The People, Process, & Progress Podcast - Here is the Reality of What Crisis Intervention Team (CIT) Training Provides | PPP #26

Episode Date: June 9, 2020

I am sharing critical points from the Crisis Intervention Team (CIT) Training, which I completed alongside the Police as an EMS Captain. CIT trains all Public Safety personnel should be able to meet and an excellent tool to be included in any Police reform conversation.

Please silence your cell phones, hold all sidebar conversations to a minimum, and we will get started with People Process Progress in 3, 2, 1. Everybody, welcome to the People Process Progress podcast, episode 26, what is crisis intervention team training? So I'm going to talk about this, honestly, I did some research on slavery in America, policing in America, civil rights, I'm not an expert of those. It was a good exercise. It was good to learn about each thing beyond what I had known before. I thought, you know what, don't try and make your show fit a situation. Help it fit the progress

piece of People Process Progress. And so one thing that's come up in the news from police, from community, from frustrated people, but it's been in existence for a while, is crisis intervention team training. So I'm going to go through the people, where it came from, kind of the process of it, from programmatic development to what's the actual course like. And I'll speak to that. I took that course a few years ago in 2015 or 2016. And then progress, like how can we make progress with this? And how do you use it in real life? I've used it in real life in different facets that'll go on. I've seen others use it. It works. And it's very simple. It's just like my foundational four concept of objectives, organizational resources and

communication. We'll get into these four coaching plays, if you will, when you know a little bit later in this episode that is what can you do when you're dealing with someone in crisis and so boys I appreciate all of you that have listened please subscribe if you haven't on whatever platform or everywhere iHeart, Apple, Blueberry, Stitcher, etc. Please also give a rating if you can do that or help bump us up get this story out out there. Get other stories out there, interviews. My Two Cents. I really appreciate everybody that's reached out all over the world. Again, probably tired of hearing it, but I'm always very happy and fortunate that folks

from around the country listen to My Two Cents or those of my guests and their experiences. So please do that if you can. So crisis intervention team training or CIT training. So where did it come from? And I'm going to do this breakdown too because I'm in Virginia. I'm in Southwest Virginia. I used to live in Central Virginia. That's where in the city of Richmond actually I didn't live there.

I worked there when I took this training and did EMS. But in that Central Virginia area. And so what I'm going to do is kind of break down for kind of the people part, you know, and how it's a little bit different is the national kind of picture of crisis intervention team training. And again, I'll put the resources and stuff so you can read a lot of this on your own. And in Virginia, how it came to be and how it's expanded and stuff like that. So let's get into it. So where did it come from? So nationally, why, right? What's the why of things? Let's go Simon Sinek on it. Let's go knowing more than just you put this together and that, we want people to do this. So why? It's to provide a safer and more humane response in times of

crisis, for mental health crisis. So when I use the term crisis here and the term crisis intervention team, largely the focus is a mental health crisis. Some kind of breakdown from some condition or some like worst day of your life, lost your job, lost a loved one on the same, you know, you don't have to be. And that's a key component of this that you learn about when you learn more about mental health is you don't have to have a lifelong diagnosed psychological disorder or mental health. We've all had those horrible days. And you could have that one day where you snap and you're in a situation where someone calls to get you help. And someone's to show up. And largely a lot of the time

it's police, unless you have a really well built out program where you have behavioral health folks responding. You know, if it's scary, they think it's not secure. Police are going to be there. So I'm going to touch on nationally how this was made. And, you know, it's a result. The National Alliance on Mental Illness or NAMI, N-A-M-I, provided some funding, the seed funding, to the Memphis Police Department. So Memphis started this. The first CIT program was Memphis. It was formed in 1988. And it followed a fatal shooting of a man that had a history of mental illness and substance abuse. And so a Memphis police officer killed that person. This was a way to enable another tool in the, in the, in the, in the tool belt and the gun

belt of an officer. There's escalation of force. There's all this, again, I'm not a cop. I know a bit of it. I'm a family that are in friends. Um, but it was another tool that didn't involve injuring the other person or the police officer, hopefully deescalating. So they don't have to protect themselves. Because again,

someone on their worst day and their worst moment could make any decision. Someone with a long history of psychological disorders could make any decision to end their life and maybe want to take someone else with them or someone that's innocent, whether it's the police officer or the person next to them. So part of this is to de-escalate the situation and get this person to the help, not just a trip to jail or a trip to the mental health facility. And so 1988, Memphis, first program established. And then there's an organization, and I'll quote them a few times. And again, I'll have the links to this. CIT, or Crisis Intervention Team International, in 2005, was established, and it helped grow this program. So there's over 3000 programs across the US, right? That's pretty awesome.

And so again, when you hear about this in the news that we have to establish this, we have to do this. Crisis intervention team training exists in a lot of places across the country. So, which we'll get to later, what could be missing? What's a factor and whether it works or not? And we'll get into some of those and not for my, not for me, but from the expertise of folks who have established these, which are a coalition of people that set this up. How, so I mentioned, so NAMI or National Alliance on Mental Illness funded it. And it was again,

with law enforcement plus mental health and advocates and officials and elected officials, right? We've all got to work together. So that was how the first kind of the first place in the United States and then CIT International helped that grow. So what about Virginia? So coincidentally, I live in the New River Valley and in Southwest Virginia now, and the New River Valley CIT program was established in 2001. And it was 14 local law enforcement agencies in five localities for the nation's first multi-jurisdictional, comma, rural adaptation of the Memphis CIT model, right? So if you haven't been to Southwest Virginia, there's a lot of mountains and trees and wildlife. And so it's a pretty rural place,

pretty spaced out. And so physically spaced out, not necessarily like being spacey. So this was developed using grant funds from the Substance Abuse and Mental Health Services Administration or SAMHSA over a three-year period. So as a project manager, I can imagine all the components of that objectives, right?

The biggest one is to establish this program. You're pulling together 14 local law enforcement agencies, plus each of them have stakeholders, plus, you know, the mental health folks, and then over a three year period and getting this and a lot of the training and establishing the standards and all this stuff. The good thing is they had a model to go from with Memphis, and then they could take that and build how they wanted to. So that was in 2001 in the New River Valley. In 2007, the New River Valley CIT program received Virginia money from the General Assembly to expand the program statewide.

