De-Escalation Skills

Law Enforcement Academy

Asheville-Buncombe Technical Community College
Asheville, North Carolina
Crisis Intervention Team Training
September 27 October 1, 2010

Overview

1 days (12 hours)

Lots of role-playing practice in small groups
Goal is for you to feel very confident in your ability to deescalate
Model = E-LEAP
E = engage (wed. pm)
LEAP = listen, empathize, affirm, partner (thur. am)
Specific strategies for consumers who are disoriented,
intoxicated, suicidal, etc. (thur. pm)

Wednesday PM
What is de-escalation
Effective communication
Non-verbals
Behavioral crisis
Engagement

What is verbal de-escalation?

Verbal de-escalation is used during

potentially dangerous, or threatening,
situation in an attempt to prevent persons
from causing harm to us, themselves, or
others

Goals of Verbal De-escalation

Open up clear lines of communication
Build trust and validate the consumers
situation
Get the consumer talking about his
situation
Gathering the necessary information make
a good resolution

What is De-Escalation
De-escalation is less like a recipe or formula
and more like a flexible set of options.
No single set of de-escalation skills: we
have tried to put together a effective set of
skills by borrowing from multiple approaches
De-escalation will not always work

What is de-escalation

Both officer and consumer safety always remain

paramount concerns in a crisis involving a
person with mental illness.
Once officers become skilled in de-escalation,
they do not simply abandon all the training and
experience that came before it.
De-escalation is another tool that officers have
at their disposal to be judiciously applied in
controlling a potentially volatile situation, rather
than serving as a substitute for sound judgment
and attentiveness to safety.
7

Effective Communication
70% of communication misunderstood
Effective communication is defined as
passing information between one person
and another that is mutually understood

Effective Communication

Communication becomes more difficult when the

persons ability to understand what you are
saying and/or their ability to express their own
thoughts or needs are compromised by their
symptoms.
When they cant express their needs, they
become more angry and frustrated more quickly
and more frequently
Your ability to engage a consumer in
conversation and successfully resolve a conflict
often depends as much on how you say the
words you choose as much as the words
themselves.
9

Barriers to Effective Communication

Barriers to communication are the things that keep the
meaning of what is being said from being heard:

Pre-judging
Not listening
Criticizing
Name-calling
Engaging in power struggles
Ordering
Threatening
Minimizing
Arguing
10

Effective Communication

11

Non-Verbal

It is very important to be able to identify exactly

what you are communicating to others nonverbally
You may be trying to de-escalate the situation by
talking to the other person, but your body
language may be saying something else. The
consumer will react to want you are saying with
your body language
12

Personal Space

Persons with mental illness often develop and altered

sense of personal space. They require more space than
usual to feel comfortable and feel intensely threatened
when other people close in on them with no warning.
Invasion or encroachment of personal space tends to
heighten or escalate anxiety
Personal space in American culture is about 3 feet
Do not touch a hostile person they might interpret that
as an aggressive action
Announce intention: I need some space, so I am going
to back up.
13

Eyes
One eyebrow raised = sternness
Eyes wide open = surprise
A hard stare = threatening gesture
Closing eyes longer than normal = I am
not listening

14

Body Posture
Challenging postures that tend to threaten another
person and escalate the situation include:
Finger pointing may seem accusing or
threatening
Shoulder shrugging may seem uncaring or
unknowing
Rigid walking may seem unyielding or
challenging
Use slow and deliberate movementsquick
actions may surprise or scare the other person
15

Voice
Tone - Usually unconscious
Volume - A raised voice could create fear
or challenges
Rate of speech - Speak slowly This is
usually interpreted as soothing
Inflection of voice - I didnt say you were
stupid

16

Face
Jaw

set with clenched teeth shows that

you are not open minded to listening to
his or her side of the story
A natural smile is good. A fake smile
can aggravate the situation

17

18

19

20

21

What is a Behavioral Crisis?

