Compassionate mental health supports can make tense situations manageable

Heritage Christian Services provides comprehensive mental health supports to a number of people with both intellectual disabilities and mental health complexities. Our community continues to struggle to support the needs of those experiencing mental health crisis. It is time for a new approach and systemic education for all first responders.

We are blessed to have a progressive and well-resourced Behavior Services team, led by Vicki Reina, and well-educated and compassionate frontline practitioners. In recent years, their work has led to tremendous success in using de-escalation techniques and eliminating power struggles. This has led to a significant reduction in the use of approved techniques that involve touching or controlling another person’s physical movements (restraint). It is very rare that we ever have to lay our hands on another at a time of crisis or disruption. We are thankful for this improved support and outcome, and I’ll let Vicki tell you more. — Marisa Geitner, President & C.E.O.

A few years back, we challenged ourselves to think differently about a person’s behavior, and about mental health supports — we knew it was time to take a more contemporary approach to supporting people with mental illness who may be in crisis. These are short-term disruptions of a person’s normal, stable state where ordinary methods of coping and problem solving aren’t effective.

We began to spend more time teaching staff members how to de-escalate. We encouraged them to practice and coach using methods such as verbal calming techniques, creating space and using distraction. What we found was when staff members had other skills to use, they used those instead of physical restraint. When you put your hands on someone who is angry, afraid and confused, especially someone who is experiencing acute mental illness, it escalates the behavior.

Other tools can provide support and safety to someone in crisis; like de-escalation, these strategies can cool tempers instead of flaming conflict, which is especially important for responding to people with impaired thinking at the time of crisis — including people experiencing acute mental health symptoms. There is no single response to crisis that will work, but there are methods that can help. These include using precise language and active listening, avoiding provocation and validating what a person is feeling or saying.

Avoiding a struggle of power is also essential. Power struggles occur when two or more people vie for control in a situation; it stops being about what one wants to be accomplished and becomes about bending the will of another, about winning. The classic example is when someone says “no” to a request, you might persist and increase your demands and exertion of power over the person.

Top of mind is the recent situation in Rochester where a 9-year-old girl was handcuffed and then pepper sprayed when she didn’t comply with what was being asked of her at a time of crisis. For someone in the midst of crisis and feeling out of control, might using de-escalation techniques have alleviated the crisis without force? We believe these techniques are essential and must be taught and utilized by all who may be called on to intervene at a time of crisis.

Our community needs a fundamental change in approach, in conjunction with more time spent educating police officers and other first responders about de-escalation techniques. De-escalation requires critical thinking in a crisis situation, the ability to quickly evaluate a situation and determine what skills are needed: force and restraint … or redirection, validation, verbal calming and effective use of space.

Now is the time for our community to invest in greater awareness of de-escalation techniques and broader education about the people who will benefit from them.

— Vicki Reina
Director of Behavior Services