Tony Potter describes a scenario that was once the norm in the hospital emergency room (ER) where he oversees security: a police officer brings in someone for a psychiatric evaluation, and both officer and patient spend the next several days in the ER while the individual waits for an inpatient bed to open up. Potter, who is senior director of Public Safety for Novant Health, a network of hospitals in North Carolina, says that this scenario benefits no one: patients received no treatment, officers waste countless hours and the hospital staff feels at a loss for how to interact with people experiencing a psychiatric crisis. Interactions were fraught; no one felt safe.
In recent years, Novant Health and several other hospitals in North Carolina have searched for a solution. Through partnerships with local law enforcement agencies’ CIT programs, hospital safety officers have participated in CIT training which equips them to respond with empathy to people living with mental illness and de-escalate a crisis. For law enforcement officers, this means that they are able to make agreements with ERs that allow law enforcement to make a quicker drop off. For patients, it can mean a reduction in the use of restraints and greater comfort because they not under constant police supervision. For hospital staff, the benefits are a safer, calmer environment.
Greg Casstevens, who is director of safety and security at Northern Hospital of Surry County in Mount Airy, N.C., says that interactions between his staff and law enforcement officers have improved since the training. Law enforcement officers would get frustrated when hospital staff removed the handcuffs on a combative patient, which the hospital is required to do by law. Now the handcuffs can come off, hospital safety officers can de-escalate the situation, and police do not have to come back to the ER.
Potter tells a similar story. In his hospital, when police bring someone in, the hospital staff does a quick risk assessment. In most cases, hospital staff is able to quickly de-escalate the individual to the point where they feel the situation is safe and send the officer back to work. “In the first month with this system, we saved the police department more than 360 man hours.” According to Potter, patients fare better with this arrangement as well, because they find the presence of a police officer stressful and upsetting.
The key to the training is learning empathy for individuals experiencing a crisis. Casstevens recalls a portion of his CIT training, which helped him to better understand the circumstances of emergency room psychiatric clients. “One of the presenters comes in and shows us she has a huge handful of pills. My first reaction is she must be a drug abuser. Then, she explained how, through trial and error and constant experimentation for a year she learned that’s the cocktail of medications that helps her have a normal day. Just a normal day.”
Casstevens and Potter are the first to admit that CIT in their hospitals is not a cure-all for the problem: A lack of services like mobile crisis units and acute inpatient psychiatric beds that can quickly stabilize a person in crisis and develop a long-term plan. Patients rarely get any treatment for their psychiatric symptoms while in the ER, and can languish for days or weeks before an appropriate inpatient bed opens up. “We would not allow a patient with any other type of illness to be treated that way. CIT at least gives us the tools to respond better and reduce the use of restraints,” says Potter. The CIT program makes this stay safer for everyone involved and slowly has helped improve coordination between law enforcement and the hospital.
According to Casstevens, it also has helped change the expectations of family members. As hospital safety staff gains a better understanding of the mental health system, they are able to better explain to family members how the process works. Families no longer expect the ER to offer a quick fix.