850.20 Police Response to Mental Health Crisis
1st Universal Review: 1/15/20-1/30/20
- ORS § 161.375(4), Authority of Psychiatric Security Review Board to issue warrant of arrest
- ORS § 426.223, Authority of facility director or designee to require assistance of a peace officer to retake custody of committed person who has left a facility without lawful authority
- ORS § 426.005, Definitions for ORS § 426.005 to 426.390
- ORS § 426.228, Authority of peace officer to take a person into custody for mental health treatment
- ORS § 426.233, Authority of community mental health program director or designee to place mental health hold and order transport to treatment
- ORS § 430.735-765, Duty of government officials (incl. Peace Officers) to report abuse of persons with mental illness or developmental disabilities
- DIR 630.45, Emergency Medical Custody Transports
- DIR 640.35, Abuse of Elderly/Persons with Disabilities
- DIR 850.25, Police Response to Mental Health Facilities
- DIR 850.39, Missing, Runaway, Lost or Disoriented Persons
- DIR 850.10 Custody, Civil Holds
- DIR 850.30 Temporary Detention and Custody of Juveniles
- DIR 900.00, General Reporting Guidelines
- Portland Police Bureau, Behavioral Health Unit’s Community Mental Health Resources
- Report of Peace Officer Custody of a Person with Alleged Mentally Illness
- Report of Peace Officer Custody of a Person with Alleged Mentally Illness as Directed by a Community Mental Health Director
- Bureau of Emergency Communications Mental Health and Enhanced Crisis Intervention Team Dispatch Protocol
De-escalation: A deliberate attempt to reduce the necessity or intensity of force to resolve confrontation.
Designated Residential Mental Health Facility: Secure and non-secure treatment facilities registered with Multnomah County Mental Health and Addiction Services to provide residential mental health treatment for adults in a home like environment supervised by twenty four (24) hour staff to provide stabilization, treatment, and community integration, which have been identified and flagged by the Portland Police Bureau’s Behavioral Health Unit (BHU). ORS § 426.005 (1) (c) (d).
Enhanced Crisis Intervention Team (ECIT): ECIT consists of sworn members who have volunteered and been selected to complete an additional forty (40) hours of mental health response training to serve as specialized responders to individuals who may have a mental illness.
Mental Health Crisis: An incident in which someone with an actual or perceived mental illness experiences intense feelings of personal distress (e.g. anxiety, depression, anger, fear, panic, hopelessness), a thought disorder (e.g. visual or auditory hallucinations, delusions, sensory impairment or cognitive impairment), obvious changes in functioning (e.g. neglect of personal hygiene) and/or catastrophic life events (e.g. disruptions in personal relationships, support systems or living arrangements; loss of autonomy or parental rights; victimization or natural disasters), which may, but not necessarily, result in an upward trajectory of intensity culminating in thoughts or acts that are dangerous to self and/or others.
Mental Health Providers: Mental health providers are professionals who evaluate, diagnose, and treat mental health conditions. Providers have advanced education, training, and/or licensure. Common types of mental health providers include psychiatrist, psychologist, physician assistant, social worker, professional counselor, and qualified mental health professional. Providers may specialize in certain areas such as depression, substance abuse, or family therapy. Providers may work in different settings such as private practice, hospitals, or community agencies.
About Mental Health:
1. Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society.
2. Mental illnesses are health conditions that are characterized by alternations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning. Alternations in thinking, mood, or behavior contribute to a host of problems-patient distress, impaired functioning, or heightened risk of death, pain, disability, or loss of freedom.
3. Mental health problems refer to signs and symptoms of insufficient intensity or duration to meet the criteria for a mental illness diagnosis. Almost everyone has experienced mental health problems in which the distress one feels matches some of the signs and symptoms of mental illness. Mental health problems may warrant active efforts in health promotion, prevention, and treatment. Mental health problems may escalate to the level of mental health crisis if the situation and person’s level of distress exceeds his or her abilities to cope.
4. Mental illness is distinct from intellectual or developmental disabilities.
1. In the context of mental health services, mental health providers are responsible for the evaluation, diagnosis, and treatment of persons with mental illnesses and assessment and intervention with those who are in mental health crisis. However, the Portland Police Bureau recognizes that its members are often first responders to individuals with mental illness who present in crisis or with immediate needs. The Portland Police Bureau is committed to serving individuals in mental health crisis in partnership with mental health providers, the justice system, emergency medical services, and community members. When appropriate, referral to community-based treatment services is a preferred alternative to arrest and incarceration of persons who are in mental health crisis.
2. The Portland Police Bureau recognizes that members will have contact with residents who experience mental illness but are not in crisis. Many members of the Portland Police Bureau will come to be familiar with individuals in the community who members know to have a mental illness. The Police Bureau provides training so that members may recognize signs and behaviors of mental illness in the absence of crisis, and expects members to engage these individuals with dignity and respect, using the skills they have learned in their crisis training. It is the Police Bureau's intention that members give special consideration to these situations, recognizing that using crisis intervention skills with all individuals experiencing mental illness will support the Bureau's goal of safely resolving situations, providing excellent service and building respectful relationships with mental health peers, family members, providers and other involved City of Portland residents.
3. Members are increasingly required to respond to and intervene on behalf of persons who are in mental health crisis. While members are not expected to make mental health diagnoses, they are expected to recognize signs and symptoms that may suggest a mental illness as well as behaviors that are indicative of mental health crisis. The goal is to use de-escalation skills to maximize the likelihood of a safe outcome for members, individuals, and the community.
1. Member Expectation and Training:
1.1. When members recognize that a person whom they are contacting has signs and symptoms indicative of a mental illness, members are expected to use their training to attempt engagement without escalating the situation. When responding to incidents involving persons who are experiencing a mental health crisis, members are also expected to manage the scene and develop a reasonable disposition plan.