So other agencies, other departments, other leaders saw this and said, hey, we should expand that program. And so they did. And then a couple years later in 2009, there was actually a Senate bill, 1294 in Virginia, to support the establishment of crisis intervention team programs and areas throughout the Commonwealth. And then for that year, the next couple years, they wanted status reports, they said, Hey, you have to do this,

or it's highly encouraged, or here's the standards, and we want to get metrics on it, right metrics, data in, you know, garbage in garbage out. So what they wanted, though, was to see if we're going to spend these three years, if we're going to spend this money, if we're going to put this training together, we want to see how many are trained, how many incidents did you use it? Think of all the different things you would want to measure on the effectiveness of a new behavioral training system, right? Because this isn't, here's how you use this new weapon or this taser. We use this system to identify an issue, talk to this person, establish a rapport, and then redirect them to a system where, you know, police aren't trained in

this other than the CIT training they get, you know, a mental health professional's whole job, their whole career, their whole specialty is this. So it's a super hard challenge for law enforcement. I was very fortunate that my EMS agency sent us as lieutenants and me as the captain to this training. So we trained with the police in these scenarios, and then we could use it in the field. I'll talk about that. But you have to think about it. It's just such a great thing. And this was, you know, a few years ago, a decade or so ago, a little bit more, at least for Virginia, a couple decades. And so, you know, that's where nationally it came from. And Memphis is what

started it after an officer involved shooting with someone that had mental illness, Virginia in 2001, New River Valley. And then they expanded that throughout the state over the course of the next few years. And there's also been some discussion lately to particularly our city Richmond police officer that shot a man with mental illness. And so as I talk through the structure of this program of CIT, of what it's like, and again, I haven't been charged with someone that's yelling, they're going to kill me after they've gotten in a car accident, after they've run naked through a hotel. So think about if someone's doing that, and it's another grown human being, the intent is for someone like that, but can you talk someone down like that? Is that the time to

do it? And I'm not going to debate on this, but I want us as citizens to think about this, or if you're law enforcement or fire or anything else, think about that. If you've never been in a fight, if you've never grappled someone, if you've never been in any actual physical conflict, then you have no idea what you would do in that situation if someone actually charged you. So for all of you that have never done that, I just want you to think about that and think about, yep, there's some techniques that we'll talk about, these four coaching plays, these ways to talk people down. But the other key component in this is paying attention and keeping yourself safe while you're trying to deescalate. CIT is not a magic pill. It's not a special, you know, green lantern ring, you can pull out and say CIT and it just deescalates everything. It's one thing

to do before you have to do more than that. So I just want anyone that's thinking about, you know, oh, well, you should have done just done this or that. If you've never been in that situation, you've never used this, if you've never done the training, if you don't understand what it's like to be out there in the worst parts of your town, just take a breath and just consider that for a second. Talk about the ground up building of this, what was the impetus for creating CIT training, where it started. So let's talk about both again, CIT International, and then Virginia CIT, what are the outlines of a program. So if you're going to set this program up, and these are from best practice documents, again, both from CIT International and then from Virginia.

So CIT International defines a good CIT program as it's community-based with community responses, right? Community, meaning police, mental health, citizens, elected leaders, the public, right? It's got to be a team effort. Everything that's going to be successful in our society has to be a team effort. It includes people living with mental illness and their families, right? So if we don't ever interact with someone that has mental illness or the effect it has on their families until we go on that call, we're not going to understand them. But if we during training have that and we can see the person with schizophrenia or that's again just totally stressed out from a traumatic event or who knows what it is.

There's so many different things that could be happening. We need to get that feedback directly from them. What is it like when I show up in a uniform, whether I'm a cop or an EMT or a firefighter or even behavioral health folks? How does that make you feel? What has been helpful? What hasn't? And that's just like good lessons learned from anything, like a project or anything. So this is a project. If you haven't established a CIT program, and I don't know if there's a lot

of places that haven't, whether it's localities or police departments, you have to consider that you have to get the feedback of the people you're going to respond to and help, whether it's a mental health person that's going to go out there or a police officer or EMT or firefighter, whatever it is. It has to be based on partnerships and relationships. And again, these are early program definitions, not even just the how to do this best progress piece of it. But you know, that's key. They did a great job on this outline. It is not just law enforcement responses to mental health crisis, right? So right now what we're hearing is CIT training, CIT training for, you know, that applies to the cases where the call is for someone in distress or crisis, right? And is it drug related, which could be, is it veteran,

you know, experience related? Is it chemical imbalance? Is it whatever else? But it's not just the law enforcement part. Everyone has to take part of it. And that's from the CIT International program that would be involved in probably a lot of the places where the people are calling for CIT training these days. CIT International's goals. So let's set some goals. Let's see what their goals are. And again, these are direct from these sources. I will cite them. I don't need to make this stuff up. I'm tacking my two cents on here, but I hope it's helpful. So CIT International's goals to improve safety during law enforcement encounters with people experience a mental health crisis for everyone involved. Why you call 911 when you see someone that doesn't seem like they're acting right, or they're actually being violent, or

they're threatening or they're yelling. So law enforcement is going to be the first folks on the scene. The second goal to increase connections to effective and timely mental health services for people in mental health crisis, right? So while the folks in blue, the men and women in blue that are out there serving and protecting, which is no joke, hard already, let alone now, let alone with the scrutiny they're getting or working there, they're not the solution. Not everyone needs to go to jail or get an emergency detention order or whatever other legal means we can do to get them in a police car, which that makes its whole experience. But it's to get them to mental health services to solve the problem. Right. And mental health come up not just now with the protests and the riots from police killing, but it's also been talked about with school

shootings, right? So mental health is not just a police brutality focused thing or improving policing or whatever it is. It's also for the regular citizen for the teenager that wants to go grab a rifle and go shoot a school up right how do we recognize that earlier how do we how do we de-escalate that how do we do all these things so it's multifaceted the third goal cit international to use law enforcement strategically during crisis situations such as when there is an imminent threat to safety or criminal concern and increase the role of mental health professionals, peer support specialists, and other community support. So, you know, strategically, how could we have the law enforcement available, but not

