De-Escalation Skills

Law Enforcement Academy
Asheville-Buncombe Technical Community College
Asheville, North Carolina
Crisis Intervention Team Training
September 27 – October 1, 2010

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Overview






1 ½ days (12 hours)
Lots of role-playing practice in small groups
Goal is for you to feel very confident in your ability to deescalate
Model = E-LEAP
E = engage (wed. pm)
LEAP = listen, empathize, affirm, partner (thur. am)
Specific strategies for consumers who are disoriented,
intoxicated, suicidal, etc. (thur. pm)

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Wednesday PM
What is de-escalation
 Effective communication
 Non-verbals
 Behavioral crisis
 Engagement

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What is verbal de-escalation?

Verbal de-escalation is used during
potentially dangerous, or threatening,
situation in an attempt to prevent persons
from causing harm to us, themselves, or
others

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Goals of Verbal De-escalation
Open up clear lines of communication
 Build trust and validate the consumer’s
situation
 Get the consumer talking about his
situation
 Gathering the necessary information make
a good resolution

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What is De-Escalation
De-escalation is less like a recipe or formula
and more like a flexible set of options.
 No single set of de-escalation skills: we
have tried to put together a effective set of
skills by borrowing from multiple approaches
 De-escalation will not always work

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What is de-escalation    Both officer and consumer safety always remain paramount concerns in a crisis involving a person with mental illness. De-escalation is another tool that officers have at their disposal to be judiciously applied in controlling a potentially volatile situation. 7 . they do not simply abandon all the training and experience that came before it. Once officers become skilled in de-escalation. rather than serving as a substitute for sound judgment and attentiveness to safety.

Effective Communication 70% of communication misunderstood  Effective communication is defined as passing information between one person and another that is mutually understood  8 .

they become more angry and frustrated more quickly and more frequently Your ability to engage a consumer in conversation and successfully resolve a conflict often depends as much on how you say the words you choose as much as the words themselves. 9 .Effective Communication    Communication becomes more difficult when the person’s ability to understand what you are saying and/or their ability to express their own thoughts or needs are compromised by their symptoms. When they can’t express their needs.

Barriers to Effective Communication Barriers to communication are the things that keep the meaning of what is being said from being heard:          Pre-judging Not listening Criticizing Name-calling Engaging in power struggles Ordering Threatening Minimizing Arguing 10 .

Effective Communication 11 .

but your body language may be saying something else. The consumer will react to want you are saying with your body language 12 .Non-Verbal   It is very important to be able to identify exactly what you are communicating to others nonverbally You may be trying to de-escalate the situation by talking to the other person.

Invasion or encroachment of personal space tends to heighten or escalate anxiety Personal space in American culture is about 3 feet Do not touch a hostile person – they might interpret that as an aggressive action Announce intention: “I need some space.” 13 . so I am going to back up.Personal Space      Persons with mental illness often develop and altered sense of personal space. They require more space than usual to feel comfortable and feel intensely threatened when other people close in on them with no warning.

Eyes One eyebrow raised = sternness  Eyes wide open = surprise  A hard stare = threatening gesture  Closing eyes longer than normal = I am not listening  14 .

Body Posture Challenging postures that tend to threaten another person and escalate the situation include:  Finger pointing may seem accusing or threatening  Shoulder shrugging may seem uncaring or unknowing  Rigid walking may seem unyielding or challenging  Use slow and deliberate movements—quick actions may surprise or scare the other person 15 .

Speak slowly – This is usually interpreted as soothing  Inflection of voice .A raised voice could create fear or challenges  Rate of speech .Voice Tone .Usually unconscious  Volume .I didn’t say you were stupid  16 .

Face  Jaw set with clenched teeth shows that you are not open minded to listening to his or her side of the story  A natural smile is good. A fake smile can aggravate the situation 17 .

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 22 .What is a Behavioral Crisis? A crisis is a perception of an event or situation as an intolerable difficulty that exceeds the resources and coping mechanisms of the person  Unless the person obtains relief. the crisis has the potential to cause severe behavioral malfunctioning.

Behavioral Crisis? Crisis intervention is emotional first aid which is designed to assist the person in crisis to return to normal functioning.  The focus of crisis intervention is what’s happening here and how!  23 .

