Podcast: Policing and Mental Illness: A Better Approach
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Guest information for ‘Policing and Crisis Intervention Training’ Podcast Episode
Officer Rebecca Skillern, senior trainer within the mental health division of the Houston Police Department, joins as a special guest to explain police protocol in answering crisis emergencies and what people with schizophrenia and their loved ones should do when an episode puts someone in danger.
She is an expert in Crisis Intervention Team Training (CIT ) which is a program that provides the foundation necessary to promote community and statewide solutions in assisting individuals with a mental illness and/or addictions. The CIT Model reduces both stigma and the need for further involvement with the criminal justice system. CIT provides a forum for effective problem-solving regarding the interaction between the criminal justice and mental health care systems and creates the context for sustainable change. Learn more by visiting www.citinternational.org.
Computer Generated Transcript for ‘Policing and Crisis Intervention Training’ Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: Welcome to the Psych Central Podcast, where each episode features guest experts discussing psychology and mental health in every day plain language. Here’s your host, Gabe Howard.
Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Psych Central Podcast. I’m here with senior police officer Rebecca Skillern to talk about what really police officers being first responders for people who are in crisis because of mental illness. We’re also going to cover the CIT program, which is Crisis Intervention Team. Rebecca, you are both a social worker and a police officer in Houston, is that correct?
Ofc. Rebecca Skillern: Almost, I’m a police officer and I’m a licensed professional counselor and supervisor.
Gabe Howard: That is unusual, is that is that correct? Usually you’re one or the other. Not a combo deal.
Ofc. Rebecca Skillern: Correct. I’ve been referred to by some of my peers as a unicorn because I’m kind of odd for having both the policing and the mental health side.
Gabe Howard: Let’s talk about that for a moment, because it kind of one of the first questions that I want to ask and you, of course, are not responsible for policing across the entire United States, but to many people hearing that police officers are first responders to medical conditions. It sounds funny. It’s almost like saying that firefighters should show up when there’s a robbery. Can you sort of explain how we got here and the logic behind that?
Ofc. Rebecca Skillern: Oftentimes with medical emergencies that involve someone who’s having a mental health crisis in the sense that they want to hurt themselves. They want to hurt someone else. In many states, but specifically in Texas, which I can’t speak for because I am in Texas. In many states, only a police officer or a peace officer can take someone into custody and detain them against their will and get them in for emergency evaluation, for stabilization, for a mental health issue. If police officers or peace officers are the only ones who can do that, then it makes perfectly good sense that when someone goes into crisis and needs that, that a peace officer is the one to do that. The other piece of that being is that when we transport if we transport in a patrol vehicle that has the vehicle with the locked doors in the back, they can’t unlock to keep them from being able to jump out and harm themselves. And in that sense it does make sense where it doesn’t make sense is that we’re not mental health providers and we’re not traditionally trained to respond to mental health issues. And that’s where there seems to be a lot of confusion. But when people are in crisis, their family members are contacting 9 1 1 and 1 9 1 1 is contacted. They are sending police and ambulance typically together. Police have to arrive on scene and render the scene safe before anybody else can approach. In that regard, it makes good sense. But it doesn’t make good sense in that we haven’t traditionally included crisis intervention training in policing. And that’s something that’s only come on within the last few decades.
Gabe Howard: Those are all really good points, and I think that their points that the average person doesn’t think about because, you know, we’re sort of trained to look at police officers as crime fighters. That that’s really sort of the information that society has. You know, it’s cops and robbers. It’s not cops and mentally ill people, but that’s actually not the role of police officers. You’re not crime fighters. Your job is is much bigger than that. Can you talk about that for a moment?
Ofc. Rebecca Skillern: We are crime fighters, we do enforce the law. But to go beyond that, we are also bound by the idea of running to protect and serve. We take an oath to protect and serve our communities, and that comes in many different forms and fashions. It includes, of course, seeking out people who are doing harm to others, you know, in a malicious way, like the robberies and assaults and things of that nature. You know, the real criminal activity, protecting and serving also means protecting people from themselves when the time comes. If people want to do harm to themselves or because of some kind of destabilization and what’s going on in their world, maybe doing harm to others. So we do intervene in those situations as well because the safety issues go well beyond just protecting people from malicious encounters from other people.