send them right in? Because maybe that person, you know, is afraid. Maybe they did have a bad experience with law enforcement, or they're just, they're in such crisis, anyone coming near them, uniform badge or not, is just going to set them off. A good example of great work using CIT that's an imminent threat to that person's self is like a jumper, a person that's on the edge of a bridge or standing at the railing. And police are first on scene, and you don't want to talk about a delicate situation. You have to try and not be the last

person that person talks to and talk them off back over the railing, or talk them to be get close enough and grab just all these things. Just think about the burden that is on law enforcement. And remember earlier, it's not just on them, but they will be the tip of the spear, so to speak, at the CIT intervention to then get them to help with mental health. The fourth goal from CIT International is to reduce the trauma that people experience during a mental health crisis and thus contribute to their long-term recovery. Think about how traumatic it is. Say you have no history of mental illness, but you've just had that series of unfortunate events and you just are overloaded, especially now, locked up with COVID, right? Protests and riots all around you, whether you

participate or not, whatever. And then something else happens, something big, you lose your job, you're laid off. And you're just, you know, you can have so many different kinds of crisis. And so say the solution is, you know, someone calls and they say you need help. And the solution is that the police come to get you and you're combative because you're so upset. Well, you know, no one's going to let you just hit them because you're having a crisis, right? So then you are going to get an altercation, then something is going to happen. And that's not going to be a good experience, even if you get help, right? So using these plays, these techniques, setting up these programs is very helpful to help deescalate that situation when possible. And again, I've said when possible and quantified that

because you can't always deescalate a situation. You just can't. So this is one tool. Again, it's one process. It's one program that can be used. It's just being touted a whole lot now. So I think it's important to share what is this? How could it help?

How can we use it? And what are some examples of when I've seen it used either by myself or other folks that I've worked with? So let's look at in Virginia CIT. Now I'm going to get into the essential elements of a CIT program that Virginia uses. A lot of crossover, right? So this is specific to, you know, the one I said for CIT International is programmatically kind of big level definition goals. This is how you should structure or how Virginia is structuring these classes. Virginia CIT, Community Stakeholder Collaboration and Oversight, right? Same as the international

thing, same as every other program, has to be community collaboration. It can't just be law enforcement driven or just community driven. It has to be together. A CIT coordinator, so have someone in the department, in your program, that this is their job or a large collateral duty, right? You coordinate the training, the implementation, case reviews, everything that goes with good program management, good coordination is to establish a CIT coordinator. And part of these standards are from the Department of Criminal Justice in Virginia, Behavioral Health Department for Virginia as well. I'll help establish these.

The training is 40 hours, right? So it's a full work week. And that part, you have to do that to be DCGS certified Virginia. So anyone that takes this class, it's an actual full week class. You're going Monday through Friday, which is no small thing. So think about the practicality of scheduling that. If it's patrol, if it's sergeants, lieutenants, fire, police, EMS, whoever, you're pulling people for an entire week straight back to back. It's not one day this week, one day. You have to do it back to back as well. Train the trainer classes. So that way you have your coordinator. They get trained the trainer.

They train more, train the trainers. And what that means is I'm going to train you to then be able to teach this class as a trainer. And then we can keep this program going. dispatcher training, right? Because the first first responders, as we say, are 911 dispatchers. So when they get a call, and someone's in crisis, and they call 911, instead of the suicide hotline or something else, or the person is calling about the person in calling about the person in crisis, that 911 dispatcher can help walk them through maybe some steps to help the other person or talk to them on the phone. Policies and procedures. Got to have those, right? Hopefully they're pretty actionable and easy to look at, not, you know, one, 200 page things, but, you know,

when should we use this? How should we use this? How are we going to do case reviews? But as part of your program, it's how are we going to implement all these things? And then what are the policies of when you have to use it, when you should use it and all that kind of stuff. Therapeutic assessment location, not a law enforcement jail, but that means can we get someone in crisis to a place where they can talk to a mental health professional and as quickly as possible, you know, if they're not posing a threat to others or themselves. And, you know, again, that's in lieu of incarceration because the solution is not to jail, right? There's plenty of folks in jail that have mental health issues. There's been a lot of over the decades of defunding of mental health where there were whole hospitals.

And there's horror stories of some of the hospitals. But, you know, some of the hospitals did great work. But it was deemed not as important now, you know, and it keeps coming back. So the good thing for this program, and particularly Virginia's outline is it shouldn't be jail, right? We shouldn't just be scooping you up and taking you to jail. We need access to another place, but they're also got to balance how many places are there available. So when you establish a system, or if you have one, got to consider that collection of data. So I mentioned this to monitor outcomes, right? So we need to monitor how is this program working? How are interventions? What's, you know, how did it work

with this case? Did it deescalate? Did it go to violence? Did it go to self harm, you know, all that kind of peer review. And so that's Virginia's CIT essential elements that are built into the programs for Virginia crisis intervention team trainings. And so that's kind of the people component, folks that were involved in establishing this, folks that coordinate these programs, what are the standards they use, what are the goals they should aspire to

when you establish and maintain the program. So now I'm going to get a little deeper into the process of a CIT. Before I do, I want to get into the process of subscribing to the podcasts. Thanks so much. Please do that. Give us a rating. More stars is better. Share this training. Share so much. Please do that. Give us a rating.

More stars is better. Share this training. Share this information. Share these links. Or I hope you do. And I thank you all for doing that so far. So let's get into the process piece of this episode. So I'm going to do a training overview.

I touched on some of this because Virginia CIT gets into that. But we're going to break those out further. So when you take crisis intervention team, I mentioned it's one week you're going, people are encouraged to wear street clothes, right? Not just being uniform all the time so that you're not in a super official feel. It kind of changes the environment. And the class is typically taught by that CIT coordinator, which could be law enforcement, or we had trained the trainers that were EMS lieutenants or captains. I think ours are all captains or whoever got into it. And so, you know, that's who's teaching it. And it's, you know, you can do the polo cargo pant thing, which is very public safety ish. But that's, that's how it happens.

