GENERAL POLICE ORDER CLEVELAND DIVISION OF POLICE ORIGINAL EFFECTIVE DATE: April 19, 2016 ASSOCIATED MANUAL: REVISED DATE: RELATED ORDERS: NO. PAGES: 1 of 11 NUMBER: CHIEF OF POLICE: This General Police Order has been revised in its entirety PURPOSE: To establish guidelines for the Cleveland Division of Police to interact with individuals who are, or may be, suffering from a crisis. POLICY: Members of the Division shall handle encounters with individuals in crisis in a manner that is reflective of the values of the community it serves and promotes the dignity of all people. Individuals in crisis require sensitivity and special consideration. Members should use reasonable precautions to avoid a violent encounter with individuals in crisis, while making every effort to preserve the safety of members, the individual, and the general public. DEFINITION: Crisis: A situation where an individual s safety and health are threatened by behavioral health challenges or overwhelming stressors. A crisis can involve an individual s perception, or experiencing of, an event or situation as an intolerable difficulty that exceeds the individual s current resources and coping mechanisms, and may include unusual stress in their life that renders them unable to function as they normally would. A crisis can result from a multitude of stressors/experiences, including, but not limited to, physical issues, mental health issues, substance abuse, relationship issues, financial problems, death of family or friend, or job troubles. Crisis Incident: Includes, but is not limited to, assignments involving individuals known to have mental health issues and are experiencing a crisis; individuals displaying behavior indicative of someone with mental health issues; attempted or threatened suicides; or calls in which individuals may be experiencing emotional trauma. Certain physical disabilities may resemble those characteristics displayed by individuals who have abused substances such as alcohol or drugs. However, individuals exhibiting these behaviors may actually be suffering from physical or medical disabilities such as diabetes, seizure disorders, multiple sclerosis, hearing/speech impairment, Alzheimer s, traumatic brain injury, and/or other disabilities.
2 of 11 Crisis Intervention: Emergency and temporary care given to an individual in crisis to interrupt a downward spiral of maladaptive behavior and is directed toward returning the individual in crisis to their level of pre-crisis functioning. Crisis Intervention Team (CIT): A partnership between police, mental health agencies, advocates, and the community that seeks to achieve the common goals of safety, understanding, and service to individuals in crisis, those with mental health issues, and their families. Developmental Disabilities (DD): A disability characterized by significant limitations in intellectual capacity, functional capacity, and/or adaptive behaviors, (e.g., autism, down syndrome, or other intellectual disabilities). DD often result in substantial functional limitations in areas such as self-care and mobility. First Responder: A CIT officer, or a non-cit officer, that arrives first on the scene of a call for an individual in crisis. Individual in Crisis: Individuals with a mental illness, addiction, substance abuse, developmental disability, or some other overwhelming personal crisis. Mental Illness: Mental illness is a disorder of thought, mood, emotion, perception, or orientation that significantly impairs judgement, behavior, capacity to recognize reality or the ability to address basic life necessities, and requires care and treatment for the health, safety, or recovery of the individual or the safety of others. Mental illness conditions may be characterized by impairment of an individual s normal cognitive, emotional, or behavioral functioning, and caused by social, psychological, biochemical, genetic, or other factors, such as infection or head trauma. Mobile Crisis Team (MCT): A 24 hours a day, 7 days a week resource that provides consultation, referral and assistance to adults, adolescents, and children in crisis. (216) 623-6888. Violent: Using or involving the use of physical force to cause harm or damage to someone or something. PROCEDURES: I. Communications Control Section (CCS) responsibilities:
