5.3 Mental Health Crisis Response, De-escalation & Trauma-Informed Care

5.3 Mental Health Crisis Response, De-escalation & Trauma-Informed Care

Law enforcement officers frequently respond to individuals experiencing severe distress, psychiatric emergencies, or the aftermath of profound trauma. Effectively managing these incidents requires specialized communication skills, an understanding of mental health law, and a trauma-informed approach to prevent unnecessary use of force and connect individuals with proper care.

Recognizing Psychiatric Crisis

A psychiatric crisis occurs when an individual's coping mechanisms fail, leading to behaviors that pose a danger to themselves or others, or an inability to care for their basic needs. Officers must learn to recognize common presentations:

• Psychosis: Characterized by a detachment from reality. Symptoms include hallucinations (hearing voices, seeing things that aren't there) and delusions (fixed, false beliefs, often paranoid in nature).
• Severe Depression: May present as profound sadness, extreme lethargy, hopelessness, or active suicidal ideation.
• Post-Traumatic Stress Disorder (PTSD): Can trigger intense anxiety, flashbacks (reliving a traumatic event), hyper-vigilance, and exaggerated startle responses. Veterans or victims of violent crime may experience acute PTSD episodes when triggered by loud noises or perceived threats.

It is crucial to recognize that erratic or non-compliant behavior may be driven by a medical or mental health condition, not intentional criminal defiance.

Crisis Intervention Team (CIT) Model

The Crisis Intervention Team (CIT) model is a specialized community policing response designed to improve outcomes in encounters with individuals experiencing mental health crises.

CIT trains officers to:

• Identify signs and symptoms of mental illness.
• Utilize specialized verbal de-escalation techniques.
• Divert individuals from the criminal justice system to mental health treatment facilities whenever safely possible.
• Collaborate with community mental health resources, hospitals, and advocacy groups.

When a 911 call indicates a psychiatric emergency, dispatch will ideally route the call to a CIT-certified officer. If a non-CIT officer arrives and recognizes a mental health crisis, they should request CIT assistance if available.

Mental Health Holds (Order of Protective Custody - OPC)

In Louisiana, the legal mechanism for taking an individual experiencing a mental health crisis into custody for an involuntary evaluation is governed by the Mental Health Law (La. R.S. Title 28).

Order of Protective Custody (OPC)

An Order of Protective Custody (OPC) is a legal document signed by a coroner or a judge (La. R.S. 28:53.2). It directs law enforcement to apprehend an individual and transport them to a treatment facility or hospital for a psychiatric evaluation. An OPC is issued when there is credible evidence that the person is:

1. A danger to themselves, OR
2. A danger to others, OR
3. Gravely disabled (unable to provide for their own basic needs for food, clothing, or shelter due to mental illness).

Physician's Emergency Certificate (PEC)

Once transported, a physician examines the individual. If the physician agrees they meet the criteria, they will issue a Physician's Emergency Certificate (PEC), which allows the facility to hold the person involuntarily for up to 72 hours.

Officer Authority Without an OPC

Under La. R.S. 28:53(L), a law enforcement officer has the authority to take a person into protective custody and transport them for evaluation without a prior OPC if the officer personally observes the person acting in a manner that gives the officer reasonable grounds to believe the person is a danger to self, danger to others, or gravely disabled.

Verbal De-escalation Tactics

When approaching a person in crisis, the officer's demeanor and communication style can either escalate or calm the situation. Effective de-escalation prioritizes time, distance, and communication.

Core De-escalation Principles

• Maintain a Calm Demeanor: Modulate your voice. Speak softly and slowly. Avoid shouting or aggressive posturing.
• Provide Space: If there is no immediate weapon or threat, maintain a safe reactionary distance. Crowding a paranoid individual will trigger a 'fight or flight' response.
• Active Listening: Validate their feelings without validating their delusions. (e.g., 'I understand you are very frightened right now, but I do not see anyone hiding in the bushes.')
• Use Open-Ended Questions: Encourage the person to talk. ('Can you tell me what happened today to make you feel this way?')
• Avoid Arguing or Challenging: Do not argue logic with a person in psychosis. It is ineffective and will only agitate them.
• One Voice: Only one officer should communicate with the subject to prevent sensory overload and confusion.

Trauma-Informed Care & Sexual Assault Response

Trauma-Informed Care is an approach that recognizes the pervasive impact of trauma and seeks to avoid re-traumatization during law enforcement encounters. This is particularly vital when responding to victims of sexual assault or violent crimes.

The Neurobiology of Trauma

During a traumatic event, the brain's survival mechanisms (the amygdala) take over, often shutting down the areas responsible for logical thought and memory sequencing (the prefrontal cortex). As a result, a sexual assault victim's recall of the event may be fragmented, non-linear, or inconsistent. They may present as flat, emotionless, or inappropriately calm. This is a biological response to severe trauma, not an indicator of deception.

Trauma-Informed Interviewing

When interviewing a victim of trauma:

• Prioritize Safety and Comfort: Ensure they are medically cleared. Conduct the interview in a private, quiet space. Offer water or a blanket.
• Give Them Control: Allow them to choose their seat. Ask permission before asking sensitive questions or moving into their personal space.
• Use Sensory Questions: Because traumatic memories are stored via senses, ask questions like, 'What is the most prominent thing you remember seeing/hearing/smelling?' rather than demanding a strict chronological timeline immediately.
• Avoid Victim-Blaming Language: Never ask 'Why did you go there?' or 'Why didn't you fight back?' Instead ask, 'Tell me what happened next.'

Victim Assistance Resources

Officers must provide sexual assault victims with immediate access to resources, including the opportunity to have a Sexual Assault Nurse Examiner (SANE) conduct a forensic exam. Providing contact information for local rape crisis centers and victim advocates is a mandatory step in supporting the victim's recovery and the integrity of the investigation.