Crisis Intervention

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This directive is for internal use only and does not enlarge an employee’s civil liability in any way. The directive should not be construed as creating a higher duty of care, in an evidentiary sense, with respect to third party civil claims against employees. Violations of this directive, if proven, can only form the basis of a complaint by the San Juan County Sheriff’s Office for non-judicial administrative action in accordance with the rules and laws governing employee discipline.
DIRECTIVE TYPE: POLICY SUBJECT: Crisis Intervention NUMBER: OPER-337.01
APPROVED BY: Sheriff Ken Christesen EFFECTIVE DATE: 3/06/2016
NMLEA STANDARDS: Not Applicable LAST MODIFIED: 5/31/2017 LAST REVIEW: 5/30/2017


PURPOSE:


San Juan County Sheriff’s deputies are, on an almost daily basis, faced with handling unpredictable and oftentimes tense and dangerous situations. As one of the primary entities called upon to resolve crisis situations, there is a public expectation that deputies are proficient in handling all types of calls for service. One of the most unpredictable and volatile events a deputy responds to involves dealing with a person who is experiencing an inability to cope with symptoms of a mental illness or a person in crisis. The purpose of this policy is to provide personnel with guidelines and procedures to assist in identifying and dealing with the mentally ill and/or persons in crisis.


POLICY:


It is the policy of the San Juan County Sheriff’s Office to respond effectively to situations involving subjects who are suspected of, or are verifiably mentally ill; or people in crisis in order to avoid unnecessary violence, ensure proper medical attention is provided, and avoid potential civil litigation.


The procedures within this policy serve as a guideline to enable deputies to identify behavior indicative of a mental illness or crisis situation, and to utilize agency and other resources to bring incidents involving people in crisis to a desirable resolution.


DEFINITIONS:


The following definitions will apply for the purposes of this policy:


  • Approved Facility – Unless by special designation or court order; approved facilities in San Juan County include the San Juan Regional Medical Center Emergency Room or Presbyterian Medical Services (PMS).


  • Certificate of Evaluation– A document completed by a licensed physician or certified psychologist that certifies a person, as a result of a mental illness or grave passive neglect, presents a likelihood of harm to their self or others and that immediate detention is necessary to prevent such harm.


  • Crisis– Any situation in which a person’s ability to cope is exceeded.


  • Crisis Intervention Team (CIT)– A team of trained Sheriff’s Office personnel that function as specialists in handling calls involving the mentally ill and other calls of crisis not related to mental illness.


  • Deputy– All sworn Sheriff’s Office personnel regardless of rank as well as reserve deputies while acting in their official capacity for the Sheriff’s Office.


  • Grave Passive Neglect– Failure to provide for basic personal needs, medical needs, or for one's own safety, to such an extent that it is more likely than not that serious bodily harm will result in the near future.


  • Mental Health Task Group- A collection of law enforcement, mental health care providers, and community members collaborating to ensure proper care and treatment of mental health patients. The group is dedicated to working together to address community problems relating to mental health and illnesses.


  • Mental Illness– Any of the various conditions characterized by impairment of an individual’s normal cognitive, emotional, or behavioral functioning, and caused by social, psychological, biochemical, genetic, or other factors, such as infection or head trauma.


PROCEDURE:


Due to the large volume of citizen contacts, deputies are usually able to recognize atypical behavior indicative of a mental illness or crisis situation that is potentially dangerous to self and/or others. Deputies should not rule out other causes of abnormal behavior such as reactions to drugs, alcohol, or temporary emotional disturbances. Symptoms of mental illnesses can, and often do, mirror those of someone being under the influence of drugs and/or alcohol. Deputies should evaluate the following symptomatic behavior(s) in the total context of the situation when determining a subject's mental state and the need for intervention absent the commission of a crime.


RECOGNITION OF MENTAL ILLNESS


At times, deputies are faced with situations in which there exists no prior knowledge or insight into the medical or mental history of an individual. As such, deputies need to watch for verbal, environmental, and behavioral clues that might establish the mental state of the subject. Indicators may include:


  • Degree of Reactions - Signs of strong and unrelenting fear of persons, places, or things. For example, the fear of people or crowds may make the person reclusive or aggressive without apparent provocation.
  • Appropriateness of Behavior - Extremely inappropriate behavior for a given situation.
  • Extreme Rigidity or Inflexibility - Becoming easily frustrated in new or unforeseen circumstances and possibly exhibiting inappropriate or physically resistive behavior.
  • Other Specific Behaviors:
    • Abnormal memory loss such as name, address or phone number;
    • Delusions of:
      • Grandeur; e.g., "I am Christ"
      • Paranoia; e.g., "Everyone is out to get me"
    • Hallucinations of any of the five senses; e.g. hearing voices, feeling one's skin crawl, etc.
    • Belief that he or she is suffering from extraordinary physical illnesses that are not possible, such as their heart has stopped beating.
    • Extreme fright or depression.


