Mental Health Calls for Service
mENTAL hEALTH cALLS FOR SERVICE2007-2011 / KENT STATE UNIVERSITY POLICE SERVICES
The Kent State University Police Services Division statistical report for mental health related calls for service from 2007 to 2011 at the Kent Campus. The report contains information such as call types, officer responses and outcomes. The report also presents the departments Crisis Intervention Team and how it operates in the University setting.
Prepared by Officer Jeff Futo
Kent State University
Department of Public Safety
Police Services Division
P.O. Box 5190
Kent, Ohio 44242
Mental Health Calls for Service
KENT STATE UNIVERSITY POLICE SERVICES
General Order 41/015 …… 1
Crisis Intervention team …… 8
Statistical Reports …… 10
General Order 41/015
Handling Incidents Involving Suspected Mental Disorders and Mental Health Crises
1. Introduction
The purpose of this directive is to establish guidelines for safely dealing with people with mental disorders or experiencing a mental health crisis. If such a person can be referred to the proper mental health resource the opportunity for treatment can improve their quality of life, impact their retention at the University and reduce the chance of future crises
2. Definitions
Mental disorder means a substantial disorder of thought, mood, perception, orientation or memory that grossly impairs judgment, behavior and the capacity to recognize reality or the ability to meet the ordinary demands of life. Crisis means any situation in which a person perceives a sudden loss of his or her ability to use effective problem‐solving and coping skills. A number of events can be considered a crisis, such as: life‐threatening situations, criminal victimization, thoughts of suicide or homicide, loss or drastic changes in relationships.
A substantial risk of harm means that the person is possessed of the means to do harm and there is a significant probability that such harm will occur.
The Crisis Intervention Team (CIT) consists of officers who have received specialized training to handle the complex issues relating to mental disorders and mental health crises. In addition to performing their regular duties, CIT officers are called upon to respond to calls involving persons in a mental health crisis.
3. Guiding Principle
Every employee will treat persons with a mental disorder or having a mental health crisis with dignity and respect. Reasonable effort will be made to divert a person requiring evaluation or treatment, voluntarily or involuntarily, to a mental health resource as dictated by the circumstances of the incident. Arrest is the least preferred alternative in these incidents.
4. Documentation
An incident where the focus is the mental health of a person will be classified as a Psychiatric Situation in an incident report. If a criminal offense occurs the incident type in a case report is a Psychiatric Situation with the relevant Ohio Revised Code listed. The primary officer on a psychiatric situation will complete a Crisis Intervention Response Stat Sheet and submit it with the report. The Records Section will forward the form to the CIT Coordinator with the report for review.
5. Guidelines for Recognition
A dispatcher will obtain as much information as possible about the nature of a mental health crisis incident and dispatch a CIT officer (if available) and emergency medical services (EMS) (if applicable). The responding officer shall investigate the circumstances to determine what further action is required. If a mental health crisis exists a CIT officer will be requested for assistance, if needed. Dealing with a mental health crisis can be a very difficult and delicate situation. Whether speaking with a person who is depressed or in the midst of psychosis, the officer needs to find a way to effectively communicate. An officer must first recognize that they are dealing with a person who has a mental disorder or a person who is having a mental health crisis. Some common signs and symptoms include:
Ø Crying
Ø Difficulty concentrating
Ø Feeling guilty, hopeless or worthless
Ø Thoughts of suicide or death
Ø Difficulty understanding what the person is saying
Ø Wearing strange or inappropriate combinations of clothes
Ø Suspiciousness or hostility
Ø Having strange behavior that makes no sense
Ø Thinking that people are after them or trying kill them
Ø Hearing voices or seeing things that others can’t see or hear
Ø Inappropriate behavior.
Additionally, cognitive awareness can be useful in assessing mental health, by asking questions or observing the person’s awareness relative to:
Ø Time (awareness of existing in the present, knowledge of the date and time),
Ø Person (awareness of who they are, and who are the people with them or around them),
Ø Place (awareness of where they are, why they are there).
