Category: Trauma-informed Care

911: To Call or Not to Call, that is the Question

Posted on by Martin Reinsel

Like almost all of us, my life has been altered in 2020 namely due the effects of the pandemic. The direct and indirect impacts of Covid 19 have been numerous for me.  Notably, I am doing trainings & consultations almost completely remotely. One thing has not changed: I am regularly asked to do “De-escalation & Personal Safety” trainings for an abundance of people that are interacting with people with behavioral health concerns, either professionally or personally.

While the presentation of remote educational in-services is a notable tangible change for me and the people & organizations with whom I work, there are other changes happening as well. I appreciate that people have been willing to share with me some of there greatest concerns around safety, whether it applies to them or others around them. You see, I am comfortable talking about that which is often uncomfortable to discuss, and I trust that people see & hear that whenever they delve deep into an interaction with me.

Consequently, I appreciate whenever anyone in my in-services asks a difficult, challenging sort of question. One question that I’ve been accustomed to answering during my professional career is one that I’m getting with greater frequency in these past few months: Should I Call 911 or should I Not Call 911 in this situation …?

Again, this is a question that is worth asking and, realistically, has been worth asking for decades. Almost no one asked me this sort of question in most of my trainings when I began doing these sorts of in-services in the early 2000’s. Sure, I had a couple of individuals who felt brave enough during the training process to ask, but honestly, very few people would engage with me or others openly about this topic. This year is different and I am glad that I am being asked more about it. Hence my writing today.

 

“I AM A PROFESSIONAL – AND I AM SEROUSLY CONCERNED WITH CALLING 911. I AM AFRAID IT’LL MAKE IT WORSE”

I got this question in a Zoom training last week.  Again, the frequency and intensity of this question has been increasing in my recent in-services. Yes, I heard this sort of question occasionally the last few years with the consistency of this question being asked of me increasing noticeably this year and for good reason.

With heightened awareness of 911 calls leading to deadly outcomes in a number of high profile police interactions – Elijah McClain, George Floyd, Daniel Prude as recent examples, let alone the long list in recent years including Tanisha Anderson and, locally here in Seattle, Charleena Lyles – it is extremely important for people to consider how best to address reporting concerns to police, whether they be Behavioral Health issue or petty crimes. This is on top of countless other examples (such as the murder of Breonna Taylor in her home as a result of a “no knock” warrant and video examples of police escalating situations involving non-violent protesters in the last few months) leads to a crisis of confidence in how law enforcement approaches situations that otherwise could have been avoided or managed without harm to the public; a public to whom they are supposed to be protecting and serving.

In short, while it is extremely unfortunate that we are dealing with this increased awareness of situations where police are serving as first responders to a multitude of concerns of the human condition, the reality is that this issue has been present for years. We have simply become more aware of these escalated situations and questionable tactics employed by select police officers, & their departments in general, as a result of the proliferation of video and reporting that is magnifying the scrutiny of emergency response in our communities.

During my professional career that has had varying levels of overlap with law enforcement professionals due to my work in crisis intervention and response positions as a clinician, I can say that I have seen the entire range of police responses: from ones that were skillfully managed to ensure de-escalation and safety for all involved, to ones that were escalated the moment police began to interact with the individual who was experiencing a behavioral health emergency. There is not a uniformity and consistency to how police may respond to a situation. When you add in systemic racism and bias in policing and the confusion, disorganization, and potential unpredictability of someone experiencing a mental health crisis there are a lot of variables that can negatively impact the success of this interaction.

Consequently, the question of calling the police, notably calling 911 because of a minor crime or unusual behavior (whether involving or exacerbated by substance use or not) is one that people ought to consider with greater depth if they have not yet done so. I’ll add, it’s especially important for white people to open up honestly about this question and admit to what they do not know, specifically as it relates to the experiences of persons of color and their experiences with law enforcement.

 

“I DON’T WANT TO CALL 911 … I DON’T THINK ANY OF US WANT 911 CALLED … CAN WE FIGURE THIS OUT? WE NEED TO BE SAFE.”

This quote come from an informal debriefing from over a year ago.  For the sake of confidentiality, I will address this situation in generalities.

I was asked by a long-time professional colleague to informally debrief a potentially dangerous situation that she had just experienced. The outcome was a positive one, but it was still one that was very emotionally charged and I applauded her for reaching out to me to debrief.