3 of 11 A. Communications Control Section (CCS) dispatchers shall, when available, dispatch CIT officers to known or possible crisis incidents. When no CIT officer is available, these two-person assignments shall be assigned to the first available car. 1. If a CIT officer is on a low priority call, he/she (shall/may) be (reassigned/sent) to the crisis incident. B. Calls shall not be held for CIT officers who are engaged in another high priority assignment. C. Having a CIT officer on scene does not negate the procedures for SWAT, Crisis Negotiation Team (CNT), or the Bomb Squad. II. First Responder responsibilities: A. Assess risk to selves and others to determine course of action. B. Assess situation to determine whether the individual may be an individual in crisis, and determine whether police intervention or medical intervention is required. 1. Request a CIT officer, if one is not on scene. a. Be aware that individuals may recognize a CIT officer and respond positively to the CIT officer. 2. If medical intervention is required request EMS. 3. Each crisis is unique and shall be treated as such. 4. Consider possibility the individual may be non-compliant due to: a. Medical situation b. Mental condition c. Drug interaction d. Emotional crisis e. Physical, hearing, or sight impairment f. Language barrier
4 of 11 5. Determine whether a family member/friend on scene can provide information to assist the CIT officer/responding officer in interacting with the individual in crisis. 6. Continue to assess situation for escalating risk. III. De-escalation. A. Actively slow down the response using verbal and tactical de-escalation techniques. B. Verbal de-escalation techniques 1. Introduce yourself and seek to establish a rapport. 2. Only one officer should speak to minimize confusion. a. Speak in a slow, calm, non-threatening voice and use nonintimidating body language. b. Ask questions to elicit information rather than issue orders. c. Demonstrate concern and better understanding of situation. d. Repeat instructions, keeping them simple and concrete. e. Keep the individual focused. f. Take threats seriously. C. Tactical de-escalation techniques 1. Waiting out the individual. 2. Move slowly, being careful not to excite the individual. 3. Create distance between members and possible threats. 4. Request additional resources, such as mental health providers or negotiators if needed. 5. Remove distractions, upsetting influences, and disruptive citizens from the scene. 6. Prepare for lengthy interaction.
5 of 11 7. Do not rush the scene. Take the time to contain and stabilize the scene. IV. Use of Force A. Force is NOT to be used for expediency. B. Use only the minimum amount of physical force necessary and only when the individual in crisis is an immediate threat to themselves, others on scene, or members. C. If use of less lethal force becomes necessary, move the individual in crisis to a sitting or upright position if possible after handcuffing, to avoid positional asphyxiation. De-escalation can be restarted after handcuffing/ullf. V. Handcuffing/Restraining and Transport: A. Members shall use discretion in restraining (e.g. handcuffing) individuals in crisis and are in custody solely for the purpose of psychiatric evaluation, as restraints/handcuffs may trigger a stress response. B. Use of handcuffs/restraints should be explained to the individual in crisis being handcuffed and to the parent/family member in a tactful manner. 1. Members should be able to articulate the reason that handcuffs were or were not used. C. If the individual in crisis to be conveyed is violent: 1. EMS shall be called to transport 2. CDP members are responsible for securing/physically restraining the individual in crisis onto the EMS stretcher. 3. When an individual in crisis is restrained, a CDP member (preferably a CIT officer), shall ride in the back of the EMS unit to the hospital. The other officer will follow EMS to the hospital. 4. If arrested, the individual in crisis shall be handcuffed and conveyed by the zone car to CPU after being treated and released.
6 of 11 D. If the individual in crisis is non-violent and arrested: 1. Member discretion will be used in handcuffing. 2. The arrested individual shall be transported to the hospital via zone car. 3. Diversion options should be considered (e.g. summons or named suspect in lieu of arrest). E. If the individual in crisis is non-violent and being transported for psychiatric treatment only: 1. If the individual in crisis is willing to be transported to the hospital by zone car, transport the individual by two-person ZC. 2. If the individual in crisis is unwilling to be conveyed by zone car, consider other options (EMS, mental health care worker, family members, etc.) 3. Handcuffing is at member s discretion. 4. Individuals in crisis, including individuals who appear to be suicidal, shall be kept under constant personal observation while they are in temporary custody. a. Other members on scene shall assist the CIT officer with constant personal observation. VI. CIT Officer Responsibilities: A. CIT Officers shall take primary responsibility for the scene if dispatched to an incident involving an individual in crisis. B. Identify resolutions to the crisis and inform the individual in crisis of the next steps. C. Offer referrals to mental health services if the individual in crisis is not being conveyed to a hospital.