2) mood disorder. 4) personality disorder 24 . 3) anxiety disorder.Behavioral Crisis 3 reasons that a consumer may be having a behavioral crisis:  Medical condition  Substance use  Psychiatric condition: 1) thought disorder.

this occurs at the initial onset of illness. rather than being criminally motivated 25 .Behavioral Crisis   The majority of encounters that you will have with consumers are because the symptoms of their illness are not under control. The consumer’s behavior is usually a result of his or her illness. Most commonly. during a relapse (that can result for a variety of reasons) and when the person s using substances.

Consumers typically will have one of 3 feelings Anger  Fear  Sadness/depression  26 .

What you may be seeing . . Consumer’s Inner Experience Hostility. evasion Fear Risk-taking Elation Self-destructive behavior Depression Odd. drugs) Hopelessness. demoralization 27 . . dangerous behavior Confusion Very odd behavior Psychosis Attempts at self-treatment (e.g.

Behavioral Crisis  Given the low likelihood that emotional people in crisis can succeed in rationalizing alternatives. Rather. law enforcement responses to emotional people in volatile situations cannot rely on convincing people by making a rational proposal to think differently. responders need to create a stable and respectful environment within which emotional individuals can take comfort and relief. 28 .

personal safety first Move to a safe place if necessary Allow plenty of space Persons with mental illnesses often can be expected to process information slowly and to have difficulty remembering things. This includes understanding and remembering instructions given by a police officer. 29 .Engagement     Be aware of your setting.

 Remain calm  You will likely have contact with the consumer again. gun. how you treat him will be important for establishing trust  30 . and handcuffs may frighten the person with mental illness so reassure consumer that no harm is intended.Engagement Be aware that a uniform.

but not directly threatening any other person or himself/herself.Engagement Know when to act: A person may be acting dangerously. This requires patience and continuous safety evaluation. give the consumer time to calm down.  Allow partner to de-escalate others on the scene as necessary  31 . If possible.

” -Lt. at times.Engagement  “It is the wise officer who can. Michael Woody 32 . conceal his or her combat-ready status.

this is another one of those homeless people.Avoid      Maintaining continuous eye contact Crowding or “cornering” the consumer Touching the consumer unless you ask first or it is essential for safety Letting others interact simultaneously with the consumer Negative thoughts (“God.”) 33 .

Avoid


Expressing anger, impatience or irritation
Inflammatory language (“You are acting crazy.”)
Feeling as though you have to rush or feeling
like you are stuck if it takes time to get the
consumer talking
Intervening too quickly or trying too hard to
control the interaction by interrupting or talking
over the consumer.
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Avoid



Saying “You need to calm down.”
Shouting or giving rapid commands
Arguing with the consumer
Taking the words or actions of the consumer
personally (They are symptoms of mental
illness.)
Lying, tricking, deceiving, threatening the
consumer to get her to comply
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Avoid
Asking why questions. Why questions are
logic-based. Persons in crisis are not
logical. Typically, what ever has worked in
the past is not working now. Why
questions put the consumer on the
defensive. Ask open-ended questions.
 Forcing discussion

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they may not  Making promises that you may not be able to keep  37 .Avoid Minimizing the consumer’s situation as a way to elicit conversation (“Things can’t be that bad. can they?”)  Suggesting that things will get better.

Telling the consumer “I know how you feel.” or “Get down on the ground” might seem to be straightforward and easy to understand. officers need to take into account the types of barriers to effective communication that the brain disorder might create. however.Avoid   Commands such as “drop the knife. When dealing with people who live with mental illness.” 38 .

In de-escalation.Avoid  Asking a lot of questions of the consumer in the beginning. however. This is a natural tendency. It will help continue the dialogue and will provide the consumer with opportunities to give information that will help to resolve the crisis. 39 . this is generally not a good idea. especially early in the interaction. encouraging the consumer to continue talking is more effective than asking a lot of questions.

DO       Speak in a calm. the consumer may be distracted Be patient. time is on your side Try to reduce background noise and distractions Use “and” instead of “but” Obtain relevant information from informants 40 . give the situation time. clear voice You may need to repeat. slow.

nutrition bar.DO       Allow the consumer to ventilate (“Tell me some more about that.” Use “please” and “thank you” often Remain friendly but firm Ask the consumer if she needs something Offer a cigarette. warm clothing Forecast: Announce your actions and movements 41 .

sexual orientation  42 . race. age.DO Accept the consumer’s feelings. thoughts and behavioral. acceptance is not easy when a consumer is behaving in a bizarre or hostile manner  Respect the dignity of the consumer without regard to sex.