And so there's, it's 40 consecutive hours. Like I mentioned, it's one full week and you shouldn't have any more than 30 per course. The student to instructor ratio needs to be pretty good because as we're going to get into, there's a lot of practical application, a lot of you will break the ice really fast in this class, which is great. I mean, that's what needs to happen. That's part of the biggest challenge. That's a whole reason for this is recognizing crisis and communication and helping with that communication. So the class has to be book and practical application work, right? So didactic wise, so slides, teaching, stand up stuff. It's a combination of, and this isn't the exhaustive list, but it's mental health, meaning what are different mental health maladies or ailments or conditions that you may experience

or that are out there just as a general knowledge, substance abuse. What are the different drugs? What are the drugs that folks with mental health have to take and how do they affect them, right? Some of the medications people take make them constipated all the time and they're in pain. So it doesn't really help their affect, but it helps their balance. Whereas, you know, there's just the medications that we have given or some that we give or the combination of them don't make people feel great.

So when they're also having a crisis, that compounds it. And so what psychiatric meds? So I mentioned that. What verbal de-escalation skills? So you talk through what we're going to practice for the rest of the course, how you can do that. Veterans issues, particularly for almost two decades now, we've been at war between Iraq and Afghanistan and other places. And so dealing with veterans, and I've had a few calls with folks, whether it was domestic violence or suicidal thoughts or tendencies.

And it's a different element, right? You know, we hear about veteran suicide rates, which is horrible. You know, as a veteran myself and someone that's been out there and responded to those calls in a different uniform, not my Navy uniform, it's super hard to do that. But we cover a lot of that in the course, in the CIT course, on how to help talk folks through it. And the good thing is that, again, those four coaching plays we'll get into, they apply across the board. Just like the foundational four apply to project management, incident management, whatever else you can use these plays. I'm going to give those examples, whether it's a veteran crisis or medication thing or, you know, whatever it is, it's just knowing, hey, the underlying issue might be this instead of that. Another key component of this training is that

for Virginia, at least to be credentials, the law enforcement officer to take it. And there's, there's localities that now want to reach out to some of my friends today where they're police, fire, and sheriff. Everyone takes it, right? But you have to be certified for criminal justice. Included in this course in the didactic piece is civil commitment, so good citizenship, doing the right thing laws, and then two hours also of cultural diversity. So that's already built into the program. So I

will be interested in police reforms that, you know, at some level, are going to come out of, you know, all the protests and riots from the killing of George Floyd. Will that change? Will that increase? Will the material, you know, will the time span stay at two hours of cultural diversity and then the focus change? I don't know. But, you know, for a program that already exists, that's been brought up quite a few times in the news or, you know, other discussions, that seems like an area that's probably going to be looked at and maybe relations there. So maybe you could build that when we get into the kind of scenario work, you know, throw components in there, mix, you know, mix different races doing calls together. And, you know, again, because part of this healing is going to be real discussions,

right? Real scenarios, real training, real world stuff. But yeah, so didactic includes that already. So I'll be interested to see if that changes. The other piece for Virginia CIT structure, and again, I'm using this breakdown at this level because that's what I went through, is experiential, right? So you're going to go to site visits. You're going to go to mental health care facilities. You're going to go to therapy groups. They're going to come to you in a room, talk about their, you know, they have two personalities

or seven or they hear voices or they try to commit suicide or they're abused or, you know, what that has caused you know, what that has caused for them, what traumatic event has caused for them to deal with now. And you're going to get it straight from the people that are dealing with that. You're going to get straight from what their life is like at the center. Right. And so it's not comfortable for everyone. I was a corpsman in EMT. So I'm very comfortable around folks with either physical, various physical injuries, ailments. And I dealt with and worked in the psychiatry ward a few times. So I was exposed to it. It's not always 100%

comfortable, but it's a great exposure, great experience both for them and you. And again, this is much heavier CIT completed by law enforcement and fire EMS from what I know. But, you know, it's also good for them to see, you know, hey, I'm here and I'm doing this training because I want to get better at it, right. And again, there's always a percentage where folks have to go to it, like any other training. But you know, that's the whole impetus for departments putting a lot of time and a lot of money into this. Because remember, now we're paying all these people going to this class for 40 hours a week. So it's another consideration as there's, you know, chatter, which I think is frankly

ridiculous about defunding or disbanding police departments and they've thrown those those are two different words, but they keep being thrown around by the media. Because folks have no idea the depth of that unless you know, you've at least been exposed to or particular been a law enforcement officer. So consumer and family presentations, you're going to hear from relatives, family members of folks that have committed suicide, that have been in crisis that have hurt themselves that are incarcerated, all these different things. Again, you need to get their perspective. So you know, when you're on the street, and it's 95 degrees, and you're frustrated, and this person's screaming at you, but they're

not really a threat, how you can deescalate it. And that's not a made up scenario. That happens all the time. You need to, as part of that program, it's suggested, but this is what I did. There's an exercise called Hearing Disturbing Voices by Pat Deegan. And Pat Deegan has schizophrenia. So she developed this program where you have an iPod and you put these new the earbuds in and you just start hearing nothing really. Then you start hearing every now and then a word on one side and then the last side like, Oh, Hey, why are you doing that? Whispers. And then you start hearing, you're dumb. You're ugly. What? Why would you say that? And it's like your mind's having an argument with yourself, but you're dumb, you're ugly, what? Why would you say that?

And it's like your mind's having an argument with yourself, but you're not doing it on purpose. And while you do this, and I would advise everyone to look it up. When I Googled it, I was trying to find the recording of it. I don't know if I could play it here or not, but Anderson Cooper, I guess, did this exercise a few years ago. So if you Google hearing disturbing voices by Pat Deegan, you'll see that and probably get a little more exposure to the audio piece of it. But it gives you insight to your mind, as they say, playing tricks on you, but your

mind deciding things that you're not consciously deciding and then saying hurtful things to you at the same time they're lifting you up. And it's really disturbing. It's really insightful, though. And at the same time you're doing this, you have to write, I forget the exercise, but you have to write like all 50 states, I think. And then you have to put these like diamond shaped pieces of wood together in the shape of a fish.