Gabe Howard: And we want to talk about specifically what Texas is doing and other states to help people like Gabe Howard. You know, people who live with severe and persistent mental illness and have been in crisis, make sure that we get the care that we need, because as you pointed out, a lot of police officers aren’t trained. And Houston’s looking to fix that and is fixing it.
Ofc. Rebecca Skillern: We are certainly trying. We are not alone in that effort. We have agencies all across the state and all across the nation. We have an international association as well where we are trying to get officers better prepared to deal with these situations because it is something we are encountering and we are encountering more and more as time goes on. I don’t have an answer as to why that is happening, but it is happening. And we have to prepare our officers who are responding to those situations as well as our community members so that they better know how to give the information needed so that we can all respond in a safer, more humane way to people who need help.
Gabe Howard: So a concerned person calls 911. Because somebody is having a mental health crisis or where they suspect that somebody is having a mental health crisis. 911 responds by sending out a police officer. So now the police officer is on the scene. What’s the next thing that happens?
Ofc. Rebecca Skillern: Well, it varies from one situation to another. The first thing you have to take into account is anyone’s safety at risk. I mean, do you have other people who are at risk of being harmed? Are the officers at risk of being harmed? Is the individual at risk of being harmed? And it can vary from one situation to another. One person might be standing in the middle of the street preaching and causing a traffic hazard with no weapons or anything like that. Or another person might be in a room with a knife in their hand. So it depends on the situation. And what we try to do is prepare officers to first assess the scene, take a quick snapshot of what’s going on. Get all the information you can while you’re in route. Take a snapshot when you arrive on scene to see if anybody’s safety is being jeopardized. So they have to act immediately. If not, we teach them to try to utilize their verbal de-escalation skills and active listening to establish rapport with the individual. Find out what’s going on to get them to talk. Kind of assess what the immediate crisis is and how they can intervene in that immediate crisis. Then get the person into appropriate treatment.
Gabe Howard: What are some things that you would say or do to de-escalate? And I do understand that there’s probably no magic words or we would just send out an email to all police officers and this problem would be resolved.
Ofc. Rebecca Skillern: Right. Well, first off, in any situation involving someone in crisis, if possible, we want at least two officers present. Again, it’s a safety issue. We only want one of them to be doing the talking because we don’t want to have too many people talking and the person to get further confused or further upset. But we try to have at least two officers respond to a situation like that so that they have backup support and someone who can be watching for the other things while they’re actually trying to engage the individual. You start by trying to establish a rapport, get the person’s name, use the person’s name in the conversation. Introduce yourself. Lower the decibel level. Try to get their attention by lowering your voice. Research actually shows that if you want someone’s attention, you can get it better by lowering your voice than you can by raising your voice. Find out what’s bothering them. Let them vent. Let them talk about what’s going on. Let them get some of their frustrations out. We also find that oftentimes the family members being in the room with the individual escalates the situation rather than de-escalate it. So that’s one of the reasons we try to get other people out of the picture so that we can have that engagement with the individual. We work with them to try to establish that rapport, to gain compliance, to try to bring them down, to let them know that we’re there to help them. We don’t want to hurt them. We want to get them into help so that they’re not feeling the pain that they’re feeling at that time or that they can better cope with what they’re dealing with. It’s not always easy. We want officers to be empathetic and understanding. At the same time, we want them to stay safe and to keep the people around them safe. Part of how we do that is by training our officers and educating them about mental illnesses and what some of those episodes might look like. Because when you have someone who is bipolar, sometimes they will go into crisis and be throwing things and kind of raging, being very upset at the drop of a hat and sometimes just letting them know that you’re there to help them, that you want to get them the help that they need to be more in control, to feel more in control of what they’re having to live with.
Gabe Howard: De-escalation becomes a lot harder if the person you’re trying to de-escalate is holding a weapon. What’s the process there?
