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De-Escalation Skills
Law Enforcement Academy
Asheville-Buncombe Technical Community College
Asheville, North Carolina
Crisis Intervention Team Training
September 27 – October 1, 2010
1
Overview
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1 ½ days (12 hours)
Lots of role-playing practice in small groups
Goal is for you to feel very confident in your ability to deescalate
Model = E-LEAP
E = engage (wed. pm)
LEAP = listen, empathize, affirm, partner (thur. am)
Specific strategies for consumers who are disoriented,
intoxicated, suicidal, etc. (thur. pm)
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Wednesday PM
What is de-escalation
 Effective communication
 Non-verbals
 Behavioral crisis
 Engagement
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What is verbal de-escalation?
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Verbal de-escalation is used during
potentially dangerous, or threatening,
situation in an attempt to prevent persons
from causing harm to us, themselves, or
others
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Goals of Verbal De-escalation
Open up clear lines of communication
 Build trust and validate the consumer’s
situation
 Get the consumer talking about his
situation
 Gathering the necessary information make
a good resolution
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5
What is De-Escalation
De-escalation is less like a recipe or
formula and more like a flexible set of
options.
 No single set of de-escalation skills: we
have tried to put together a effective set of
skills by borrowing from multiple
approaches
 De-escalation will not always work
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What is de-escalation
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Both officer and consumer safety always remain
paramount concerns in a crisis involving a
person with mental illness.
Once officers become skilled in de-escalation,
they do not simply abandon all the training and
experience that came before it.
De-escalation is another tool that officers have
at their disposal to be judiciously applied in
controlling a potentially volatile situation, rather
than serving as a substitute for sound judgment
and attentiveness to safety.
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Effective Communication
70% of communication misunderstood
 Effective communication is defined as
passing information between one person
and another that is mutually understood
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Effective Communication
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Communication becomes more difficult when the
person’s ability to understand what you are
saying and/or their ability to express their own
thoughts or needs are compromised by their
symptoms.
When they can’t express their needs, they
become more angry and frustrated more quickly
and more frequently
Your ability to engage a consumer in
conversation and successfully resolve a conflict
often depends as much on how you say the
words you choose as much as the words
themselves.
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Barriers to Effective Communication
Barriers to communication are the things that keep the
meaning of what is being said from being heard:
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Pre-judging
Not listening
Criticizing
Name-calling
Engaging in power struggles
Ordering
Threatening
Minimizing
Arguing
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Effective Communication
words we
use
7%
tone of
voice
38%
body
language
55%
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Non-Verbal
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It is very important to be able to identify exactly
what you are communicating to others nonverbally
You may be trying to de-escalate the situation by
talking to the other person, but your body
language may be saying something else. The
consumer will react to want you are saying with
your body language
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Personal Space
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Persons with mental illness often develop and altered
sense of personal space. They require more space than
usual to feel comfortable and feel intensely threatened
when other people close in on them with no warning.
Invasion or encroachment of personal space tends to
heighten or escalate anxiety
Personal space in American culture is about 3 feet
Do not touch a hostile person – they might interpret that
as an aggressive action
Announce intention: “I need some space, so I am going
to back up.”
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Eyes
One eyebrow raised = sternness
 Eyes wide open = surprise
 A hard stare = threatening gesture
 Closing eyes longer than normal = I am
not listening
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Body Posture
Challenging postures that tend to threaten another
person and escalate the situation include:
 Finger pointing may seem accusing or
threatening
 Shoulder shrugging may seem uncaring or
unknowing
 Rigid walking may seem unyielding or
challenging
 Use slow and deliberate movements—quick
actions may surprise or scare the other person
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Voice
Tone - Usually unconscious
 Volume - A raised voice could create fear
or challenges
 Rate of speech - Speak slowly – This is
usually interpreted as soothing
 Inflection of voice - I didn’t say you were
stupid
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Face
 Jaw
set with clenched teeth shows that
you are not open minded to listening to
his or her side of the story
 A natural smile is good. A fake smile
can aggravate the situation
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What is a Behavioral Crisis?