A crisis is a perception of an event or
situation as an intolerable difficulty that
exceeds the resources and coping
mechanisms of the person
Unless the person obtains relief, the crisis
has the potential to cause severe
behavioral malfunctioning.

22

Behavioral Crisis?
Crisis intervention is emotional first aid
which is designed to assist the person in
crisis to return to normal functioning.
The focus of crisis intervention is whats
happening here and how!

23

Behavioral Crisis
3 reasons that a consumer may be having a
behavioral crisis:
Medical condition
Substance use
Psychiatric condition: 1) thought disorder;
2) mood disorder; 3) anxiety disorder; 4)
personality disorder
24

Behavioral Crisis

The majority of encounters that you will have

with consumers are because the symptoms of
their illness are not under control. Most
commonly, this occurs at the initial onset of
illness, during a relapse (that can result for a
variety of reasons) and when the person s using
substances.
The consumers behavior is usually a result of
his or her illness, rather than being criminally
motivated
25

Consumers typically will have

one of 3 feelings
Anger
Fear
Sadness/depression

26

What you may be seeing . . .

Consumers Inner
Experience
Hostility, evasion

Fear

Risk-taking

Elation

Self-destructive behavior

Depression

Odd, dangerous behavior

Confusion

Very odd behavior

Psychosis

Attempts at self-treatment
(e.g. drugs)

Hopelessness, demoralization

27

Behavioral Crisis

Given the low likelihood that emotional people in

crisis can succeed in rationalizing alternatives,
law enforcement responses to emotional people
in volatile situations cannot rely on convincing
people by making a rational proposal to think
differently. Rather, responders need to create a
stable and respectful environment within which
emotional individuals can take comfort and
relief.
28

Engagement

Be aware of your setting; personal safety first

Move to a safe place if necessary
Allow plenty of space
Persons with mental illnesses often can be
expected to process information slowly and to
have difficulty remembering things. This includes
understanding and remembering instructions
given by a police officer.
29

Engagement
Be aware that a uniform, gun, and
handcuffs may frighten the person with
mental illness so reassure consumer that
no harm is intended.
Remain calm
You will likely have contact with the
consumer again; how you treat him will be
important for establishing trust

30

Engagement
Know when to act: A person may be acting
dangerously, but not directly threatening
any other person or himself/herself. If
possible, give the consumer time to calm
down. This requires patience and
continuous safety evaluation.
Allow partner to de-escalate others on the
scene as necessary

31

Engagement

It is the wise officer who can, at times,

conceal his or her combat-ready status.
-Lt. Michael Woody

32

Avoid

Maintaining continuous eye contact

Crowding or cornering the consumer
Touching the consumer unless you ask first or it
is essential for safety
Letting others interact simultaneously with the
consumer
Negative thoughts (God, this is another one of
those homeless people.)
33

Avoid

Expressing anger, impatience or irritation

Inflammatory language (You are acting crazy.)
Feeling as though you have to rush or feeling
like you are stuck if it takes time to get the
consumer talking
Intervening too quickly or trying too hard to
control the interaction by interrupting or talking
over the consumer.
34

Avoid

Saying You need to calm down.

Shouting or giving rapid commands
Arguing with the consumer
Taking the words or actions of the consumer
personally (They are symptoms of mental
illness.)
Lying, tricking, deceiving, threatening the
consumer to get her to comply
35

Avoid
Asking why questions. Why questions are
logic-based. Persons in crisis are not
logical. Typically, what ever has worked in
the past is not working now. Why
questions put the consumer on the
defensive. Ask open-ended questions.
Forcing discussion

36

Avoid
Minimizing the consumers situation as a
way to elicit conversation (Things cant be
that bad, can they?)
Suggesting that things will get better; they
may not
Making promises that you may not be able
to keep

37

Avoid

Commands such as drop the knife, or Get

down on the ground might seem to be
straightforward and easy to understand. When
dealing with people who live with mental illness,
however, officers need to take into account the
types of barriers to effective communication that
the brain disorder might create.
Telling the consumer I know how you feel.
38

