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Crisis Intervention Team training

EMS, mental health practitioners sharpen de-escalation skills


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HOYT LAKES — Being mentally ill is not a crime. Being suicidal is not a crime, nor is having a substance use disorder. Yet when one is experiencing a mental health crisis, law enforcement or firefighters/ paramedics are the only ones who are called and respond to these situations.

Although these responders may be familiar with mental health first aid, they often have not had specific training to respond to a behavioral health crisis. In these instances, a mental health professional would be a more appropriate and safer responder for the person in crisis. When a mental health crisis happens, it deserves a mental health response.

Local law enforcement, EMS services and a mental health services provider recognize this and are taking steps to remedy the need for a more qualified response to mental health crises in East Range communities.

Range Mental Health Center (RMHC) is working with Virginia Fire Department and Virginia Police Department to establish Crisis Intervention Teams (CITs). RMHC will be embedding a mental health professional with VFD and a mental health practitioner with VPD to respond to mental health crisis incidents in the community.

In February, a dozen area law enforcement officers, firefighters/paramedics and mental health staff from RMHC participated in a certified CIT Training course in Hoyt Lakes. It was the first step in forming these teams.

Conducted by the Twin Cities-based nonprofit Minnesota Crisis Intervention Team (MNCIT) and hosted by RMHC, participants increased their awareness and understanding of mental health illnesses and practiced de-escalation techniques.

RMHC did this training about three years ago and offered it this time specifically for emergency services workers as the agency moves forward in establishing the co-responder models, according to RMHC CEO Janis Allen.

The 40-hour training was conducted via Zoom and in-person, during which participants did role-playing scenarios with professional actors.

“We stress that this is not a mental health course. It is a safety course,” said MNCIT instructor and Clinical Director Steve Winkelgren. “People go through the training, learn more about mental health and how to recognize it. When you understand the crisis and understand the specific de-escalation approach, the primary benefit is that you are doing it safer. The secondary benefit is the person you are dealing with ends up in a safer position.”

The training tools

Participants reviewed the basics of depression, anxiety, mania and psychosis and talked about other conditions such as developmental disabilities, autism, substance use disorder and dissociative disorders.

“We focus on those that get the crisis 911 attention and go over them in more detail than what most people need,” explained Winkelgren. “Part of our goal is to also say, ‘hey, this is complicated.’ We go over some de-escalation tactics too. This isn’t to purposely confuse them [the participants] but to show them that the human brain is an amazing thing.”

The focus for responders should be on the behaviors of the person in crisis. Once one recognizes the signs and symptoms, an appropriate de-escalation approach can be applied. In some instances, more than one technique may be necessary.

“At times behavior can be all over the board,” acknowledged Winkelgren. “And it’s not always about being nice and using active listening. There are times when you have to use other techniques based on what you’re seeing.”

Participants engaged in hours of roleplaying.

“The scenarios are where the training takes place,” said Winkelgren. “This is where they try things out. For 10 hours they are doing it or watching others literally do it. We watch them, take a time out, discuss what’s working and what’s not, make some adjustments and suggestions, and send them back in. It is this training, I’d say, that we hear back from participants who say thanks, how they used it on the street and it was awesome.”

MNCIT’s time in Hoyt Lakes culminated with a panel discussion by advocates and mental health staff. Those at the table included: Range Treatment Center Director Dave Archambault; Essentia Health- Virginia ER Director Leah Johnson; an ER nurse, ER doctor and nurse practitioner; St. Louis County Adult Mental Health Supervisor Kelly Sather; Virginia Fire Chief/ EMS Director Allen Lewis and RMHC CEO Janis Allen.

“We had a great panel,” stated Janis Allen. “The outcome was the need for increased collaboration to work together to meet the needs of people in our communities.”

Winkelgren concurred, adding he saw and heard a lot of passion during the discussion.

“What I really liked is that all sides really were on the same page of wanting to do what’s best,” he said. “The whole idea of CIT is that when all of these team members come together, you end up with good people, hospitals, cops, mental health professionals that all want what’s best for the person. When they work together, that’s what the person gets.”

Law enforcement and mental health professionals approach crisis incidents from different perspectives. Acting out the scenarios brought that to light and allowed for discussion and comparison.

“The thinking that came out of watching the scenarios is that we all have our own focus, which is helpful, but it does not solve the issue if we aren’t doing it all together,” said Allen. “It was a good learning curve for all of us.”

Bringing the two professions together on the street will prove interesting, opined Winkelgren.

Officers are trained to be intimidating, to gain control of a situation efficiently and quickly, and use a commanding voice with hands ready on weapons. And if a suspect does not obey, police are trained to move in closer and shout louder until compliance is obtained. In the context of dealing with persons with mentally illness, approaching a crisis situation in this way can quickly turn tragic.

Mental health professionals are typically versed in using verbal interventions that can de-escalate crisis situations. Respectfully and empathically pointing out an individual’s loud or pressured voice can help them recognize their behavior and open a dialogue. More often than not, empathic responses can defuse the crisis.

“There will have to be a pause in their [law enforcement’s] thinking when paired with a mental health practitioner,” said Allen. “We don’t want to limit the thought to going to the ER or jail or staying here.”

Adding tools to the toolbox

Patrol officer Malachi Moser of the Hibbing Police Department always strives to learn more to better serve the community. He said that taking the CIT Training did just that, as well as gave him insight on the transformation of how law enforcement polices communities.