Here was her situation: She was working in clinical capacity as a counselor in a “residential” sort of situation and she was alerted to two clients in conflict at this residence’s common area. She carefully moved toward the two people who were in a verbal argument. Threats were being made and, while there was not a weapon present, the reality was that either of the verbal combatants had materials around that could be used as a weapon at any given moment.

The clinician used her usual verbal and situational skills to attempt to de-escalate the situation. However, the verbal threats between the two people escalated and they were not seemingly ceasing, despite attempts to re-direct and de-escalate by the clinician.

The clinician was seemingly patient and spoke intermittently and selectively. She wanted to allow the two clients to “vent” their frustrations and hoped it would subside and calm. This did not occur. Instead, the situation was escalating.  To summarize her report, since the verbal threats were escalating and the tangible risk of violence was high (due to the proximity of potential weapons), she offered the following (paraphrased):

“Hey, we are all People of Color and I know none of us wants the cops called. (Pause) What can we do now so that I do not have to call the cops? (Pause) I don’t want to call them, but if we can’t calm this down, I gotta call them.”

While this did not lead everyone to immediately calm down, it did help de-escalate the situation. Essentially, the clinician gave a “big picture” insight that the two verbal combatants were not able to see with apparent “tunnel vision” in the heat of the moment.

The clinician noted that both clients were still upset after she made this statement, but they were able to follow her verbal direction to separate. The statement served a purpose: It was life a verbal mirror that let these two people know what others were seeing from the reflection of this interaction. The subsequent separation that the two agitated clients equally participated in (going separate ways) allowed both upset people the time and space to calm down enough to not escalate it further.  911 was never called. Police never responded, as there was no need.

When I was debriefing with the clinician, she was visibly upset. I noted “You did great!” and she said she wasn’t so sure. I let her know that I thought that she found a way to “name” the situation in a compassionate manner aimed at de-escalation and that she avoided making a “threat” to call 911. Instead, she found a way to talk about the potential 911 call in order to facilitate a shift in perspective: She truly believed that all involved (including her) did not want police to respond to this situation. She named it and by doing so she let all involved know that there was a seriousness to what was unfolding. If she had not have named her experience and what she was witnessing and the potential “next steps” for separation (“taking a break”), we do not know if the same outcome would have occurred.

 

TAKEAWAY CONSIDERATIONS

As I communicated to my training group last week, the big takeaway is this: Have you considered a way to talk about the potential 911 call in a way that can help lead to de-escalation of the situation; notably while being careful to not use the potential 911 call as a threat to those involved?

Honestly, I do not believe that most people have given this question much thought. I invite you to do so.  Please make an effort to consider when & where you might say this. What would you say? How would you say it (e.g, not being too loud or sounding punitive or threatening)?

If you are struggling with this, I invite you to reach out to someone – – you are welcome to email me.

I am also going to list a few additional considerations for how you may want to prepare your approach to a potential 911 call, if you need to make one.

 

ADDITIONAL CONSIDERATIONS IF YOU MUST CALL 911

I provide a lot of training and clinical consultation for a wide range of people, so I may have specific insights to offer people facing unique issues that go beyond what I list here.  That being said, there are some general insights and considerations when someone is calling 911 & police are the First Responders to a behavioral health emergency (as opposed to a First Responder who is not a uniformed police officer, like the ones provided in the CAHOOTS program in Eugene, OR) to consider:

  • How you communicate with the 911 Dispatcher can help influence the direction of the initial interaction. For example:
    • When first on the call with the Dispatcher, consider saying something like “I’d like Crisis Intervention Trained professionals responding to the scene/situation.” This immediately alerts the dispatchers and the first responders that this is a Behavioral Emergency more than a criminal situation. Hopefully, in the jurisdiction that is responding, officers with extensive, 40-hours or more of “Crisis Intervention Training” (CIT)*** are the responders.
    • When on the call with the Dispatcher, please be consistent with your messaging and your descriptions of events. Namely, please be careful to:
      • avoid “catastrophizing” a situation
      • avoid using words that “speculate” about a threat
      • avoid using “emotional” terms more than “descriptive” ones

 

  • When police are present on the scene, consider how best to proceed as a bystander:
    • Consider how best to keep a Safe Distance, while also being an Active Bystander, in that you can still serve as a Witness to what is going on.
    • Be consistent with your language when interacting with Police in person that you want to see this situation “De-escalated” and that you want everyone involved to be safe.
    • Encourage the responding Law Enforcement officers to communicate with you if they need more information. Let them know that you want to give everyone involved the “Benefit of the Doubt” and if the officers could benefit from more information, you want to encourage them to pause their interaction with the agitated individual to return to talk with you (or others around would can offer support, insights, and other potentially valuable information to lead to a safe resolution of this situation) for the sake of De-escalation.