DETERMINING DANGER


Not all persons experiencing an inability to cope with symptoms of a mental illness are dangerous. Some may be dangerous only under certain circumstances. Specific indicators may exist to assist the deputy in determining if an apparent mentally ill person represents an immediate or potential danger to their self, deputies, or others. These indicators include but are not limited to:


  • The availability of weapons to the subject.
  • Substantiated statements (direct threats or subtle innuendos) by the person that he or she is prepared to commit a violent or dangerous act, or the actual commitment of a violent or dangerous act.
  • Personal history, known or provided, that reflects prior violence under similar circumstances. (Failure to commit a violent or dangerous act prior to the arrival of the deputy does not guarantee that such an act will not occur.)
  • Behavioral indicators of violence, such as clenched fists, advancing towards deputies, heavy breathing, blank stares, etc.
  • The lack of control the subject demonstrates over his/her emotions of rage, anger, fright and agitation, characterized by:
    • Inability to sit still.
    • Inability to communicate effectively, rambling thoughts and speech.
    • Wide eyes.
    • Clutching one's self or objects to maintain control.
    • Begging to be left alone.
    • Frantic assurances that he or she is alright.


The volatility of the environment is a relevant factor deputies must evaluate. Agitators that may affect the person or a particularly combustible environment that may incite violence should be taken into account when determining danger.


HANDLING PERSONS IN CRISIS


As stated in the Sheriff’s Office Use of Force Policy “Law enforcement by nature is a dangerous occupation which requires deputies to put their lives at risk for the safety of citizens and victims. While the chief goal of the Sheriff’s Office is to protect lives and enhance safety, deputies are not required to retreat from situations nor are they required to be exposed to possible physical injury before the application of force.”


When a deputy recognizes that there are symptoms related to mental illness, they should consider applying some of the following de-escalation techniques.


When possible, deputies should:


  • Assess safety issues/concerns.
  • Wait until backup deputies are present before taking any action.
  • Try to obtain any information on the subject from family, friends, dispatch, or other deputies or law enforcement officials.
  • Calm the situation
    • Cease emergency lights and sirens.
    • Assume a quiet, non-threatening manner when approaching the subject.
    • Avoid physical contact, if possible, while assessing the situation.
    • Move slowly, being careful not to excite the subject.
  • Attempt to build a positive rapport with the individual through communication and engaging in dialogue.
    • Provide reassurance that the deputy is there to help and that they are safe.
    • Attempt to find out what is bothering the subject.
    • While relating to the subject's concerns, allow subject to ventilate their feelings.
    • Always be truthful; if the subject perceives deception, he or she may withdraw and further complicate the situation.
    • Guide the conversation towards topics that seem to ease the situation.


Deputies should not:


  • Bring up topics which may agitate the subject.
  • Threaten the subject with arrest or physical harm.
  • Allow others to interact simultaneously while the deputy is attempting to speak with the person and to stabilize the situation.
  • Corner or be cornered. Give the person expanded space and ensure that you, the deputy, have expanded space and a safe exit should it become necessary.
  • Attempt to gain compliance based on the assumption that the person has a reasonable state of mind.
  • Argue or get involved in a power struggle.
  • Buy in to or agree with delusions or hallucinations in order to gain compliance.


PROCEDURES FOR EMERGENCY MENTAL HEALTH EVALUATION


In accordance with NMSA 43-1-10, a deputy may detain and transport a person for an emergency mental health evaluation and care to a hospital, mental health facility, or evaluation facility in the absence of a legally valid court order only if:


  1. The person is otherwise subject to lawful arrest;
  2. The deputy has reasonable grounds to believe the person has just attempted suicide;
  3. The deputy, based upon personal observation and investigation, has reasonable grounds to believe the person, as a result of a mental disorder, presents a likelihood of serious harm to himself or herself or to others and immediate detention is necessary to prevent such harm. This would include incidents of grave passive neglect; or
  4. A licensed physician or a certified psychologist has certified that the person, as a result of a mental disorder, presents likelihood to commit serious harm to him or her or others and that immediate detention is necessary. Such certification shall constitute authority for the deputy to transport the subject.


If a subject meets the criteria for an emergency mental evaluation, the deputy will arrange transportation to an approved facility. If possible, the deputy will, ascertain the subject’s health care provider information and transport the subject to that provider’s facility. If the specified facility is not one listed in this policy as an approved facility, supervisory approval must be obtained prior to transportation. Facility information will be documented and forwarded to the Crisis Intervention Team for future follow-up purposes.