Then you just so basically you're trying to do functions by using your brain. And again, I'm not a pro that thinks through problem solving like that or just memory recall while you're getting bombarded with these voices. It is, like I said, super eye-opening. I would suggest anyone that has access to this training or that exercise to do it to give you an idea of folks that have schizophrenia, however it's induced or something like that. The other thing we did in that program is we watched this documentary called The Bridge. And it's about, for folks, if you don't know, the Golden Gate Bridge has a lot of people that have jumped off. According to sci-com.net, where there's an article about

Kevin Hines, who survived jumping off the Golden Gate Bridge. So over 200 feet, going up to like 75 miles an hour and hitting water is not good. And broke you know vertebrae and ankles and we heard a little bit of his story um but it says since it was erected in 1937 more than 1700 people are estimated to have jumped off that bridge off the golden gate bridge which is pretty astounding so it's a super depressing i mean it's probably one of the most if not the most depressing documentary i've seen probably because it's real right it's probably one of the most, if not the most depressing documentary I've seen, probably because it's real, right? It's people on the bridge. You see them make that decision in their mind. Some just climb the rail and just jump.

Some climb the rail and stand there and hold on and then do it. Some climb the rail, stand there, hold on, and then are talked back off. Some get snatched by folks pulling them back up. But what it does is it really shows you a window into, you know, people make that decision to end their own life. And in particular there, right, whether it's because it's public or they know it's largely final or whatever reason. But, again, it's a window into mental health crisis. But I highly recommend it. Again, it's very educational because they talk through mental health issues.

And they talk with Kevin Hines, who survived him jumping. And so you get a lot of good insight there. So we watch that. So that's part of the experiential and then practical, right? So this is where the rubber meets the road. This is where you get pushed out of your comfort zone. And it starts with a buildup, super basic scenarios. So, you know, you've already gone through the slides that teach you the four plays.

And so we'll just do one of the plays. Let's just work on one. Okay, now two, some intermediate. We're just going to, they gonna they're gonna in the instructors that i had were fantastic because they know how to set the scenarios up they've done it so long both in real life and for training that they set the scenarios up where they expect you to use just this one primarily or these couple and then eventually advance it's full blown you have to be dynamic and use whatever plays you can. And again, not everything

fits in these four, you know, the four plays. So you have to, that's where you have to get into. They want to see how you adapt to the situation. So it's, it's like any great training. We got to give you some slides. We're going to have some discussions. We're going to give you some exercises. Now we're going to do this for more than one day, right? You start off doing exercises pretty, pretty quickly. And really to that, let me give you the class outline from Monday through Friday. So on Monday, you get that intro to CIT, you get the basic mental health, and then you do the hearing voices exercise. So your first day, you're getting a lot of information, you're gonna do that exercise, you're like, Whoa, this is something Tuesday, second day site visits, that's when you're going to see folks that have been in crisis, the family of folks that have been in crisis or maybe taken

their own lives or have substance abuse issues. And then Wednesday, you're getting right into your basic skills. You're starting to use those. You're getting more heavily into both learning more and applying the four coaching plays. And you're doing those basic role play exercises. Thursday's intermediate and then Friday's advanced. So you have to pass the scenarios. You can't freak out. You can't freeze up. You can't break some of the cardinal rules, so to speak,

that set people off that we'll get into here in a little bit. But you have to go through all these to get your pin and be certified and get your certificate in crisis intervention team training. So it is an outstanding training, but like every other training, it depends on how the person does or doesn't apply it in the real world. Right. But for training, I would say the tactical combat casualty care course, and then the instructor course and, and the CIT training are the two best realistic trainings I've had in, in the past decade or so, because it makes you feel like you were in a situation with someone in crisis, like the instructors role played, which you couldn't tell they were instructors, you know, someone digging up moon rocks that fell from a satellite in their backyard

and also happens to have a knife and then they pick up a baby, like no joke stuff. And the thing is a lot of the scenarios, like the one I just said sounds off the wall, but a lot of the scenarios are from real incidents. So again, here's a window into the world of police and public safety is this crisis intervention team training is really good, but some of these scenarios, even in practice, can't end with just a talk. And that's unfortunate, but that's also a reality that you get out of this class. It's really, again, it's outstanding. So I've talked about these four plays. Let's get into what they are, right? They're the four coaching plays. And so the principle of these when you, you'll notice if you've done communication training, or you know, you're in the business

world, even these have to do with just communicating well to and from other people, you know, you're in the business world, even these have to do with just communicating well to and from other people, you know, listening to listen, not just to answer those kinds of things. And so key principles of these plays are of CIT and applying this to be empathetic, not sympathetic, right? So I'm not going to give you sympathy and, oh, you poor dear, I'm so sorry, but you know, I can feel your pain. I can see the anger. I can, you know, that, right? So you're can see the anger. I can, you know, that, right? So you're going to show them empathy, empathy, empathize with them and understand, but not be sympathetic for their plight necessarily where you're looking down on them.

Be sincere and genuine, right? When you're on the street or you're in a shelter with a kid that isn't eating because his mom's taking all of his behavioral health drugs because she keeps saying that he's a problem, but he's really just as hungry. Again, not fake. You need to be real, right? And that's a different scenario, but you need to be real because it's that person's maybe worst day of their life. They don't want sugarcoating. They don't want just a pat on the head and condescension. They want you to talk to them for real. You have to be accepting. Now is not the time for you to judge why this person's there. Sure, if they committed a crime, if they're next to someone they just attacked, like that's a whole different thing, right? If it's someone that is just really upset, they haven't hurt themselves or anybody else, they're not threatening. And even if a little bit, they are just like,

don't come near me kind of thing. But if they're not saying like, I'm going to kill you or I'm going to do this, you have to be accepting and not sit there and look really judgmental because you all know that if I'm listening to you and acting like I care, but then I'm judging you with my eyes, that's a horrible conversation to have. You want to use I statements, right? You connect with it, not, well, the department, well, the agency, well, the city, I am here. I can see this. I hear what you're saying. I, you know what I mean? So it makes that connection just like when you're talking to somebody else. But, and probably most importantly, which maybe could be number one, just going in the order, you know, from the curriculum is you have to maintain situational awareness and safety, right? Just because I want to try and deescalate and I'm going to wear my EMT hat because I've been in this situation just because I want to try and deescalate and not get into a scuffle with you, right? Whether it's in your house or on the street or somewhere else, doesn't mean that you might not decide that you want to come take a swing at me,