Hot Buttons
Consumers will sometimes push a hot
button
 We all have them
 Example: The consumer calls you a “pig”
or swears at you.
 This is NOT the time to demand respect

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Hot Buttons: Rationale Detachment
 Staying

in control of your emotions
during a crisis situation
 3 steps

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1. Develop a Plan
 Decisions

made ahead of time are
more likely to be rationale
 Identify your hot buttons
 Strategic visualization – practice
what you would do
 Helps you gain confidence
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Use Positive Self-Talk You are not the target of the outburst  Never take anything personally  Remember that most of us have been irrational and said inappropriate things when we are under extreme stress  46 .2.

“I really want to help you but I find it difficult because of your name-calling. I would appreciate it if you try. Recognize Your Limits Let someone else take over if necessary  Set a limit with the person.”  47 . Thanks. use an “I” statement. could you help me and stop the cursing so that I can work on helping you.3.

LESS confrontational approach. The consumer’s normal coping measures are not working at this time.The Logic of De-Escalation    If you take a LESS authoritative. You are trying to give the consumer a sense that he or she is in control. LESS controlling. which by definition means the consumer is feeling out of control. 48 . Why? Because he or she is in a crisis. you actually will have MORE control.

I am a CIT officer with the Sheriff’s Department.Introduce Yourself       An introduction promotes communication Hi. a neighbor called to say someone is upset) 49 . Be prepared to explain the reason you are there (e.. my name is Doug (or Deputy Smith). Can you tell me your name? State what you see/know (“I can see you’re upset.g.”) State or convey that you are there to help.

that will help you remember it  Use the consumer’s name often  50 . and within a few seconds you have already forgotten it  Make a point of immediately starting to use the consumer’s name.Introduce Yourself How many of you can have someone tell you her name.

Introduce Yourself “Get out of here you damn cop!”  Don’t take the bait and turn confrontational  51 .

they are an opportunity to learn  You can rewind and try again  52 .Role-playing Scenarios Role-playing is a learning tool  Allows us to try out new approaches  Expect mistakes.

observer  53 .Role-playing Scenarios Everyone feels uncomfortable in role play  Feedback will be constructive  Scenarios are derived from real-life experiences  We will be working as a team to assist one another in skill development  Small groups: 3 roles—Law enforcement. consumer.

Thursday AM Listen  Empathize  Affirm  Partner  What Ifs  5 special strategies  54 .

that’s why you have 2 ears and 1 mouth  What is the difference between listening and hearing?  55 .L = Listen Silent and listen are spelled with the same letters  Listen twice as much as you talk.

heart 56 .The Chinese symbol for listen: eyes. ear.

Listen Listen for the total meaning  Focus on what the consumer is telling you  Block out distractions  57 .

Sometimes their thoughts are disconnected and you’ll hear this in their speech. 58 . Since mental illness is a brain disease. which can be difficult to follow and make sense of.Listen  It is important understand and remember that what the consumer is saying or believing may be real or imagined. thinking is what is most affected by mental illness.

Techniques that Show You Are Listening 1. Minimal encouragers Reflecting Ask open-ended questions (“Can you tell me more about that. 3. 2.” 59 .

or simple verbal responses such as Okay.Minimal Encouragers   Minimal encouragers are brief statements that can be either nonverbal. without stalling the dialogue or creating an undue interruption. I see. such as a positive nod of the head. 60 . Especially early in the encounter. I am listening. Uh-huh. consumers need these types of encouragers to feel that the officer is really attending to them and listening to what they are saying. Minimal encouragers demonstrate to the consumer that you are listening and paying attention.

Often the reflecting response will simply consist of the last few words the consumer says. you provide the consumer with evidence that you are listening by actually repeating what he or she has said.Reflecting  Whereas minimal encouragers provide initial confirmation that you are listening. 61 . These statements should be brief and used in such a way as not to interrupt the consumer. Here. reflecting adds another dimension to the communication.

Reflecting Repeat the last few words that the consumer said  Example: “I am tired of everyone not listening to me and it make me angry.”  “Jim.”  62 . it makes you angry.

Open-Ended Questions Open ended questions allow you to get more information  Open ended questions enable us to assess the consumer’s level of dangerousness  Open ended questions allow you to assess whether the consumer is in touch with reality  63 .

thirsty) Is the consumer receiving services Where is the consumer receiving services Does the consumer have a case manager Is the consumer taking medication When did the consumer last take his or her medication 64 .Specific Questions That You May Want You Ask.g. When Appropriate       Does the consumer need something (e.. hungry.

the consumer may want to talk about his or her medication. In some cases. Also. many consumers have had negative experiences with therapists and don’t want to talk about it their counselor.Medication     Mentioning “medication” must be given careful thought. the topic is best left to mental healthcare providers after the consumer has calmed down. 65 . In other situations.