Avoid

Asking a lot of questions of the consumer in the

beginning. This is a natural tendency, however,
this is generally not a good idea, especially early
in the interaction. In de-escalation, encouraging
the consumer to continue talking is more
effective than asking a lot of questions. It will
help continue the dialogue and will provide the
consumer with opportunities to give information
that will help to resolve the crisis.
39

DO

Speak in a calm, slow, clear voice

You may need to repeat; the consumer may be
distracted
Be patient; give the situation time; time is on
your side
Try to reduce background noise and distractions
Use and instead of but
Obtain relevant information from informants
40

DO

Allow the consumer to ventilate (Tell me some

more about that.
Use please and thank you often
Remain friendly but firm
Ask the consumer if she needs something
Offer a cigarette, nutrition bar, warm clothing
Forecast: Announce your actions and
movements
41

DO
Accept the consumers feelings, thoughts
and behavioral; acceptance is not easy
when a consumer is behaving in a bizarre
or hostile manner
Respect the dignity of the consumer
without regard to sex, race, age, sexual
orientation

42

Hot Buttons
Consumers will sometimes push a hot
button
We all have them
Example: The consumer calls you a pig
or swears at you.
This is NOT the time to demand respect

43

Hot Buttons: Rationale Detachment

Staying

in control of your emotions

during a crisis situation
3 steps

44

1. Develop a Plan
Decisions

made ahead of time are

more likely to be rationale
Identify your hot buttons
Strategic visualization practice
what you would do
Helps you gain confidence
45

2. Use Positive Self-Talk

You are not the target of the outburst
Never take anything personally
Remember that most of us have been
irrational and said inappropriate things
when we are under extreme stress

46

3. Recognize Your Limits

Let someone else take over if
necessary
Set a limit with the person; use an I
statement; I really want to help you
but I find it difficult because of your
name-calling; could you help me and
stop the cursing so that I can work on
helping you. Thanks, I would
appreciate it if you try.

47

The Logic of De-Escalation

If you take a LESS authoritative, LESS controlling,

LESS confrontational approach, you actually will
have MORE control.
You are trying to give the consumer a sense that he
or she is in control.
Why? Because he or she is in a crisis, which by
definition means the consumer is feeling out of
control. The consumers normal coping measures
are not working at this time.
48

Introduce Yourself

An introduction promotes communication

Hi, my name is Doug (or Deputy Smith). I am a
CIT officer with the Sheriffs Department.
Can you tell me your name?
State what you see/know (I can see youre
upset.)
State or convey that you are there to help.
Be prepared to explain the reason you are there
(e.g., a neighbor called to say someone is upset)
49

Introduce Yourself
How many of you can have someone tell
you her name, and within a few seconds
you have already forgotten it
Make a point of immediately starting to
use the consumers name; that will help
you remember it
Use the consumers name often

50

Introduce Yourself
Get out of here you damn cop!
Dont take the bait and turn confrontational

51

Role-playing Scenarios
Role-playing is a learning tool
Allows us to try out new approaches
Expect mistakes; they are an opportunity
to learn
You can rewind and try again

52

Role-playing Scenarios
Everyone feels uncomfortable in role play
Feedback will be constructive
Scenarios are derived from real-life
experiences
We will be working as a team to assist one
another in skill development
Small groups: 3 rolesLaw enforcement,
consumer, observer

53

Thursday AM
Listen
Empathize
Affirm
Partner
What Ifs
5 special strategies

54

L = Listen
Silent and listen are spelled with the same
letters
Listen twice as much as you talk; thats
why you have 2 ears and 1 mouth
What is the difference between listening
and hearing?

55

The Chinese symbol for listen:

eyes, ear, heart

56

Listen
Listen for the total meaning
Focus on what the consumer is telling you
Block out distractions

57

Listen

It is important understand and remember that

what the consumer is saying or believing may be
real or imagined. Since mental illness is a brain
disease, thinking is what is most affected by
mental illness. Sometimes their thoughts are
disconnected and youll hear this in their speech,
which can be difficult to follow and make sense
of.

