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Mental Illness – First Responder Access & Functional Needs Training Series

January 15, 2020

(♪♪ Sirens and Music ♪♪) This video training series is courtesy of the County of San Diego Office of Emergency Services. Every emergency call, every emergency run, every life saved starts with you – the first responder. But what do you do when confronted with evacuations with needs who may pose a challenge to your typical training methods? The following video is 1 of a series of 8. It’s designed to educate you on the various visual cues, do’s and don’ts, proper behaviors, mannerisms and sensitivities relating to those members of our San Diego community with mental illness and/or emotional disorders. Our hope is that you learn as much as you can so when lives are depending on quick thinking and fast maneuvering, you have the knowledge and training to make the best decision possible. (♪♪ Music ♪♪) Hello. I’m Chancie. Hi, Chancie. How are you? I’m good. I’m Piedad. I’m the Director for Behavioral Health Services in the County of San Diego. What are some common myths when dealing with people with mental illnesses? I think some common myths or taboos are that the individual or the person with a mental health condition or mental illness are going to lose it. That they are going to, you know, be out of control. That they’re going to be reluctant to follow directions that they don’t understand and that’s not so. That’s not so. On the contrary, I think that a first rule is to treat everybody the same. (Sirens) (Heavy breathing) And what sort of mental illnesses or emotional illnesses will a first responder encounter in the field? There are a variety of mental health conditions, but the most probably common would be persons with Schizophrenia or with bipolar disorder, also depression or anxiety. I think the clear response here would be what is the individual reacting to? How is the individual behaving? You know, cheerful, cryful, nervous, perhaps not organized in their thinking. Maybe screaming. Persons with mental health conditions sometimes can present agitation. They can present with some disorganized thinking. They can also be anxious or more nervous. And so these are some of the visual signs or cues that first responders should be looking at. Any other sort of behaviors we might look for? I think one of the things that first responders should be looking at is the way the individual or the person acts or behaves or what the person sounds like. Probably pacing. Pacing back and forth, forgetting about things — you know, maybe their medication or looking for things. More anxious, more agitated — I think those are some of the visual cues. (Knocking) “Hi. It’s the San Diego Police Department.” (Sniffing) (Heavy breathing) (♪♪ Music ♪♪) (Knocking) “Hi. It’s the San Diego Police Department.” “Who?” “It’s the San Diego Police Department. There’s an emergency evacuation.” “No. I don’t understand why you’re here.” What tips would you have for first responders, or someone like me, who might be encountering someone with a mental illness in the field? I think always, you know — introduce yourself. “How do I know you’re really the San Diego Police?” Introduce yourself by name and ask for the person’s name. “Hi.” “Hi.” “Hi. I’m Sergeant Lowe. San Diego Police Department.” “Okay.” “Are you Ashley Holland by chance?” “Yeah.” “Okay.” “So tell me why again, why I have to go. I don’t understand.” And let them know why you’re there. You know, you’re there to help them. This is a critical situation. Ask them do they have any special needs or any health conditions? Do they have any medications that they need to take with themselves? And how is the person feeling? “Do you need help? Can I help you pack a few things up? It’d probably just be a few hours, but you want to be prepared for maybe, you know, four or five hours or so.” “And I could take my cats?” “You can take your cats, cat food, medication, anything that’s important that you need to take.” “Will you help me? With my cats?” “I’ll help you if you need help. Sure. Can I come inside?” “Okay.” “Would you let me in?” “Okay. Yeah.” “Okay. I’ll come help you.” “Alright.” Sometimes, you know, persons or individuals that are more comfortable with managing their mental health condition or their mental illness will come and tell you and volunteer that information, but most of them not because of the stigma associated with having a mental health diagnosis. “Well, what’s wrong? What can I answer for you?” “Well, I mean I just — I’m not sure that I’m ready to go, okay? I mean all — this is a little too much. I mean, all of a sudden you’re in my house.” What if they aren’t willing to go with you? They’re not willing to, you know, be helped, I guess. Sometimes, you know — individuals freeze, don’t want to leave their home because they feel insecure. The first responder has to use their judgment. “So, you’re taking some medication? Do you have more that you need to grab?” “What do you mean?” “Well, like I said, you might be gone for a few hours from your house, so –” “Well, this isn’t the medication, medication.” “Okay.” “I mean, there’s just, you know — I mean everybody takes a little something, you know. This is just –” “Sure.” “You know, it’s just — um — it’s like vitamins.” (Clears throat) “Do — do you have any medical problems that I should be aware of?” “Like what?” “Diabetes –” “Why are you asking me about my medical problems if you’re supposed to be here because of a gas leak?” “I understand that. I understand — ” Don’t yell and scream. Don’t make the situation more grave than it already is. And I also would not touch them, you know. I wouldn’t, um — you know, approach them by handling them. Actually, I would also ask them to, you know, lead the way or follow me. You know, be empathic and reassuring. ‘Is there anything that you need that I can help you with?’ Okay. And are there any specific dangers that we should as first responders look out for not only for ourselves, but for the person that we’re dealing with? I don’t think so. I think that, you know, first responders are very well trained in picking those cues up whether you have a mental health condition or not. I think again, you know, if the person is agitated or nervous, you know, one other thing is to calm the person and also if you are unable — if the first responder is unable to maybe deal with the person, maybe ask for support. (Heavy breathing) (Clicking noise) (Heavy breathing) (Bag crackling) Okay, what are are some of the best practices that first responders should have when dealing with someone with an emotional disorder or mental illness? I think it’s basically using common sense. You know, first responders should be treating all persons the same. I think when a person is agitated, when a person is too anxious, too nervous, is for me — it really is looking at: keep calm, keep cool, keep collected. Be directive; gently directive. If that person is to be evacuated, asking the person, ‘are there any health issues or health conditions that you want me to know’ and ‘are there any medications that you should be taking with you and I can help you collect those.’ I think that empathic, low tone guiding, gently guiding and directing – I think that that will get you far. Well, thank you so much for your time. That was very helpful. Well, thank you. I appreciate the opportunity of answering some questions. This concludes the mental illness and emotional disorder video for first responders. Call (619) 563-2700 to reach the County’s
Behavioral Health Services Division. For access to services or the crisis line,
call 1 (888) 724-7240. I’m Tony Mecham, San Diego County Fire Chief. I’m Shelley Zimmerman, Chief of Police of the San Diego Police Department. Thank you for watching. (♪♪ Music ♪♪)

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