Immediately upon arrival at the evaluation facility, the deputy shall be interviewed by the admitting physician. For the purpose of this policy, the Sheriff’s Office defines “immediately” as prior to the deputy leaving the evaluation facility.


When a subject is taken to a mental health facility the deputy will:


  • Ensure that the mental health staff has an accurate account of the incident surrounding the protective custody.
  • Complete and sign an application for emergency hospitalization.


If a subject is identified as a danger to their self or others, the deputy will guard the subject until the mental health facility assumes responsibility.


If a subject is physically injured or has a pre-existing medical condition requiring attention, physical medical care needs will take priority. The subject will be transported to the hospital emergency room. The hospital will then assume responsibility for the physical care and any mental health care intervention.


Court ordered or doctor ordered Certificates of Evaluation will be processed through the Civil Division.


INFORMATIONAL REFERRALS TO CIT


Whenever a subject is transported to a mental health facility, as outlined in PROCEDURES FOR EMERGENCY MENTAL HEALTH EVALUATION (including but not limited to voluntary transports, involuntary transports, service of Certificates of Evaluation, grave passive neglect incidents, or when the subject is under arrest) an Offense/Incident report will be completed and a copy forwarded to the CIT Sergeant. The CIT Sergeant will assign the report to a CIT member for follow up. An exception to this is a Civil Division “Order of Transportation” to a mental health facility ordered by the courts or a doctor.


FOLLOW-UP REFERRALS TO CIT


If a deputy determines that a person does not meet the criteria for an emergency mental health evaluation as outlined in the EMERGENCY MENTAL HEALTH EVALUATION procedure, but exhibits behavior that is indicative of a mental illness or crisis the deputy will make a referral to the Crisis Intervention Team Sergeant for the appropriate assessment and follow up. These behaviors include, but are not limited to:


  • Signs of escalating problematic behavior.
  • Access to weapons and displaying signs of escalating behavior or who has made threats to harm others or their self.
  • All suicide attempts or threats.


If a situation does not meet the criteria, it does not prevent a deputy from contacting or referring the incident to the CIT if the deputy feels it is appropriate. The following steps will be taken when non-emergency referrals are made:


  • Document observations of specific behavior and the reasons why the deputy is concerned in an Offense/Incident Report.
  • Forward the documentation to the CIT Sergeant who will then assign the case to a CIT member for follow up.
  • CIT members will have no longer than 72 hours to complete the initial follow-up, document the information gathered and any action taken, and complete a follow-up CIT referral. The CIT sergeant may extend this time limit during abnormal circumstances.
  • Nothing in this section will preclude a deputy from immediately forwarding a copy of a report to, or contacting anyone from, CIT when they feel it is appropriate.


Examples of behavior that might cause concern:


  • Repeated and seemingly unnecessary calls to police.
  • Repeated contact with police for petty incidents (i.e., disorderly, neighbor troubles).
  • Unusual or inappropriate behavior in public that is not dangerous or illegal at that time.


In the event a deputy determines that a person is struggling to manage symptoms of a mental illness or is in crisis but is not dangerous and would benefit from further crisis intervention, linkage to services and/or education regarding services in the community should be arranged. When appropriate, deputies will utilize the Crisis Intervention Team to assist in locating the appropriate resource.


All referrals to the CIT Sergeant will be submitted by the primary case deputy via the Sheriff’s Office Intranet system.


INTOXICATED OR INCAPACITATED SUBJECTS IN NEED OF MENTAL HEALTH EVALUATION


If a subject is intoxicated or incapacitated and in need of a mental health evaluation, he or she will be transported to a medical emergency room pending the evaluation pursuant to NMSA 43-2-8 “Protective Custody”. A protective custody application (Attachment A) which states the facts supporting the need for protective custody will be completed. This application is a two-part form. The medical emergency room receives the original and the copy will be submitted with the deputy’s case file.


CIT CALL OUT PROCEDURES


When available, CIT members will respond to the following calls:


  • Any incident involving mental illness or a crisis that could be accelerated by a response from law enforcement.
  • Any incident when a subject poses a risk of harm to their self or others.
    • Example- Threatened or attempted suicide
  • When serving a certificate of evaluation from a licensed physician, judge or mental health facility.
  • Incidents involving grave passive neglect.


Once on scene, CIT deputies have the primary responsibility for the incident and, if necessary, should advise other deputies of requests that support a team effort for a safe resolution. The CIT deputy will maintain scene responsibility unless otherwise directed by a supervisor.


CIT members will draw from training and experience to ensure an appropriate intervention takes place during and following a crisis response. When not acting in a CIT capacity, CIT members will perform normal activities related to their specific duties. A CIT Sergeant and a CIT On-Call Team will be available 24 hours a day in order to assist with or provide information to patrol deputies or other law enforcement entities.