A crisis is a perception of an event or
situation as an intolerable difficulty that
exceeds the resources and coping
mechanisms of the person
 Unless the person obtains relief, the crisis
has the potential to cause severe
behavioral malfunctioning.
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Behavioral Crisis?
Crisis intervention is emotional first aid
which is designed to assist the person in
crisis to return to normal functioning.
 The focus of crisis intervention is what’s
happening here and how!
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Behavioral Crisis
3 reasons that a consumer may be having a
behavioral crisis:
 Medical condition
 Substance use
 Psychiatric condition: 1) thought disorder;
2) mood disorder; 3) anxiety disorder; 4)
personality disorder
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Behavioral Crisis
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The majority of encounters that you will have
with consumers are because the symptoms of
their illness are not under control. Most
commonly, this occurs at the initial onset of
illness, during a relapse (that can result for a
variety of reasons) and when the person s using
substances.
The consumer’s behavior is usually a result of
his or her illness, rather than being criminally
motivated
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Consumers typically will have
one of 3 feelings
Anger
 Fear
 Sadness/depression
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What you may be seeing . . .
Consumer’s Inner
Experience
Hostility, evasion
Fear
Risk-taking
Elation
Self-destructive behavior
Depression
Odd, dangerous behavior
Confusion
Very odd behavior
Psychosis
Attempts at self-treatment
(e.g. drugs)
Hopelessness, demoralization
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Behavioral Crisis
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Given the low likelihood that emotional people in
crisis can succeed in rationalizing alternatives,
law enforcement responses to emotional people
in volatile situations cannot rely on convincing
people by making a rational proposal to think
differently. Rather, responders need to create a
stable and respectful environment within which
emotional individuals can take comfort and
relief.
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Engagement
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Be aware of your setting; personal safety first
Move to a safe place if necessary
Allow plenty of space
Persons with mental illnesses often can be
expected to process information slowly and to
have difficulty remembering things. This includes
understanding and remembering instructions
given by a police officer.
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Engagement
Be aware that a uniform, gun, and
handcuffs may frighten the person with
mental illness so reassure consumer that
no harm is intended.
 Remain calm
 You will likely have contact with the
consumer again; how you treat him will be
important for establishing trust
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Engagement
Know when to act: A person may be acting
dangerously, but not directly threatening
any other person or himself/herself. If
possible, give the consumer time to calm
down. This requires patience and
continuous safety evaluation.
 Allow partner to de-escalate others on the
scene as necessary
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Engagement
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“It is the wise officer who can, at times,
conceal his or her combat-ready status.”
-Lt. Michael Woody
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Avoid
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Maintaining continuous eye contact
Crowding or “cornering” the consumer
Touching the consumer unless you ask first or it
is essential for safety
Letting others interact simultaneously with the
consumer
Negative thoughts (“God, this is another one of
those homeless people.”)
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Avoid
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Expressing anger, impatience or irritation
Inflammatory language (“You are acting crazy.”)
Feeling as though you have to rush or feeling
like you are stuck if it takes time to get the
consumer talking
Intervening too quickly or trying too hard to
control the interaction by interrupting or talking
over the consumer.
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Avoid
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Saying “You need to calm down.”
Shouting or giving rapid commands
Arguing with the consumer
Taking the words or actions of the consumer
personally (They are symptoms of mental
illness.)
Lying, tricking, deceiving, threatening the
consumer to get her to comply
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Avoid
Asking why questions. Why questions are
logic-based. Persons in crisis are not
logical. Typically, what ever has worked in
the past is not working now. Why
questions put the consumer on the
defensive. Ask open-ended questions.
 Forcing discussion
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Avoid
Minimizing the consumer’s situation as a
way to elicit conversation (“Things can’t be
that bad, can they?”)
 Suggesting that things will get better; they
may not
 Making promises that you may not be able
to keep
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Avoid
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Commands such as “drop the knife,” or “Get
down on the ground” might seem to be
straightforward and easy to understand. When
dealing with people who live with mental illness,
however, officers need to take into account the
types of barriers to effective communication that
the brain disorder might create.