right? So I am not going to be two feet from you with my hand on your shoulder, right? I don't know what weapons you have or anything. And let alone if you are a police officer and folks may already have negative intentions or negative thoughts about you. And again, the uniforms that we wore in some fire war to their button downs with badges too, right? And some people don't care. So you have to maintain your distance. And here's a great analogy that I picked up in jiu jitsu. And probably I'm sure it's taught in other fighting places or, um, you know, police academies, there's a, there's a green zone and a red zone. The red zone is anywhere that person can reach me with their arms and legs or something that's in their hands. The green, you know,

and the greener zone for talking to someone is outside that space, right? If it comes to it, where they're attacking you, the green zone then becomes, if you can grapple and police, you know, knowing how to use, do what they do is right up against them. But again, you don't know what that is. So stay out of reach of their hands and feet and heads and have a good discussion and do those other things that we mentioned. But your situational awareness and safety has to come into play. It has to, it has to be first and foremost, every time you go on a call, the plays, let's get into them. First thing you want to do, just like you would do being a good person to another person, is introduce yourself. Crazy, right? I'm Kevin

Pinnell. I'm an EMT with blah, blah, blah. I'm John Smith. I'm a police officer with blah, blah, blah. That's it. I'm going to tell you exactly who I am. So I'm not just standing here with a name badge or a name plate and talking to you at you down to you, whatever. I'm here to make a connection with you because we need to help you get out of this crisis. That's the mindset. Play number two, get their name, right? Get the individual's name. Starting with, can you tell me your name? You don't have to be like, what's your name? Tell me what it is. But can you tell me your name? Hey, I don't know what to call you. What should I call you? Easy things to do in a tense situation a little hard, but this initiates the conversation.

I'm telling you who I am. I just want to know what to call you. I don't have to call you by your given name. What do you want to be called? You know, how can I address you? How should I address you? Right? What, you know, what's your name? Those kinds of things. The third thing, express what you see here or we're told. Pretty straightforward. You look upset. You look really angry. I can hear that you say that you are all these kinds of things, right? Again, we're keeping it real, right? We're not, oh man, it's all right. Like we're not doing that. That's what fake people that have fake conversations doing when someone's in mental crisis, that is not helpful. So we've introduced ourselves. We've asked them for their

name or what they want to be called. We've expressed that we see this or that, right? You know, we see that you're upset, you're sad, you're angry, something. I see that you have these things sitting over there. I see this or that, right? And summarize what you've heard. So like a good conversation, I'm going to come into the conversation listening. I'm going to introduce myself. I'm going to listen to you.

I'm going to note some things that I notice or that you've told me. And the fourth play is I am going to summarize what you've heard. So I hear that you're saying you're angry because that doesn't put my words in their mouth, right? It's I'm summarizing what I believe you just told me or you expressed, right? It lets them know you're listening. That lets people know you're listening when you're having a regular conversation, right? Oh, wait a minute.

Tell me about that thing that I just heard about, right? It's just good conversation. So these four plays, these four coaching plays are the actions you take in these different scenarios. And it's not the only, you don't just keep repeating the same thing, but that happens in training. It happens in real life, right? You're stressed out and your mind's locked on four plays, four plays, four plays, not foreplay, the forecoaching plays. So that's what we want to do when we get into these situations where we're helping someone in crisis and we're helping someone in the crisis, right? And so some tips that go with that is to avoid statements like calm down or relax or no big deal. You have no idea what that person's gone through in their past life that's led to this, that they

go through every day that just happened to them. You have no idea. that person's gone through in their past life that's led to this, that they go through every day, that just happened to them. You have no idea. So again, don't give those condescending one or two word things to people. Avoid how you doing. In fact, in the curriculum, it's like Joey Botafugo, but you know, coming in and be like, hey, how you doing? What's going on? Right? They're not having a good day. They don't need the jokey coming in there like that. Avoid saying you understand. This is a big one in general too, but particularly here, someone in crisis, have you lived their life and been through their situations and had their calamities? If you haven't, you saying you understand is disingenuous and it's not helpful. Now,

I had cancer. If someone's upset because they have terminal cancer or their husband does or something, could you emphasize, you know, I see you're upset and you get to the point and they say, yeah, they told me I have like, you know, six months or something going on or whatever it is. And you say, you know what? I had cancer. I remember what the fear is like. You know, it's not the same as yours, right?

So there's a connection just like you make with someone when you have a conversation, but I'm not BSing that person and saying, oh, I understand. Yeah. Well, have you had that? No. Boom. You just broke the trust, right? Don't say you understand. You could use similar experiences or the same, but if you've never gone through what they're doing, you don't. The other thing, and here's a handshake, right? That shows trust these days with the pandemic. Do we fist bump? Do we do elbows? Again, safety and security. Do I get within that reach before it's time to either get a ride with the ambulance or the police car or maybe social services or whoever can give the person that ride to get help if they choose to go somewhere or if it's in their best interest to have to be taken somewhere?

And sometimes that happens. What do we do there? And that's at the discretion of the person dealing with this person in crisis, right? So we talked about kind of the people that established this program. We've talked about the process and kind of got, you know, deep into what is the class like? What do you go through? And so now I want to get to what are some real world applications. And I touched on some of these in instances where I've seen this used, where I've used it myself, or where we did talk about this based on real cases in the class. So the first one is violent people.

So I mentioned this. There was a shooting a couple years ago in the city of Richmond. There's been other shootings of people in mental health and in crisis. So the moment when someone is running at you and attacking you and says they are going to kill you or they're going to do things is not the moment to stand there and say, hi, I'm this person. What's your name? Oh, I see that you're upset. Oh, in summary, you would like to kill me, right? That's not it.

