Crisis Intervention Training (CIT)
Dallas Police Academy
Terms in this set (55)
General Definition: Illness, disease, or condition that either substantially impacts a person's thought, perception of reality, emotional process, or judgment, or grossly impairs a person's behavior, as manifested by recent disturbance behavior.
Mental illness is diagnosed based on behaviors and thinking as evaluated by a psychiatrist, psychologist, licensed professional counselor, licensed social worker, or other qualified professionals using a tool known as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, most commonly called the DSM-IV.
Professional Definition of Mental Illness
is considered "a diminished capacity and inability to tell right from wrong." This is not a psychological term. The definition varies from state to state. It is generally used by the court with regard to an individual's competency to stand trial.
Insanity (Legal Term)
Points about Personality Disorders
• Individuals experiencing these disorders show personality traits that are inflexible, maladaptive, or inappropriate for the situation, and this causes significant problems in their lives.
• Usually have very little insight that they have a problem
• Tend to believe that the problems are caused by other people, the "system", or the world at large
• Are taught a variety of communication and coping skills, or treated for other problems such as chemical dependency or depression.
Causes of Personality Disorders:
Although the causes for these disorders may not seem relevant for the officer dealing with these individuals, their backgrounds are significant.
Three Most Common Personality Disorders Encountered by Law Enforcement
Points related to Paranoid:
• Tendency to interpret the actions of others as deliberately threatening or demeaning
• Foresee being in position to be used or harmed by others
• Perceive dismissiveness from other people
Points related to Antisocial
• Most commonly recognized in males
• A pattern of irresponsible and antisocial behavior diagnosed at or after 18
• May have one or more of the following:
o History of truancy, may have run away
o Starting fights
o Using weapons
o Physically abusing animals or other people
o Deliberately destroying others' property
o Other illegal behavior
• As adults, these people often have trouble with authority and are reluctant or unwilling to conform to society's expectations of family and work
• These individuals know that what they are doing is wrong, but do it anyway
Points about Borderline
• Most commonly recognized in females
• May have one or more of the following:
o Unstable and intense personal relationships
o Impulsiveness with relationships, spending, food, drugs, sex
o Intense anger or lack of control of anger
o Recurrent suicidal threats
o Chronic feelings of emptiness or boredom
o Feelings of abandonment
Identify prevalent behaviors associated with personality disorders
• Usually will not seek treatment because they don't think they have a problem
• May end up in criminal justice system because their disorder may lead them to break laws and come to the attention of law enforcement
• May use alcohol and illegal substances as a form of self-medication
• They often need treatment for chemical dependency or depression
The Two Most Common Mood Disorders Encountered by Law Enforcement
Points about Depression:
• A common, widespread disorder
• A natural reaction to trauma, loss, death, or change
• Major depression is not just a bad mood or feeling "blue" but a disorder that affects thinking and behavior not caused by any other physical or mental disorder
• A major depressive syndrome is defined as a depressed mood or loss of interest of at least two week duration
• Other symptoms:
o Prolonged feelings of hopelessness or excessive guilt
o Loss of interest in usual activities
o Difficulty concentrating or making decisions
o Low energy/fatigue
o Changes in activity level
o An inability to enjoy usual activities
o Changes in eating habits leading to weight gain or loss
o Changes in sleeping habits
• Five or more symptoms are generally present during the same two-week period and are represented by a change from previous functioning in major depression
Myths About Suicide:
• People who talk about suicide won't commit suicide.
• People who commit suicide are "crazy"
• Once the person begins to improve, the risk has ended
• Prior unsuccessful suicide means there will never be a successful suicide
Evaluating the Levels of Suicide Danger:
• Nature of current stressor?
• Method or degree?
• Prior attempt?
• Acute vs. Chronic?
• Medical status?
• Chance for rescue?
• Social resources?
Suicide - Danger to Themselves:
• Intent (actions/words)
• Gross neglect for physical safety
• Specific plan (actions/words)
• Plans/means available
Suicide - Danger to Others:
• Intent (actions/words)
• Specific person identified
• Agitated, angry, explosive
• Irrational, impulsive, reckless (intent/actual)
Listen, Empathize, Ask, Paraphrase, and Summarize
Points about Bipolar Disorder:
• A mental illness involving mania (an intense enthusiasm) and depression (see above)
• Mania Phase may include:
o Abnormally high, expansive or irritated mood
• Quick tempered
o Inflated self-esteem
o Decreased need for sleep
o More talkative than usual
o Flight of ideas or feeling of thoughts racing
o Excessive risk-taking
• Depressive Phase may include:
o Prolonged feelings of sadness or hopelessness
o Feelings of guilt and worthlessness
o Difficulty concentrating or deciding
o Lack of interest
o Low energy
o Changes in activity level
o Inability to enjoy usual activities
• An individual may quickly swing from the manic phase to the depressed stage.