Telling the consumer “I know how you feel.”
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Avoid
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Asking a lot of questions of the consumer in the
beginning. This is a natural tendency, however,
this is generally not a good idea, especially early
in the interaction. In de-escalation, encouraging
the consumer to continue talking is more
effective than asking a lot of questions. It will
help continue the dialogue and will provide the
consumer with opportunities to give information
that will help to resolve the crisis.
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DO
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Speak in a calm, slow, clear voice
You may need to repeat; the consumer may be
distracted
Be patient; give the situation time; time is on
your side
Try to reduce background noise and distractions
Use “and” instead of “but”
Obtain relevant information from informants
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DO
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Allow the consumer to ventilate (“Tell me some
more about that.”
Use “please” and “thank you” often
Remain friendly but firm
Ask the consumer if she needs something
Offer a cigarette, nutrition bar, warm clothing
Forecast: Announce your actions and
movements
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DO
Accept the consumer’s feelings, thoughts
and behavioral; acceptance is not easy
when a consumer is behaving in a bizarre
or hostile manner
 Respect the dignity of the consumer
without regard to sex, race, age, sexual
orientation
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Hot Buttons
Consumers will sometimes push a hot
button
 We all have them
 Example: The consumer calls you a “pig”
or swears at you.
 This is NOT the time to demand respect
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Hot Buttons: Rationale Detachment
 Staying
in control of your emotions
during a crisis situation
 3 steps
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1. Develop a Plan
 Decisions
made ahead of time are
more likely to be rationale
 Identify your hot buttons
 Strategic visualization – practice
what you would do
 Helps you gain confidence
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2. Use Positive Self-Talk
You are not the target of the outburst
 Never take anything personally
 Remember that most of us have been
irrational and said inappropriate things
when we are under extreme stress
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3. Recognize Your Limits
Let someone else take over if
necessary
 Set a limit with the person; use an “I”
statement; “I really want to help you
but I find it difficult because of your
name-calling; could you help me and
stop the cursing so that I can work on
helping you. Thanks, I would appreciate
it if you try.”
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The Logic of De-Escalation
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If you take a LESS authoritative, LESS
controlling, LESS confrontational approach, you
actually will have MORE control.
You are trying to give the consumer a sense that
he or she is in control.
Why? Because he or she is in a crisis, which by
definition means the consumer is feeling out of
control. The consumer’s normal coping
measures are not working at this time.
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Introduce Yourself
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An introduction promotes communication
Hi, my name is Doug (or Deputy Smith). I am a
CIT officer with the Sheriff’s Department.
Can you tell me your name?
State what you see/know (“I can see you’re
upset.”)
State or convey that you are there to help.
Be prepared to explain the reason you are there
(e.g., a neighbor called to say someone is upset)
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Introduce Yourself
How many of you can have someone tell
you her name, and within a few seconds
you have already forgotten it
 Make a point of immediately starting to
use the consumer’s name; that will help
you remember it
 Use the consumer’s name often
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Introduce Yourself
“Get out of here you damn cop!”
 Don’t take the bait and turn confrontational
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Role-playing Scenarios
Role-playing is a learning tool
 Allows us to try out new approaches
 Expect mistakes; they are an opportunity
to learn
 You can rewind and try again
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Role-playing Scenarios
Everyone feels uncomfortable in role play
 Feedback will be constructive
 Scenarios are derived from real-life
experiences
 We will be working as a team to assist one
another in skill development
 Small groups: 3 roles—Law enforcement,
consumer, observer
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Thursday AM
Listen
 Empathize
 Affirm
 Partner
 What Ifs
 5 special strategies
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L = Listen
Silent and listen are spelled with the same
letters
 Listen twice as much as you talk; that’s
why you have 2 ears and 1 mouth
 What is the difference between listening
and hearing?