Incidents including but not limited to hostage/barricaded subjects, high risk suicidal subjects, high risk warrant services, or high risk apprehensions which require SWAT activation will be handled by a trained Crisis Negotiation Team as outlined in Sheriff’s Office Special Weapons and Tactics Policy.


CIT DATABASE


The Crisis Intervention Team will maintain a secured and encrypted database of those people who meet select criteria. This database is accessible as view-only by countywide law enforcement and dispatch through the San Juan County Sheriff’s Office intranet system. Only the CIT Sergeant or the SWAT Commander will have the ability to enter, delete, or modify any entry into the database. Entering a subject into the database enhances the safety of citizens and first responders by providing deputies:


  • Intelligence of observed behaviors from past encounters.
  • Knowledge of verbal techniques that have worked in the past at de-escalating a subject.
  • Knowledge of any self-admitted mental illnesses, prescribed psychiatric medications, health care provider, or any other beneficial information a subject has disclosed.


While deputies respond to reported suicidal subjects and persons in crisis calls on a daily basis, it does not immediately or automatically dictate that the person in question will be entered into the CIT database.


Upon receiving referrals from deputies, the CIT Sergeant or his or her designee will screen the referrals and, if needed, enter that person into the database. Criteria for entry into the database include but are not limited to:


  • Repeated and seemingly unnecessary calls to police.
  • A person struggling to manage symptoms of a mental illness who is threatening to harm others.
  • Unusual or inappropriate behavior in public that is not dangerous at that time.
  • A person with a known diagnosed mental illness, who is displaying signs of escalating behavior.
  • Repetitive calls for service for the same person who has a history of suicide threats or attempts.


In addition to entering persons into the CIT database, the CIT Sergeant will, when appropriate, also submit the proper information to the San Juan County Communication Authority for a “Code 25” entry pursuant to the policies in place at the SJCCA. This alerts responding deputies to potential officer safety related concerns, including but not limited to:


  • Psychological conditions that can result in violence such as Bipolar Disorder, schizophrenia, etc.
  • Autism,
  • Traumatic brain injury,
  • Previous violence or hostility to first responders,
  • Weapons use or threatened use against first responders.


CRISIS INTERVENTION TEAM ORGANIZATION AND STRUCTURE


CIT is composed of a sergeant and deputies who have received specialized training in crisis intervention. For supervisory oversight purposes, the team falls under the SWAT commander’s chain of command.


The CIT Sergeant oversees the Crisis Intervention Team members and is responsible for recruiting and training CIT members; receiving and screening any incident reports that are referred to CIT and assigns, files, and ensures follow up is done on each case; ensuring that all appropriate referrals are entered into the CIT database, and that necessary information about high risk subjects is appropriately disseminated; acting as a liaison between the CIT Team and mental health providers.


CIT deputies are responsible for the following tasks:


  • Conduct investigations and follow-up on cases assigned to them.
  • Assist all divisions within the Sheriff’s Office, as well as outside agencies, citizens or family members on request involving concerns of individuals living with mental illness or in crisis.
  • Conduct CIT training for agency personnel and assist with training as it pertains to CIT, mental illness, proper response to crisis situations, and any other training needs as determined by the CIT chain of command.
  • Be a liaison for and work with all mental health providers.
  • Assist with instructing and training for the Basic Police Academy at the San Juan County Criminal Justice Training Authority.


CIT deputies are required to attend a 40 hour basic Crisis Intervention Team training as well as receive a minimum of 10 hours of advanced CIT related training per year. CIT deputies will also attend monthly trainings as a team, consisting of, but not limited to:


  • Scenario training
  • Case reviews and discussions
  • Legal updates


CRISIS INTERVENTION TEAM ROLE IN CRIMINAL JUSTICE DIVERSION


The Crisis Intervention Team will promote diversion of individuals from the Criminal Justice System through the following measures:


  • When appropriate, seek professional mental health intervention in lieu of criminal charges.
  • The Crisis Intervention Team will network with mental health care providers within the community to deter future events that may lead to an individual being introduced to the Criminal Justice System.
  • Attend meetings with the Mental Health Task Force to ensure familiarization with diversionary goals and any other mental health concerns.
  • Provide testimony in civil commitment proceedings to promote mental health resolution versus criminal sanctions.


CROSS REFERENCES:


  1. Emergency mental health evaluation and care [43-1-10 NMSA 1978]
  2. Definitions [43-1-3 NMSA 1978]
  3. Protective custody [43-2-8 NMSA 1978]
  4. SJCSO Policy OPER-304.00 “Use of Force”
  5. SJCSO Policy OPER-325.00 “Special Weapons and Tactics”
  6. SJCCA SOP 4C1 v2.0 “Officer Safety/House Watch/Local Entries”
  7. Emergency Mental Health Evaluation and Protective Custody Form