While none of these items cannot ensure that there will be a safe, non-violent, de-escalation presented by the First Responding officers, my experience indicates that these approaches align with our greatest goals to “Do No Harm” and to help serve and protect any individuals impacted by a potentially dangerous behavioral situation.

Please remember: the person who is “acting out” behaviorally is a vulnerable individual. It may be counter-intuitive to see that in the moment of their hostility, yet it important to remember that they are a human being “having a hard time” (I invite this way of thinking, as opposed to thinking “this person is giving Me a hard time”).  If we can safely get this person to help, that will likely help all involved – including our community. Again, it is often hard to acknowledge this in the moment, that is why it is important to consider this as part of preparation and desire for preventative measures, rather than “interventions” that may make the situation worse.

I wish you all well with navigating these situations. As usual, if you have questions or comments, I welcome them.

{***If you are unfamiliar with CIT programs locally and internationally, I encourage you to check out www.citinternational.org or your local state branch of CIT. I’ll add that I have been an Advisory Board member for the WA State Criminal Justice Training’s CIT program since 2016, and have done local and regional presentations dating back more than a decade in conjunction with this program.***}

Black Lives Matter: Shining a light on inequality and bias

Posted on by Martin Reinsel

{Please note, this was an extremely challenging writing task … it took me days of processing and reviewing. Please read with as open a mind as possible.}

A month ago I posted a lengthy Blog entry on “Coping, Validation, and Normalization during COVID 19.” In that blog entry, I noted how many of us do not want to go back to the “old normal;” as the harmful, biased, and inequitable conditions & systems that have existed in our world for hundreds of years were not something to which I wish to see re-established or normalized. I could not have predicted what we have seen since my entry in early-May.

The homicide of George Floyd on May 25, 2020 and the demonstrations that have followed in the two+ weeks since have shown evidence that there are many people who do not wish to maintain a status quo. The preponderance of inequitable and unjust systems in our world is something that no one can nor should turn away from. It is imperative to shine a light on the inequities and unjust histories of systems in our nation and in our world.

MY PRIVILEGE

I write this as a privileged white male. I was born and raised in the latter-part of the 20th century in middle-class America. I have multiple college degrees, including a Master’s degree in Psychology from the clinical program at Duquesne University in Pittsburgh, PA.  I am cis-gendered and a parent. I have a clean legal history and I have found success in more than one professional field.

The paragraph above makes it all the more imperative for me to speak up at this time.  It is important that during this historical moment I along with other people with any sort of privilege speak up about the cumulative systemic injustices that have worsened our societies. This is not a “black person” issue. It is a human rights issue and it is imperative for white folks like me to stand up, speak up, and also listen up – – I have no interest in trying to “white-splain” or “man-splain” what is going on. That said, silence at this time is absolutely not ok.

With all of this being said, I feel it is important for people to know a little bit more about me: I have witnessed a great deal of suffering in my life. Of greatest importance, in my life I have witnessed horrific suffering of multiple people. I’ve witness violence, injustice, and a great deal of physical and mental suffering that is not easily apparent to all.  Of a personal note, I grew up with a mother who had a debilitating condition that worsened over the course twenty-five years (beginning in my childhood and ending with her death while I was an adult), whereby my family watched her loose functioning of her limbs from Multiple Sclerosis until her last years were lived as a quadriplegic. I believe that growing up with an abundance of suffering in my home had a variety of impacts upon me. I feel that my thoughts, feelings, values, and behaviors were shaped as much by my early experiences of suffering and family hardship as they were by anything else in my life. These early experiences started me on a path.

EXPANDING MY JOURNEY TO BETTER UNDERSTAND SUFFERING

Similarly (and perhaps consequentially), I’ve chosen a personal and professional path that has afforded me the opportunity to get very, very close to individuals and groups of people who have been historically under-served,  marginalized, and/or oppressed in our communities. Decades of working in Crisis Intervention and Inpatient (often, Involuntary) Psychiatric settings provided me a window into the worlds of other people that many do not get to see up close. Additionally, I am a musician. In that capacity – back in 2008 – I sought out the opportunity to be able to play music and help support the touring and recording for a very, very unique individual: James T-Model Ford. 