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The Chinese symbol for listen:
eyes, ear, heart
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Listen
Listen for the total meaning
 Focus on what the consumer is telling you
 Block out distractions
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Listen
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It is important understand and remember that
what the consumer is saying or believing may be
real or imagined. Since mental illness is a brain
disease, thinking is what is most affected by
mental illness. Sometimes their thoughts are
disconnected and you’ll hear this in their speech,
which can be difficult to follow and make sense
of.
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Techniques that Show You Are
Listening
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Minimal encouragers
Reflecting
Ask open-ended questions (“Can you tell
me more about that.”
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Minimal Encouragers
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Minimal encouragers are brief statements that
can be either nonverbal, such as a positive nod
of the head, or simple verbal responses such as
Okay, Uh-huh, I see, I am listening.
Minimal encouragers demonstrate to the
consumer that you are listening and paying
attention, without stalling the dialogue or
creating an undue interruption. Especially early
in the encounter, consumers need these types of
encouragers to feel that the officer is really
attending to them and listening to what they are
saying.
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Reflecting
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Whereas minimal encouragers provide initial
confirmation that you are listening, reflecting
adds another dimension to the communication.
Here, you provide the consumer with evidence
that you are listening by actually repeating what
he or she has said. Often the reflecting response
will simply consist of the last few words the
consumer says. These statements should be
brief and used in such a way as not to interrupt
the consumer.
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Reflecting
Repeat the last few words that the
consumer said
 Example: “I am tired of everyone not
listening to me and it make me angry.”
 “Jim, it makes you angry.”
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Open-Ended Questions
Open ended questions allow you to get
more information
 Open ended questions enable us to
assess the consumer’s level of
dangerousness
 Open ended questions allow you to
assess whether the consumer is in touch
with reality
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Specific Questions That You May Want You
Ask, When Appropriate
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Does the consumer need something (e.g.,
hungry, thirsty)
Is the consumer receiving services
Where is the consumer receiving services
Does the consumer have a case manager
Is the consumer taking medication
When did the consumer last take his or her
medication
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Medication
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Mentioning “medication” must be given careful
thought.
In some cases, the topic is best left to mental
healthcare providers after the consumer has
calmed down.
In other situations, the consumer may want to
talk about his or her medication.
Also, many consumers have had negative
experiences with therapists and don’t want to
talk about it their counselor.
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E = Empathy
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2.
Emotion labeling
Paraphrasing
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Empathy
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What is the difference between empathy and
sympathy?
Feeling sorry versus trying to understand what it
is like to be in their shoes.
Being sincere and real will convey
understanding
“To my mind, empathy is in itself a healing agent
. . . because it releases, it confirms, it brings
even the most frightened person into the human
race. If a person is understood, he or she
belongs.” (Carl Rogers)
It’s hard to stay angry and aroused when
someone empathizes
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Emotional Labeling
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In emotional labeling, you again take listening to
a higher level by trying to help the consumer
identify feelings.
This is different from “telling” the consumer what
he or she is feeling because your statement is
based on what the consumer has been
communicating through his or her words and
behavior.
If you have used your listening skills well, it will
often be rather easy to provide an emotional
label to assist the consumer.
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Emotional Labeling Examples
You seem to be . . . .
 It seems to me like you feel . . . .
 If I were in your situation, I think I’d feel . . .
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Paraphrasing
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Paraphrasing is similar to reflecting except
that now you begin to communicate that
you are trying to understand the
consumer’s entire message by putting
what the consumer has said into your own
words.
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Paraphrasing
Builds rapport between officer and
consumer
 Helps the officer refine the assessment of
the crisis
 Provides information that lays the
groundwork for an eventual resolution of
the crisis
 Communicates that you are listening and
understanding
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Paraphrasing Examples
Consumer: I don’t know what I am going to
do. My family doesn’t want me here.
 CIT Officer: You’re not sure where you can
stay for awhile, but home doesn’t seem
like the best place right now.
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Paraphrasing Examples
What I hear you saying is . . . .
 If I am hearing you right . . . .
 Let me see if I understand what you are
saying . . .
 These types of statements also
summarize what has been said in the
communication.