58

Techniques that Show You Are

Listening
1.
2.
3.

Minimal encouragers
Reflecting
Ask open-ended questions (Can you tell
me more about that.

59

Minimal Encouragers

Minimal encouragers are brief statements that can

be either nonverbal, such as a positive nod of the
head, or simple verbal responses such as Okay,
Uh-huh, I see, I am listening.
Minimal encouragers demonstrate to the consumer
that you are listening and paying attention, without
stalling the dialogue or creating an undue
interruption. Especially early in the encounter,
consumers need these types of encouragers to feel
that the officer is really attending to them and
listening to what they are saying.
60

Reflecting

Whereas minimal encouragers provide initial

confirmation that you are listening, reflecting adds
another dimension to the communication. Here,
you provide the consumer with evidence that you
are listening by actually repeating what he or she
has said. Often the reflecting response will simply
consist of the last few words the consumer says.
These statements should be brief and used in
such a way as not to interrupt the consumer.
61

Reflecting
Repeat the last few words that the
consumer said
Example: I am tired of everyone not
listening to me and it make me angry.
Jim, it makes you angry.

62

Open-Ended Questions
Open ended questions allow you to get
more information
Open ended questions enable us to
assess the consumers level of
dangerousness
Open ended questions allow you to
assess whether the consumer is in touch
with reality

63

Specific Questions That You May Want You

Ask, When Appropriate

Does the consumer need something (e.g.,

hungry, thirsty)
Is the consumer receiving services
Where is the consumer receiving services
Does the consumer have a case manager
Is the consumer taking medication
When did the consumer last take his or her
medication

64

Medication

Mentioning medication must be given careful

thought.
In some cases, the topic is best left to mental
healthcare providers after the consumer has
calmed down.
In other situations, the consumer may want to
talk about his or her medication.
Also, many consumers have had negative
experiences with therapists and dont want to
talk about it their counselor.
65

E = Empathy
1.
2.

Emotion labeling
Paraphrasing

66

Empathy

What is the difference between empathy and

sympathy?
Feeling sorry versus trying to understand what it
is like to be in their shoes.
Being sincere and real will convey understanding
To my mind, empathy is in itself a healing agent .
. . because it releases, it confirms, it brings even
the most frightened person into the human race.
If a person is understood, he or she belongs.
(Carl Rogers)
Its hard to stay angry and aroused when
someone empathizes
67

Emotional Labeling

In emotional labeling, you again take listening to a

higher level by trying to help the consumer identify
feelings.
This is different from telling the consumer what he
or she is feeling because your statement is based on
what the consumer has been communicating
through his or her words and behavior.
If you have used your listening skills well, it will often
be rather easy to provide an emotional label to assist
the consumer.
68

Emotional Labeling Examples

You seem to be . . . .
It seems to me like you feel . . . .
If I were in your situation, I think Id
feel . . .

69

Paraphrasing

Paraphrasing is similar to reflecting except

that now you begin to communicate that
you are trying to understand the
consumers entire message by putting
what the consumer has said into your own
words.

70

Paraphrasing
Builds rapport between officer and
consumer
Helps the officer refine the assessment of
the crisis
Provides information that lays the
groundwork for an eventual resolution of
the crisis
Communicates that you are listening and
understanding

71

Paraphrasing Examples
Consumer: I dont know what I am going
to do. My family doesnt want me here.
CIT Officer: Youre not sure where you can
stay for awhile, but home doesnt seem
like the best place right now.

72

Paraphrasing Examples
What I hear you saying is . . . .
If I am hearing you right . . . .
Let me see if I understand what you are
saying . . .
These types of statements also
summarize what has been said in the
communication.

