Sunday, October 15, 2006

Crisis Intervention Team explained

I have given the first two of six 2-hour "intro to CIT" training sessions for dispatchers. The first was laid back and fun-filled. At the second I had some technical difficulties and as a result went randomly off-script. Upon reflection, the second group probably got the message I was trying to deliver but through a bigger cloud of pessimism or cynicism than I intended.


For everyone who is not a dispatcher at my agency and is curious about this CIT thing I'm always referring to, here's the short version of the dealio:

You will either experience a period of mental illness in your lifetime or will have a friend, family member, co-worker who does. Guaranteed or your money back.

Jocelyn from The Smussolay sums it up best:

"You're less than six degrees of separation from someone who suffers or is diagnosed with a major mental illness, whether you actually know it or not (we don't talk about these things because they're SHAMEFUL and SECRET and PRIVATE and DIRTY). [they'll be a] close family member, co-worker, buddy's girlfriend, cousin, neighbor, mailperson, that hot chick on the train.

"We're not mutants. We're just normal people who need a little help. Just like the insulin dependant diabetic, the breast cancer survivor who needed chemo, the guy who lost his leg. Maybe you don't personally *gain* anything from us, but you might not have any idea what you're -missing.-"

Mental illnesses are not character flaws, not the result of bad parenting, and not something people can overcome through just "sucking it up" or "getting over themselves." This stuff is real and sometimes it's real bad. Sanity is a continuum. Feel fortunate if you never stray out of the bracket deemed "normal."

Simply admitting to yourself that you have a mental problem is difficult and having to admit to your boss and coworkers (okay, now imagine working for… oh I don't know… the POLICE DEPARTMENT!). Yeah, that's a conversation you want to have over and over and over while you get it all sorted out.

Dealing with mental illness is not easy for the patient or their family and friends. Medication often works but it is expensive (think super-duper expensive) and those who need to take them most desperately are often the least able to afford them. For those who are in crisis or are deep into the worst kinds of symptoms (everything from psychotic episodes with hallucinations to issues like profound depression and suicidal ideation) the hospitalization they might need is also very expensive.

Plus such serious symptoms are frightening and potentially dangerous to others besides the consumer. And if you don't understand or agree that you are mentally ill then... well then your family is indeed plotting against you, the goverment is watching you, and you might actually be kidnapped and held against your will at a hospital. The hospital will also force you to take drugs which make everything go a little fuzzier around the edges.

Oh quick note: the acceptable term these days for the mentally ill is "mental health consumers" which sounds a little too politically correct at first but is much preferable to the metaphoric "wing-nut" or the bluntly clinical "crazy as a bedbug."

What is generally deemed to be mental illnesses are classified (at least by me) into 5 groups (DSM-IV mileage might vary):

Major depression,

Bipolar Disorder,


Borderline Personality Disorder and Dissociative Personality Disorder,

Anxiety Disorders,

and Everything Else (OCD, ADD, ADHD, and all those things which almost never become police matters).

Yeah, it's not a perfect set of pigeonholes but since I'm not a clinician or a medical professional of any kind I feel I can make up my own rules to introduce laypeople to the different wonderful world of mental illness.

My police department, and many others around the country, have created a Crisis Intervention Team with the purpose of better helping mental health consumers. Police department are generally very conservative with regard to "touchy-feely" programs so I consider my department pretty enlightened. That being said, I'd like to see more money for continuing education but that too is a digression.

The goal of CIT is simple: To treat mental health consumers with respect and dignity and to always remember that "I am a whole person, I'm not just the symptoms you might be seeing now" and "I'm mentally ill, I'm not stupid."

While I think all police employees should have some basic CIT introduction (which is what I'm doing with these 2 hour classes as part of a bigger in-service refresher training for dispatchers) not everyone has the temperament nor the interest in being a member of the team itself. The officer who is our driving force describes it this way, "I don't want to be a sniper. I don't want to be on the SWAT team. Not everyone does and not everyone is qualified for those teams." Neither is everyone suited to be a CIT officer or dispatcher.

Which is why you have to ask/fight to be trained as a CIT officer or dispatcher. That's a good thing in my opinion.

CIT officers and dispatchers are given 40 hours of classroom training so that they better understand the illnesses themselves, the medications and their effects, the fears/concerns of the consumers and their families, and the resources available in the community. They get to tour the various facilities and (separately) to hear from and speak with consumers who are by far the best able to describe their situations and how things have worked well or poorly for them during their police contact. 40 hours isn't a whole lot but it inspires team members to seek further education on their own and then share what they can with the whole team. Remember: we wanted to get the extra training. Now we are obligated to use it when appropriate and keep ourselves educated.

As far as being "touchy-feely" we all have the primary job to do first and foremost.

