Moving past what to how--the next step in responding to individuals with mental illness.

Law enforcement officers accept the need for firearms instruction before going to the range to practice what they have learned. After they have the necessary education on weapons, their training time can be more effectively spent on the range. Perhaps, training officers to improve the skills used to respond to citizens with mental illness can be enhanced with a similar approach--a high priority on practice.

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Tulsa, Oklahoma, like most other communities across the country, has long experienced the difficulties of the increasing pressure on individuals with mental illness and their families as a result of state funding problems and constant changes in mental health care delivery systems. Most of the responsibility for providing services to those seriously ill or less able to pay for services has shifted from one agency to another, sometimes more than once. Because of this challenge, the Tulsa Police Department's (TPD) apprentice police officer (APO) academy training has included a component similar to the "Memphis Model (1) since 1988. Integrating front-line mental health professionals into the broad, multidisciplinary training given to APOs for almost 15 years has helped TPD field officers become proficient in the task of responding effectively to individuals with mental illness.

To answer a growing need, the TPD resolved to go beyond refresher classes for incumbent officers and, instead, committed to developing an advanced mental health response officer school. The school was designed to help police and mental health professionals work in a collaborative partnership as both instructors and students. (2)

THE GUIDING PRINCIPLE

The guiding principle for the school's development, the "operational triangle," represents a model the TPD has used for many years to instruct APOs. The foundation of the operational triangle is safety. Ensuring safety is the first step in all interactions between officers and citizens. Only after this is established and maintained should an officer focus on using communication skills to form an effective relationship with a subject. Officers first must have a safe environment before they can apply interpersonal skills directed toward possible problem solving.

Once officers establish a state of safety, they are tempted to move directly to problem solving. Yielding to this temptation means skipping the middle section of the triangle and, often, results in ineffectiveness. Increasing officers' confidence in their abilities to effectively use interpersonal communication skills improves the likelihood that they will incorporate each section of the operational triangle.

Over the last 20 years, the law enforcement profession has made huge strides in raising officers' awareness and competence in the areas of citizen and officer safety. Agencies should devote attention to increasing officers' awareness of the essential step between safety and problem solving. These human relation skills, like officer safety skills, improve with practice. Enhanced interpersonal skills will amplify the ability of officers to project a powerful influence with citizens they serve, especially those with mental health issues.

THE INSTRUCTIONAL OBJECTIVE

The school's mission is to assist people in need of mental health services in a way that secures the safety of all concerned, respects the dignity of the person in need of attention, and increases the chances of a good outcome with mental health service providers following the law enforcement contact. This statement defines the instructional objective of maximizing the time spent conducting collaborative cross training between law enforcement officers and mental health professionals most likely to have direct contact with individuals in need of mental health services. Minimal time expended on reviewing mental health knowledge (e.g. facts, diagnostic categories, mental disorder descriptions) in lecture-type presentations allows instructors to spend more time on practical applications of interpersonal communication and intervention skills.

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CURRICULUM DEVELOPMENT

Various departments of the TPD and the mental health community designed the school's 40-hour curriculum in the spring of 2002 over a 6-month period. Classes are limited to 20 police officers and 5 mental health professionals. Attendees are divided into smaller groups composed of four officers and one mental health professional with a TPD special operations team crisis negotiator acting as facilitator/instructor because of this person's experience and expertise.

Upon completion of the school, sworn law enforcement graduates earn department certification as advanced mental health response (AMHR) officers. Further, mental health professional graduates are certified AMHR responders and can receive continuing education credits as well.

CURRICULUM

Day 1

The entire first day centers on the middle section of the operational triangle--effective interpersonal communication skills--divided into five segments. The first segment reviews basic active listening, then focuses on more advanced verbal concepts in the second segment. Both are followed by an exercise requiring students to use active listening skills, as well as the additional verbal skills, in a role-play situation where an observer evaluates performance and provides feedback.

The third segment concentrates on nonverbal components of communication followed by an exercise requiring students to deliberately add the nonverbal component to the rapport-building process. The relationship between autonomic (i.e., involuntary) nervous system arousal levels (degree of physical and psychological tension) and the ability to effectively use interpersonal communication skills also is discussed. Instructors emphasize that functioning effectively from the bottom level of the operational triangle (safety) requires a relatively higher level of autonomic arousal. Functioning effectively from the middle section (interpersonal communication skills aimed at rapport building) requires a relatively lower level of autonomic arousal. Instructors also examine potential safety problems inherent in negotiators lowering their arousal levels enough to engage in rapport building. A subsequent exercise helps attendees review and practice a simple relaxation technique that leads to a decrease in arousal level.

Next, students receive a lesson on understanding, appreciating, and applying the idea that power can be divided into two subtypes: authority and influence. In this model, authority is the ability to make things happen by force, while influence gets its power from the strength of a relationship. The tactics of authority strategies range from a uniform presence to deadly force interventions. Authority strategies generally call for functioning from the bottom or top level of the operational triangle. Influence strategies focus on the rapport established with a subject and call for functioning from the middle of the operational triangle. The lesson concludes with a very challenging role-play exercise requiring students to demonstrate both authority and influence strategies in the context of a simulated possible emergency order of detention (EOD) call. (3)

Day 2

The second day consists of a field trip to a local juvenile inpatient facility that receives individuals taken into protective custody under an EOD. Presentations and practical exercises are given later on various topics, such as psychotropic medications, chemical dependency, and bipolar disorder.