73

A = Affirm

You need to know what the consumer is upset

about
You may have a tendency to go to the solution
step without really identifying what the issue is
with the consumer. You should not assume that
you know why the consumer is upset. You
should ask and let the consumer tell you what
the problem is before looking at possible
solutions.
After getting the information that you need, steer
the conversation toward a resolution by affirming
the consumers situation
74

Affirm Example

Okay, let me make sure I understand you,

Youve told me that people are bothering
you and that your case manager is not
helping you. That your meds are hurting
you because they make you feel sick. Did
I understand you correctly.

75

P = Partner
Also plan, problem-solve
Goal is to find a resolution and return to
pre-crisis state.
You are looking to find the combination
that will unlock the crisis.

76

Partner
You can ask the consumer what she
thinks will resolve the problem
Look for alternatives with the consumer
Try to have 2 or more options
Empower the consumer to choose
If one approach doesnt work, throw
another lure

77

Partner

Putting yourself in the consumers shoes will

help you find a solution
Dont force particular points of discussion
Try to get agreement on a course of action.
Repeat what the plan is and what is expected.
Meet reasonable demands when possible
Reach for small concrete goals
Its never too late to reassess and change a
plan
78

Partner
If repeated attempts fail, set firm limits and tell
the consumer that you are worried about his
safely and you want to help him.
Ask if there is a family member you could talk
to.
State your expectations by linking to safety
issue: I need to make sure that everyone
stays safe.

79

Partner
In your attempts to resolve an escalating
situation you may be tempted to use
bargaining, deal-making, or saying/promising
anything to gain compliance.
They are not recommended as they
ultimately violate trustwhich is important in
your repeated encounters with people.

80

Resolution
Can it be informally resolved?
Is an evaluation needed?
Are commitment criteria met?
Was a crime committed?

81

What Ifs
What if the consumer asks you a longterm question?
Say that you dont know the answer but
that you and the consumer can handle the
immediate situation

82

What If
The consumer says that theres nothing
you can do to help?
Say that youre not sure what you can do,
but that you want to work with the
consumer to figure out something

83

What If
The consumer will not engage problemsolving and is distracted?
Say Stay with me, Frank. Lets work on
this together. Id like for you to stop for a
minute and take a deep breath with me.
Like this. Thats good. Thank you, Frank.

84

What If
The consumers moves too close you?
Say I need some space, Jim, so I am
going to back up.

85

What If
The consumer is talking so loudly it is
disruptive?
Drop the volume in your own voice and
say, Jim, I am having a hard time
understanding you because of how loud
your voice is.

86

What If
You think the consumer might become
aggressive?
If possible, bring in another trained
person.
There is less chance of aggression if two
people are talking to one person.

87

What If
The consumer will only respond nonverbally, like with a head nod
Respond positively

88

What If
The consumer remains unresponsive?
Simply validate the consumer by stating
what you observe about their situation
You look really sad; you must be really
hurting right now.

89

Five Special Strategies

1.
2.
3.
4.
5.

Assertive Intervention
Corrective Action
Reducing Stimuli
Reducing Arousal
Pro-active (as opposed to reactive)
engagement of consumers

90

1. Assertive Intervention
Can be used when:
The consumer is uncooperative or
unresponsive to directives that they are
expected to follow.
The consumer is violating rules which
serve to maintain security

91

Three Step Assertive Intervention

1.

2.

3.

Empathy statement: A statement that lets the

consumer know that you understand where he or
she is coming from and how he or she likely feels.
Conflict statement: A statement that describes to
the consumer that you have a conflict that needs
to be addressed.
Action statement: A statement that lets the
consumer know what you want him or her to do.
This statement can be in the form of a request.