Ofc. Rebecca Skillern: Well, again, every situation is going to have its own kind of unique circumstance. But if you have someone who’s holding a weapon, the officers are trained to use cover and concealment to the best of their advantage. If they have someone who’s holding a knife and that person is the only person they risk hurting themselves, then we are looking at more and more. We’re looking at tactical disengagement. If the only person they can hurt is themselves, we’re going to back off. We’re going to put more distance between them and us. We’re gonna be ready. We’re going to be paying attention. We’re also going to be verbalizing specific commands to lower the weapon, to drop the weapon, to try to talk the person into putting the weapon down. At the same time, we have to stay very vigilant and keep our officers safe. And again, that’s going to be one of those situations where we’re going to want more than one officer on that scene. Obviously, when it’s a call that’s involving a weapon, we’re going to have more than one officer go to a scene if possible, depending on the kind of weapon and who is at risk of being harmed in the situation that will dictate the response. At no point in the crisis intervention training are we telling officers that they need to put their lives at risk. We want them to engage, but within tactics, within appropriate safety standards. And so we want them to utilize their skills at the same time, we want them to stay safe. So tactical disengagement, if you have someone who has a knife and there’s nobody else around that, they can hurt you, isolate that individual into an area and you try to engage them verbally and build rapport and talk them into lowering the weapon. And that actually happens more often than people realize. It’s just when it happens that way, it doesn’t make the news.
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Gabe Howard: We’re back speaking with Rebecca Skillern, an officer from Houston, Texas, about crisis intervention, training and police involvement with people with mental illness. It’s hard to have this conversation about what all police officers across America are seeing. And, of course, you can only speak for Houston, Texas. But but from your standpoint, which call is more common? The scared, agitated mental health crisis or the I have a weapon and I want to do harm to others because again, like you pointed out, we hear about mentally ill people with weapons all the time. But is that really the most common call that police officers get?
Ofc. Rebecca Skillern: Actually, anecdotally, I can say no. And I would say probably the statistics would support me in saying that the majority of calls we get regarding people in mental health crisis don’t involve something that’s going to make headline news like that most of the time. You know, what we’re gonna get is people who are feeling suicidal, you know, someone who is in a mental health crisis to the point that their depression or their bipolar or their schizophrenia or just their basic anxiety disorders have gotten them to the point that they’re feeling depressed and suicidal. Most of the time in situations like that, even if they have a weapon, what they’re asking for is help. What they want is help. They just don’t know how to get it. Those don’t make the news because so many times officers engage individuals who are in crisis like that and they’re able to talk with them and they’re able to get them into custody and get them to appropriate locations so that they can be evaluated, stabilized and possibly treated again. Those aren’t making the headline news all the time. Only the ones involving weapons and particularly the ones involving weapons where things go badly, the majority of our calls are not going to be involving weapons when we’re dealing with people in crisis. But I can again only say that anecdotally, because I haven’t actually looked at the statistics lately. But from my perspective, I would say that it’s definitely the ones that people aren’t going to be interested in hearing about.
Gabe Howard: The statistics are very clear that the majority of the calls are are pretty mundane and pretty boring. Statistically, people with mental illness are much more likely to be victims than they are perpetrators. And you can kind of see why that is if you think about it for a moment. The majority of people with mental illness, you know, depression. Let’s take, you know, major depression, for example, which, of course, is where we get suicidality. You’re depressed. You’re not really moving all that much. So it’s it’s really difficult to perpetrate a crime when you’re unable to get out of bed. You are right. The media doesn’t help people with mental illness in a number of ways. The big thing that a lot of people believe, and I’m asking you as a police officer and what you’ve seen personally, are people with mental illness more violent than the rest of the population?
Ofc. Rebecca Skillern: I would say absolutely not. I would say exactly what you said. The statistics show that people with mental illness are more likely to be victims rather than perpetrators of crime. I think more often they are taken advantage of or they are easily manipulated or they are very vulnerable to being taken advantage of or manipulated and being victims of crime.
Gabe Howard: You know, again, crisis makes the news. And I’m glad that somebody like you is on the front lines to say, look, it’s just not true. We’re not saying that it never happens. That’s not the message of mental health advocates. We’re saying that it’s exceptionally rare. And we’re saying that it can be made even more rare because of police stations and police officers like yours. Is that what you found?
Ofc. Rebecca Skillern: It is. Oftentimes when we have officers who come through the training who don’t know much about mental illness, by the time they finished the weeklong training, they have a different perspective. I think the scariest part about mental illness for most people is that they don’t know it. They’ve not been educated about it. So they remain kind of in an ignorant position. People fear schizophrenia. There were surveys done years ago that indicated that people don’t want to live next to obviously child molesters and things of that nature. But pretty close to that on the list were people who had schizophrenia because they don’t understand it. And it’s all about education, you know, educating them and helping them to understand that these are symptoms. And, you know, this is how a person may respond and it doesn’t mean that they’re gonna be violent. Now, there are some situations where they might become violent, but that’s really more of an exception than a rule. It doesn’t happen as often as the movies would portray.