The opportunities that I had playing multiple tours over a four year period with James afforded me the opportunity to spend time with the man – literally thousands of hours – far beyond the time people saw of us on stage or heard on an album. Time spent in vans, on planes in a restaurant or hotel often were the hours I most came to appreciate the opportunity to connect so closely with a man who had experienced things I could never understand … and things I’d never wish for anyone to ever experience again, like witnessing hangings, having their homes burned to the ground, and other atrocities that never entered into the consciousness of the white-control legal systems of Mississippi and Tennessee {James was imprisoned in Humboldt, TN for the killing of a man during a dice-game melee … James said it was self-defense, but that there was no “self-defense” recognition for a Black man in the Tennessee legal system, so he served time … until he got “bought” off the chain gang by a “boss man.” I have no proof of James’ story but even if just a portion of it is completely true, it shows a number of examples of the systemic injustices he was up against}.

James (he liked when I called him “T”) had grown up as a Black man in rural Mississippi during the “Jim Crow” era. He witnessed a great deal. Spending those hours together travelling tens of thousands of miles, he’d occasionally discuss the racial violence he witnessed and the near-misses he had with the KKK and police.  Along with my fellow musicians who traveled with him over the years I’d toured with him, many of us especially enjoyed the mornings with “T” when we were not hurrying to check out of a hotel. It was during his morning coffee, when we were all relaxed and well-rested, that he often shared the most powerful and in-depth stories of what he witnessed and/or experienced during his nine decades on this earth. I was drawn to work with T-Model because of his music and his apparent resilience. James – like all people – was not perfect. That being said, he had qualities about him – grace, calm, joy, enthusiasm, etc. – that burned brightly. He’d note that he had it better in life than many people. For him to see it this way during the final years of his life left a lasting impression on me.

Many of the people with whom I’ve had the honor of working with have helped me learn and grow as a person. I’ve learned from patients in crisis, from co-workers who provide compassionate care, and ordinary people who enlighten me about what I did not know or see.  I appreciate all of the gifts I have been given … even if I was not immediately able to fully appreciate the gift(s) being presented to me.

MY INVITATION TO ALL OF US (ESPECIALLY WHITE PEOPLE)

It is with this attitude that I invite all people to view the current historical events in our world. The world is turning. It is changing. I invite all of us to be open and present to the change. One person cannot be expected to be able to drive all aspects of desired change by themselves. Instead, it is the collective of many people that are going to help us drive tangible, measurable, and honorable changes for our communities. We all want safety. Yes, all lives matter … but we have to take a historical look at our country and our world: There has been injustice to black people, brown people, native people & other non-white persons that has lasted too long. Black Lives Matter now because for too long they have not mattered to the degree that a just society can abide. Black Lives Matter.

The homicide of George Floyd was a Tipping Point. I know more about manual and mechanical restraints than most people. As part of my years of work in psychiatric and crisis settings as a “Clinical Educator” of De-escalation and Trauma-informed care trainings, I had a unique role. Since I worked as a Clinical Educator who trained professionals in a setting where manual and mechanical restraints were a “last-resort” for the management of imminently dangerous behavior, I had the opportunity to become a trainer to staff about the safe application of retraints. This involved me being “restrained” a lot. Hours upon hours. I cannot tell you how many people in the Seattle area have learned how to safely and non-violently provide de-escalation and restraint techniques as a last resort by incorporating aspects of practicing how to manually and mechanically restrain me.

In short, I was the person most often “restrained” by staff at a psychiatric hospital here in Seattle for the better part of a decade and a half. I may have been the person most restrained in the state of Washington (or perhaps anywhere) during the 15 or so year period that ran from 2002-2017, as I trained hundreds of people over thousands of hours of training. That experience and the perspectives gained were & are extremely valuable to this day.

With this abundance of experience, I want people to know that I was horrified watching the entire video of the officer with his knee on the neck of George Floyd (and the additional airway restrictions from the weight of other officers on Mr. Floyd’s back).  There is no reasonable explanation that can be used to rationalize this aggressive example of police brutality. It was horrific and to those that might say “if he can talk, he could breathe” or something else trying to explain away what happened, I request that you Please Stop any rationalizations. The reality is that the officers involved either “over-responded” via the use of excessive force or “under-responded” by not trying to intervene.  George Floyd would be alive today if it were not for the police’s actions. I hope that we see Justice for George Floyd in the weeks and months to come.

