A MENTAL HEALTH NEWSLETTER FOR LAW ENFORCEMENT PROFESSIONALS
 

Mental Health Association of Greater St. Louis A United Way Agency

In this issue . . .

By Officer Tara Cira.  Officer Cira has worked for the St. Louis County Police Department for five years, primarily in the west and central areas of the county.  She is one of 55 officers who were trained in the first CIT class for St. Louis County Police. In preparation for writing this cover story, Officer Cira asked several of her fellow officers what information about CIT they would find helpful. Here is her description and insights on the CIT philosophy and program.

 What is CIT? It has become the buzzword within the St. Louis County Police Department and the surrounding law enforcement agencies. What exactly do CIT officers do and why do we have it? 

CIT stands for Crisis Intervention Team, which is a voluntary team of patrol officers who receive an additional 40 hours of training in the mental health field.  The training provides skills, tools, and tactics for police officers to safely deescalate persons in mental illness crisis. Officers receive information regarding different mental illness, developmental disabilities, crisis intervention techniques, common resources, and all major areas useful in interacting with persons in crisis. This training produces confident CIT officers, who can professionally respond to a situation in an empathetic and calming manner. 

Unfortunately there are more mentally ill people on the streets today than ever before. When a crisis arises, the police are often the first persons to be called and arrive on scene. It is important to have someone who is familiar with different types of mental health issues and has the expertise to contain and control the situation. 

The CIT officer has that training and knowledge and contacts within the mental health field in order to get the proper help.

The key to make this program successful is that the CIT officers respond to all calls involving a person with mental illness in addition to their regular service calls. While this may temporarily take a unit from its usual patrol area, that short-term loss pales in comparison to the time spent when a situation is poorly handled or escalates. When a dispatcher recognizes a call involves a mentally ill person, they will automatically dispatch a CIT officer. However if another officer arrives on scene and determines the subject suffers from a mental illness or is in a mental illness crisis they can request a CIT officer to respond. The effective CIT officer is able to respond to and understand the needs of a consumer, as mentally ill people are called, and demonstrates sensitivity and caring. The goals of the CIT are to provide immediate response to and management of situations where the mentally ill are in a state of crisis. Calming consumers in emotionally explosive situations that could erupt into violence is the job of a CIT officer. Sometimes a calming influence is all that is needed; other times a consumer must be hospitalized. The officer’s role is to attempt to safely resolve the conflict to the point that the consumer can be safely transported to the appropriate facility, whether that it is jail, a mental health facility, or if the situation can be resolved at the scene, no facility. If the consumer is a suspect in a crime, the CIT officer then will make warrant application through the St. Louis County Mental Health Court. The CIT officers hope to prevent, reduce, and eliminate injury to both the consumer and responding officers, as well as the community at large.

CIT officers regularly visit with the consumers in their area.  This allows the consumers to feel comfortable with the officer, calling if they have a question, need help obtaining a service or sense they are about to have an episode. Some consumers and their families think they should call only when a situation is totally out of control. However, CIT officers would rather be proactive and help to eliminate as many crisis situations as possible.

St. Louis County CIT officers work with the community for the common goals of safety, understanding and service to the people who suffer from mental illness and their families. This is one reason I volunteered to be a member of the Crisis Intervention Team. It was one way I could become a better officer to serve the citizens of St. Louis County. This training gave me the tolls not just to help person with mental illness, but for me to better help all citizens that I come into contact with on a daily basis CIT officers are not social workers with a badge. I believe the Crisis Intervention Team is more than a shoulder to cry on, a hand to hold, or an ear with which to listen. 

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By Capt. Robert Trittler, St. Louis County Police Department

In 1988, the Memphis Police Department recognized that their officers were inadequately prepared to deal with citizens experiencing a mental health crisis. To better serve those needs, they partnered with mental health professionals, practitioners and service organizations to develop and implement a methodology and procedure for responding to that type of call for service. 

This Memphis partnership developed training for police officers that concentrated on recognizing the behaviors, or symptoms, associated with the several forms of mental illness and the most appropriate responses for producing a peaceful, safe conclusion for the incident. Officers were given the resources to assess and respond to a given situation without over-reacting and exacerbating the incident. Officers were also provided access to a myriad of sources providing immediate or deferred intervention by mental health professionals, as dictated by the situation. At no time was the concept of Officer Safety discounted or diminished during this training.