• An individual cannot maintain the level of activity normally associated with mania for a long period of time.
• Want control of his environment
It is not defined as a split personality.
Points about Psychosis:
* Psychosis is an illness involving a distortion of reality that may be accompanied by delusions and/or hallucinations.
* Most commonly seen in persons with schizophrenia, bipolar disorder, sever depression or drug induced disorders.
False beliefs not based on factual information.
Distortions in the senses, causing the individual to experience hearing or seeing something that is not there.
It is not uncommon for a person hearing voices to hear _____________
two or more at a time
Behavioral cues of persons with a psychosis:
• Inappropriate or bizarre dress
• Body movements are lethargic or sluggish
• Impulsive or repetitious body movements
• Responding to hallucinations
• Causing injury to self
• Home environment:
o Strange decorations (e.g. aluminum foil on windows)
o Pictures turned over
o Waste matter/trash on floors and walls
• Unusual attachment to childish objects or toys
Emotional cues of persons with psychosis:
• Lack of emotional response
• Extreme or inappropriate sadness
• Inappropriate emotional reactions
Substance and Cognitive Disorders (Drug Related Disorders included):
• A major loss of contact with reality
• A gross interference with the ability to meet life's demands
• May have possible delusions and hallucinations
• Alteration of mood
• Defects in perception, language, memory, and cognition
Substance Abuse Disorder:
Prolonged abuse of any drug (alcohol, prescription medications, or "street" drugs) will cause chemical dependency or addiction. This has an effect on consciousness, and if used long enough or in large dosages, may cause permanent damage to the central nervous system. This may cause a wide range of psychological reactions that can be classified as disorders.
Points about Schizophrenia:
• Schizophrenia consists of a group of psychotic disorders characterized by changes in perception.
• These disorders cause oversensitivity to sounds and visions characterized by hallucination and/or impaired distorted thinking.
• Distorted thinking results in:
o Poor processing of information / attention deficit
o Illogical thinking that can result in disorganized and rambling speech, and/or delusions.
• Changes in Emotion:
o May overreact to situations
o "Flat affect" (decreased emotion expressiveness, diminished facial expression and apathetic appearance)
o Anhedonia (lacking pleasure or interest in activities that were once enjoyable)
o Person is withdrawn - the media tends to portray this as violent, but it is rarely the case.
Points about Alzheimer's Disease:
• The most common organic mental disorder of older people
• May get lost easily, have poor memory, and become easily agitated
• 2-3 million Americans are afflicted
• 11,000 die each year from it
• It is a form of dementia
• It is not considered a mental illness, and most mental health facilities will not admit Alzheimer's patients
• Drugs can help the progression of the disease, but there is no cure.
• It is now being diagnosed in persons considerably younger than 65.
Ponts about Autism:
• A developmental disorder
• Usually appears before age 3
• Characterized by:
o Impaired non-verbal communications (including abnormal speech patterns or loss of speech)
o Lack of eye contact
o A restricted range of interest
o Resistance to change of any kind
o Obsessive repetitive body movements
o A lack of awareness of the existence or feelings of others
o Social isolation.
• Symptoms vary from child to child and can range from mild to severe
• Treatment is experimental, and few autistic children show significant remission of symptoms
• Try not to put hands on them
• Communication can be very limited
• Do not APOWW
Helpful hints for interacting with autistic:
o Speak slowly and clearly
o Use concrete terms and ideas
o Repeat simple questions; allow 10-15 seconds for a response
o Proceed slowly and give praise and encouragement
o Do not attempt to stop self-stimulating behavior
Degrees of mental retardation:
o Mild: IQ 69-55
o Moderate: IQ 54-40
o Severe: IQ 39-25
o Profound: Below 25
Questioning Methods for the Mentally Retarded
o Be patient for a reply
o Repeat question as needed
o Ask short, simple questions using simple language
o Speak slowly
o Ask open-ended rather than "yes/no" questions
Lacks social skills and social interaction
Categories of Psychopharmacology Drugs:
o Thorazine, Mellaril, Haldol
o Controls hallucinations
o Elavil, Prozac, Zoloft
o Controls feelings of sadness, feelings of hopelessness, and suicidal thoughts
• Mood Stabilizers
o Tegratol, Lithium, Depakote
o Control mood swings
o Bipolar disorder
• Anti-anxiety drugs
o Xanax, Valium, Buspar
Difference between old and new Psychopharmacology drugs:
New drugs have significantly fewer side effects, but old drugs are still used today, especially with the indigent due to lower costs.