TRAUMA: SEEN AND UNSEEN

During my professional clinical work, I’ve learned a lot about restraint-related trauma, both in terms of the physical and psychological impacts. Restraint-related positional asphyxia was clearly listed as a “Risk of Restraints” in the De-escalation intervention manual I authored for a local psychiatric hospital. The research has been available for years.

Additionally, the “Trauma-informed” aspects of my various trainings shined a light on the often-invisible impacts of trauma on individuals and communities; the lingering harms of violence and injustice to those that are not in positions of power or advantage in our society.  Many people – and I’m directly looking at people that are White here – do not get it. We live in a world where “seeing is believing.” Well, for those of you that have not yet seen it or experienced it with your own eyes, or hear it with your own ears, or felt it in your own body, the suffering and harm that people of color have experienced in America is real. America literally has used chains in the past. These days, there are chains you do not see but they are there.

Let me conclude this post with an expansion of my insights from my hours of being manually and mechanically restrained in a psychiatric hospital for the sake of training my colleagues: Even when I was being restrained in a seemingly “safe” training environment, it did not feel completely safe to me.

Everyone is imperfect. There were the risks of someone’s individual imperfections intersecting with my ability to maintain safety. Basically, when I was being restrained, my safety was in the hands of those restraining me. I witnessed multiple examples of people maintaining safety … but I also witnessed examples were not in control of themselves and put me and/or others in harm’s way. Multiply this by a million (or more) and this is what we are facing today: a society where many millions of people’s safety hinges upon the acts and behaviors of people who may or may not understand the impacts of their decisions and their behaviors.

That is why I stand with those demonstrating and protesting for systemic changes and improvements. I will use future posts for giving examples of what is working across the world to help re-imagine a more just and equitable future for all people. Now is the time. Thank you for reading and thank you for keeping your eyes open, your ears open, and your hearts & minds open. We need as much light shining on this moment as possible.

Managing “Stress Response” during COVID 19.

Posted on by Martin Reinsel

Prelude: Appreciation & Gratitude

I’d like to start this article with a simple Thank You to all who continue to work in a capacity serving the public. Whether it is providing health care, outreach, social support, protecting & serving the community, or performing any other “essential” capacity: Thank you! I had to go to the grocery store two days ago and I could say nothing except “Thank you” repeatedly to the store’s few employees with whom I interacted. There’s almost nothing else to say except “Thanks.” I feel like saying “Stay safe” is disingenuous: they know they need to Stay Safe but they really cannot do what is being asked by the CDC (to stay at home) as they go about their work. They are in a very difficult spot – likely one that did not anticipate when signing up for that sort of service employment.

Continue reading “Managing “Stress Response” during COVID 19.”

De-escalation training benefits for 5 unique professional settings & groups

Posted on by Martin Reinsel

During this COVID 19 pandemic, we are all adjusting to life in its current form.  Our collective response to the Coronavirus has made some aspects of life completely different and, hopefully, some things remain the same.

One of the constants through this time of challenge is being able to identify and embody the qualities and characteristics of composure and calm amidst all of the changes and unpredictabilities around us. For many years, I have been providing “De-escalation & Personal Safety” courses for an array of professionals. As our lives have changed and will continue to change as a result of the COVID 19 outbreak, the need for more de-escalation training, consultation, and support services will remain in demand.

Continue reading “De-escalation training benefits for 5 unique professional settings & groups”

Synopses Of Most Common Training In-Services

Posted on by Martin Reinsel

Overview

Each of the trainings listed below (de-escalation training, trauma informed care training, compassion fatigue, etc…) are geared towards audiences that work with potentially challenging populations of clientele.  It is imperative that professionals have education and tools to manage the stress, struggles, and potentially challenging behaviors of the work they do, while still providing empathy and compassion in lieu of difficult interactions or events.  This writer has a quarter century of experience providing direct care and support to clients and staff in a variety of settings. Trainings are intended for social service providers, health care staff, educators or other para-professionals who provide valuable service to a community of people who suffer from ailments, disabilities or are in any way a marginalized population.  It is an honor to train and educate the professionals who impact the lives of so many people.

Finally, please know that these in-services are geared to be approximately 2 hours. I have people who find that they want 2.5-3 hours for the De-escalation and the Compassion Fatigue trainings. All of this can be negotiated to meet your greatest needs.

Continue reading “Synopses Of Most Common Training In-Services”