The CIT ECHO for Law Enforcement Grand Rounds January 3, 2018 Presented by: Dan Duhigg, DO MBA Detective Matthew Tinney MATT
“The Network is amazing in providing useful information “The Network is amazing in providing useful information. Although I came in with a significant amount of training in the area of CIT, the Network provides me more information, and also keeps my skills sharp.” MATT Define the CIT Knowledge Network on this slide.
Multiple Points of Interaction with Individuals with Mental Illness and Substance Use Disorders One in four people with mental illness have histories of police arrest One in 10 individuals have police involved in their pathway to mental health care.1 One in 100 police dispatches and encounters involve people with mental health problems.1 Among males aged 18-49 (2009 data).2 Probation Parole General Pop Serious Psychological Distress 20% 16.8% 9.7% Illicit drug or alcohol dependence or abuse in past year 40.7% 34.6% 15.8% Any mental illness 33.3% 29% 18.8% MATT A review of over 85 studies found that.. (Livingston in 2016). Serious Psychological Distress (SPD) is defined for this table as having a score of 13 or higher on the K6 scale during the past year The Kessler 6 (K6) nonspecific psychological distress scale was used to assess those who met the threshold for SPD in the 30 days prior to the interview. The K6 is a six-question tool developed to screen for serious mental illness among adults age 18 or older in the general U.S. population, with a score of 13 or higher indicating SPD.1 Inmates were asked how often during the 30 days prior to the interview they felt— nervous hopeless restless or fidgety so depressed that nothing could cheer them up everything was an effort worthless. The response options were (1) all of the time, (2) most of the time, (3) some of the time, (4) a little of the time, and (5) none of the time. The responses were recoded from 4 to 0, with 4 assigned to “all of the time” and 0 assigned to “none of the time. Any Mental Illness (AMI) is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a substance use disorder, that met the criteria found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In 2008, a split-sample design assigned adults aged 18 or older randomly to one of two impairment scales, the World Health Organization Disability Assessment Schedule (WHODAS) or the Sheehan Disability Scale (SDS). For comparability purposes, estimates for Any Mental Illness for 2008 are based only on the WHODAS half-sample. For details, see Section B.4.3 in Appendix B of the Results from the 2009 National Survey on Drug Use and Health: Mental Health Findings. 1Livingston, (2016), Contact Between Police and People with Mental Disorders: A Review of Rates, Psychiatric Services, 67:8, 2016; 2Feucht & Gfroerer, (2011) Mental and Substance Use Disorders among Adult Men on Probation or Parole: Substance Abuse and Mental Health Services Administration Data Review, Summer May 2011
Need for Specialized and Ongoing Training Training historically focused on command/control and officer safety Non-compliance may result in the use of force Historically, no special training focused on interactions with people living with mental illness A lack of guidance and training on how to apply police tactics to people living with mental illness resulted in highly publicized of uses of force CIT (Crisis Intervention Team) programs are local initiatives designed to improve the way law enforcement and the community respond to people experiencing mental health crises. They are built on strong partnerships between law enforcement, mental health provider agencies and individuals and families affected by mental illness. CIT, Crisis Intervention Teams MATT 1987 Memphis Model created Closure of long-term psychiatric treatment facilities resulted in more chronically psychiatrically ill people living in our communities Law enforcement & public safety have become a more common point of contact for people living with mental illness The CIT Knowledge Network is based on Crisis Intervention Training (CIT), a first-responder model for police interactions with people living with mental illness. CIT is a pre-booking approach to increase officers’ abilities to respectfully and safely interact with persons living with mental illness and is associated with improved knowledge and attitudes
THE CIT ECHO HUB TEAM DAN Dr. Daniel Duhigg Addiction Psychiatrist Presbyterian Healthcare Services UNM Department of Psychiatry and Behavioral Sciences Matthew Tinney Detective Crisis Intervention Albuquerque Police Department Dr. Nils Rosenbaum Psychiatrist Medical Director Behavioral Health Division Albuquerque Police Department DAN Dr. Nancy Martin Psychiatrist UNM Department of Psychiatry and Behavioral Sciences Denise Hovey-Thomas Crisis Specialist Crisis Intervention Albuquerque Police Department Jennifer Earheart Project Coordinator UNM Department of Psychiatry and Behavioral Sciences
The CIT ECHO Is Using Project ECHO To Provide Critical, Ongoing Training To Agencies Around New Mexico And The Nation. NILS
CIT ECHO Curriculum MODULE 1: CIT POLICING MODULE 3: PSYCHIATRIC DIAGNOSES 101 MODULE 5: SELF MANAGEMENT Intro to CIT policing Schizophrenia and First Episode Psychosis Officer Suicide CIT Team Roles Bipolar Disorder Burnout prevention for police CIT Guidelines Depression Workplace mental health awareness How to Interface with the Medical System Anxiety I: GAD, OCD, Panic Mindfulness Based Stress Reduction for police Triage Anxiety II: PTSD 10 Deadly Errors: How to Avoid Becoming a Victim Cop Spree Killings Autism Spectrum Disorders Homelessness Substance Use Disorders MODULE 6: SPECIAL TRAININGS Barricades and High Risk Suicide Medication Awareness for Police Identifying Drug Induced Intoxication in the Field Recognizing signs and side-effects of medications, drugs, mental illness for police: What is a threat vs. a side-effect? Traumatic Brain Injury Rising Rates of Homicide: A look at the data Alzheimer’s and Dementia When to go to the hospital (psychiatric emergencies) MODULE 4: DE-ESCALATION & COMMUNICATION Media Relations Q&A Role of Media in Reporting Mass Shootings Hallucinations and psychosis: how to respond De-escalation Techniques Suicide by Cop MODULE 2: RESOURCES 7 Active Listening Skills Communicating with medical professionals Adult Protective Services PURE Model I Disability Rights PURE Model II Sexuality and Stress Resources for Veterans Transgender 101 NILS
Case Example SMA Walking Into Traffic on Route 66 Staffed Case Command Control Surround Use of Taser Staffed Case Took less authortative approach Created a safer scene Able to link to treatment MATT Case 1 – PA System Case 2 – Sgt. Dietzel Case 3 – Murder suicide example
Qualitative Feedback: Weekly Feedback “I will keep in mind that individuals with this disorder are very smart and can catch on to my reactions and behavior. Even though the likelihood that things are happening as they say are probably not, it is still very real and scary for them.” “I really enjoyed being a part of these conversations. Going beyond ‘do this, this way’ to discussing aspects officers never really would of thought about. I love these training sessions.” “I liked the give and take of the session and getting to hear from both law enforcement officers and from physicians. I enjoyed hearing all of the different perspectives. I also enjoyed hearing the feedback [case debriefing] about the delusional individuals that one of the participants was trying to deal with and find resources. I actually learned a few things from that.” DAN