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A = Affirm
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You need to know what the consumer is upset
about
You may have a tendency to go to the solution
step without really identifying what the issue is
with the consumer. You should not assume that
you know why the consumer is upset. You
should ask and let the consumer tell you what
the problem is before looking at possible
solutions.
After getting the information that you need, steer
the conversation toward a resolution by affirming
the consumer’s situation
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Affirm Example
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“Okay, let me make sure I understand you,
You’ve told me that people are bothering
you and that your case manager is not
helping you. That your meds are hurting
you because they make you feel sick. Did I
understand you correctly.”
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P = Partner
Also “plan,” “problem-solve”
 Goal is to find a resolution and return to
pre-crisis state.
 You are looking to find the combination
that will unlock the crisis.
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Partner
You can ask the consumer what she
thinks will resolve the problem
 Look for alternatives with the consumer
 Try to have 2 or more options
 Empower the consumer to choose
 If one approach doesn’t work, “throw
another lure”
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Partner
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Putting yourself in the consumer’s shoes will
help you find a solution
Don’t force particular points of discussion
Try to get agreement on a course of action.
Repeat what the plan is and what is expected.
Meet reasonable demands when possible
Reach for small concrete goals
It’s never too late to reassess and change a
plan
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Partner
If repeated attempts fail, set firm limits and
tell the consumer that you are worried
about his safely and you want to help him.
 Ask if there is a family member you could
talk to.
 State your expectations by linking to safety
issue: I need to make sure that everyone
stays safe.
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Partner
In your attempts to resolve an escalating
situation you may be tempted to use
bargaining, deal-making, or
saying/promising anything to gain
compliance.
 They are not recommended as they
ultimately violate trust—which is important
in your repeated encounters with people.
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Resolution
Can it be informally resolved?
 Is an evaluation needed?
 Are commitment criteria met?
 Was a crime committed?
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What Ifs
What if the consumer asks you a longterm question?
 Say that you don’t know the answer but
that you and the consumer can handle the
immediate situation
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What If
The consumer says that there’s nothing
you can do to help?
 Say that you’re not sure what you can do,
but that you want to work with the
consumer to figure out something
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What If
The consumer will not engage problemsolving and is distracted?
 Say “Stay with me, Frank. Let’s work on
this together. I’d like for you to stop for a
minute and take a deep breath with me.
Like this. That’s good. Thank you, Frank.”
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What If
The consumers moves too close you?
 Say “I need some space, Jim, so I am
going to back up.”
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What If
The consumer is talking so loudly it is
disruptive?
 Drop the volume in your own voice and
say, “Jim, I am having a hard time
understanding you because of how loud
your voice is.”
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What If
You think the consumer might become
aggressive?
 If possible, bring in another trained person.
 There is less chance of aggression if two
people are talking to one person.
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What If
The consumer will only respond nonverbally, like with a head nod
 Respond positively
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What If
The consumer remains unresponsive?
 Simply validate the consumer by stating
what you observe about their situation
 “You look really sad; you must be really
hurting right now.”
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Five Special Strategies
1.
2.
3.
4.
5.
Assertive Intervention
Corrective Action
Reducing Stimuli
Reducing Arousal
Pro-active (as opposed to reactive)
engagement of consumers
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1. Assertive Intervention
Can be used when:
The consumer is uncooperative or
unresponsive to directives that they are
expected to follow.
 The consumer is violating rules which
serve to maintain security
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Three Step Assertive Intervention
1.
2.
3.
Empathy statement: A statement that lets the
consumer know that you understand where he
or she is coming from and how he or she likely
feels.
Conflict statement: A statement that describes
to the consumer that you have a conflict that
needs to be addressed.
Action statement: A statement that lets the
consumer know what you want him or her to
do. This statement can be in the form of a
request.
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Examples
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“Jack, I understand that you are upset and that
you feel like no one is listening to you or doing
enough to help you. But you and I need to let
these people get back to work here, so we are
going to have to get out of this waiting room. I’d
like you to walk with me down the hallway to an
empty room so you and I can talk.”