6. Assessment Procedures
While interacting with the subject the officer shall make an assessment of their mental state. This is accomplished by the observations of the officer and others regarding the behavior of the person. Officers are not expected to diagnose mental disorders but rather to recognize behavior that is potentially harmful, dangerous or would be of a concern to mental health professionals. Because police assistance is usually requested after a person’s behavior becomes inappropriate, disorderly or dangerous, the first priority is often de‐escalating the situation. The distorted perceptions that accompany a mental health crisis can make communications difficult. Communications can be enhanced by remembering the following guidelines:
Ø Request a backup officer, and always do so in cases where the subject may be taken into custody.
Ø Take steps to calm the situation. Where possible, eliminate emergency lights and sirens, disperse crowds, and assume a quiet non‐threatening manner when approaching or conversing with the subject. Where violence or destructive acts have not occurred, avoid physical contact, and take time to assess the situation.
Ø Attempt to determine the cause of the crisis. Use active listening or de‐escalation skills to gain rapport and trust with the subject.
Ø Where possible, gather information on the subject from acquaintances or family members.
Ø Do not threaten the subject with arrest as a means to control behavior. This will create additional fright, stress, and potential aggression.
Ø Attempt to avoid topics that may agitate the subject and guide the conversation toward topics that help bring them back to reality.
Ø Always attempt to be truthful. If the subject becomes aware of a deception, he may withdraw from conversation in distrust or become hypersensitive or retaliate in anger. The deception may be remembered and make future contacts more difficult to manage.
Ø Once rapport has been established an effort should be made to determine if the subject has been prescribed medication.
Ø If the subject provides medical information and appears to be comfortable with the topic, consideration should be given to asking whether they are being treated for a specific illness.
7. Referral Procedure
Emergency Psychological Services (EPS)
An officer may take into custody and transport a person suspected to be in a mental health crisis to an EPS or hospital if the following applies:
Ø The person represents a substantial risk of physical harm to himself as manifested by evidence of threats of, or attempts at, suicide or serious self‐inflicted body harm;
Ø The person represents a substantial risk of physical harm to others as manifested by evidence of recent homicidal or other violent behavior or evidence of recent threats that place another in reasonable fear of violent behavior and serious physical harm;
Ø The person represents a substantial and immediate risk of serious physical impairment or injury to himself as manifested by evidence that he is unable to provide for and is not providing for his basic physical needs because of his mental illness and that appropriate provision for such needs cannot be made immediately available in the community;
Ø The person would benefit from treatment in a hospital for his mental illness and is in need of such treatment as manifested by evidence of behavior that creates a grave and imminent risk to substantial rights of others or himself.
If the above criteria are met and the officer is considering a referral to EPS, the officer should first ask the subject if they would accept a transport. If the subject refuses the officer shall make a reasonable effort to convince the subject otherwise. Every reasonable and appropriate effort should be made to take people into custody in the least conspicuous manner possible. The officer will inform the subject being taken into custody of their name, professional designation, and agency affiliation. The subject will be informed that the action is not a criminal arrest and that they are being taken for evaluation by mental health professionals at a specific mental health facility identified by name. The officer shall complete an Application for Emergency Admission form that includes a statement of facts explaining the reason for the referral to the EPS or hospital. A copy of this form shall be provided to the EPS or hospital or other applicable mental health facility.
Once the subject is in custody and the application is complete the officer will contact the EPS or hospital to make arrangements for the delivery of the person needing assistance. The EPS may request that the person be transported to a hospital if the subject is suspected to be under the influence of alcohol or drugs. After arrangements are made, the person will be transported to the proper facility.
It is not required that an officer sign an Application for Emergency Admission when transporting a voluntary admittance. Officers should consider signing when the subject meets the requirements of ORC 5122.01because it will allow the EPS or hospital to hold them for an evaluation to be conducted within 24 hours. If a suspected medical emergency exists, the officer shall contact the Kent Fire Department (KFD) for EMS. Upon their arrival, the EMS shall be informed of the nature of the medical emergency and that the person is in custody in accordance with ORC 5122.10. The officer shall contact an EPS, hospital, or applicable mental health facility. If requested to accompany EMS, the officer shall inform the OIC of the request. If the request is granted, the officer shall accompany EMS to the hospital. The Dispatcher shall coordinate the officer’s return to campus as well as contacting the EPS. Coleman Professional Services (Access) does not have a license to hold persons against their will. When an officer transports a person involuntarily to Access, staff will determine if the person can be evaluated there or needs to be transported to another facility. If an evaluation cannot be done at Access, they may request an ambulance transport to another facility. The officer shall wait until the ambulance arrives to transport the person. The officer shall request assistance from the appropriate police agency if needed.