“This class helped me become more aware of recognizing mental health breakdowns, and it also taught me ways I can better handle situations,” he said. “If everyone had this training, they may be able to assist someone before they get to the point of law enforcement being called.”

Although designed specifically for law enforcement, Moser said he’d recommend it to anyone.

“It shows the challenges that social workers, law enforcement, paramedics and medical staff have to deal with on a daily basis, as well as better educating that person on how to deal with someone with mental health issues, whether that is a family member or friend,” he added.

Even though it was in a controlled environment, Moser—like the others— said the role-playing was impactful as it allowed participants to practice de-escalation methods.

As a mental health practitioner with RMHC, Megan Moberg is familiar with deescalation techniques. She said she took the CIT training to fine tune her skills and described it as the best one she’s been through.

“I really enjoyed the role-playing scenarios,” she added. “The actors were great, and the coaches were encouraging. I liked how they’d pause us, review what we’re doing and give us their input, which I felt was educational.”

Linda Wald often sees people in various forms of crisis as a firefighter/medic with the Virginia Fire Department. She enrolled in CIT Training to gain better insight on mental health and to become better skilled at de-escalation.

“I thought this would be a great opportunity to add ‘tools to my toolbox’ for different crisis situations,” she said.

Wald described the training as “enlightening, informative and sometimes challenging.” The challenges came in the form of scenarios, which depicted persons struggling with addiction, mental illness, sexual assault, PTSD and more.

“The greatest lesson I took from this training was how important it is to validate how someone is feeling,” said Wald. “This is true in my employment and also in everyday life. There’s so much disconnect between people with so much being done over social media or text, especially with COVID restrictions this past year. Sometimes people really need someone to listen to what they’re going through and acknowledge their struggle.”

The training was a good reinforcement of the importance of communication and connection, she added.

“A lot of my job, most days, isn’t about what medications or treatments I can provide, although those are also necessary sometimes. It’s about making a connection with our patients, listening to them and treating people with kindness,” said Wald. “Some other skills that I will keep in mind with my assessments in crisis situations would be tone, timing and patience, being direct, distance, eye contact and how even distraction or a noise can be used and effective.”

A 15-year veteran of law enforcement, John Swenson has developed deep compassion for those who experience mental illness. A lieutenant with Virginia Police Department who also serves as the community relations officer, he opines that situations can be handled with a deeper understanding and reasoning.

This mindset makes Swenson a good fit to lead the VPD Crisis Intervention Team, which he’s confident will help change the current policing model.

“The training provided good insight to mental illnesses and how to work and de-escalate situations,” said Swenson. “The handson approach provided some more realistic approaches and are applicable to any work environment or career.”

Swenson said he took a few key lessons from the training. First, when working with persons with mental illness, one can switch their de-escalation tactics to achieve a positive result.

“The second lesson regards having a deeper understanding of how treatment works in Minnesota and that we [law enforcement] are only exposed to one side of treatment while there is more than what we are exposed to,” he said. “I also learned that I like to take things slow and use a calmer approach, which doesn’t always fit the scenario or other people’s perception (of law enforcement).”

Help, not handcuffs

The new Crisis Intervention Teams will consist of a mental health worker trained in crisis intervention, assessment and referral hired through RMHC and trained EMS personnel from VFD and Swenson from VPD. The teams will respond to crisis incidents in northern St. Louis County communities.

Here’s how it will work: Incidents will be reported to the team through 911, where a screening would take place to determine if a CIT is needed. Mental health crisis incidents vary and could include welfare checks, verbal or physical conflicts, substance use or abuse and suicide threats, among others. If warranted, the team will respond and meet with the person(s) in crisis.

Using de-escalation and harm-reduction techniques if necessary, the team will then assess the situation and the person(s) experiencing the crisis for immediate needs through a series of screening instruments and tests.

Following assessment, the team will then work in coordination with RMHC’s Mobile Crisis Team through referral or warm hand-off for follow-up care. This process will allow persons to be served in the community instead of being taken directly to an ER, jail or detox center.

“The goal is to change the way our community responds to crisis incidents and people struggling with mental health help,” said Allen.

People with mental health illnesses need care, not criminalization. A goal of the CITs is to help redirect people living with mental illness from incarceration to recovery and empower individuals to get the care they need and deserve for their mental illnesses.

For those who took the CIT Training, Allen said she hopes that they walked away with a better understanding of mental health and better recognition of what resources are available.

“When they come upon someone in a mental health scenario, they’ll have in mind what the next step is,” she added.

Winkelgren hopes the training encouraged law enforcement to think a little differently and reconsider their automatic responses.

“We need them to slow down,” he said. “They deal with so many people and have to keep moving. But if they slow down and take their time, they will end up doing better.”

And as different as the approaches of law enforcement and mental health practitioners are, they are similar in their motivation.

“CIT is about really helping someone, which gets at the core of who we all are—cops, firefighters, nurses, mental health workers. We are all helpers,” said Winkelgren. “In this case, we’re making law enforcement empathetic and really wanting to help someone. It takes them back to the core of what they really want.”

Kelly Grinsteinner lives in Hibbing. She is the communications and marketing specialist for Range Mental Health Center and can be reached at kgrinsteinner@rangementalhealth.com.

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