3.400 Responding to Persons in Behavioral Crisis or with Special Needs

Question 1

The department recognizes that incidents involving persons experiencing ____________________ may be resolved more effectively with collaborative resources outside of the criminal justice system. It is the policy of the department, when suitable and as outlined below, to divert certain individuals to treatment.

Answer 1

Behavioral crisis or with special needs

Question 2

Persons with a mental illness are to be treated like other citizens. Mental illness alone does not signify a specific police response. They should only be taken into custody when there is probable cause or reasonable suspicion to believe they have committed an arrestable offense and arrest is the best choice based on the ________________, or they present a clear danger to themselves or others.

Answer 2

Totality of the circumstances

Question 3

A community partnership with law enforcement, mental health, and addiction professionals, individuals who live with mental illness and/or addiction disorders, their families, and other advocates. It is a model of police-based crisis intervention training to help persons with mental disorders and/or addictions access medical treatment rather than place them in the criminal justice system due to illness-related behaviors. It also promotes officer safety and the safety of the individual in crisis.

Answer 3

Crisis Intervention Team

Question 4

A report used to track and document a CIT response and to share information for officer safety and follow-up services.

Answer 4

CIT after action report

Question 5

Any person who has a mental illness and/or whose capacity to exercise self-control, judgement, and discretion in the conduct of a person’s affairs and social relations, or to care for their personal needs is diminished as a result of the mental illness, to the extent that the person presents a substantial likelihood of serious harm to self or others. This does not include any person in whom that capacity is diminished by epilepsy, intellectual disability, dementia, delirium, brief periods of intoxication caused by alcohol or drugs, or dependence upon or addiction to alcohol or drugs, unless a mental illness that can be diagnosed is also present which contributes to the diminished capacity of the person.

Answer 5

Criteria for mental crisis

Question 6

Autism, cerebral palsy, epilepsy, or any other neurological condition diagnosed by a qualified professional that:
1. Is manifested before the person affected attains the age of 22;
2. Is likely to continue indefinitely;
3. Results in substantial functional limitations, as measured by a qualified professional, in three or more of the following major life
activities:
a. Taking care of oneself
b. Understanding and use of language
c. Learning
d. Mobility
e. Self-direction
f. Capacity for independent living; and
4. Results in the person affected requiring a combination of individually planned and coordinated services, support, or other
assistance that is lifelong or has an extended duration.

Answer 6

Developmental disability

Question 7

Person who has been declared of unsound mind by court order and has walked away from a public or private hospital or mental health facility.

Answer 7

Walk away mental patient

Question 8

A state of extreme excitation usually associated with illicit or prescription drug
use and manifested by behavioral and physical changes that may result in sudden and unexplained death. Signs of this condition typically include elevated body temperature, profuse sweating, dilated pupils, uncontrollable shaking, talking incoherently, yelling, paranoia, extreme aggression toward objects, violent resistance/struggling, inappropriate shedding of clothing, or self-inflicted injuries.

Answer 8

Excited delirium

Question 9

Behavioral Health Unit consists of what coordinators?

Answer 9

CIT coordinators and LIMA coordinators

Question 10

The department recognizes there is a likelihood of conflict when officers encounter persons experiencing a mental crisis. To assist in those interactions, the Behavioral Health Unit (BHU) offers social services and outreach to ________________.

Answer 10

At risk populations

Question 11

BHU focuses on who?

This unit attempts to prevent potentially violent interactions with law enforcement, which may lead to incarceration or the use of force. BHU serves as the central point of contact for associated initiatives, and area commands will coordinate with BHU prior to initiating related programs.

Answer 11

Unhoused, substance abuse addicts, and persons with mental illness, who have had past interactions or may have future interactions with law enforcement.

Question 12

This unit (BHU) attempts to prevent potentially violent interactions with law enforcement, which may lead to ___________________. BHU serves as the central point of contact for associated initiatives, and area commands will coordinate with BHU prior to initiating related programs.

Answer 12

Incarceration or the use of force

Question 13

CIT coordinators facilitate required CIT training for department personnel and are responsible for compiling and reviewing CIT after-action reports for the purposes of improving procedures, sharing information for officer safety, and identifying subjects for follow-up contacts.