Non‐Emergency Psychological Services
An officer may encounter a person who is having a mental health crisis but does not meet the criteria for emergency admission to a mental health facility. If the person does not represent a substantial risk of harm but would benefit from a mental health evaluation an effort should be made to get the subject to submit voluntarily. Officers should assist with this voluntary evaluation, including transport to a local mental health facility if possible.
The phone numbers to the following mental health resources are located in the Communications Center:
Kent State University
Ø Psychological Services
Ø The Psychological Clinic
Ø Counseling and Human Development Center
Ø Coleman Professional Services
Ø Townhall II
Ø NAMI
Ø Family and Community Services
Ø Children’s Advantage
Ø The Mental Health and Recovery Board of Portage County
Ø Portage County United Way
8. Juveniles
An officer may take into custody and transport a child suspected of having a mental health crisis to an EPS if there is reasonable grounds to believe that the child is suffering from an illness or injury and is not receiving proper care, as described in ORC 2151.03, and the child’s removal is necessary to prevent immediate or threatened physical or emotional harm.
A child who is taken into custody under ORC 2151.31 does not require an Application for Emergency Admission Form.
A juvenile can also be taken into custody under ORC 5122.10. The officer will determine which section of law is most applicable under the circumstances and document in a report which section of law was applied. When a juvenile is taken into custody the parent/guardian shall be notified and should accompany the juvenile to the facility, if possible.
9. Incidents Involving Extreme Mental and Physiological Excitement
Officers may encounter a person who is displaying extreme mental and physiological excitement. The incident may originate as a property damage or unusual behavior call. The person may display characteristics such as:
Ø Naked or partially clothed
Ø Incoherent speech or gibberish
Ø Yelling or screaming
Ø Disoriented and hallucinating
Ø Exceptional agitation and hyperactivity
Ø Overheating
Ø Hostility
Ø Superhuman strength
Ø Aggression
Ø Acute paranoia
Ø Endurance without apparent fatigue.
These are symptoms of a medical emergency that often present itself as a mental health crisis. These symptoms are commonly referred to as Excited Delirium Syndrome. Excited Delirium Syndrome is not a recognized medical or psychiatric condition, but it is a recognized cluster of symptoms that has been associated with sudden in‐custody deaths. There are several recognized medical conditions that also reproduce these symptoms; hypothermia, delirium tremens (alcohol withdrawal), diabetes, head injuries, hyperthyroidism, and meningitis. These symptoms, regardless of the cause, are indicative of a person with a life‐threatening condition and medical assistance is a priority. De‐escalation techniques will likely be ineffective. When officers observe these symptoms, they will immediately call for backup and for EMS. EMS should respond and stage at a safe distance until the person is restrained. Unless there is an immediate public safety threat, the first responding officers will focus on containing the person. Unless there are compelling reasons to do otherwise, officers will not approach the person until substantial backup and EMS are on scene. Once sufficient numbers are on scene, officers will focus on getting the person under control as quickly and safely as possible. Officers should keep in mind that the person maybe impervious to pain. Control through balance displacement and joint manipulations will probably be the most effective techniques. If officers utilize restraints or if the person is in the prone position, they will be placed on their side or in a kneeling position as soon as possible in order to allow them to breathe with less difficulty. Once the person is brought under control, officers will monitor the person in case of “sudden tranquility” (transition to a depressed state) and turn them over to EMS as soon as possible. Upon turning the person over to EMS, restraints may have to be removed or altered. This should be done in coordination with EMS and several officers. The goal with incidents involving extreme mental and physiological excitement is to get the person in the hands of EMS and the hospital as quickly and safely as possible.