Day 3

One of the most valuable experiences, according to students, is a "virtual hallucination" (4) exercise. Each group member listens to a short, commercially produced audiotape simulating the experience of auditory hallucinations while being interviewed by group members. Presentations on the medications and illnesses commonly seen regarding homeless individuals follow this exercise.

Next, the Tulsa Mental Health Association, a panel of mental health consumers, and their family members lead a presentation and open panel discussion to humanize the school's objectives. Following the discussion is a presentation of the "third criteria," which provides an option for EOD subjects to be taken into protective custody if they have a history of serious mental illness, currently demonstrate worsening symptoms, and it is reasonably believed that treatment will prevent a progressively more debilitating mental impairment. Clearly, the option proves a very positive choice in some situations and, in others, may provide fertile ground for disagreement between police officers, mental health professionals, and individuals with mental illness.

Day 4

Because mental health consumers often are incarcerated, students tour the county jail's diversion program. The program seeks to appropriately identify and provide a basic level of care for persons with mental illness while in the facility. Because health professionals and police officers have different experiences and perceptions regarding suicidal subjects, students also hear a presentation on suicide prevention. Mental health professionals often are more aware of the passive, depressive symptoms that develop gradually over time. In most cases, when officers have contact with a suicidal subject, the person likely has shifted to an angry, ambivalent, and possibly violent state of mind, which calls for an alert approach.

Next, attendees complete a practical exercise to use polished interpersonal skills, combined with information from the presentation, to intervene with a suicidal subject in a role-play scenario. Observations on safety, interpersonal skills, and problem solving follow each scenario. The day ends with presentations on developmental disabilities and dementia.

Day 5

On the final day, the TPD's psychologist presents a lecture on personality disorders followed by a presentation and open class discussion on violence and threat assessment. A final practical exercise challenges students to apply skills and knowledge gained throughout the week. Nonclass member mental health professionals are recruited from the community to roleplay the parts of mental health consumers in a variety of scenarios. Instructors provide observations and feedback to each student on safety issues, interpersonal skills, and problem solving throughout the course of the exercise.

Finally, all class members and crisis negotiators participate in an evaluation and discussion session. Although the school's organizers place a very high priority on small group practical exercises, students usually feel that even more time in future classes should be dedicated to practical application activities. Further, one student suggested that a standing committee composed of selected graduates of the school, crisis negotiators, other appropriate mental health professionals, and Tulsa Police Department administrators be formed and meet quarterly to advise on ongoing changes in the community's mental health environment.

CONCLUSION

Two interwoven key factors have contributed to the success of the advanced mental health response officer school. First, the inclusion of mental health professionals as students and instructors helps build a collaborative partnership between law enforcement professionals and individuals in the mental health care system. Equally important is the decision to place a higher value on how to intervene with individuals with mental illness than on academic presentations about mental health knowledge.

The small group exercises accomplish three very important functions. First, they help students polish their interpersonal communication skills in the context of interacting safely and effectively with individuals with mental illness. Second, both a police and a mental health perspective are present. Finally, and perhaps most important, officers and mental health professionals are together in a cooperative educational setting that encourages the development of positive, personal relationships and a genuine appreciation for the differences and similarities in both jobs. Combining all of these factors helps ensure that law enforcement officers receive the best possible training to respond effectively to individuals with mental illness.

For additional information, contact Captain Tracie Crocker, Tulsa Police Department, at 918-596-1105 or [e-mail].

Endnotes

(1) For more information, visit the Memphis, Tennessee, Police Department's Web site at www.memphispolice.org

(2) The authors acknowledge Chief David Been whose interest, involvement, and insistence on excellence in officer response to individuals in the mental health system ensured the development and implementation of this school. They also acknowledge retired Tulsa, Oklahoma, Police Officer Charles V. Miller who served as the first special operations crisis negotiator team leader, as an academy instructor, and as the major influence that prepared officers to receive, and crisis negotiators to provide, the most valuable portion of the training that takes place in this school.

(3) An EOD occurs when individuals need treatment because they are considered a danger to themselves or others.

(4) Virtual Hallucination, Janssen Pharmaceutics, April 1997, cassette.

RELATED ARTICLE: Training Curriculum

Day 1

Active Listening Skills

Advanced Verbal Concepts

Nonverbal Components

Autonomic Nervous System 

Arousal Levels

Interpersonal Communication

Skills

Power Subtypes

Day 2

Juvenile Inpatient Facility Tour

Psychotropic Medications

Chemical Dependency

Bipolar Disorder

Day 3

"Virtual Hallucination"

Schizophrenia

Open Panel Discussion

The "Third Criteria"

Day 4

County Jail's Diversion Program Tour

Suicide Intervention

Developmental Disabilities

Dementia

Day 5

Personality Disorders

Violence and Threat Assessment

Role-Playing Scenario

Evaluation

By Douglas Gentz, Ph.D., and William S. Goree

Dr. Gentz provides psychological counseling, consulting, and training for Tulsa, Oklahoma, Police and Fire Department employees.

Sergeant Goree currently is a field supervisor and the special operations crisis negotiator team leader for the Tulsa, Oklahoma, Police Department and formerly served as the department's training supervisor.