“It looks to me like you are pretty upset, and I’m
here to help you. But I am afraid someone is
going to get hurt by those stones. So I’d like you
to stop tossing them and step up here on the
curb so I can talk to you and try to understand
what is going on with you today.”
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Choice
If possible, offer a choice:
 Joe, I want you to stop throwing the stones
or, if you prefer, step over here with me on
the grass and throw them in the grass
while we talk. What is best for you?
 This helps the consumer “save face.”
 Everyone reacts better to a choice versus
being told what to do.
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2. Corrective Action: AAA
If you make a mistake (and you will) and the
consumer escalates:
1. Acknowledge: “Jim, I can see that mentioning
your medication is a real sore point.”
2. Apologize: “I’m sorry to have upset you. I didn’t
mean to.”
3. Try Again: “I want to help, not upset you, so
let’s try something else.”
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3. Reducing Stimuli
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
Remove the audience or move the
consumer to a private space
Turn off flashing lights
96
4. Reducing Arousal

Encourage the consumer to take 3 deep
breaths; you can do this with the
consumer. “Let’s take 3 deep breaths like
this”; then demonstrate and do it with the
consumer.
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5. Pro-active Engagement
of Consumers

Many of you will interact with the same
consumer on repeated occasions so you
will get to know him or her. If you talk to a
repeat consumer on a good day, you will
have much better information to base an
assessment come the bad day. That
information will provide greater options for
resolving conflicts.
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Pro-active Engagement of
Consumers
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Drop by the consumer’s residence. Ask if there
is anything you can do to help. (e.g. call the case
manager to try to access a resource for the
consumer.)
If you see the consumer in the community,
acknowledge him or her. Stop to say hello if it
would not embarrass the consumer.
Get to know some of the providers (e.g., case
managers) who serve your consumers.
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Thursday PM
 Verbal
Intervention Strategies for
People who are Suicidal,
Homeless, Delusional,
Hallucinating, Confused, Agitated,
Intoxicated, Having Flashbacks,
Manic
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Review of Terms
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Thought Disorder = usually a reference to a
psychotic disorder
Psychotic = out of touch with reality; often
experiencing delusions or hallucinations
Delusion = false belief
Hallucination = false sensory perception (most
common is auditory)
Mania = A manifestation of bipolar disorder
(manic depression), characterized by profuse
and rapidly changing ideas, exaggerated
sexuality, gaiety, or irritability, and decreased
sleep
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Suicide
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Asking about suicide: “Sometimes when people have
been feeling down for a long time, they begin having
thoughts that they would rather be dead, are you having
any feelings like that?”
“Have you ever tried to hurt yourself before?”
“When and what did you do?”
“Do you have a plan now?”
“Do you have any weapons that you could use to hurt
yourself?”
Show support and interest
Be non-judgmental and accepting
Offer help that is available
Assess availability of supports
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Suicide: Threatening Harm
Focus on the anger or fear that is causing
the threats
 Repeat that you are here to help and keep
everybody safe
 Get the names of significant others (even
pets), as a way to make a personal
connection and keep the consumer
grounded
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Suicide Attempt
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Verbal communications should focus on
providing hope for the consumer during a time
when he is feeling hopeless.
Generally, helpful comments to make during
questioning include: These feelings will not last
forever, even though it may seem like it now.
There is help available. Many other people have
felt this way and have gotten better.
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Suicide Attempt

Unhelpful comments include clichés such as,
There’s a silver lining in every cloud, or
comments about all that they have, You have a
nice home, family who loves you, who will take
care of your kids. And finally comments about
yourself, I felt the same way once or a friend of
mine felt this way once. These types of unhelpful
comments only elicit more profound feelings
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Homelessness
40% of homeless persons have a mental
illness
 The ways in which homeless people dress
may seen bizarre to other people
 Mental health professionals may refer to a
homeless person’s choice not to take
medications as noncompliance, but to a
homeless person the decision not to take
sedating psychiatric medications may
make good sense.
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Thought Disorder
The 3 possible responses to a person who loses
contact with reality, and are either hallucinating or
delusional, are:
Agree with them
B. Dispute them, or
C. Defer the issue
A.
