Articles

Responding to People with Mental Illness

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Emergency responders face an increasing number of calls involving people with behavioral and mental health issues. To deal effectively and safely with these individuals, responders must be able to recognize signs of mental distress, apply proven techniques for de-escalating potentially dangerous situations and make appropriate referrals for them to obtain mental health care.

A number of programs are available to help communities and responders learn what they need to know. The National Council for Behavioral Health, an association of 2,000 community mental health and addiction treatment organizations, teamed with the Maryland Department of Health and Mental Hygiene and the Missouri Department of Mental Health to pioneer Mental Health First Aid (MHFA) in the United States and has trained almost 300,000 people. The eight-hour MHFA course introduces participants to risk factors and warning signs of mental illnesses such as anxiety, depression, schizophrenia, bipolar disorder, eating disorders and addictions. It also provides an overview of common treatment methods and offers practical tools and resources for guiding youth and adults to appropriate mental health and addiction care. More than 5,000 certified MHFA instructors offer the course in communities across the country.

MHFA is listed on the Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence-based Programs and Practices.

MHFA serves to educate communities, but what about training specifically for responders?

“I just think mental illness is coming out of hiding,” says Ann Marie Jensen, a paramedic and the Resource Access Program (RAP) coordinator for the San Diego Fire-Rescue Department’s Emergency Medical Services (EMS). RAP links frequent EMS users with additional health, mental health and social needs resources to reduce their dependency on the city’s emergency services. “In our frequent 911 caller group, 60 percent […] have underlying psychiatric problems or mental illness, and when we get to our very high utilizers, people who are calling, you know, 50 times a year or so, it’s about 80 percent psychiatric issues. We usually get there knowing that there’s some kind of underlying mental illness.”

Of course it’s not just paramedics who face this challenge.

“Just the other day we ran [a call] where a daughter and her friend are trying to get medical treatment for her mother,” says Captain Gerard Morrison, Engine 42, Fairfax County [Virginia] Fire and Rescue. When the firefighters arrived “the father is brandishing a gun. He doesn’t want any intervention in the home.” The father previously had been diagnosed with Alzheimer’s disease, which although not a mental disability often mentally impairs its victims. “We had to retreat. But the daughter was crying, so, you know, the police were called and the guns were secured.” Only then could the Fairfax County firefighters get access to the ill mother. “It’s emotionally draining on a fireman when somebody is disabled mentally.”

Morrison also has spoken with police. “Law enforcement is beginning to recognize that some of the situations they have found themselves in recently have been misjudgments of people with mental health issues […] and if they had been able to recognize certain symptoms, they may not have taken the, you know, forcible action that they took.” Talking about responders in general, he adds, “If we don’t have a baseline training for these guys […] they can only draw on their own experience. And if they don’t have any experience in [dealing with mental illness], then they’re going to come up with their own idea, whether it’s right or wrong,” because in the situations where responders find themselves, “we’d rather make a decision than not make a decision.”

In its publication “Improving Officer Response to Persons with Mental Illness and Other Disabilities: A Guide for Law Enforcement Leaders” the International Association of Chiefs of Police (IACP) offers solid suggestions for agencies to improve their response to this segment of society. Among them:

• Be aware that mentally ill and mentally disabled persons not only exhibit behavior that might be or be perceived to be criminal activity, but also experience high rates of victimization;
• Focus on data-driven strategies based on an accurate picture of the community’s geography, demographics, available resources and the number of calls involving mental health issues; and
• Identify local mental health organizations that can assist in training and providing treatment to individuals responders encounter.

The IACP also recommends a number of resources to help agencies implement effective strategies. In addition to MHFA, the organization strongly endorses Crisis Intervention Team (CIT) training. Focused primarily on law enforcement, CIT programs are local initiatives that involve 40 hours of training. They aim at improving the way response agencies and communities respond to people experiencing mental health crises and building strong partnerships among law enforcement, mental health providers and those affected by mental illness. CIT emphasizes:

• De-escalating crisis situations to improve the outcomes of police interactions with people with mental issues;
• Decreasing the use of force by officers; and
• Increasing consumer access to community mental health treatment options.

Two organizations are preeminent in the CIT arena: the National Alliance on Mental Illness, which maintains a growing network of state and local affiliates that provide training and resources, and CIT International, a non-profit membership organization that implements CIT programs throughout the United States and worldwide.

“A psychiatric patient can make you very uncomfortable, and sometimes it’s very awkward to even know what to say back,” Jensen says. “It’s kind of like negotiation, crisis negotiation. […] How do you get the patient to do what they need to do? How do you talk a patient down so that they’ll get on the ambulance gurney by themselves rather than you having to restrain them on the gurney?” Training, she says, “gives us tools to know how to make that call run smoothly.”