92

Examples

Jack, I understand that you are upset and that

you feel like no one is listening to you or doing
enough to help you. But you and I need to let
these people get back to work here, so we are
going to have to get out of this waiting room. Id
like you to walk with me down the hallway to an
empty room so you and I can talk.
It looks to me like you are pretty upset, and Im
here to help you. But I am afraid someone is
going to get hurt by those stones. So Id like you
to stop tossing them and step up here on the
curb so I can talk to you and try to understand
what is going on with you today.
93

Choice
If possible, offer a choice:
Joe, I want you to stop throwing the stones or, if
you prefer, step over here with me on the grass
and throw them in the grass while we talk. What
is best for you?
This helps the consumer save face.
Everyone reacts better to a choice versus being
told what to do.

94

2. Corrective Action: AAA

If you make a mistake (and you will) and the
consumer escalates:
1. Acknowledge: Jim, I can see that mentioning
your medication is a real sore point.
2. Apologize: Im sorry to have upset you. I didnt
mean to.
3. Try Again: I want to help, not upset you, so
lets try something else.
95

3. Reducing Stimuli

Remove the audience or move the

consumer to a private space
Turn off flashing lights

96

4. Reducing Arousal

Encourage the consumer to take 3 deep

breaths; you can do this with the
consumer. Lets take 3 deep breaths like
this; then demonstrate and do it with the
consumer.

97

5. Pro-active Engagement
of Consumers

Many of you will interact with the same

consumer on repeated occasions so you will
get to know him or her. If you talk to a repeat
consumer on a good day, you will have
much better information to base an
assessment come the bad day. That
information will provide greater options for
resolving conflicts.
98

Pro-active Engagement of
Consumers

Drop by the consumers residence. Ask if there is

anything you can do to help. (e.g. call the case
manager to try to access a resource for the
consumer.)
If you see the consumer in the community,
acknowledge him or her. Stop to say hello if it would
not embarrass the consumer.
Get to know some of the providers (e.g., case
managers) who serve your consumers.
99

Thursday PM
Verbal

Intervention Strategies for

People who are Suicidal,
Homeless, Delusional,
Hallucinating, Confused, Agitated,
Intoxicated, Having Flashbacks,
Manic
100

Review of Terms

Thought Disorder = usually a reference to a

psychotic disorder
Psychotic = out of touch with reality; often
experiencing delusions or hallucinations
Delusion = false belief
Hallucination = false sensory perception (most
common is auditory)
Mania = A manifestation of bipolar disorder
(manic depression), characterized by profuse
and rapidly changing ideas, exaggerated
sexuality, gaiety, or irritability, and decreased
sleep
101

Suicide

Asking about suicide: Sometimes when people have

been feeling down for a long time, they begin having
thoughts that they would rather be dead, are you having
any feelings like that?
Have you ever tried to hurt yourself before?
When and what did you do?
Do you have a plan now?
Do you have any weapons that you could use to hurt
yourself?
Show support and interest
Be non-judgmental and accepting
Offer help that is available
Assess availability of supports
102

Suicide: Threatening Harm

Focus on the anger or fear that is causing
the threats
Repeat that you are here to help and keep
everybody safe
Get the names of significant others (even
pets), as a way to make a personal
connection and keep the consumer
grounded

103

Suicide Attempt

Verbal communications should focus on

providing hope for the consumer during a time
when he is feeling hopeless.
Generally, helpful comments to make during
questioning include: These feelings will not last
forever, even though it may seem like it now.
There is help available. Many other people have
felt this way and have gotten better.
104

Suicide Attempt

Unhelpful comments include clichs such as,

Theres a silver lining in every cloud, or
comments about all that they have, You have a
nice home, family who loves you, who will take
care of your kids. And finally comments about
yourself, I felt the same way once or a friend of
mine felt this way once. These types of unhelpful
comments only elicit more profound feelings

105

Homelessness
40% of homeless persons have a mental
illness
The ways in which homeless people dress
may seen bizarre to other people
Mental health professionals may refer to a
homeless persons choice not to take
medications as noncompliance, but to a
homeless person the decision not to take
sedating psychiatric medications may
make good sense.

106

Thought Disorder
The 3 possible responses to a person who loses
contact with reality, and are either hallucinating or
delusional, are:
Agree with them
B. Dispute them, or
C. Defer the issue
A.

