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Role-playing scenarios help train those who deal with mental-health crises

Barbara Schneider Foundation
A scene illustrating de-escalation from a Crisis Intervention Team training session.

As she pulled up to the liquor store curb, Laura Moe remembered how great her friend looked two weeks earlier when they had been out dancing at the club. Now, her former roommate at Pepperdine University was barefoot and beat up in downtown Los Angeles, kicked out of a store, Laura said, “like a bum.”

Her beautiful, smart friend had schizophrenia, Laura said, and had stopped taking her medication, “because she didn’t want to believe she was sick.” Within years, “she just vanished, into outer space.”

Decades later, on a recent Friday afternoon, Laura was in a conference room at Hennepin County’s jail complex in downtown Minneapolis. Floors above hundreds of inmates, she was crouched on the floor, cowering in front of a man. He gently approached her, slowly crouching and extending his hand to help her. She recoiled.

And even though she was role-playing — and the man was a coach for the nurses, police officers and jailers taking notes at a table just feet away — Laura said the feeling of pretending to have bipolar disorder, depression, substance abuse or, like her friend, schizophrenia, can “hang on me for days.”

“To convince yourself you’re this person for hours at a time,” she said, “it’s hard to just let that go.”

Method created in Memphis after a shooting

An actor and musician, Laura is one of about 70 actors hired to role-play scenarios for the Barbara Schneider Foundation, a Minneapolis nonprofit that trains law enforcement and health-care workers in a method called Crisis Intervention Team training, or CIT. The method was created in 1988 in Memphis, Tennessee, after officers responding to a 911 call shot and killed a mentally ill man who had been cutting himself and threatening others with a large knife.

The grassroots CIT program caught on. Twenty-five years after the advent of the “Memphis Model,” nearly 3,000 departments nationwide — including Hennepin and Ramsey counties, each of the Twin Cities and the state corrections department — have some form of experience with the training. (There is no accreditation or formal definition apart from a 2007 paper on “core elements” [PDF] by the University of Memphis CIT Center.)

But as the New York Times reports, “the problem has gotten worse in recent years, according to mental health and criminal justice experts, as state and local governments cut back on mental health services.”

Specifically, from fiscal years 2009 to 2012, states cut [PDF] an estimated $4.35 billion from mental health care – during the same time a million more people sought help. Entire hospitals have closed and mental health programs shut down, the National Alliance on Mental Illness (NAMI) said in a report. Minnesota, one of the better in the country, kept its funding just below the level of inflation.

The cuts have exacerbated other disquieting trends. Liz Rahuba, a CIT actor who trains the Chicago Police Department, said occurrences of mental illness “are still growing because of the economic climate and others factors,” including people left homeless from budget cuts, veterans coming home with PTSD, and a rise in mental illness in school-age children.

Jails and prisons fill some of vacuum

Unfortunately, the United States had already been miserably failing people with mental illness. The vacuum left by the closing of state psychiatric hospitals in the 1950s [PDF] meant that people with untreated or undertreated illnesses had nowhere to go. Today, more than 10 times as many people with severe mental illnesses are in prison or jail than are in state psychiatric hospitals. At the CIT training this month in Minneapolis, a corrections officer at the Pine County jail told me a similar story. The mental health agency serving the five-county area closed suddenly in March, after it lost county funding. Three thousand people were left without help. “We’ve already seen people from there coming in.” He said it’s been a trend over the last several years: budget cuts leading to closed facilities.

“We see a lot more people getting dumped [here],” he said. “And basically they just sit there in limbo.”

“In limbo” — whether it’s in a county jail or on the street, in the middle of a crisis with a police officer that doesn’t know how to handle you — is a dangerous place to be for a person with mental illness. Fully half of the people shot dead by police are mentally ill. Sometimes they are killed by officers responding to the very 911 call meant to help them, like the death that prompted Memphis to create its program.

The eight to 12 hours prescribed by the Memphis Model for trainees to role play de-escalation techniques with actors may not, in light of this challenge, be nearly enough. But when the nation’s two largest cities have no similar program to speak of, it’s a start.

***

Across the hall from Laura in a small room, a man is standing tensely in the corner. The ceiling is low, or maybe it just feels that way. He is pacing back and forth.

“I don’t want to make him mad,” he says, “I don’t want to make him mad, I don’t want to make him mad.” His eyes are bloodshot and practically gasping. He keeps repeating things in threes, but whatever that means to the woman standing across the long table from him, about eight to 10 feet away, is anyone’s guess. The woman, in a U of M hoodie, looks like she’s in her mid-20s, about the same age as the man. She’s speaking to him in a calm voice, leans forward while softly gripping the edge of the table.

“What are you pressing?” he asks suddenly. The woman lifts up her hands to show nothing.

And then, as if in a movie, someone in the room calls for the action to stop. The actor sits down.

His name, I learn later, is Dustin Bronson; a professional actor since college, he’s performed at theaters including the Illusion, Park Square and Pillsbury House theaters. Out of character, his eyes aren’t as red and bloodshot, and his voice is calm. But as he offers feedback to his de-escalation partner, he looks drained.

