10.3 Crisis Intervention & Mental Health

10.3 Crisis Intervention & Mental Health

Quick Answer: On behavioral-health calls, start with a medical and safety lens, use CIT-style communication (time, distance, calm dialogue) when feasible, know Missouri involuntary hold concepts under RSMo Chapter 632 (including 96-hour hold awareness) as an officer support role, handle suicide-in-progress with containment and lethal-means caution, and treat extreme agitation presentations as medical emergencies first—not punishment problems.

Crisis intervention is a major thread of Interpersonal Perspectives (~60 hours) and overlaps de-escalation content from Skills and Legal Studies. The MPOLE expects judgment: when to slow down, when to take someone into protective custody pathways, when force is unavoidable, and how to avoid turning a medical crisis into a preventable death in custody.

Recognizing Crisis Behavior

A person in crisis may show:

Medical vs. criminal first lens: Ask, “Is this primarily a health crisis with public-safety implications, a crime in progress, or both?” Trespass by a person who is lost and psychotic is not the same as an armed robbery. You still protect the public, but charging every symptom as attitude is poor policing and poor medicine.

Stabilize Before You Diagnose

1. Scan for weapons, traffic, bystanders, and environmental hazards.
2. Request backup and EMS early when medical instability is likely.
3. Create a reactionary gap; use cover when weapons are possible.
4. Assign one primary communicator when possible—multiple officers shouting competing orders increases chaos.
5. Gather history from family, caseworkers, or prior CAD notes: medications, diagnosis labels, triggers, what worked last time.

CIT-Style Communication

Crisis Intervention Team (CIT) models train officers to respond to mental-health calls with communication and resource connection. Not every Missouri officer is formally CIT-certified, but academy and CLEE culture expect CIT-informed skills.

Scenario: A man in a park yells at unseen people and holds a small stick, not advancing on anyone. Contain the area, keep distance, use one calm voice, request mental-health resources if available, and avoid an immediate tackle that is unnecessary for public safety. Contrast: the same man charges a child with a knife—defense of life overrides dialogue theory.

Communication Script Skeleton

1. Introduce yourself and purpose: “I’m Officer Lee. I’m here to help you stay safe.”
2. Ask their name; use it.
3. State what you need in plain language: “I need to see your hands.”
4. Acknowledge emotion without agreeing to delusions.
5. Explain next steps before they happen when safe: “A medic is going to check your pulse.”
6. Avoid sudden unexplained touching—telegraph movements when feasible.

Missouri Involuntary Commitment Awareness (RSMo Chapter 632 Concepts)

Missouri’s civil mental-health detention framework is associated with RSMo Chapter 632 (concepts taught at academy awareness level). Officers are not expected to practice psychiatry, invent courtroom procedures, or quote every subsection from memory. Know the role concept:

96-Hour Hold — Conceptual Awareness

Training commonly discusses a short-term involuntary detention often referred to as a 96-hour hold (approximately four days) for evaluation and treatment when legal criteria for danger to self/others or grave disability-type standards are met under civil mental-health law. Exact petition titles, who may apply, judicial review steps, and hospital acceptance rules are procedure-sensitive and can vary with updates—follow current academy handouts and agency policy.

Do not invent precise form names, mandatory hospital lists, or minute-by-minute statutory checklists on the exam if not taught. Correct answers emphasize: observe facts, protect life, complete required paperwork accurately, transport safely, and hand off to medical/mental-health professionals.

Voluntary vs. Involuntary

Whenever safe and appropriate, voluntary evaluation is preferable—it preserves dignity and may reduce force. When the person meets involuntary criteria and refuses help while remaining dangerous, civil detention pathways exist. Family members and qualified mental-health professionals may also initiate processes; officers coordinate rather than freelance a private “diagnosis arrest.”

Suicide-in-Progress Response Safety

Suicide calls include threatened, attempted, and in-progress means (jumping, cutting, overdose, firearms, vehicle, CO, etc.).

Priorities

1. Officer and public safety first—you cannot help if you are shot with the subject’s firearm or pulled off a bridge.
2. Contain and isolate the scene; remove audience stimulation when possible.
3. Lethal-means management: If a firearm is involved, treat it as a high-risk armed encounter with crisis overlay—cover, distance, specialized negotiators when time exists.
4. One communicator; reduce radio chatter the subject can hear.
5. Do not make false promises (“Nothing bad will happen”) that destroy trust.
6. EMS staging for rapid medical aid after securement or overdose.
7. Aftercare: Even if the person “calms down,” evaluate hold/transport needs; document statements of intent and means.

Barricade + suicide threat: Integrate crisis negotiation principles with standard barricade protocols. Time is often an ally if no third-party hostage is being harmed.

Extreme Agitation and Medical Emergency Awareness

Older training materials used the term excited delirium for a presentation of extreme agitation, hyperthermia, bizarre behavior, imperviousness to pain, and sudden collapse risk—often associated with stimulants or underlying medical/psychiatric crisis. Modern Missouri-relevant training emphasis aligns with national movement toward medical emergency first language:

Whether or not a particular agency still uses the phrase “excited delirium,” the MPOLE-relevant takeaway is constant: severe agitation with medical red flags is a medical crisis with a public-safety overlay. CEW, OC, and empty-hand control may still be reasonable against violent assault—but the end state is medical evaluation, not booking-as-punishment without care.

Positional and Restraint Cautions (Link to Force Training)

• As soon as handcuffed and control is achieved, get the person off the chest when safe.
• Monitor for silence after screaming—quiet is not always compliance; it can be medical decline.
• Coordinate with EMS on stimulant overdose, hyperthermia, and excited/agitated delirium-type presentations.
• Report force and medical response completely.

Connecting Crisis Work to Curriculum Hours

Common Exam Traps

• Treating every mental-health call as a criminal “refuse to obey” problem first.
• Believing CIT skills forbid all force against imminent deadly threats.
• Inventing detailed RSMo 632 court procedures beyond officer affidavit/transport awareness.
• Ignoring EMS on extreme agitation calls.
• Leaving a suicidal person without evaluation because they “promised to be fine.”
• Prolonged unmonitored prone restraint after control is achieved.

Crisis work rewards patience with a plan: protect life, communicate simply, use civil mental-health tools when criteria are met, and hand medically unstable people to clinicians as fast as safety allows.