Gabe Howard: I agree with you completely. I do see CIT in Columbus, Ohio. And when I say I do CIT, I’m responsible for one tiny section and that’s the lived experience section. I’m a person who lives with mental illness and I come in and speak to police officers for a couple of hours as a person who is living well with mental illness. That’s my entire job. That’s my entire goal. And it’s amazing how people react because the police officers who, you know, let their guards down and who are being honest, they’re like, yeah. I didn’t think mentally ill people owned houses. I saw the car that you drove up in. And I didn’t I didn’t know you could own a new car. You seemed well-dressed. Oh, my God, you’re married? And I love this. I’m not offended by this realization. I’m encouraged by this realization, because when they’re honest, they’re like, look, we always see people in crisis. And because there’s no representation of people who are well, we think that we’re just spitting in the wind. Nothing good is happening. They have told me numerous times we didn’t know that our intervention could be step one to them becoming somebody like you and somebody like me. I’m not that great. I just I’m just a married guy who owns a home and has a job and pays taxes. And that’s that’s what we all want to be. We just want to be happy and live a life. But I think the police officers don’t have a good understanding that people like me are out there because we aren’t well represented. Is that what you’re seeing in your ranks as well, that they just think it’s a revolving door for people with mental illness? They go in. They come back. They go in. They come back and they don’t see the potential.
Ofc. Rebecca Skillern: I think sometimes, Gabe, that is how it’s perceived. The reality is we have many, many, many people who are functioning well in their lives who are also living with a serious and persistent mental illness, and their only contact with the police might be a traffic ticket. And they’re not gonna tell a police officer when they’re pulled over on traffic. Oh, by the way, I have bipolar, and everything is going well, but I have bipolar disorder, as you write my ticket. There’s no need for that. And part of what we do in the training is we try to normalize as much as possible. One of the points that I make the very first day of the training is I tell officers we might encounter in a crisis situation maybe five percent of the population. 95% of the population with mental illness we don’t know. We don’t have encounters that enlighten us to that information. The difficulty we run into, just like the the difficulty we run into with the criminal element, is that 95% of people are living live and they’re doing fine. It’s that bottom 5 percent that we do respond to over and over, whether it be someone who’s criminal or someone who is not doing well managing their mental illness. They need our help the most. The people we are encountering on a regular basis, people who are chronic consumers, many people their first experience of serious mental illness might be something that warrants a police engagement. And we might be their first entrance into the mental health system if we know what we’re looking at. If we understand symptomology and behaviors, we might be able to get them into the mental health arena quicker than they otherwise would have. And that’s because officers more and more are being trained in crisis and crisis intervention in mental health. And they can take the person in for care rather than in for photo opportunities at a jail.
Gabe Howard: I like the way that you worded that, but you’re absolutely right. And I’m glad that police officers in a lot of jurisdictions across the country are starting to realize the powerful role that they play in people getting help with mental illness, because you’re right, 20, 30 years ago, they knew it zero. Are you hopeful that these trends will continue and that it will get better and better as time moves forward?
Ofc. Rebecca Skillern: I absolutely am, Gabe. It is sad to me that we have gone so far into the criminalization of mentally ill. And we need to reverse that. We need to get people into treatment so that they stop having those encounters with law enforcement at the same time because of the role that we’ve been cast into, because people get scared when people go into rages or when they are so severely depressed that they’re threatening to harm themselves or someone else. They’re calling the cops and they’re calling police. We respond to those situations. We need to have our officers educated so that they can stay as safe as possible and keep the people around them as safe as possible. At the same time, we need to do more on the front end within our communities to get people into treatment before they engage in activities that lead to police encounters. We spend a lot more money providing services through the criminal justice system than we would if we gave them community based services. And we have to realize that if we do it on the front end before they have multiple encounters with law enforcement, is going to make everybody happy and be much more cost effective.
Gabe Howard: I love everything that you just said there.
