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Improving Crisis Response and Safety:

Sgt. A.D. Reflects on Partnerships with People Living with Mental Illness, Families and Mental Health Providers
Description

Introduction

Sergeant A.D. Paul is a 33-year veteran of the Plano, TX Police Department and a veteran of the U.S. Air Force. He coordinates Plano P.D.’s Crisis Intervention Team (CIT) program and testified before the U.S. Senate Judiciary Committee’s hearing on Law Enforcement Encounters with People with Disabilities in 2014. Sgt. Paul is the father of 15-year-old Christopher, who is on the autism spectrum.

In this interview, Sgt. Paul answered questions about how he and his department respond to mental health crisis situations.

Q: Like most officers, you had experiences early in your career with people experiencing a mental health crisis. How did you respond on those calls?

Sgt. Paul: I’ve been in law enforcement for 37 years, including four years in the military police. We always fall back on our training. Before Plano had our Crisis Intervention Team (CIT) program, we would use our command presence and command voice in a mental health crisis. If a person wasn’t following commands, we might end up physically restraining them for our safety. This rarely ended well. With CIT the use of active listening, rapport building, and patience has made a world of difference as well as saved lives.
 

Q: How has your perspective on people with mental illness changed with training and experience interacting with people in crisis?

Sgt. Paul: We come to the job with the same stigma about mental illness the public has. Our CIT program has two major components. There’s the training piece, where law enforcement and detention officers are trained on what mental illness is, what it looks like, what it feels likes. We spend a lot of time humanizing people with mental illness and training with that population.

The other piece is partnerships with mental health providers, families and advocates. We’ve learned that working together and working with the person’s support system—parents, neighbors, providers—we stop being their crisis clinicians. The whole point of CIT is to get the police out of the business of being counselors and get the real providers involved. Every encounter with law enforcement can be a traumatic event for the child or adult involved—no matter how hard we try to use the least traumatic approach.

 

Q: How can officers build trust with people living with mental illness and their families before crisis situations occur? 

Sgt. Paul: You have to go where they are and build rapport and trust.  Law enforcement agencies need to find advocacy groups, providers, and support groups and introduce your program. Educate on what you are about and how to make everyone safe. For example, we are involved in our local National Alliance on Mental Illness (NAMI) chapter and Mental Health America chapter. We’ve contacted a lot of behavioral health providers, as well, told them we have a CIT program and they help us meet with people with mental illness.  People with mental illness need to meet us in order to trust what we are doing.

We also try to follow up with all the people we have to take into custody for an involuntary mental health evaluation, to try to connect them to services. Not everyone is receptive at first; their experiences haven’t always been so positive! Just as officers can have a stigma towards people with mental illness, people with mental illness can have a mistrust of law enforcement.

We have to combat that and build those bridges. You have to have people in your agency who can see from the 30,000-foot view, that this all about officer safety. If you can build those relationships and build that trust, it leads to fewer crisis situations. Sometimes it’s unavoidable, but on a lot of those calls, you really don’t need a law enforcement officer to stabilize a person in crisis.
 

Q: How do you recognize a mental health crisis when it's occurring?

Sgt. Paul: It’s kind of like real estate—but in the case of a crisis call, it’s “information, information, information.” If you have the information that there’s someone with a mental illness is involved, it helps you shift gears. It’s so important that the call takers and dispatchers have the training, and they can listen and ask for clues about mental illness.

So, when we’re arriving on a scene, hopefully, we have information from dispatch that indicates a mental health crisis is occurring. When we get there, we’re looking at behavior like body language, eye contact, stream-of-consciousness, and even appearance. Anything about their speech or disposition can be a sign.

The circumstances the individual is found in can also be a sign. When I was trained early on, the example was, it’s 3 a.m. and 23 degrees outside, and someone’s standing nude in the middle of the street screaming to God—something’s not right. But that’s an extreme example. There are many more subtle situations, like someone sitting alone in a park, talking to themselves, or someone sitting at the edge of a bridge. Once I was called to a restaurant where a man refused to leave, and he had collected all the silverware, telling the manager that it was all his.

 

Q: In your experience, when an officer is intervening in a crisis situation, what's the best way to interact with the family during and after the crisis? 

Sgt. Paul: Always take time to explain what you are doing and why. Just that alone will bring some trust and calm the crisis.  

It’s hard to see loved ones being involuntarily committed; it looks and feels like an arrest, and can be very traumatic. If you can take a few seconds to explain yourself and the process in a non-technical way, that goes a long way. If you tell the family what happened and why it happened from your perspective, you’ll gain trust and you’ll de-escalate any unintended consequences of what you had to do.

Once you take someone to the hospital, the providers can’t always communicate back to the people in their lives. The provider is sometimes talking directly to the patient, but he or she is not always in a place to process that information. Even if they’ve been stabilized after 24, 48 or 72 hours, this can be life or death information. A lot of times, loved ones don’t even have a clue they’ve been released from the facility. We reach out to get as much information as possible, and we reach out to the family member to let them know about resources in our county to help them.

 

Q: Has your experience and training taught you to go into crisis situations with a particular strategy or mindset?

Sgt. Paul: Yes, the mindset is: time is on your side, distance is on your side. If the person is not really threatening anyone but themselves, don’t close in on that person, but give them lots of time and space. CIT training has always been about taking your time, slowing yourself down, lowering your voice and building a rapport. Now, we’re adding space.

If they have a weapon, like a knife, you still try to isolate the person so they can’t hurt someone else. You set up a perimeter and then you set up communication from a distance. It’s kind of a weird dynamic because you’re yelling to set up communications.  Typically, if you have multiple officers there, you’ll have someone capable of dealing with force if the person were to take action, and then you have someone who is focused on communicating.

A key lesson is if someone is in a fight-or-flight mode because of mental illness, they are not going to react the same as a typical citizen.  As the officer, you need to know that this person might not hear or interpret your commands correctly.

 

Q: Do you see your role as a law enforcement officer differently now that you have had training in interacting with people experiencing a mental health crisis?

Sgt. Paul: I think my role has changed. Sometimes I have to be an advocate for a person with mental illness. If I know the history of the person and know how they came to be in crisis, I can sometimes be the only person on their side. You may have to dig and get that information and convince the provider through our report that they are more serious and need intensive services. Now with the lack of funding and in a community system instead of a hospital system we sometimes take the role of advocate.