t mean I need to use this on every caller. People who call for help deserve to be helped in the most pleasant way possible.

Two examples of how CIT knowledge has translated into changing how we do things:

1) One of the more useful pieces of information I learned in an Autism Spectrum class was that often autistic kids are attracted to reflective surfaces like mirrored glass buildings and water. As a direct result, whenever one of my coworkers takes a call about a missing autistic kid I immediately search the map for bodies of water and start putting those in as places that responding officers need to check quickly. It works. When a non-CIT dispatcher starts seeing their coworkers do the “look for water” trick, they too incorporate that into their list of things to do. If just one officer finds a missing kid by a pond, then we look like magicians and feel like we’ve saved a life. Win-Win.

2) Naked people are bad. There’s a condition called excited delirium where your body (due to drugs or psychosis) dumps massive amounts of dopamine into your system. One of the ways this presents is a mental health consumer having a psychotic episode, usually violent or threatening, often involving the consumer breaking glass objects, and often the consumer has shed their clothing. This is a dangerous situation for officers since it’s violent but it’s potentially lethal for the victim who can often go into immediate cardiac arrest after being subdued by police. If an officer or a sergeant calls for an ambulance before officer contact due to learning about this in use of force training, great. If a dispatcher gets medics started even before an officer requests it due to CIT training, that’s great too. Either way, the fewer people who die in police custody the better for everyone.

JG: How do you liaise with the officers to help them with that?

R: If I craft my comments correctly, I can get across the message that this is a “CIT” type call and they should take that into account even if they are not part of the CIT. If I know the particular background of a consumer, then that information will be helpful for the officers.
When a specific consumer is having a period of recurring crisis or escalating crisis, I can contact the CIT coordinator who can contact the clinicians and family of the subject if possible so that everyone is on the same page and we can work together to get the person as much help as possible to avoid going to jail, getting hurt, or hurting someone else.

JG: What do you think the most important things officers should or could know about mental illness?

1. It can happen to anyone.

2. It is not a character flaw.

3. Just because I’m mentally ill, it doesn’t mean I’m stupid. Do not be disrespectful, patronizing, or condescending.

4. Mentally ill people are victims of crime too. Just because you’re paranoid, doesn’t mean they are not out to get you.

JG: What do you think the most important things regular people could know in dealing with police officers in times of crisis?

1. Know where you are and tell 911. We might be able to find you by your cell phone, but it’s not like on TV, it only works under certain circumstances and mostly only when you are still on the 911 line.

2. Call as early as you can in your crisis. No one wants to call the police, but better to call when you notice your four-year-old child has been missing for 10 minutes rather than going to search for another 30 minutes before calling. We’ll be happy to cancel that kind of call as a false alarm.

3. Don’t be afraid to ask for a CIT officer or to talk to a CIT dispatcher.

JG: What do you think is going right right now in police work?

R: I have read a lot of articles lately criticizing the militarization of police forces in the U.S. While I sometimes see the point of these writers, police forces have also become more advanced in areas not related to bigger guns and military type vehicles.

With more veterans coming home with traumatic brain injuries and post traumatic stress, police agencies have had to learn to better help that community. Domestic violence prevention and sexual assault prevention have also become bigger priorities. Speaking only of my agency, I believe that we are the good guys. I have to hope this is the case for most police agencies in the U.S.A.

JG: What do you think could be going better?

R: More training, better training. Everyone’s budgets are tight but training nearly always pays rich dividends. CIT training is its own reward to the team member too. I want to do CIT well because I know CIT is doing good.

I can't tell you how much I learned from this and how grateful I am to Rafael for answering my questions. Even after years of being sober and seeing the cops as the "good guys" again, I still am skeptical when it comes to how things get done, especially in Chicago and especially when it is regarding mental illness or addiction. I really appreciate the insider look and hope that as many officers get CIT training as possible.

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