0850.20 Police Response to Mental Health Crisis

Administrative Rules Adopted by Bureaus Pursuant to Rule Making Authority (ARB)
Policy number
PPB-0850.20
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0850.20 Police Response to Mental Health Crisis

Refer:

  • 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 – Persons with Mental Illness
  • 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 0630.45, Emergency Medical Custody Transports
  • DIR 0640.35, Abuse of Elderly/Persons with Disabilities
  • DIR 0720.00, Special Emergency Reaction Team (SERT) and Crisis Negotiation Team (CNT) Use
  • DIR 0850.21, Peace Officer Custody (Civil)
  • DIR 0850.22, Police Response to Mental Health Director Holds and Elopement
  • DIR 0850.25, Police Response to Mental Health Facilities
  • DIR 0850.30 Temporary Detention and Custody of Juveniles
  • DIR 0850.39, Missing, Runaway, Lost or Disoriented Persons
  • DIR 0900.00, 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

Definitions:

  • De-escalation: A deliberate attempt to prevent or reduce the amount of force necessary to safely and effectively resolve confrontations.
  • 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 Bureau’s Behavioral Health Unit (BHU). ORS § 426.005(1)(c)-(d).
  • Disengagement: The intentional decision, based on the totality of the circumstances, to discontinue contact with a person the member could lawfully take into custody.
  • 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 persons who may have a mental illness.
  • Feasible: When time and safety allow for a particular action.
  • Mental Health Crisis: An incident in which someone with an actual or perceived mental illness experiences intense feelings of personal distress, a thought disorder, obvious changes in functioning, and/or catastrophic life events, 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.
  • Police Action: Any circumstance, on or off duty, in which a sworn member exercises or attempts to exercise police authority. This includes, but is not limited to, stops, searches, arrests, and use of force.

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, including but not limited to 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.

4. Mental illness is distinct from an intoxicant or a substance-induced condition.

5. Mental illness is distinct from intellectual or developmental disabilities.

Policy:

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 Bureau recognizes that its members are often first responders to people with mental illness who present in crisis or with immediate needs. The Bureau is committed to serving persons 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 Bureau recognizes that members will have contact with people who experience mental illness but are not in crisis. Many Bureau members will become familiar with persons in the community known to have a mental illness. The Bureau provides training so that members may recognize signs and symptoms of mental illness in the absence of crisis, and expects members to engage these persons with dignity and respect, using the skills they have learned in their crisis training. The Bureau expects that members give special consideration to these situations, recognizing that using crisis intervention skills with all persons 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 may 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 indicate a mental health crisis. The Bureau prioritizes using de-escalation skills to maximize the likelihood of a safe outcome for everyone.

Procedure:

1. Member Expectation and Training:

1.1. When members recognize signs and symptoms of a mental illness in someone they are contacting, they 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 shall receive Mental Health Response training.

1.3.2. All existing sworn members shall 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 persons experiencing mental illness with dignity and respect.

2. Police Action and Involvement.

2.1. When responding to incidents involving persons displaying signs and symptoms of mental health crisis, members shall consider the following actions to manage the incident for the safety of all at the scene:

2.1.1. Evaluate the incident and determine the need for police action 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 police action is needed, consider, when feasible, using 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. If the member decides police action is not needed, document the reason why in the CAD call or a police report.

2.1.4. If custody is necessary, develop and communicate a tactical plan, when feasible, to participating members, to take advantage of the most effective options that may safely resolve the incident.

3. Resources and Strategies for Mental Health Crisis Response.

3.1. When responding to and managing scenes involving persons in mental health crisis, members should consider making a plan and using the following resources and strategies:

3.1.1. Requesting specialized units such as Enhanced Crisis Intervention Team (ECIT) members or the Crisis Negotiation Team (CNT);

3.1.2. Consulting with a mental health provider;

3.1.3. Surveillance;

3.1.4. Area containment;

3.1.5. Requesting more resources/summoning reinforcements;

3.1.6. Delaying arrest (get a warrant, or try different time/place);

3.1.7. Using time, distance, and communication to attempt to de-escalate the person; and

3.1.8. Disengagement with a plan to resolve later.

4. Disengagement.

4.1. Members shall consider a disengagement plan, when feasible, if the benefits to be gained by police action are clearly outweighed by the risks associated with the call.