2. Emotion labeling Paraphrasing 66 .E = Empathy 1.

empathy is in itself a healing agent . If a person is understood. . it confirms. Being sincere and real will convey understanding “To my mind.Empathy      What is the difference between empathy and sympathy? Feeling sorry versus trying to understand what it is like to be in their shoes. it brings even the most frightened person into the human race. he or she belongs.” (Carl Rogers) It’s hard to stay angry and aroused when someone empathizes 67 . . because it releases.

68 . you again take listening to a higher level by trying to help the consumer identify feelings. it will often be rather easy to provide an emotional label to assist the consumer.Emotional Labeling    In emotional labeling. If you have used your listening skills well. This is different from “telling” the consumer what he or she is feeling because your statement is based on what the consumer has been communicating through his or her words and behavior.

. I think I’d feel . .  It seems to me like you feel .  69 . . . . .  If I were in your situation. . .Emotional Labeling Examples You seem to be .

70 .Paraphrasing  Paraphrasing is similar to reflecting except that now you begin to communicate that you are trying to understand the consumer’s entire message by putting what the consumer has said into your own words.

Paraphrasing Builds rapport between officer and consumer  Helps the officer refine the assessment of the crisis  Provides information that lays the groundwork for an eventual resolution of the crisis  Communicates that you are listening and understanding  71 .

but home doesn’t seem like the best place right now.  72 .  CIT Officer: You’re not sure where you can stay for awhile.Paraphrasing Examples Consumer: I don’t know what I am going to do. My family doesn’t want me here.

. . .Paraphrasing Examples What I hear you saying is .  Let me see if I understand what you are saying . .  If I am hearing you right .  73 . .  These types of statements also summarize what has been said in the communication. . . .

steer the conversation toward a resolution by affirming the consumer’s situation 74 . You should ask and let the consumer tell you what the problem is before looking at possible solutions. After getting the information that you need.A = Affirm    You need to know what the consumer is upset about You may have a tendency to go to the solution step without really identifying what the issue is with the consumer. You should not assume that you know why the consumer is upset.

Affirm Example  “Okay.” 75 . That your meds are hurting you because they make you feel sick. let me make sure I understand you. Did I understand you correctly. You’ve told me that people are bothering you and that your case manager is not helping you.

 76 .  You are looking to find the combination that will unlock the crisis.P = Partner Also “plan.” “problem-solve”  Goal is to find a resolution and return to pre-crisis state.

Partner You can ask the consumer what she thinks will resolve the problem  Look for alternatives with the consumer  Try to have 2 or more options  Empower the consumer to choose  If one approach doesn’t work. “throw another lure”  77 .

Partner       Putting yourself in the consumer’s shoes will help you find a solution Don’t force particular points of discussion Try to get agreement on a course of action. Meet reasonable demands when possible Reach for small concrete goals It’s never too late to reassess and change a plan 78 . Repeat what the plan is and what is expected.

Partner If repeated attempts fail.  State your expectations by linking to safety issue: I need to make sure that everyone stays safe.  79 . set firm limits and tell the consumer that you are worried about his safely and you want to help him.  Ask if there is a family member you could talk to.

or saying/promising anything to gain compliance. deal-making.Partner In your attempts to resolve an escalating situation you may be tempted to use bargaining.  80 .  They are not recommended as they ultimately violate trust—which is important in your repeated encounters with people.

Resolution Can it be informally resolved?  Is an evaluation needed?  Are commitment criteria met?  Was a crime committed?  81 .

What Ifs What if the consumer asks you a longterm question?  Say that you don’t know the answer but that you and the consumer can handle the immediate situation  82 .

but that you want to work with the consumer to figure out something  83 .What If The consumer says that there’s nothing you can do to help?  Say that you’re not sure what you can do.

”  84 . Like this. Let’s work on this together. That’s good. I’d like for you to stop for a minute and take a deep breath with me. Frank.What If The consumer will not engage problemsolving and is distracted?  Say “Stay with me. Thank you. Frank.

Jim. so I am going to back up.”  85 .What If The consumers moves too close you?  Say “I need some space.

”  86 . “Jim. I am having a hard time understanding you because of how loud your voice is.What If The consumer is talking so loudly it is disruptive?  Drop the volume in your own voice and say.

