L3 – 4.4 De-Escalation During a Mental Health Crisis

De-Escalation During a Mental Health Crisis

With increasing frequency, first responders are being called upon to engage with individuals in serious mental health crises. It is necessary for security officers to understand mental illness, and de-escalation techniques that have been proven to work most effectively when responding to individuals in these situations. These techniques can be different than those routinely taught in conflict management. Generally, the underlying elements behind mental illness-related behavior is usually not criminal or malicious.

Due to individual, environmental, cultural, and circumstantial factors, any one person might react to or perceive a crisis situation differently than another person. This might be especially true for an individual suffering from a mental illness due to the possibility of disrupted emotions or thought distortions.

Think of mental health conditions as falling along a continuum. The severity of each condition varies from person to person (mild, moderate, severe). Some individuals experience ‘chronic’ or long-term conditions, while others experience more “acute” or immediate symptoms. Those symptoms, and their severity can change; occasionally being acute, and then receding. Mental health conditions often occur simultaneously, for example, individuals often suffer from substance abuse issues in addition to other mental health conditions.

Remember that you aren’t trying to diagnose the person or resolve the underlying issues. Your top priority is to verbally defuse the situation to the best of your ability.

Consider this three-phase process:

  • Safety – of the public, the subject, and the security officer
  • Stability – attempt to stabilize the person through verbal and non-verbal de-escalation skills
  • Problem solving – Try to get the person into a rational frame of mind (lessen emotional reactivity). Increases the likelihood of future compliance and resolution

Do not rush into situations (unless necessary). Patience can increase the safety of everyone involved. Focus on calming the situation and minimizing the level of stress.

I Assessment

This quick assessment can be used to roughly determine a subject’s mental health status.

  1. Level of comprehension
    • Does the person understand what you’re saying?
    • Can the person follow instructions?
    • Is person able to answer basic questions related to orientation (i.e. person, place, time)?
    • When person speaks do their comments make sense related to the circumstances?
    • How is the person speaking (quickly, slowly, slurred, mumbled)?
  2. Behavior
    • How is the person practicing basic self-care (Disheveled, dressed appropriately for the season)?
    • Is the person caring for hygiene (bathing)?
    • When was the last time the person ate or drank anything?
    • How is the person’s physical coordination?
    • Compliant or non-compliant? If non-compliant, could it be due to mental health issues?
  3. Emotion
    • What is the prevailing emotional state (anger, sadness, euphoria, anxious)?
    • Is the emotional state appropriate to the context of the situation?
    • Does the person exhibit quickly fluctuating emotional expressions (laughing to crying)?
    • Is person exhibiting extreme or baseless suspiciousness or paranoia?
    • Is person’s facial expression and body language consistent with their stated mood?

Do not rush the person or crowd his/her personal space. Any attempt to force an issue may quickly backfire in the form of violence.

They may be waving their fists, or a knife, or yelling. If the situation is secure, and if no one can be accidentally harmed by the individual, you should adopt a non-threatening, nonconfrontational stance with the subject.

Excessively emotional or even violent outbursts by those with mental illness are often of short duration. It is better to let the outburst dissipate rather than wrestle with a person who is under extreme emotional stress. Bizarre behavior alone is not reason for physical force.

What works best and what is most beneficial is patience and communication. The tone and outcome of a subject interaction are almost always impacted by the degree to which a security officer can build rapport with the subject(s).

II     Building Rapport

Rapport is defined as “a friendly, harmonious relationship; especially a relationship characterized by agreement, mutual understanding, or empathy that makes communication possible or easy.” Synonyms for rapport include “communion or fellowship” (Merriam Webster, 2017). The degree of rapport can often determine the course of the interaction (positive or negative).

Tactics for gaining trust and building rapport:

  • Honesty and sincerity are essential for rapport and trust.
  • Individuals suffering from mental health issues can be very attuned to nuances of communication (dismissiveness, ulterior motives, condescension, non-verbal cues, labeling).
  • Use the person’s name (the name that they prefer to be called).
  • Be patient and try to match their conversational speed.
  • Maintain a calm tone of voice.
  • Do not minimize or discount the subject’s point of view.

Make sure that you validate the positive things that the person has done while you have been talking. Gain confidence by forewarning that certain things may take place. For example: “You have been very straightforward with me and I am going to be straightforward with you. You are going to have to be handcuffed when you ride in the car, for your safety, and for mine.”

In addition, maintain good eye contact (but not confrontational or unending eye contact), minimize distractions, do not interrupt while the person is speaking, validate and empathize, use engaged body language (lean forward into the conversation or nod), and remember, it’s not what you say, but how you say it.

Non-Verbal Communication:

  • Friendly and helpful – behaviors that convey safety, respect, and a desire to help. Can be conveyed verbally, and nonverbally (through neutral body language, and pleasant facial expression).
  • Aggressive and hostile – behaviors that communicate a distance from or even a danger to another individual (blading, hand on grip of pistol).
  • Ambiguous – These behaviors are open to interpretation and can have a wide range of meanings to individuals in crisis. Often if the posture is not overtly friendly; it is interpreted as dangerous.

Remember that you aren’t trying to diagnose the person or resolve the underlying issues. Your top priority is to verbally defuse the situation to the best of your ability. People in crisis may not be able to understand your statements or commands but can often read your non-verbal cues and sense your level of concern, empathy, investment, and genuineness.