Officer safety always comes first. Someone who has a weapon will be disarmed, quickly and if necessary forcefully.

Dispatchers answering phone calls, seldom customer service super-stars in the first place, have to collect all pertinent information to get a clear picture of the situation and it express it to the dispatchers on the radios (and thereby to the responding officers) quickly and thoroughly.

In practice the difference between a CIT officer or dispatcher response might only differ from that of their other coworkers in that they spend a little more time and patience with each consumer.

This might seem simple but it makes both officers and dispatchers (on the phones in this case) take a bit more time and spend a little more patience on people having a mental health crisis. Time affects productivity. In the case of an officer this means calls in his 'beat' will stack up while he takes extra time with a consumer. In the case of a dispatcher it means that while one dispatcher is on the phone with a consumer everyone else who is staffing the phones has to field more calls.

So everyone not on the team must be "on-board" in order for the CIT to work best.


The benefit to the department is potentially great: Developing appropriate relationships with consumers and their families will likely result in less police contacts in the future and those contacts will likely be less dangerous and more welcoming.

The benefit to the community is potentially great as well: dispatchers can occasionally spend a couple minutes on the phone and eliminate the need for officer response entirely. No officer response means other citizens will get their officers faster. Officers who have the extra training to at least recognize when a person might be in crisis and speak "their language " in a reassuring but not patronizing manner can eliminate the need for 'tactical' responses which might injure or kill the consumer.

No officer wants to kill anyone and certainly not someone who is not a criminal. And I'm not just talking about shooting folks or Tazering folks unnecessarily.

One of the topics discussed in the most recent advanced CIT training was naked people.

A consumer experiencing a severe psychotic break can get into a very dangerous medical situation called "excited delirium." Excited delirium causes the subject's core body temperature to spike (therefore the nakedness) as his body is being flooded with adrenaline and other hormones in toxic levels. Think Lou Ferrigno's Incredible Hulk without the greenness and who is likely (and this is the important part) going to crash and die right there very soon.

And officer who recognizes that a subject is in excited delirium will notify dispatch to send paramedics lights and sirens because, when the person gets handcuffed – likely after a brief but intense struggle – they are going to need an ambulance and a hospital or they will die.

An officer who doesn't know to look for this might very well put a handcuffed (and hobbled probably) subject in the back of their patrol car to be taken either to jail or to the hospital. The consumer has a good chance of dying in the back of that patrol car.

Did I mention officers don't want to kill mentally ill folks? Yeah, well neither does the chief of police or the mayor. Some dies in the back of a police car and the media will become involved. Nothing good comes of that. Oh yeah, and someone has died too.


So that's a brief introduction to CIT. It's not costing the tax-payer much if anything (it's not a funded program and no one will be called in from off-duty to respond to such a call, unlike negotiators, SWAT team members, detectives, etc.) and it has the potential to make a huge difference in the lives of folks in crisis.

Which is why I like being a dispatcher. Oh the stories are great and it's always fun when the sierra hits the foxtrot and you can ride that adrenaline wave yourself while showing your high level of talent. When things go right, it's fantastic.

But the real reason I like being a dispatcher is that I know that a caller who gets me or one of my recruits (or 99% of my coworkers) will be treated well. As I mentioned before, our customers are not always right and we're probably ruined from working in any customer service job in the future but all of my callers are treated with respect and with dignity no matter if they are mentally ill, intoxicated, belligerent, nearly unintelligible for whatever reason, children, or just plain not thinking clearly due to whatever their crisis is.

I could be belittling or rude back but what's the percentage in that? After all, you pay my salary. You've told me so.


PJ said...


Eric said...

I'll send you a private email with some contact information for Memphis Police Department (who created CIT after some unfortunate incidents where mental health consumers were killed by police).

Being a little biased, I recommend the training to any LE agency whose mission statement mentions anything about serving their community.

Eric said...

Okey dokey, cant find an email for you... so here's the straight dope:

Memphis PD is the nexus of the CIT universe (sort of like San Jose is the nexus of the FTO universe).

Contact person: Major Sam Cochran, CIT Coordinator. his email is: (without the XX's).

He should be able to send your agency information on how to get a couple of your folks CIT trained (probably in Memphis)and then they in turn will be able to arrange appropriate CIT training materials.

I recommend folks who are pretty passionate about helping people (not necessarily even mental health consumers) be the folks who Memphis trains. They will need that passion to make sure things go forward back home.

It'd be nice if somone high up in admin (the higher the better) is on board. CIT training doesnt cost much but it will require some training time and whatever payroll money and sheduling time that requires.

Good luck! I wish our agency had a great website to guide you too but I honestly think that would require ME to do it.. and my plate is fulllllll.