What If You think the consumer might become aggressive?  If possible.  There is less chance of aggression if two people are talking to one person.  87 . bring in another trained person.

like with a head nod  Respond positively  88 .What If The consumer will only respond nonverbally.

you must be really hurting right now.”  89 .What If The consumer remains unresponsive?  Simply validate the consumer by stating what you observe about their situation  “You look really sad.

5. 2.Five Special Strategies 1. 4. Assertive Intervention Corrective Action Reducing Stimuli Reducing Arousal Pro-active (as opposed to reactive) engagement of consumers 90 . 3.

Assertive Intervention Can be used when: The consumer is uncooperative or unresponsive to directives that they are expected to follow.  The consumer is violating rules which serve to maintain security  91 .1.

Empathy statement: A statement that lets the consumer know that you understand where he or she is coming from and how he or she likely feels.Three Step Assertive Intervention 1. 92 . Conflict statement: A statement that describes to the consumer that you have a conflict that needs to be addressed. 3. 2. Action statement: A statement that lets the consumer know what you want him or her to do. This statement can be in the form of a request.

But I am afraid someone is going to get hurt by those stones.Examples   “Jack. so we are going to have to get out of this waiting room.” 93 .” “It looks to me like you are pretty upset. But you and I need to let these people get back to work here. So I’d like you to stop tossing them and step up here on the curb so I can talk to you and try to understand what is going on with you today. I’d like you to walk with me down the hallway to an empty room so you and I can talk. and I’m here to help you. I understand that you are upset and that you feel like no one is listening to you or doing enough to help you.

What is best for you?  This helps the consumer “save face.”  Everyone reacts better to a choice versus being told what to do. I want you to stop throwing the stones or. step over here with me on the grass and throw them in the grass while we talk. offer a choice:  Joe.  94 . if you prefer.Choice If possible.

not upset you. I didn’t mean to. I can see that mentioning your medication is a real sore point. Corrective Action: AAA If you make a mistake (and you will) and the consumer escalates: 1. Acknowledge: “Jim.” 3.2.” 95 .” 2. Try Again: “I want to help. so let’s try something else. Apologize: “I’m sorry to have upset you.

Reducing Stimuli   Remove the audience or move the consumer to a private space Turn off flashing lights 96 .3.

“Let’s take 3 deep breaths like this”. then demonstrate and do it with the consumer. you can do this with the consumer. 97 .4. Reducing Arousal  Encourage the consumer to take 3 deep breaths.

If you talk to a repeat consumer on a good day. 98 . Pro-active Engagement of Consumers  Many of you will interact with the same consumer on repeated occasions so you will get to know him or her.5. That information will provide greater options for resolving conflicts. you will have much better information to base an assessment come the bad day.

g. Get to know some of the providers (e. call the case manager to try to access a resource for the consumer. case managers) who serve your consumers.) If you see the consumer in the community. (e.. 99 .Pro-active Engagement of Consumers    Drop by the consumer’s residence. Ask if there is anything you can do to help. acknowledge him or her. Stop to say hello if it would not embarrass the consumer.g.

Having Flashbacks. Agitated. Delusional. Confused. Intoxicated. Homeless. Manic 100 .Thursday PM  Verbal Intervention Strategies for People who are Suicidal. Hallucinating.

often experiencing delusions or hallucinations Delusion = false belief Hallucination = false sensory perception (most common is auditory) Mania = A manifestation of bipolar disorder (manic depression). gaiety. exaggerated sexuality.Review of Terms      Thought Disorder = usually a reference to a psychotic disorder Psychotic = out of touch with reality. characterized by profuse and rapidly changing ideas. or irritability. and decreased sleep 101 .

they begin having thoughts that they would rather be dead. are you having any feelings like that?” “Have you ever tried to hurt yourself before?” “When and what did you do?” “Do you have a plan now?” “Do you have any weapons that you could use to hurt yourself?” Show support and interest Be non-judgmental and accepting Offer help that is available Assess availability of supports 102 .Suicide          Asking about suicide: “Sometimes when people have been feeling down for a long time.

as a way to make a personal connection and keep the consumer grounded  103 .Suicide: Threatening Harm Focus on the anger or fear that is causing the threats  Repeat that you are here to help and keep everybody safe  Get the names of significant others (even pets).

There is help available. Many other people have felt this way and have gotten better. even though it may seem like it now. 104 . Generally. helpful comments to make during questioning include: These feelings will not last forever.Suicide Attempt   Verbal communications should focus on providing hope for the consumer during a time when he is feeling hopeless.

or comments about all that they have. And finally comments about yourself. These types of unhelpful comments only elicit more profound feelings 105 . I felt the same way once or a friend of mine felt this way once. There’s a silver lining in every cloud. You have a nice home. who will take care of your kids.Suicide Attempt  Unhelpful comments include clichés such as. family who loves you.