Locally, a similar consortium was established when area mental health professionals and service organizations approached the St. Louis County Police Department (SLCPD) to establish such a program. A POST-certified, 40-hour training program for crisis intervention was developed, resources marshaled and training for 50 officers and supervisors was conducted in September 2003. A second training class for additional SLCPD officers will be held in March 2004. The county department’s experience has been positive. The local mental health partners have honored their commitment to deliver needed services and referrals to persons in crisis. Families of persons receiving these services have been most complimentary of the program and the officers.

The training program established for crisis intervention has proven to be contemporary and successful. It is believed that through the use of this training, and the attendant ancillary services provided by the mental health community, the tragic results of inadequate training as evidenced by recent history will not reoccur. All police agencies in the St. Louis area, regardless of size, are welcome and encouraged to take advantage of this training. As we have seen already, mental health issues and police involvement know no boundaries. A person in a mental health crisis may need crisis intervention anywhere. If the responding officers are adequately trained, the situation will more likely be resolved in a positive fashion.

Graduates of the September, 2003 CIT Class

Graduates of the September, 2003 CIT Training Class

For more information on Crisis Intervention Training for your department, contact Captain Robert Trittler, CIT Council Chairman, at 314-615-2551.

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By Lisa Caraffa, Ph.D., Director of Psychology and the Director of the Residential Program at Hawthorn Children’s Psychiatric Hospital. Dr. Caraffa is also a member of the Street Talk Advisory Committee.

Obesity is now considered one of the top health threats in America.  Current statistics indicate that 65% of adults are either overweight or obese.  The three leading causes of death in the US are heart disease, cancer and stroke, all of which are influenced by excess weight.  Magazines, talk shows and family physicians all exhort us to watch our weight while fast food restaurants and other food industries look for ways to give us "more." More fat, more sugar, more salt, more calories.  The average adult male should have about 2200-2800 calories a day and the average adult female should eat about 1600-2200 calories a day (based on height, activity level and medical conditions). Salt, which can raise blood pressure, should be limited to 2400 milligrams a day. Just one fast food meal can meet over half of a day’s calorie needs and half the amount of your salt needs.  For instance, McDonald’s large fries have 540 calories and 330 mg of salt, a Quarter Pounder with cheese has 530 calories and approximately 600 mg of sodium and a McFlurry shake has 600 calories.  Stop next at Starbucks and get a Venti Chocolate Mocha which has 500 calories. You’ve had 2170 calories and haven’t had breakfast or dinner.  No wonder obesity is becoming the norm.

Ironically, the development of “police sub-stations” at fast food restaurants and gas stations, places police officers in close proximity to high calorie, high fat foods as part of the job. 

Here are some calorie counts of common restaurant or fast foods:

• Pizza Hut P’Zone—1200 calories, 1,000 mg of sodium

• Domino’s Pepperoni Pizza--- ( 2 slices)  560 calories, 1300 mg. of sodium

• Stuffed potato skins with sour cream ---1260 calories

• Turkey club sandwich---740 calories

• Spaghetti with meatballs---1160 calories

• Taco salad with guacamole and sour cream---1100 calories

• Chicken or beef enchilada with beans and rice ---930 calories

Officers are often forced to eat on the run, so it’s especially important to eat well/healthfully.  How to do this requires making good choices based on your knowledge of fat and calories in various foods.  Fortunately, almost all fast food chains have some healthy choices available. Some good choices are:

• Boston Market—Skinless roast turkey, steamed vegetables, new potatoes--335 calories

• McDonalds, Hardee’s and  Burger King  --Broiled chicken salad with light dressing--around 215-270 calories

• Dairy Queen--Grilled Chicken Sandwich--310 calories

• KFC--Roast chicken breast, green beans and corn on the cob--364 calories

• Pizza Hut—2 slices Veggies Lover’s Pizza--170 calories

• Subway—Turkey breast salad with fat free dressing--102 calories

• Taco Bell—Steak Gordita Fiesta--270 calories

• Wendy’s-- Mandarin Orange Chicken Salad (w/o dressing)--150 calories, Soft chicken taco--190 calories, Grilled chicken sandwich--310 calories

• Burger King-- BK Veggie Burger--330 calories

• Arby’s-- Light menu—sandwiches--under 300 calories

Another way to reduce calories easily is to skip the sodas and drink water.  Many people mistake hunger for thirst and would find that they eat less when well hydrated.  And when possible, keep fruits and vegetables available for snacking.  They fill you up, control hunger longer and are low in calories. 

If you have further interest in this subject, Suffolk Co. Massachusetts police department produces videos for police officers that focus on health and wellness. (Check them out at www.LawEnforcementVideos.com)  Also, there are numerous books on the market that give information about the calories contents of most foods, including many fast food chains.