Which is the appropriate response: A, B or C?

107

Thought Disorder

The engagement goal is to validate the consumers

situation and how frightened and anxious he must feel
without agreeing with their hallucinatory/delusional
experience.
It is OK to indicate that you do not hear or see what he is
seeing/hearing but that you believe he does.
Persons who are psychotic develop an altered sense of
personal space and require more space than usual to
feel safe.
Remember to maintain a safe reactionary distance of
from the consumer.
Use friends and family members to get information if
they are available and their presence is not escalating
the consumer.
108

Delusions

Paranoid delusions can lead to dangerous

behavior because they cause a great amount of
fear. This is especially true if the delusion
includes a belief that ones thoughts are
controlled by external forces.
Convey your acceptancebut let the consumer
know that you are not experiencing it and
reinforce reality.
I can see that you are scared that someone is
out to get you, but I dont know of anyone who is
trying to hurt you . . . Im here to keep you safe.
Dont argue about the delusionno one will win
this argument
109

Hallucinations
Ask if they are hearing voices: When
people are stressed or scared, they may
hear or see things, is that happening to
you.
Ask, are the voices telling you to do
something, what?
People who are abusing substances or
are in withdrawal may see things or feel
things crawling on them

110

Hallucinations

Indicate that you understand that those

experiences are real and frightening for the
consumer.
You can attempt to calm the person by letting
them know that voices may quiet if you can
help the consumer lessen their stress and get
help.
You may have to repeat a reassuring message
many times before the consumer can respond to
it. Repeat: Im here to help; I am not going to
hurt you.
111

Hallucinations
Hallucinations/voices that are command
oriented involving religion, good versus
evil, or are declaring self-harm are higherrisk than non-religious, nonconfrontational hallucinations.
This can lead to dangerous behavior
because many persons will obey the
command.

112

Confused/Disorganized Speech
People with a variety of mental illnesses
may experience confusion: schizophrenia,
bipolar, neurological disorders, traumatic
brain injury, people who are actively using
or withdrawing from substances
Keep interactions brief and to the point

113

Confused/Disorganized Speech
When it is difficult to understand the
consumer, say so and ask for clarification.
If the consumer is rambling nonsensically,
comment periodically that you realize that
he must be frightened and that you are
there to help.
Drop the volume in your speech and say,
I am having a hard time understanding
you because of how loud your voice is.

114

Agitation, Anxiety, Fears

Encourage 3 slow deep breaths
If this is difficult for the consumer, ask him
to look at you and do it with you
Reassure and converse calmly

115

People Who Are Intoxicated

Remember, substance use, especially alcohol is

a significant risk factor associated with violence.
Do not let your guard down (She is only drunk.)
Keep statements brief and to the point
Avoid engaging in arguments
Point out that it is difficult to understand what is
being said

116

PTSD Flashbacks

Some people with post traumatic stress disorder

experience flashbacks. During a flashback, the
person is experiencing the traumatic event. So
all the senses and thoughts are in the moment.
It is really important to maintain personal space
and avoid touch during a flashback.
Orient and ground: My name is . . . today is . . .
you are (describe where), its our job to keep you
safe
Provide simple directives and reassurance softly
and slowly
117

Rapid Speech / Mania

Some people talk rapidly when they are
stressed or scared. People who are manic
often talk very rapidly
Encourage the person to slow down, take
deep breathes.
I want to understand what you are saying,
but you are talking really fast. Lets take
some deep breaths together.

118

Acknowledgements
This material was adapted from numerous sources,
including:
Memphis CIT Curriculum
Sam Cochran
Randy Dupont
Georgia CIT Curriculum
Responding to Individuals with Mental Illness by
Michael Compton and Raymond Kotwicki
Connecticut State Department of Mental Health
and Addiction Services
Findlay/Hancock County CIT
119

Thank you for going the extra

mile to help people with mental
illness!

120