Homelessness 40% of homeless persons have a mental illness  The ways in which homeless people dress may seen bizarre to other people  Mental health professionals may refer to a homeless person’s choice not to take medications as noncompliance. but to a homeless person the decision not to take sedating psychiatric medications may make good sense.  106 .

and are either hallucinating or delusional. B or C? 107 . Defer the issue A. Dispute them. Which is the appropriate response: A.Thought Disorder The 3 possible responses to a person who loses contact with reality. or C. are: Agree with them B.

Thought Disorder      The engagement goal is to validate the consumer’s situation and how frightened and anxious he must feel without agreeing with their hallucinatory/delusional experience. Remember to maintain a safe “reactionary” distance of from the consumer. 108 . Use friends and family members to get information if they are available and their presence is not escalating the consumer. Persons who are psychotic develop an altered sense of personal space and require more space than usual to feel safe. It is OK to indicate that you do not hear or see what he is seeing/hearing but that you believe he does.

I’m here to keep you safe. “I can see that you are scared that someone is out to get you.Delusions     Paranoid delusions can lead to dangerous behavior because they cause a great amount of fear. . .” Don’t argue about the delusion—no one will win this argument 109 . This is especially true if the delusion includes a belief that one’s thoughts are controlled by external forces. but I don’t know of anyone who is trying to hurt you . Convey your acceptance—but let the consumer know that you are not experiencing it and reinforce reality.

Hallucinations Ask if they are hearing voices: “When people are stressed or scared. they may hear or see things. is that happening to you.”  Ask. “are the voices telling you to do something. what?”  People who are abusing substances or are in withdrawal may see things or feel things crawling on them  110 .

You may have to repeat a reassuring message many times before the consumer can respond to it. You can attempt to calm the person by letting them know that voices may “quiet” if you can help the consumer lessen their stress and get help.Hallucinations    Indicate that you understand that those experiences are real and frightening for the consumer. Repeat: I’m here to help. 111 . I am not going to hurt you.

good versus evil.Hallucinations Hallucinations/voices that are command oriented involving religion.  112 . nonconfrontational hallucinations. or are declaring self-harm are higherrisk than non-religious.  This can lead to dangerous behavior because many persons will obey the command.

people who are actively using or withdrawing from substances  Keep interactions brief and to the point  113 . neurological disorders. traumatic brain injury. bipolar.Confused/Disorganized Speech People with a variety of mental illnesses may experience confusion: schizophrenia.

”  114 . comment periodically that you realize that he must be frightened and that you are there to help. say so and ask for clarification. “I am having a hard time understanding you because of how loud your voice is.  Drop the volume in your speech and say. If the consumer is rambling nonsensically.Confused/Disorganized Speech When it is difficult to understand the consumer.

Anxiety. ask him to look at you and do it with you  Reassure and converse calmly  115 . Fears Encourage 3 slow deep breaths  If this is difficult for the consumer.Agitation.

”) Keep statements brief and to the point Avoid engaging in arguments Point out that it is difficult to understand what is being said 116 . substance use. especially alcohol is a significant risk factor associated with violence.People Who Are Intoxicated     Remember. Do not let your guard down (“She is only drunk.

. It is really important to maintain personal space and avoid touch during a flashback. . it’s our job to keep you safe Provide simple directives and reassurance softly and slowly 117 . Orient and ground: My name is . So all the senses and thoughts are in the moment. you are (describe where). today is . the person is experiencing the traumatic event. .PTSD Flashbacks    Some people with post traumatic stress disorder experience flashbacks. . During a flashback.

 “I want to understand what you are saying. People who are manic often talk very rapidly  Encourage the person to slow down. but you are talking really fast. take deep breathes.Rapid Speech / Mania Some people talk rapidly when they are stressed or scared.”  118 . Let’s take some deep breaths together.

Acknowledgements This material was adapted from numerous sources. including:  Memphis CIT Curriculum  Sam Cochran  Randy Dupont  Georgia CIT Curriculum  Responding to Individuals with Mental Illness by Michael Compton and Raymond Kotwicki  Connecticut State Department of Mental Health and Addiction Services  Findlay/Hancock County CIT 119 .

Thank you for going the extra mile to help people with mental illness! 120 .