Side Effects of Psychopharmacology:
o Can be uncomfortable
o Can be dehumanizing
o Are often irreversible
Common reasons for deviating from a drug schedule:
o Nasty side effects
o The stigma associated with being mentally ill
o They start feeling better and think they no longer need the medications
First Three-Minute Assessment - Elements of Evaluation:
• Appearance and behavior
• Stream of talk
• Thought content
• Perceptual abnormalities
• Affect-prevailing emotional tone
• Cognitive-intellectual functions
First Three-Minute Assessment - Intellectual Functioning:
• Clear/alert vs. foggy/confused
• Understands easily or difficulty in understanding (is it due to low IQ or language difficulty?)
• Stream of meantal activity is distorted
• Over-productive (runs on and on, rambles)
First Three-Minute Assessment - Behavioral Reactions:
• Attitude (cooperative, helpful, interested, uncooperative, resistant, indifferent)
• Controlled behavior?
• Coordination and gait (normal or disturned?)
• Distrusting/withdraws/isolate self
First Three-Minute Assessment - Emotional Reactions:
• Low (depressed/sad)
Introduction of Officer to Subject/Suspect:
• Identify yourself as a police officer
• Use identifying statements
o "I am Sean, I am a police officer with the Dallas Police Department, and I want to help you"
Opening Statements - the initial contact does several things:
• Establishes a leadership role in the conversation
• Identifies the ultimate goal - to resolve the situation with minimal harm to any person
• Allows the subject/suspect to respond with his immediate thoughts structuring a dialogue
• Encourage communication
• Neutral responses to statements made by the subject/suspect to encourage him to continue talking
Methods for Gaining Trust:
• Honesty and sincerity are essential for maintaining trust
• Very simple tasks assigned to yourself on which you can follow through immediately reflect honesty.
• Make sure that you validate the positive things that the subject/suspect has done
• Gain confidence by forewarning that certain things may take place.
Communication to Defuse - calming techniques:
• Show understanding/empathy
• Use modeling - attempt to calm by displaying your own calmness
• Reassure - easing his fears: assure subject/suspect of safety
• Allow ventilation
Level of Communication:
• Communicate on a level that is easy for the subject/suspect to understand and respond
• Use similar words
• Don't talk over the subject's/suspect's head
Lack of Active Listening includes:
• Jumping to conclusions
3 Listening Levels:
• Listening to words
• Listening to whole message
• Reflecting the whole message
Techniques of Active Listening:
o Simply restate what the subject/suspect has said in his words
• Reflection of feeling
o Express awareness of the other person's feelings
• Minimal encouragers
o Words like "un-hunh," "yes," "I understand," encourages communication and reinforces that you are listening.
Use "I" statements instead of "You" statements because _______________
• "You" statements point a verbal finger of accusation at the message receiver. They are not conductive to effective communication.
• "I" statements establish a non-blaming tone.
List the Basic Strategies that are Necessary When Communicating in Crisis Situations
• Stay calm
• Be patient
• Double-check information by restating what you hear
• Use the individual's name in talking to them
• Give instructions or directives one at a time, and allow time for the person to comply
• The size and age of a person with mental illness has little to do with whether a back-up officer should be called
• A person with mental illness may exhibit extraordinary strength
• Engagement is pivotal - keep trying
• Don't underestimate the power of hallucinations or delusions - they are real from the individual's point of view and can be very frightening, so try to be understanding
• Never argue about a delusion, since arguing only solidifies the conviction - simply accept and move on
• Ask about treatment in the past - sometimes that can help with offering potential solutions to the current situation
• Remember that psychiatric medications have side effects that make them hard to take
• Don't express disapproval
• Persons in mental health crisis need more personal space - watch for cues
Describe at lease four effective communication/interaction skills used when dealing with persons with a mental illness:
2) Crisis Facts
d. Control is very important to persons in crisis
a. Use the person's name
b. Talk quietly
c. Limit the number of instructions
a. Need more physical space
What is Anhedonia?
Lacking pleasure or interest in activities that were once enjoyable. Common in schizophrenia.