Calling 9-1-1

Having to call 9-1-1 is an extremely stressful decision.  It is by definition an emergency.  Not only do you have concern for the person about whom you are making the call, but you also want to make sure that law enforcement has enough information so that they will be able to respond effectively and safely. 

Try to control the volume of your voice.  When you shout over the phone, it is difficult for the 9-1-1 operator to understand what you are saying.  Certainly this is a very emotionally charged time, but if the operator can only hear shouting, the information is not efficiently received.  As calmly and clearly as possible, tell the operator the following if the information is available:

• Your name.
• Your address.
• The patient’s name.
• Your relationship to the patient.
• That the patient is mentally ill.
• Name of the diagnosis (schizophrenia, depression, etc).
• Any medication being used.
• Has medication use stopped?  If so, for how long?
• Describe what the patient is doing now.
• Do you feel threatened?
• Is there a history of violent acting out?
• Does the patient hear voices?
• Does the patient fear someone?
• Are there any weapons in the house?  If so, try to safely remove them before calling 9-1-1
• Where the patient is within the house.
• Request a CIT Trained deputy / officer.

WHEN LAW ENFORCEMENT ARRIVED

Have all the lights in the house turned on, so that all occupants can be clearly visible to the arriving officers. 

It is estimated that the officers responding to the emergency call establish a comfort zone, by knowing that you are not a threat, who the patient is and who is possibly also agitated.

As calmly as possible, identify yourself and tell the officer:

• Who you are.
• Who you have called about.
• What you relationship is to the patient.
• That the patient has a mental illness.
• What kind of mental illness it is.
• What medication is being taken.
• Has medication use stopped and for how long.
• If the patient is violent or delusional (paranoid)
• Any history of suicide attempt.
• An attending psychiatrist’s and / or case manager’s telephone number.

Officers responding to a 9-1-1 emergency call are very focused when they arrive on the scene.  First, they will make the scene safe for you, the patient, and themselves.  The more informed and at ease the officers are, the less likelihood that someone will get injured or that the situation will worsen.   

Spend the time that is necessary answering all of the officer’s questions.  Answer directly and concisely.  Do not ramble, but offer any advice you deem helpful.  After this is done, they will usually be able to deal with the situation and to answer any questions.  Although it is difficult in times of crisis, being patient is essential. 

CRISIS INTERVENTION TEAMS (CIT):

A PROGRAM FOR LAW ENFORCEMENT OFFICERS

If the individual with mental illness is in danger of physical injury, if his or her behavior is out of control, or if other persons are in danger, it is important to know what steps to take.  Plan ahead by locating available sources for help, the number for the local police or sheriff’s department, name and phone number of a mental health professional, community mental health center crisis emergency number, friends or neighbors who may be of help, and the nearest National Alliance of Mental Illness affiliate.  Keep these numbers posted by the telephone along with 2-1-1 services if available in your area.  Talk with the patient’s social worker or psychiatrist and with the community mental health center so you will know how to obtain services when needed.  

If you sense deterioration in you relative or friend’s mental condition, try to find out what is going on.  Everyone occasionally has a bad day.  However, these are usually early warning signs that signal problems; changes in sleep or social activities, increased hostility or suspiciousness.  Try to get him or her to see a psychiatrist or social worker.  The object is to avert a crisis. 

If you should have to call for help in a crisis, if possible have information available about the family member or friend’s diagnosis, medications, previous hospitalization (s), and a description of the specific behavior that precipitated the crisis.  It may be useful to have several copies of such information to give to the police and to mental health professionals. 

However, if the individual needs crisis intervention, you might need to contact a CIT officer, if available in your area.  The Crisis Intervention Team (CIT) Program is composed of specially trained uniform patrol officers who respond to all calls related to a person having a mental illness crisis.  Officers can face challenges from or about persons attempting suicide, threatening harm to others or displaying other dangerous symptoms or behavior.  This requires new and special talents and knowledge.  In Florida, over 3,000 law enforcement officers have been trained in the nationally acclaimed 40-hour CIT course.  The faculty, who are all professionals, family members or consumers from the local mental health community, volunteer their time and talents to provide the most up-to-date information to law enforcement officers, regarding mental illnesses, medications, de-escalation techniques, Baker Act authority, and unusual behaviors such as suicide, homicide, and aggressiveness.  The course includes several hours spent in discussion with persons with mental illness who share their past interactions with the law. 

CIT was originated by the Memphis Police Department.  It is staffed by officers who are capable and willing to routinely and repetitively handle this type of non-criminal call for service in addition to their normal patrol duties.  Repeated opportunities to develop techniques and gain knowledge of the mental health system, is of paramount importance for successful and safe interventions.  Dispatching only CIT trained officers on calls involving persons having a public crisis due to a mental disorder demonstrates CIT’s value to the community through the saving of lives, time and money. 

JAIL AND JAIL DIVERSION

According to the Surgeon General, the criminalization of mental illness is the silent epidemic of our times.  One attorney stated our jail and prison system is perhaps the greatest danger facing persons with mental illness today.  The number of inmates in Florida’s prisons with a mental illness and the number of those incarcerated in county jails with a mental illness has grown at an alarming rate since the mid 80’s.  Placing individuals who have had a public crisis with a mental illness in jail, or sending them to a prison creates a vicious cycle as they are generally not able to receive all of the care and support they need to manage their mental illness.  When released, they tend to recycle back to jail and / or prison.  Early treatment, early diagnosis and early intervention when symptoms escalate, may well succeed in avoiding incarceration.  When this is not possible, NAMI members have worked with state and local law enforcement agencies and community health centers, to make it possible to treat rather than punish persons who are mentally ill, by diverting them from jails and courts into residential treatment programs.  This is true for both adults and children who find themselves in the juvenile justice system. 

Individuals living with a mental illness who are facing legal problems should seek legal assistance.  If they cannot afford a private attorney, Florida Legal Aid Service or the local State of Florida Public Defenders Office, mental health advocates, and others should be able to help.  The attorney representing the individual should look into release of the person on bond as quickly as possible to allow them to get into treatment before their situation worsens.  In cases where this may not be possible, the attorney should make an appropriate motion to ensure that proper psychiatric treatment and support is available while release or trial is pending.

It is also helpful to find an attorney who has some understanding of brain disorders, the legal defenses available, and their impact of on the consumer who is charged.  If the offense is of a minor nature, a skilled attorney may be able to arrange for a transfer to a psychiatric facility for treatment in exchange for delaying the criminal case with ultimate dismissal of the charges.  Compliance with the recommended treatment may be ordered by the court as a condition of probation or even an alternative to trial or a substitute for serving time in jail. 

It is not unusual that contact with the criminal justice system may provide the first opportunity to identify mental illness and connect the individual with community mental health centers.  While it may not always be possible to avoid the original incident and incarceration, it should be the goal of the family, the person with mental illness, and the mental health system to eliminate future incidents.