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Street Tips: When Someone is "Acting Strangely."

By Lisa Caraffa, Ph.D., Director of Psychology and the Director of the Residential Program at Hawthorn Children’s Psychiatric Hospital. Dr. Caraffa is also a member of the Street Talk Advisory Committee.

Hawthorn Children’s Psychiatric Hospital (HCPH) serves children (ages 6 to 17) from eastern and southeastern Missouri.  Hawthorn serves children with severe psychiatric illnesses who do not have the resources to pay for private care.  The children manifest a wide range of problems, which include severe depression and suicidal behavior, aggression, schizophrenia and psychosis, autistic disorders and Bipolar Disorder to name a few. A majority of the children have been exposed to abuse and neglect, and many do not have families to care for them. 

Admissions to the Inpatient (hospital) program occur between 8:00 am and 5:00 pm on regular workdays.  Emergencies that occur after 5:00pm on weekdays or on weekends and holidays, are dealt with by the emergency room at Metropolitan Psychiatric Rehabilitation Center.

As well as an Inpatient program, Hawthorn also has a long-term residential care program designed to help adolescents successfully return to their home or community.

Hawthorn is located at 1901 Pennsylvania, three miles east of I-170, about half way between Page Avenue and St. Charles Rock Road.  Hawthorn is served by the St. Louis County police.  The main phone number is 314-512-7800, fax is 314-512-7812 or TTY 314-512-7593.

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Criteria for Involuntary Commitment

By Jim House, Executive Director of the Mental Health Association of Greater St. Louis.

The Mental Health Association often receives questions from officers regarding the correct criteria for involuntary commitment. Quite simply, the criteria are: 

• A person who is alleged to have a severe mental disorder, mental illness or substance abuse problem, and,
• Presents a likelihood of serious harm to self or others

may be committed to a mental health facility or an alcohol/drug abuse program for 96-hour evaluation and treatment. 

Police officers generally must complete an affidavit attesting to the above. When you complete an affidavit, you must use behavioral terms to describe who, what, when and where.

You need to “make the case” to meet the first criterion, i.e., the person is alleged to have a mental disorder, mental illness or substance abuse problem. The individual, relatives or neighbors may be able to tell you that the person has a psychiatric diagnosis or what medications the person should be taking. (Although several new medications have come out in the past two or three years, see the July 2000 edition of Street Talk [print edition only] for a list of commonly prescribed medications. If you don’t have a copy, call our office at 314-773-1399.)  This information needs to be in the affidavit, and if a relative or neighbor is involved, they should also complete supporting affidavits. 

The person may be acting in a bizarre manner. This can include threats, violent behavior or behavior that has caused a prior commitment. When you include this in the affidavit, you need to write things like, “John J. threatened to stab his mother” or “John J. threatened to take his own life.”  You should include dates, places and times if you witnessed these actions.

In Missouri, past acts can warrant a commitment order. For example, in the past this person has been hospitalized, was discharged, quit taking the medication and became violent. If this particular person has recently been hospitalized, been released and has quit taking the medication, the court can assume that violent behavior will result and order a commitment. 

Remember, state your case in behavioral terms: who, what, when, where. DO NOT use terms like “acts bizarre” or seems “psychiatrically troubled.” 

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Open Mind is a column produced by the Mental Health Association, which appears weekly in many Suburban Journals.  Click here for the reprint above and access to the entire Open Mind Archive on this website.

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We have archived past issues of Street Talk on this website.  All back issues also include a link to a relevant Open Mind column and a Mental Health Directory.

October 2002

July 2002

April 2002

Following is a dated index of previous articles that have appeared in Street Talk.  To get a copy of any article or a previous issue, please call LaDonna Haley at 314-773-1399.

"It Worked for Me" (Officer Gorman)

Holiday blues vs. Seasonal Affective Disorder (SAD)

What should I know about Bipolar Disorder?

"When it finally hit home – part 1" (FBI agent Burt Jensen)

Public policy, mental health, your work

Liability issues for officers and departments

In the Limelight: Hazelwood PD

At Your Service: St. Patrick Center

I’d like you to know (helpful hints)

Dealing with frequent callers

"When it finally hit home – part 2" (FBI agent Burt Jensen)

Officer and Department of the year awards

At Your Service: Provident Counseling

Q&A: All about EAP’s

Know your mental health options

What does confidentiality really mean?

Rethinking our strategies (John Bozarth)

Anger management

Helping peers in distress

In the Limelight: Ballwin and Hazelwood PD’s

January 2002

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