Ofc. Rebecca Skillern: Right. Keep in mind, Gabe, that officers are trained to use whatever force is reasonable and necessary to take a person into custody when something is going wrong. At the same time, they’re also trained to continually reassess their situation so that they can decrease or increase that level of force as is necessary when they are able to detain a person and get more information and find out in that discovery and that investigation, they begin to realize or understand that this is something that is not normal or usual for this individual. They are able to better assess the situation nowadays when they’ve been through the training, of course, to see if there might be something else going on. And it gives them the understanding and the information that they need to make a better call and to use appropriate discretion to divert the individual into appropriate care.
Gabe Howard: Thank you so much for speaking with me on this. I know this is kind of a weird thing to say and maybe it’s not a popular thing to say. But throughout America, Texas is not known as a place that’s light on crime. And in fact, generally the opposite is true that Texas is tough on crime. And the very fact that you’re saying, hey, look, we’re trying to differentiate between people who need psychiatric help and criminals so that we can get them the right help. I really hope that this is not seen as, oh, we’re trying to let people off the hook. You’re not making excuses for people with mental illness. You’re not saying, oh, because you’re mentally ill, you can behave however you want and get a pass. You’re saying that you want to give them the right care, the right resources, whether that be jail or psychiatric involvement or wherever that may be. The last thing that you want to do is the wrong thing. And the very last thing that you want to do is nothing.
Ofc. Rebecca Skillern: Correct. We are very strong advocates for getting people into appropriate care and treatment. If someone has committed a crime and they are fully aware of what they’re doing is wrong, it does not matter if they have a mental illness or not. If they are completely cognizant that what they’re doing is wrong, then they have to be held accountable. And part of helping people to improve is helping them to accept accountability for their behavior. At the same time, if they don’t know what they’re doing, we have to recognize that, too, because you have to have intent as part of your assessment there. We want people to get appropriate care and treatment. And sometimes that appropriate care and treatment will be a hospital or a psychiatric emergency center. And sometimes they will need to go to jail. If there is a criminal nexus to it and they have culpability, then they have to be held accountable, just like you or me or anybody else. At the same time, if what they need is care and treatment, so that they don’t commit these minor offenses. Because for the most part, what we’re seeing with regard to mental illness is minor offenses is not something that’s going to be huge and significant to the point that it requires that other level of response. If they get appropriate treatment, most of the time, you’re not going to see it again. You know, if they get what they need to stabilize and feel supported in learning coping skills and educating even their family members, because oftentimes families don’t know either. It helps them. And we don’t have to see them again.
Gabe Howard: And ultimately, that’s the goal. Because police officers live in the community with us. They’re members of the same society. They want all of us to be OK. Because then their neighborhoods will be safe and OK as well.
Ofc. Rebecca Skillern: Gabe, we are one community. You know, we live in the communities we serve oftentimes. And we want everybody to be happy and stable. I mean, we’re not singing Kumbaya sitting around the campfire together. But we want everybody to be able to be safe and live as productive a life as possible. Protecting and serving is why officers join departments and agencies across the country. No, it’s not because we want to go fight and chase and have gun battles. It is because we want to serve our communities. We want to protect our communities. We want to keep people safe, whether it’s from somebody else or from themselves. We want people to remain safe, of course. And officers, too, are susceptible to things like bipolar or depression or post-traumatic stress. We see it all the time. So no one is immune to mental illness and we recognize that as well. There are appropriate places for treatment and we would much rather people who need mental health treatment be in the mental health system than in the criminal justice system.
Gabe Howard: Rebecca, thank you so much for doing this. Thank you for just helping us to understand it’s really necessary and appreciated. Thank you.
Ofc. Rebecca Skillern: Absolutely.
Gabe Howard: And thank you, everybody, for tuning in. Please, now is your opportunity. Wherever you downloaded this podcast, give us as many stars as humanly possible. Use your words and write us a nice review. Share us on social media. E-mail us to your friends and help us go viral. And remember, you can get one week of free, convenient, affordable, private online counselling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentral. We will see everybody next week.
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About The Psych Central Podcast Host
Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.
Howard, G. (2019). Podcast: Policing and Mental Illness: A Better Approach. Psych Central. Retrieved on April 5, 2020, from https://psychcentral.com/blog/podcast-policing-and-mental-illness-a-better-approach/