4.2. In determining whether to disengage, members shall, when feasible:

4.2.1. Attempt to gather relevant information about the person in crisis from readily available sources, such as the Multnomah County Behavioral Health Call Center, and

4.2.2. Consult with a supervisor to determine whether to make contact at a different time or under different circumstances.

4.3. Members shall not disengage if an individual presents an immediate danger to a third party.

4.4. If a person presents an immediate danger to themselves, before disengaging members shall assess whether they could reasonably remain at the scene and use other tactics to diminish the risk of harm to the person without increasing the risk of harm to the member or third parties. A perception of risk shall be based on articulatable facts and not suspicion alone.

4.4.1. If a member decides to disengage, they shall:

4.4.1.1. Complete a general offense report;

4.4.1.2. Notify the Multnomah County Behavioral Health Call Center of the situation (e.g. name, date of birth, disposition); and

4.4.1.3. Develop a plan in accordance with Bureau training.

5. Non-Criminal Disposition:

5.1. In determining a non-criminal resolution for a person with a mental illness or in mental health crisis, members shall consider the totality of the circumstances, including the behavior of the person and the governmental interests at stake. Non-criminal dispositions that may be appropriate at the scene include, but are not limited to, the following:

5.1.1. Refer the involved person to a mental health provider; see the Behavioral Health Unit’s Community Mental Health Resources, for referral information.

5.1.2. Request ambulance transport for the involved person to a mental health or medical facility for voluntary care. Members should inform ambulance personnel of the situation so they can pass the information along to staff at the facility upon arrival. Members may coordinate with medical providers and arrange to 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.

5.1.3. Take the involved person into custody and arrange for ambulance transport to a medical facility in accordance with Directive 0850.21, Peace Officer Custody (Civil), or Directive 0850.22, Police Response to Mental Health Directors Holds and Elopement.

5.2. Regardless of which disposition above is used, members shall complete an appropriate police report.

5.3. If a person in mental health crisis is taken into custody, either civilly or criminally, members are required to document consideration and/or use the strategies outlined in section 3. of this directive.

6. Enhanced Crisis Intervention Team (ECIT) Member Responsibilities:

6.1. When requested, ECIT members shall respond to support the dispatched member on a mental health crisis call. The dispatched member shall maintain their status as the primary member on the call, unless the ECIT member volunteers to become the primary member.

6.1.1. The dispatched member shall be responsible for fulfilling all other requirements related to the call, such as investigation, collection of evidence, follow up, and the completion of appropriate reports.

6.1.2. The dispatched member shall include in their report the name of the ECIT member who provided support and a brief description of assistance they provided.

6.2. 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 shall not be used in place of CNT. Members should refer to Directive 0720.00, Special Emergency Reaction Team (SERT) and Crisis Negotiation Team (CNT) Use, for additional guidance.

6.3. ECIT members shall notify their supervisor when leaving their assigned precinct.

6.4. ECIT members who participate in a mental health crisis call by using their crisis intervention skills shall complete any required report.

7. Supervisor Responsibilities:

7.1. Supervisors shall manage the dispatch and use of ECIT members and coordinate with the Bureau of Emergency Communications (BOEC) as appropriate.

7.2. Supervisors shall acknowledge or respond to all calls where a member is dispatched to a designated mental health facility, in accordance with Directive, 0850.25, Police Response to Mental Health Facilities.

7.3. Supervisors shall ensure their members follow reporting requirements for mental health crisis response.

Effective: 11/15/2022

Next Review: 11/15/2023

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