So, again, think about when right now it's on everyone's mind. Think about those scenarios and think about practically what you it's on everyone's mind, think about those scenarios and think about practically what you would do, what you could do. Is CIT the best thing to do there? And again, this is my outsider's view because I'm not a cop and that hasn't happened to me. But if you're just thinking practical for a second, I'm not going to use the four coaching plays on someone that's screaming, they're going to kill me and they're running at me

naked. It's just not going to happen. So earlier interventions, could that have helped before that person, you know, kind of got spun up more, whatever happened, maybe, and hopefully so. And hopefully in the future, it helps tons of people. But you have to think about, you know, is there someone that's saying, don't touch me, and they're just staying away, but they're not attacking anyone. They're not rushing anyone. Pretty viable, right? They're really upset. Could it spark something how it goes? Yeah. And that's a touchy situation. But you can talk people down that way. And it's happened

before. And I say that not for me doing it, but other people have done that. Offended people. This was not even a really a person in crisis, but I use the foreplays on someone where one of my colleagues happened to, they were trying to talk to the family member, getting, you know, doing a report or rather an assessment, trying to figure out what's wrong with them. It was an EMS call and they happened to say, hold on, sir. And they put their hand up and not in really a mean way, not spiteful. And that person became very offended, right? It wasn't in their face. It wasn't anything like that, but you know, it was a, don't put your hand up. I mean, it was got to deescalate. I happened to be there with them. Talk to the person, four plays, just talk to them, deescalated, right? So that's another thing when you're on a call, whether you're a mental health person,

whether you're a public safety person, whether you're just someone that's trying to help in a situation, is you got to think about, you know, your mannerisms, your physical mannerisms, your face, your body language, right? Are you coming in aggressive? Are you letting your frustration out? It all has to do with how effective these are or are not. Youth. So I mentioned, you know, getting called somewhere where a young man was trouble, right? He's always causing trouble. And so we get there and we're at a shelter, church-based shelter. And really, it turns out he's sitting over there.

He's crying. He's upset. And then we see his mom going in and out of the bathroom with this big bag of medicine, whether she was taking them or not. I don't know. Didn't test her for that. We were there for the child that was, air quote, a problem. And coming to find out, one of my colleagues sat down, foreplays a a bit different with youth. Hey, I'm so-and-so, you know, there you do get down the level. You kneel down, you get a little closer, right? Could they lash

out? Sure. But less dangerous than another grown man running at you, right? Or woman. So come to talk to it. He hadn't eaten. He didn't eat regularly, right? He probably wasn't having a great experience with his life at that moment, with a lot of things at that moment. And so you can still establish rapport who, you know, here's who I am. Here's, here's, you know, what's your name? What do you call it? You know, I can see you look like you're really upset. You're sitting there, you know, crying and, and, you know, we're called to maybe come and help you, right? And, and try and talk to that person. Sometimes they won't talk. He didn't want to talk a whole lot. But then you

can also, through your situational awareness, observe the entire scene, right? What's happening. One of the huge frustrations in public safety, and again, police see this more than I have, is sometimes you can't do anything about that, right? You want to spirit people away, give them all the food they want, give them a place to live, clean clothes, get their mom help if they have substance abuse issues. And sometimes you can't, and there's not a mechanism for it. But what you can do is in that moment, make it better for that person you're interacting with. In your home, I have used the four plays or parts of them with my kids, with my wife, 100%. Right now, I don't have to tell my wife my name or ask her name. But I can certainly

use the last two of Hey, I see that you're upset. Hey, you know, you're I heard you yelling at your brother, what's going on? And then summarize it, right? Let them know you're listening, let them know your care. Have that conversation. And it makes a huge difference. Again, it's just good conversation. It's good listening. It's good communication. At the workplace, right?

Whether new project team, or even if it's with your team members, let's say something new. Hey, it's what we do all the time, right? Hey, I'm Kevin Pannell. I want to be the IT project manager on this project. What's your name? You shake hands. Hey, I see you've come in from here or there. You can use it without saying, hey, I see you're angry or upset or whatever emotion. It's the, I read the paper you sent ahead of time or the presentation. It was really good. Thanks a lot. In your summary, you're going

to have summaries of next steps at the end of project meetings or program meetings or even incident action planning meetings. And you're going to summarize all right so in summary next steps and then you're going to go through the stuff that everybody owns next right that's that's four plays right that's that's the four coaching plays in public how many times you know if you've been around you've gone to bars you've done this and that you've seen people bump against each other and everybody postures or there's a problem, whatever, right? You can deescalate there. You can use exactly the four plays, right? Unless it's some egregious thing.

You know, you can use this with strangers in public, whether you're a law enforcement officer in public safety or just someone, you know, that doesn't want to get in a fight, right? Or wants to help someone that looks like they're upset. Keeping in mind the safety things I mentioned, those four coaching plays, introduce yourself, ask them their name, note things that are happening with them, and then summarize it with the conversation.

So those four plays are key. And again, they're pretty straightforward, which is great. And I'm sure not an accident, because when you're in a hot and heavy situation where you can use this, use CIT, use the elements of it needs to be simple, right? Not not really complicated. And so in talking about kind of some of those things, ways I've used it, so how do we measure success in this area? How can can your programs measure success? So from CIT International Program Measures of Success, they say establish a network of relationships, right? Relationships, relationships, relationships. That's between black people and cops. That's between just everyone and everyone, right? That's

the focus now and reform needs to be made in many areas. But the relationships can be between nonprofit organizations, government, private sector, you know, what industries, what partners do you need to be involved with mental health, social services, health department, you know, fire department, EMS, you get everyone together, stakeholders, you know, family that have been impacted and have all those people together as part of your program and that you've had those relationships. So if it comes to find out that you could have used CIT and something happened and it's like, well, did you,

have you worked with this population before or these programs and the answer is no, well, that's a gap, right? And so again, I'm sure there's plenty of gap analysis is going on with CIT now, just because again, people somehow it keeps being come up, coming up that, Hey, we need to get more CIT right for mental health. Ongoing commitment from leaders. Leadership buy-in is huge early in any project, program, revisions, whatever. You have to get it, and it has to be real-based, not politics-based or trying to get favor-based.