Scenario 23 — The Wanderer

On the opposite side of the table, a woman who’s learning how to be a coach for future CIT classes has a piece of paper in front of her. On the top, it says Scenario 23 — The Wanderer.

“Individual found wandering around the police department,” it reads, “talking to self and looking in rooms inappropriately.” The scenario lays out a list of behaviors and symptoms the man will present — “that he knows something is not right, but also feel’s it’s a game and he is not sick,” and that “there are cameras everywhere linked to a control room in the basement of city hall” — that the officer getting up to “de-escalate” Dustin’s character doesn’t know about. All he knows is that Dustin needs to be booked, and that Dustin doesn’t want to be.

“I’m not supposed to be here, I’m not supposed to be here, I’m not supposed to be here,” he panicked. “I just need to leave, I just need to leave, I just need to leave.”

“We have to complete the process first,” said the man. He said it calmly, and was standing relaxed as he chewed his gum, but it didn’t matter. The character, who had already mentioned fearing a judge and not wanting his picture taken, seized on the words immediately: “I don’t like the process,” he said.

Scenes from role-playing CIT training in Memphis in August 2014.
Rachelle Hopkins with Creative Images Photography
A scene from a CIT training in Memphis in August 2014.

My reaction to the officer’s focus on getting Dustin booked, and not his obviously debilitating mental illness, was that the whole thing seemed Kafkaesque. So I asked Mark Anderson, who runs the Barbara Schneider Foundation and organizes the trainings, whether the man couldn’t have been more clear and patient. Mark, who also watched the scenario, told me the officer had done a decent job.

“You have to realize,” he said, “that cops are pressured to get people through the system, because dispatch is calling them to hop on a new case.” Besides, he said, law enforcement are only carrying out the laws that we create, with the resources we give them. Even if their job description was to diagnose and help treat mentally ill people, law enforcement wouldn’t have enough time.

That said, if an officer or nurse does a good job at de-escalating, it can help someone regulate his or her emotions in the short-term, said Evelyn Digirolamo, one of the actors at the training. Even though it’s a “band-aid,” it does make the job easier and safer. “If they can de-escalate me,” she said, “they can lead me to other sources who can help” in the longer-term.

Evelyn, a CIT actor for two years, is in a show this month that explores criminality and why people murder, and works with both cognitively delayed adults and at-risk children. When she saw the foundation’s notice in Minnesota Playlist, she saw that it asked for actors “who had maybe some sort of interest in the mission.”

‘A similarity in understanding’

“My younger brother has Asperger’s,” she said, and growing up she “witness[ed] a lot of his tantrums” and how people reacted to them. So “There was a similarity in understanding somebody who is thinking differently and perceived wrongly in these crisis situations.”

Evelyn thinks also of her at-risk students, many of whom, due to the trauma and stress of poverty and discrimination, have emotional-behavioral disorders. When they’re upset, she said, “they could be perceived as more aggressive than they are.” She said she understands that.

“It’s really hard to feel those feelings and it’s really hard to come out of that,” she said. “It’s really hard to calm down.”

“You can’t just tell someone to calm down,” she adds, “when they don’t have any tools to calm down or experience regulating themselves. If they knew how to be[come] calm, they’d already be calm.”

Most are open, though some resist the ideas

That’s why Evelyn appreciates that police, health workers and others are at the training. “For the most part,” she said, “people are really open and enthusiastic about the trainings,” even though Evelyn’s characters are stressful — often her characters intrude into an officer’s physical space, move erratically and scream extremely insulting things at them. “They’re never surprised by the way I’m acting,” she said, “I hear them talking afterwards and they will say, ‘Oh, I’ve been called that before’ or ‘Oh, I hear that everyday.’ I can’t imagine doing that on a regular basis.”

But she said that there are people at trainings  – health workers as well as those in criminal justice — who aren’t interested in de-escalating people in crisis.

“The first time I heard an officer saying that his next step, in a normal situation, would be to tase me … uh, yeah. It seemed very quick to me. I mean, I’m not very threatening — I’m a 5’5″ woman with no weapons. What am I going to do to you?”

Laura mentioned a similar experience. She was playing a character in jail who, after being sexually assaulted, had fears about the dark. Now was panicking after the facility went “lights-out” for the night.

In the scenario, the jailer needed to bring Laura, in crisis and screaming at him, somewhere else. After five minutes, the exercise was paused for feedback on how the jailer was using his de-escalation techniques. Laura remembers what the jailer had to say.

If this was my real job, he said, “I would have tased her five minutes ago.”

“You would taser me for yelling or screaming?” she said. “It makes you feel a little scared. It’s scary to think that would elicit such a response.”

Other actors shared similar stories. Zainab Musa, a Twin Cities actor now living in Brooklyn, recounted how she once played a character whose mental illness manifested in hypersexual behaviors. The police officer, meant to de-escalate her, became uncomfortable and grabbed her wrist. He tightened his grip, Zainab said, and “proceeded to shake me” — despite rules against touching in the scenarios.

