Use Of Police And 911 For Mental Health And Psychological Emergencies

By: Michael G. Conner, Psy.D, Clinical & Medical Psychologist

E-mail: Conner@OregonCounseling.Org
Resume: www.OregonCounseling.Org/Resume.htm
Phone: 541 388-5660

Revised:  May 21, 2014


Comments By The Author.  This article is based on three years of intensive work by the author with police officers, emergency medical service (EMS) and 911 dispatchers located in four surrounding counties in the Portland Metro area.  In addition to working with these fine professionals on a weekly and daily basis, I developed and conducted year long and weekly training programs for law enforcement and 911 to deal with people in crisis and people experiencing mental health and psychological emergencies.  Nearly all of the training materials and programs I developed are based on my research, participation and observations of police officers and dispatcher who were not only outstanding, but recognized and respected by their fellow professionals. This paper is also based on years of experience working on crisis lines and hospital emergency rooms where I had frequent contact with 911, police and EMS services.  I have witnessed and been involved in miraculous successes and I have witnessed some of the most tragic failures in the history of local 911, police and EMS services. 

I am admittedly a strong supporter of police, EMS and 911.  I was a fireman and EMT at one time in my career.  My Sister is a decorated police officer in L.A. County.  My Grandfather was also a decorated police officer and the chief of a police department in Bakersfield California for 25 years. 

 

Not knowing when and how to involve 911, police and EMS is the main reason things don't go well.  Familiarize yourself with how these community services work.

Introduction

The role of police and 911 when dealing with mental health and psychological emergencies is an extremely important public service.  Few people appreciate how difficult and important the job is until they need help.  Television reenactments and docudramas portray these jobs with an element of truth, but these jobs are far more complex and involve issues that the media never encounter.  Unfortunately, the public's expectations and assumptions are invariably mistaken about what can or will happen when 911, Police or EMS are called upon to deal with mental health and psychological emergencies.  Understanding what happens, and what can happen, may help if you ever anticipate the need to call 911, the police or EMS for assistance.

First of all, there is tremendous variability between police agencies, their training, their professionalism and their general orders when handling a call that involves angry, aggressive, violent, suicidal, self-harming, dangerous or severely disturbed behavior.  There is also tremendous variability within 911 and law enforcement regarding their attitudes, skills, patience and the degree to which they are willing to be thorough when handling a call.  In the State of Oregon there are fairly uniform procedures which 911 dispatchers will follow when assessing your call.  These apply when giving you direction and dispatching police or emergency medical services.  Police usually have general orders that set forth guidelines, but these can vary significantly and usually give officers wide latitude which is both a necessity and occasionally a problem.

About  911

When calling 911, it is absolutely essential that you cooperate with the dispatcher.  This means you should listen and answer their questions.  Don't argue when they insist that you answer certain questions.  They are trained to ask specific questions and to respond in a particular manner.  There are reasons.   Don't worry if you are upset.  911 dispatchers are experienced and trained to deal with people who are distressed or in a panic. 

There are many reasons why you might call 911.  The following is a partial list of  the primary mental health and psychological emergencies that 911, police and EMS handle.

  • Self-harming behavior.  When there is evidence of intent or an immediate risk of physical harm.   [ link scheduled for June ]
  • Strange, unusual or disorganized behavior.   When there is behavior that may be dangerous or the result of a medical emergency or health problem.

You may have noticed above that I used the words, "When there is evidence of intent or an immediate risk..."  Of course 911, police and EMS will respond to calls in which there may or may not be evidence or an immediate risk.  They call this response a "welfare check."  However, the priority assigned to the call will depend on the dispatchers assessment of the situation.

911 calls are recorded and every call is assigned an incident number.  It is a good idea to ask for the incident number if you call.  911 will not normally give you an incident number unless you ask.  Having the incident number can help tremendously, especially if you need to call back.  If the call was for someone else, the incident number can help you track down and find out what eventually happened. 

911 calls are matter of public record and are not confidential. You can generally obtain a tape copy of any call if you know the incident number or time, especially if the call involved you.  911 is usually reluctant and slow to give people a copy - even though it is relatively easy for them to make a copy.   The delay is usually part of their risk management protocols.  Even though dispatchers routinely make copies of a call and listen to them later, there is no point in forcing the issues of getting a tape quickly unless the matter is extremely important. 

The personality, attitude and professionalism of 911 dispatchers varies considerably.  In fact, there are a significant  number of dispatchers who are routinely overworked or severely distressed by their jobs and working conditions.  Some have serious personal and psychological problems.  These problems can have a negative effect on how they handle your call and how they treat you.  The fact that your call is recorded is a good assurance that you will be treated in a professional manner.  Supporting 911 programs to improve working conditions and employee health is important.  Unfortunately very few people who are treated unprofessionally will ask for an incident number, ask for a copy of their conversation with a dispatcher, and then file a complaint. 

Fortunately there are many dispatchers who are extremely professional and talented beyond anything you could imagine or would ever see on television.  Some dispatchers are more than highly trained and experienced.  There are dispatchers who are naturally gifted in their ability to remain calm, to manage a crisis on the phone, to assess a problem, and manage all the activities that may follow.  The job of 911 dispatcher is incredibly complex and requires the ability to manage powerful emotions while involved in multiple competing tasks and resources all at one time.

Communication breakdown and loss of information is the biggest problem when calling 911.  Imagine that you call 911 with first hand or second hand information.  The 911 dispatcher will ask you questions, listen, ask more questions, give you some direction, and take further action. 