But the leader commitment that they will support this program, updates to it, whatever, and they'll be with you the whole time. You have to understand the community-wide response to mental health crisis, right? So you have to understand what's going to work best in different areas, who should respond where, get a feel for that, ask the community. But you have to have an understanding of it. You have to revise policies and procedures, which includes staffing and data collection, right? If you're not going to send police more to a CIT-like call, are you going to staff up your mental health department or your health department?

Or how are you going to do that? You have to figure it out. You have to train law enforcement 911 call takers, right? But I would also highly encourage, and I know some other, like I mentioned, some of our friends in some of the localities that I either worked in or with, they do this with fire and EMS as well.

You know, why just enable the police to have these four coaching plays and the principles and the knowledge behind it when it's a public safety team that's out there all the time, right? Fire and EMS deal with folks, you know, and so if police show up and this person's totally fine and then they leave because the scene's secure and fire and EMS are there and then they start having an issue, well, now fire and MS are empowered with the skills to use their CIT. It's huge. The last of the measures of success from CIT International Program

is to commit to ongoing improvement and engagement with partners, right? It has to be ongoing. It has to be reviewed. It has to be fair and impartial and transparent, right? Case reviews, call reviews, frank discussions, who's involved, who's not involved, who's participating, who's not participating, because it's not a one-sided thing. It's just not. Nothing is. There's another reference that I looked at for this episode,

and it has to do, it's called the five-legged stool model. And it's about your CIT program. And I thought it was really good. It's from Nick Marghiata, who's a CIT coordinator for Phoenix Police Department from 2015. And it's more than just training. And I think I've maybe touched on that or hopefully have expressed that. But I'm going to talk about, you know, the five legs of the stool that he mentions. And again, I'll link this in the show notes so you can go read the whole thing. But the first one's police training, right? This started from a police interaction with someone in mental health that maybe didn't

have the tools to deal with that person or who knows how that person acted. I didn't read that case, but that's how it started. So police training, and again, police are called to do a lot of things that's not their primary deal, including crisis intervention, which is their primary deal now or a lot of it. So it starts with police training, community collaboration, right? Community collaboration. That's everyone in the community of every ethnicity of every socioeconomic status. It doesn't matter. Everyone has to be involved, not just point and go, you should change this, but get involved, uh, vibrant and accessible crisis system. So what this means, or at least from the five-legged stool model is the handoff so the law enforcement to behavioral health handoff needs to be set up

pretty well right so in a lot of hospitals there's rooms for psychiatric patients and they're secured rooms it's not a jail cell but it's a locked door and it's one room so the difference is it's a door not bars um but is there a handoff there so that the handoff is from law enforcement that maybe they just gave them a ride, they weren't, you know, didn't, you know, cuff them or arrest them or something. And that's different policies that I'm not going to speak to is, you know, right in the car, cuffed and all that jazz. But is there a good handoff from the point where law enforcement is taking custody of this person, orMS or fire and then hand it off to the behavioral health folks at the facility that they take them to? And is it accessible, right? So are there

places to take folks that are in crisis beyond the jails? We touched on that way earlier. There has to be, right? Because that's a horrible place to have put someone that's in crisis. But if there's not access or a better place to take them, then you know what, what's supposed to happen. And that's a tough call. You don't you can't just give them a ride down the road and strap them off at a friend's house because you have no idea what's going to happen. The fourth thing is behavioral health staff training. So part of that is kind of the other side of it is is behavioral health staff and mental health staff have to understand the role of law enforcement officers. And a great suggestion is do ride alongs, right? Folks don't understand. And I again, I was never a cop. So I have a smidge of having been,

you know, on calls and have friends and stuff with police. But I've never done their job and never pulled over a car and hope they didn't shoot me when I was going to talk to him about driving or something like it's never happened. And, or, you know, gone to the crisis intervention call, I was first in by myself as a police officer. And so behavioral health staff training, and I think Nick Marghiata touches on, it's a great suggestion, is to understand what is a law enforcement officer's role and do a ride-along. So take them on a shift with you, with the law enforcement officers, and do a ride along. So take them on a shift with you with the

law enforcement officers and get a picture. And what are all the different things we see from the mundane, this dog, you know, my neighbor's dog poops on the grass to, you know, these people are abusing their children, like all these different things, you get a window into it. And the fifth of the five legged stool, which is often called the forgotten leg, according to Marguerita is family,, consumers, and advocates collaborate and educate. So that's everyone affected by mental health from the person to the family member to the people that are going to get called to respond and support. And then the system that's going to support them because it has to be a whole system, but everybody has to be involved in the solution. That is the last of the five-legged stool model.

So it's police training, community collaboration, vibrant, accessible crisis system, behavioral health staff training, and then family consumers and advocates collaborate and educate everybody working together. Just like I hope we in America start to work together better and have real discussions and not assumptions because of the way someone looks or votes or says like America's great. And I have had disagreements with other folks, particularly veterans, you know, maybe of other eras where I a hundred percent believe in free speech from the free speech from the standpoint that, you know, I served in the military because I chose to, right? And part of that and part of the whole defending the country and all this stuff is so that people can say and use their First Amendment rights and give them that. And some folks disagree. It's like, I didn't fight, you know, for a serve so that people could do that. I think absolutely, if things are wrong, then people should be able to speak to it. But I think just like with developing a CIT program, just like

with community collaboration and CIT and helping folks in mental crisis in this country, if we don't have real discussions and listen to each other, it could get heated. That's cool. But keep it open-minded and not just throw everybody in a bucket and the same label, positive, negative, et cetera, then we're not going to make that progress. And I think it's very fitting that the show is people, process, and progress because people are 100% at the heart of how we're going to get through this and who need to change to help us all get through this. There are so many processes I can imagine, you know, between the COVID stuff and police

reform and also realistic solutions to societal reform, right? Because it's not just the police and it's not all police. And I 100% believe that and I know it for us to all make progress together and we have to make progress together. So thank you all so much for listening, for spending just about an hour with me as I go through the CIT program. I hope this was informative and helpful. Please come back, give us a rating and review. Godspeed.