1.2. All members on a call shall answer the mental health indicator question. Members shall document the incident on an appropriate police report, complete all reporting requirements for a mental health crisis response, and submit the information to a supervisor before the end of shift.
1.3. Mental Health Response Training:
1.3.1. All new sworn members will receive Mental Health Response training.
1.3.2. All existing sworn members will receive Mental Health Response refresher training during annual, in-service training.
1.3.3. The Bureau provides training so that members may recognize signs and symptoms of mental illness and develop skills to engage individuals experiencing mental illness with dignity and respect.
2. Responding to and managing scenes involving persons in mental health crisis:
2.1. When responding to incidents involving persons displaying behavior indicative of mental health crisis members will consider the following actions to manage the incident for the safety of all at the scene:
2.1.1. Evaluate the nature of the incident and necessity for police intervention when feasible, based on information known to the member at the time (e.g. reports, known history, observed behavior, etc.).
2.1.2. If the member decides to intervene, consider, when feasible, the use of verbal and non-verbal communication skills to engage a person who may be agitated, upset or at risk of becoming emotionally unstable in order to calmly and safely resolve the situation.
2.1.3. Tactics members should consider in devising a response plan include, but are not limited to, the following (“ROADMAP” is a mnemonic device that assists members in remembering tactics taught in training):
126.96.36.199. R – Request specialized units,
188.8.131.52.1. Evaluate the need for assistance from individuals with additional training in working with mental health crisis situations (e.g. Enhanced Crisis Intervention Team (ECIT) members, Project Respond, Crisis Negotiation Team (CNT)). When a member determines that ECIT assistance is needed, they shall make the request through the Bureau of Emergency Communications (BOEC).
184.108.40.206.2. Evaluate the need for possible consultation with a mental health provider (e.g. see the Behavioral Health Unit’s Community Mental Health Resources such as the Multnomah County Call Center, the involved person’s mental health providers), and/or anyone else the member deems appropriate.
220.127.116.11. O - Observe or use Surveillance to monitor subject or situation,
18.104.22.168. A – Area Containment (perimeter, containment),
22.214.171.124. D – Disengage with a plan to resolve later,
126.96.36.199.1. Disengagement is a tactic to be considered to reduce undue safety risk to the member, the involved persons, or others. Prior to disengagement, members will make reasonable efforts to gather relevant information about the person in crisis from readily available sources, such as the Multnomah County Call Center, and consult with a supervisor to determine whether to make contact at a different time or under different circumstances. The tactic requires members to complete a general offense report, notify the Multnomah County Call Center of the situation (e.g. name, date of birth, disposition), and develop a plan in accordance with Bureau training. Members shall not disengage where an individual presents an immediate danger to a third party. Where an individual presents an immediate danger to her/himself, prior to disengagement members shall assess whether they could reasonably remain at the scene and use other tactics to diminish the risk of harm to the individual without increasing the risk of harm to the member or third parties. A perception of risk based on mere suspicion will not constitute ‘immediate danger.’
188.8.131.52. M – More Resources/Summon Reinforcements,
184.108.40.206. A – Arrest Delayed (get a warrant, or try different time/place),
220.127.116.11. P – Patience. Use time and communication to attempt to de-escalate the subject.
2.1.4. If custody is necessary, develop and communicate a tactical plan to participating members, so as to take advantage of the most effective options that may safely resolve the incident.
3.1. In determining a non-criminal resolution for a person with a mental illness or in mental health crisis, members will consider the totality of the circumstances, including the behavior of the person and the governmental interests at stake. Following is a list of non-criminal dispositions that may be appropriate at the scene, among others:
3.1.1. Refer the involved person to a mental health provider; see the Behavioral Health Unit’s Community Mental Health Resources, for referral information.
3.1.2. Request AMR transport for the involved person to a mental health or medical facility for voluntary care. Members should inform AMR personnel of the situation so AMR can pass the information along to staff at the facility upon arrival. Members may meet up with AMR at the facility and may escort the person into the waiting area, introduce them to facility staff, and share with staff a brief verbal report on the facts of the case. Members are not required to standby.
3.1.3. Take the involved person into custody and arrange for AMR transport to a medical facility in accordance with Directive 850.21, Peace Officer Custody (Civil), or Directive 850.22, Police Response to Mental Health Directors Holds and Elopement.
3.2. Regardless of which disposition above is used, members are required to complete an appropriate police report.
3.3. If an individual is taken into custody, either civilly or criminally, members are required to document consideration and/or use of ROADMAP tactics.
4. Enhanced Crisis Intervention Team (ECIT) Member Responsibilities:
4.1. ECIT members will respond as the primary member on a mental health crisis call when dispatched or at the request of any member.
4.2. ECIT members may also volunteer to become the primary member on any call.
4.3. ECIT officers may serve as a resource to the Crisis Negotiation Team (CNT). Additionally, ECIT officers may facilitate an efficient transition when CNT arrives on scene. However, ECIT will not be used in place of CNT.
4.4. ECIT members will notify his/her supervisor when leaving their assigned precinct.
4.5. ECIT members who participate in a mental health crisis call by using their crisis intervention skills shall complete any required report.
5. Supervisor Responsibilities:
5.1. Supervisors will manage the dispatch and use of ECIT members and coordinate with the Bureau of Emergency Communications (BOEC) as appropriate.
5.2. Supervisors will acknowledge or respond to all calls where a member is dispatched to a designated mental health facility, in accordance with Directive, 850.25, Police Response to Mental Health Facilities.
5.3. Supervisors will ensure their members follow reporting requirements for mental health crisis response.
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