Based on the information you provide the dispatcher will give the call a priority and dispatch the necessary resources.  In some cases this may involve dispatching police or EMS (or both) to your location or to another  location.  How police or EMS handle calls involving mental health and psychological emergencies can vary considerably with the attitude of the caller, dispatcher, EMS and police.

What a dispatcher will tell police or EMS can be quite different than what you assumed or expected them to say.  For the most part, there may be significant omissions of fact or content.  A dispatcher is trained to summarize a call and to use an abbreviated communication format.  Even when the dispatcher relays your content in the most accurate manner possible, unless the officer knows the dispatcher, he or she may disregard a great deal of what a dispatcher has to say about your call.   Whether it is deserved or not, 911 dispatchers are not usually considered reliable reports of fact by police primarily because the information may be third or fourth hand.  

About Police

Police officers, as a group, are professional and will do their best to get the job done. 

Asking the police to get involved with a mental health or psychological emergency will usually turn out fine.  Many officers have good to excellent skills when dealing with these problems. Most of the time a crisis will settle down by the time the officer arrives or calm down once the officer arrives.  Sometimes the situation will get worse when the officer arrives.  This may have nothing to do with  officer behavior.  In rare situations, the presence of police will cause a situation to escalate.  There is no way to predict this.   Escalation is usually very rare and should never be used as an excuse to not call 911 or police. 

There are other issues.  The amount of factual information and the observations necessary for an officer to take action will vary significantly.  Some officer are strict in their interpretation of their general order and their job description and will do everything they can to clear the call and get back to "real police  work."  In addition, there are many instances in which the lead officer who is responsible for handling the call will take minimal action where as the cover officer at the scene would have done a lot more.  This attitude is not common and is no longer encouraged or reinforced.

Officers in some law enforcement agencies are trained to respond and handle mental health and psychological emergencies.  Police in some cities have specially trained officers to handle these calls.  Most police departments do not.  There can be a world of difference between officers who are trained and want to work with mental health and psychological emergencies and those who don't consider it "real police work."  Dealing with parental problems when parents are unable to control or manage their own children is problem which police officers are generally unwilling and poorly trained to deal with.  Most police would consider their job to include law enforcement and community safety.  Police are unable to force children to obey their parents.  It is highly unlikely that an office called to a family dispute will coerce a child to comply with a parents wishes.

Most police officers do not enjoy working with what used to called "mentals".  Most prefer to avoid dealing with mental health and psychological emergencies.  Up until 1996, Oregon law enforcement recruits were  trained in the academy to think of people in terms of  "Criminals", "Know it all's", "Busy bodies", and "Mentals."  The FBI used to train recruits to think of people in terms of "Criminals", "Crusaders" and "Crazies".  This has recently been changed as well. 

There are other reasons why many officers prefer to catch other calls.  One main reason in Portland was based on how badly and unprofessionally hospitals and community mental health treated police officers and consumers in the past. This went on for years and had a significant impact on police officers.  Recent efforts have been made to change this - especially in Portland Oregon.  Still, most officers don't like dealing with mental illness, alcohol or drug affected behavior, or facing people who are strange and make them feel uncomfortable.  The level of support and respect officers received in the past was simply awful.

The personality and attitude of police officers dealing with mental health and psychological emergencies is absolutely critical.  For one thing, a police officer must be able to recognize and overcome the fear, anger and insecurities that their uniform and demeanor can inspire in some people.  Some officers are better at understanding the impact they have on different people and are outstanding in their ability to read people, manage a crisis, and determine the best course of action.  There are clearly officers who have greater interpersonal skill and the ability to deal with people in crisis.  Many are more highly skilled in facing and calming people in crisis than most people in the mental health profession.  Unfortunately some officers are not aware of the impact they have on people with severe mental health problems.   The mere fact that some officers have very little contact with these problems can make their job difficult.

You can expect certain things when police are dispatched to handle a mental health or psychological emergency. The first thing you can assume is that the police will not have all the information. You can also assume that police will be persuaded mostly by what they can see people doing and what people say in their presence.  They are more willing to take the word of bystanders or witnesses if there is physical evidence, a consensus of opinions or facts to corroborate the story.  

This can present a real problem for you if you have just called the police and in doing so angered or upset the person you are trying to help.  In some instances, people will pull it together temporarily once the police arrive.   If they can't, the police will get a pretty good idea of the problem.  All but the most out of control people will change their behavior and act normally when the police or emergency services arrive.   As always, don't assume police won't do their job.  At the same time, it is important that you help them and work with them to assure the best possible outcome.

A Word of Advice

  • Not knowing how or when to involve 911, police and EMS is the main reason things don't go well.  Familiarize yourself with these community services.
  • You should contact a representative of 911 and law enforcement if it is your responsibility or you expect to rely on police for personal or public safety.   Find out how things work and what you can expect.
  • To deal effectively with a mental health, crisis or psychological emergency, you must understand that what you can realistically expect from 911, police and EMS services. 
  • Once you are in the middle of a problem, there is not much you can do that will force 911, police and EMS to do things your way.  Cooperation can help tremendously.
  • Police, 911 and EMS have procedures and general orders to follow as well as responsibilities to other field officers who may need their assistance.
  • Most mental health and psychological emergencies are predictable.
  • The best thing you can do is to take responsibility for the problems you may be facing and develop a plan to manage a crisis when it occurs.  If you suspect the possibility of a mental health or psychological emergency in the future, take time to learn more about emergency services in your community. 
  • The best way to develop a crisis intervention plan is to consult with a qualified mental health or crisis intervention professional in advance.  Be sure you work with someone who understands community crisis services and has experiences using these services.