It was a tense situation. At the end of the day, Zainab said, “there were a few men in the room who would not make eye contact with me.”

“I try not to judge,” she said, and suggested that the tense, awkward experience could have triggered something from the officer’s own experiences. But that is part of what makes CIT work, Zainab said — “if you’re not willing to be vulnerable to someone in a crisis, who is it exactly that you’re serving and protecting?”

Experience handling emotional vulnerability, in both life and in work, may be why older, experienced officers tend to do better at the trainings than younger ones: With less experience, a younger officer is more likely to revert to physical tactics they know will keep them safe. “The ones that have been on the street for a long time,” Evelyn said, “already have a lot of these skill sets.”

“I don’t want to make generalizations,” she said, “but it’s mostly the newer or younger police officers” who have trouble keeping calm or aren’t interested in a “talk it out” approach. “The people who do get flustered,” Evelyn said, “it happens pretty fast.”

“It’s also understandable,” she adds. “I’m really pushing them, I sometimes get into their space, at what could be an endangering distance.”

“I do seem very hard to predict, I’m sure,” she added. “I feel that the people who do pretty well, they’re kind of superhuman.”

Sheila Regan, an actor for the program since 2010, agrees. “It’s a really hard thing to do, to de-escalate someone,” she said. “The main struggle is with students who don’t really believe in it. There’s always one or two in one workshop day,” she said, but it has “gotten better over the years.”

Respect for law enforcement’s challenges

For their concerns over how quickly force can be used, the actors were also universal in their respect for the challenge.

“I have occasional outbreaks of fights amongst my kids,” Evelyn said, “but this is stuff [officers] are dealing with on a regular basis, sometimes several times a day, in more extreme situations. I can’t imagine doing that every day.”

Laura mentioned the challenge that officers face to square their new training with their initial, tactical training. “I realize what a struggle it is for them because they’re really taught the opposite of what they’re doing,” she said. “I’ve seen these guys, actually struggling, trying to figure out the right thing to say or do, and it’s really genuine.”

The need to protect themselves and people in crisis, said Mark Anderson, the training director, has actually been the reason more officers use CIT practices.

“It keeps them safer,” he said. “They don’t get hurt because they’re not getting into physical confrontations and literally wrestling with people.”

After the training, Maurice Smith said that’s what he realized, too. As a Hennepin County security officer, he often had to physically subdue high, drunk and mentally ill people at the overnight detox unit at the jail, dragging them to a room where they were tranquilized. Replacing shirts ripped in confrontations was a regular part of his job. He wasn’t sure what CIT could do for him. “What is it, like verbal judo or something?” he remembers thinking.

Today, Smith is a CIT trainer with the foundation, and helps train people who want to become coaches themselves. He marvels at the effect de-escalation has had in his work.

“I haven’t written a use of force report in at least six years,” he said. Before, he was writing “four or five a week.” He said he’s even used CIT principles in his personal life — say, when his brother’s daughters are making too much noise during the football game on Sunday. And it works.

‘It’s a communications training’

“Really,” said Mark Anderson, “it’s a communications training. It teaches you how to communicate with someone who’s really tough to communicate with.”

There are limits to the training. Police trained in CIT still shoot mentally ill people dead in questionable circumstances; one in four officers in Albuquerque’s police department, currently under investigation by the Justice Department, has received training.

Sam Cochran, a retired major in the Memphis Police Department, helped create the CIT model and is advocates the approach across the country. He said crisis situations “bring multiple levels of fear together”: the person in crisis, the bystanders, the officers responding to the scene. In that situation, “choices have to be made very quick,” he said. “It requires a very skilled officer.”

And so much of the time, he said, that skilled officer is in fact there. Officers are “saving lives every day, every night,” he said, “and yet, how do you prove something didn’t happen because of a CIT officer on the scene? It’s hard to measure something not happening.”

It is sadly fitting that CIT, a method which can’t be verified, is the main approach to solve a problem — mentally ill people dying in a police/emergency response — that itself isn’t measured by the government. That problem, in turn, is the result of another omission: the public’s care for mentally ill people. When society pushes a population into the margins, law enforcement is left to deal with it. We shouldn’t be surprised that a grassroots, voluntary training hasn’t solved a community problem.

“Law enforcement,” Cochran said, “happens to be a reflection of the community.”

His comment reminded me of a promotional video I watched on the Barbara Schneider Foundation’s website. Part of the video, which explains CIT, shows part of a role-play scenario. It’s in a courtroom, and a woman behind a table is trying to calm down a manic woman on the other side.

“I need to ask you to keep your voice down a little,” the woman says in a calm, tired voice, “because it’s going to disturb them from their work.”

Across the table, the woman in crisis is indignant. “The disturbance is going to go deeper than that!” she said. “This is a disturbance of the utmost importance.”

The woman’s voice rises more and more, and soon she’s yelling each word.

“I am trying to save these people, all right? It’s not my fault if all of a sudden they get a little annoyed in the middle of their day, all right? This is going to save their lives!”

Graison Hensley Chapman is a reporter and writer based in Northfield. Contact him at graison4@gmail.com or 612-202-6779.

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