Which is the appropriate response: A, B or C?
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Thought Disorder
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The engagement goal is to validate the consumer’s
situation and how frightened and anxious he must feel
without agreeing with their hallucinatory/delusional
experience.
It is OK to indicate that you do not hear or see what he is
seeing/hearing but that you believe he does.
Persons who are psychotic develop an altered sense of
personal space and require more space than usual to
feel safe.
Remember to maintain a safe “reactionary” distance of
from the consumer.
Use friends and family members to get information if
they are available and their presence is not escalating
the consumer.
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Delusions
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Paranoid delusions can lead to dangerous
behavior because they cause a great amount of
fear. This is especially true if the delusion
includes a belief that one’s thoughts are
controlled by external forces.
Convey your acceptance—but let the consumer
know that you are not experiencing it and
reinforce reality.
“I can see that you are scared that someone is
out to get you, but I don’t know of anyone who is
trying to hurt you . . . I’m here to keep you safe.”
Don’t argue about the delusion—no one will win
this argument
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Hallucinations
Ask if they are hearing voices: “When
people are stressed or scared, they may
hear or see things, is that happening to
you.”
 Ask, “are the voices telling you to do
something, what?”
 People who are abusing substances or are
in withdrawal may see things or feel things
crawling on them
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Hallucinations
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Indicate that you understand that those
experiences are real and frightening for the
consumer.
You can attempt to calm the person by letting
them know that voices may “quiet” if you can
help the consumer lessen their stress and get
help.
You may have to repeat a reassuring message
many times before the consumer can respond to
it. Repeat: I’m here to help; I am not going to
hurt you.
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Hallucinations
Hallucinations/voices that are command
oriented involving religion, good versus
evil, or are declaring self-harm are higherrisk than non-religious, non-confrontational
hallucinations.
 This can lead to dangerous behavior
because many persons will obey the
command.
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Confused/Disorganized Speech
People with a variety of mental illnesses
may experience confusion: schizophrenia,
bipolar, neurological disorders, traumatic
brain injury, people who are actively using
or withdrawing from substances
 Keep interactions brief and to the point
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Confused/Disorganized Speech
When it is difficult to understand the
consumer, say so and ask for clarification.
If the consumer is rambling nonsensically,
comment periodically that you realize that
he must be frightened and that you are
there to help.
 Drop the volume in your speech and say,
“I am having a hard time understanding
you because of how loud your voice is.”
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Agitation, Anxiety, Fears
Encourage 3 slow deep breaths
 If this is difficult for the consumer, ask him
to look at you and do it with you
 Reassure and converse calmly
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People Who Are Intoxicated
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Remember, substance use, especially alcohol is
a significant risk factor associated with violence.
Do not let your guard down (“She is only drunk.”)
Keep statements brief and to the point
Avoid engaging in arguments
Point out that it is difficult to understand what is
being said
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PTSD Flashbacks
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Some people with post traumatic stress disorder
experience flashbacks. During a flashback, the
person is experiencing the traumatic event. So
all the senses and thoughts are in the moment. It
is really important to maintain personal space
and avoid touch during a flashback.
Orient and ground: My name is . . . today is . . .
you are (describe where), it’s our job to keep
you safe
Provide simple directives and reassurance softly
and slowly
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Rapid Speech / Mania
Some people talk rapidly when they are
stressed or scared. People who are manic
often talk very rapidly
 Encourage the person to slow down, take
deep breathes.
 “I want to understand what you are saying,
but you are talking really fast. Let’s take
some deep breaths together.”

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Acknowledgements
This material was adapted from numerous
sources, including:
 Memphis CIT Curriculum
 Sam Cochran
 Randy Dupont
 Georgia CIT Curriculum
 Responding to Individuals with Mental Illness by
Michael Compton and Raymond Kotwicki
 Connecticut State Department of Mental Health
and Addiction Services
 Findlay/Hancock County CIT
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Thank you for going the extra
mile to help people with mental
illness!
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