7 of 11 D. Use discretion to direct individuals in crisis with mental health and substance abuse issue to the health care system, rather than the judicial system, in those instances where it is appropriate to do so. E. CIT Officer may be utilized in their district of assignment for any crisis incident. F. Upon request, and in a life threatening incident, a CIT Officer may be utilized in another district with permission from the Officer s supervisor. G. Crisis incidents are a two-person assignment; however, only one CIT Officer and any other officer may be assigned or respond. VII. Supervisor Responsibilities: A. Shall indicate on the daily roster which cars have CIT officers when faxing their log to CCS following roll call. B. Respond to CIT calls when requested by patrol personnel to assist in resolving crisis situations and conducting appropriate investigations. C. If a supervisor has assumed responsibility for the scene, and a CIT officer is on scene, seek the input of the CIT officer regarding strategies for resolving the crisis, where it is reasonable for them to do so. VIII. The CIT Coordinator or their designee shall: A. Biannually provide CCS with a list of current CIT officers. B. Retain a copy of the Crisis Intervention Statistic Sheet in accordance with standard record retention policies and procedures. C. Forward a copy of the Crisis Intervention Statistic Sheet to the ADAMHS Board. IX. A psychiatric emergency exists when a member learns of, or has custody of, a person who is in crisis and likely to injure themselves or another.
8 of 11 A. Under Sec. 5122.10 of the Ohio Revised Code, members have authority to take the person into custody involuntarily and immediately transport the individual in crisis to a hospital for psychiatric evaluation. B. If probable cause exists that an individual in crisis presents a risk of harm to themselves or others, members shall stabilize any dangerous or potentially dangerous situation, and take that individual in crisis into custody, using handcuffs if necessary. 1. Per ORC 5122.10, members shall make every reasonable and appropriate effort to take individuals in crisis into custody in the least conspicuous manner possible. A member(s) taking the individual in crisis into custody pursuant to this section shall give the individual in crisis the name, professional designation, and agency affiliation of the person taking the individual in crisis respondent into custody; that the custody-taking is not a criminal arrest; and that the individual is being taken for examination by mental health professionals at a specified mental health facility identified by name. 2. If the individual in crisis is suffering from serious physical injury or illness, including drug overdose, members shall, based on the circumstances surrounding the incident, call for EMS or convey the individual to the nearest hospital. The hospital is responsible for transporting individuals, not under arrest, for psychiatric evaluation after medical treatment. C. Members shall search individuals before entering a mental health facility. D. Conveying members shall complete a Police Referral for Psychiatric Evaluation form, explaining the reason the individual is in custody and the details of the crisis, including one of the following categories: 1. The individual represents a substantial risk of physical harm to self, evidenced by threats of, or attempts at, suicide or other serious selfinflicted bodily harm. 2. The individual represents a risk of physical harm to others as shown by violent behavior, evidence of recent threats that place another in fear, or other evidence of danger. 3. The individual represents a risk of physical impairment or injury to self
9 of 11 and unable to provide physical needs for self. X. Temporary Orders of Detention (Probate Warrant) A. Members shall execute Temporary Orders of Detention (Probate Warrant) as required by ORC 5122.11, Judicial Hospitalization. 1. In this instance, the court has already adjudicated that probable cause exists and members need not independently verify that the individual named in the warrant is a threat to themselves or others. Every reasonable effort will be made to execute the Order in a timely manner. 2. Probate Warrants do not expire. B. Members shall search an individual taken into custody and convey the individual to the hospital named in the order for admission. C. Members shall sign the warrant and return it to the Officer-In-Charge. XI. Medical Certificate/ Pink Slip A. A document issued by a health authority/police officer declaring that an individual is a threat to themselves or others. B. There is no mandate that members seize an individual based solely on the issuance of a Medical Certificate. 1. Seizure requires sufficient probable cause or a warrant. a. Sufficient probable cause shall be based on the contents of the Medical Certificate and the application of objective reasonableness by the member. b. Members shall rely on their own observation of the individual s mental condition to justify seizing the individual. c. Members may contact the Mobile Crisis Team (MCT) of FrontLine Service at 216-623-6888 for further assistance in assessing if probable cause exists when the individual refuses to cooperate. C. St. Vincent Charity Hospital has a separate Emergency Department for individuals with mental health issues.
10 of 11 1. Members may transport individuals in crisis who are experiencing any type of acute psychiatric crisis to St. Vincent Charity Hospital located at 2351 E. 22 nd Street. D. Members have legal authority to complete the Pink Slip when appropriate. Specifically, when an individual presents a substantial risk of harm to themselves or others, or is at risk because they are unable to care for themselves properly due to mental disability. E. Members shall take all the same precautions regarding searches and handcuffing as with any other such seizure. XII. Return of AWOLs (Absence without Leave) and those visiting from mental hospitals. A. Members shall contact the hospital by telephone or CCS before returning the person, to confirm acceptance of the individual. If the hospital will not accept the AWOL patient, members shall determine if the individual needs psychiatric evaluation. Members may contact MCT to assist with assessing the treatment needs of the individual. B. If members have an AWOL patient from a non-local hospital, members may contact MCT to assist with assessing the treatment needs of the individual. C. If a sponsor or family member of a patient on a trial visit requests return of the patient, members shall contact the hospital from which the patient is released to determine the proper action. XIII. Voluntary admissions and advice to relatives. A. In non-emergency cases of suspected mental health issues, members shall advise the family or guardian to consult MCT, 2-1-1 First Call for Help, a physician or healthcare provider, general hospital, public mental health hospital, or seek assistance from Probate Court. Members shall also provide the 24-hour hotline number for the Mobile Crisis Team, (216) 623-6888. B. In non-emergency cases of suspected mental health issues with no relative or guardian available. 1. Members shall encourage the individual in crisis to contact MCT for available services, or offer to transport the individual in crisis to a
11 of 11 hospital for psychiatric evaluation. 2. Members are encouraged to provide an individual in crisis with additional referral options and encouragement to contact community support agencies in non-emergency cases (eg. Frontline, Recovery Resources, Connections, Murtis Taylor, or NAMI. 211 may also be called for appropriate referrals) XIV. Requests for assistance at mental health crisis shelters. A. Members shall respond to shelters and stabilize the situation by taking the necessary action to ensure the safety and security of the individuals there. If members need to consult with MCT, members shall do so after the situation at the shelter has been stabilized. B. Shelter staff will inform members of arrangements they have made. If they include transport to another facility, the members shall make the transport. XV. Crisis Intervention involving Juveniles. A. When members respond to a crisis involving a juvenile, they will respond in a manner that reflects a developmental (age-appropriate) approach which includes an understanding of the teen brain, psychological and emotional maturity, intellectual ability and the potential impact of trauma. B. If members respond to a crisis intervention call and believe a juvenile is in need of Psychiatric care (under arrest or not), they should, when possible, call MCT (216-623-6888) and request CRT (Child Response Team of Mobile Crisis), as a resource to the members, and present a list of the juvenile s symptoms. C. CRT will guide members to the most appropriate level of care and a facility, if necessary. The CRT staff members may be able to respond on scene to assist in making this determination. D. Hospitals with in-patient child and adolescent psychiatric units 1. University Hospital, Rainbow Babies & Children 1100 Euclid Ave., (216) 844-391. 2. Fairview Hospital, Cleveland Clinic 18101 Lorain Ave., (216) 476-7000.
12 of 11 XVI. Members shall make a Crisis Intervention RMS report whenever they respond to an individual in crisis. The transportation of the individual in crisis to a mental health facility or a violation of law is not required for creating a Crisis Intervention RMS report. A. These reports may assist members in the future by providing: 1. Documentation about all previous contacts with this individual. 2. Previously successful and unsuccessful intervention tactics. 3. Additional resources to provide assistance to this individual. B. Crisis Intervention RMS reports shall: 1. List the individual in crisis as the victim. 2. List the member(s) as the reporting person(s). 3. List successful and unsuccessful intervention tactics. 4. List resources the individual is familiar with. 5. Contain a narrative including the incident facts, police units present (i.e. SWAT, Crisis Negotiation Team), and results of intervention. 6. Contain, if applicable, the hospital the individual in crisis was taken to and the name of the treating physician. XVII. Prisoners shall remain the responsibility of the Division after psychiatric treatment. CDW/jeh Policy Unit Attachment