CIT coordinators conduct follow-up contacts with subjects who have ________________________. These follow-up contacts should be done with the
assistance of civilian service providers when available.

Answer 13

Multiple Legal 2000s and/or a high
likelihood of a violent interaction with first responders

Question 14

LIMA coordinators facilitate the diversion program within BHU in instances when _________________________ can be diverted from the criminal justice system and the offense was driven by substance abuse.

Answer 14

Low-level, non-violent criminal offenses

Question 15

Who can LIMA referrals be initiated by?

Answer 15

Any law enforcement officer or a community partner

Question 16

Officers with Crisis Intervention Team (CIT) training will be dispatched to provide direction and guidance to events involving persons who are _________________, _________________, or_______________.

Answer 16

In crisis
Showing signs and symptoms of excited delirium
Who are believed to have a mental illness or developmental disability

Question 17

CIT officers will be dispatched to:

Answer 17

1. Events involving a subject threatening suicide under volatile circumstances, such as a subject holding a weapon or threatening to jump from a height
2. Subjects who are experiencing symptoms of excited delirium
3. Disturbances involving a subject who has been reported as having a mental illness
4. Assist in taking into custody a walk-away mental health patient who has been located
5. Any incident involving escalating or volatile circumstances that suggest immediate presence of a CIT officer may be beneficial

Question 18

CIT officers will not be dispatched to events:

Answer 18

1. Involving threats of suicide which are vague, non-violent, or where no imminent threat of harm is suggested to implied
2. Involving intentional or accidental overdose of a subject who is non-violent and has no known history of mental illness
3. When the subject has been transported to a hospital, and officers are needed for report purposes only

Question 19

When assigned to a call, the CIT officer will provide direction for responding patrol officers unless relieved by who?

Answer 19

A field supervisor.

Consider a pre-arrival meeting with responding officers near scene to coordinate response tactics, coordinate tactics

Question 20

On a CIT call, the CIT officer will gather information on the subject’s mental condition, and develop tactics based upon available information from friends, family members, neighbors, and other sources. If the subject is active-duty military or an active reservist, who is to be notified?

Answer 20

Nellis Air Force Base Security Forces Watch Desk (BDOC)

Question 21

If a CIT officer responds and the subject is a juvenile under the age of 18, and will be transported due to a Legal 2000, what must be done?

Answer 21

A parent or guardian will be notified and CAD will be updated with the time, date, and type of notification (e.g., in person or phone).

If unable to contact a parent or legal guardian, the officer will note that as well and continue with the Legal 2000.

Question 22

The CIT officer will complete a CIT after action report when what criteria is met?

After the report is completed, it is printed, signed, and forwarded to the sergeant for review.

Answer 22

1. Threats to officers
2. Officer safety concerns
3. Homeland security concerns
4. Violence involved
5. Weapons involved
6. Repeat contact where additional resources may assist in reducing future police contacts

Question 23

When a filed supervisor is notified by dispatch about a CIT call, what will they do?

Answer 23

Acknowledge notification over the radio, monitor the event, and ensure a CIT officer is en route to the call.

Question 24

When will a field supervisor respond to the scene and assume command and control of tactics on a CIT call?

Answer 24

1. Events involving persons threatening to suicide under volatile circumstances (individuals holding a weapon or threatening to jump)
2. Persons who are experiencing symptoms of excited delirium and/or medical emergency
3. Any event where circumstances indicate the situation may become volatile

Question 25

When a supervisor signs a CIT after action report, do you email or fax it to the CIT detail?

Answer 25

No.

It is to be placed in the station basket to be scanned into OnBase

Question 26

It is the policy of this department to identify a subject displaying symptoms of excited delirium and de-escalate the situation with care. Persons in this acute, excited state should be considered in medical crisis. Typical signs of a subject displaying excited delirium include:

Answer 26

Elevated body temperature, increased heart rate, and may be under the influence of drugs or alcohol, which can lead to sudden death

Question 27

On a CIT call, what will the responding patrol officer do?

Answer 27

1. Assess situation and confer with on-site responders to determine if the person is suffering from mental illness or excited delirium
2. If ED is suspected, request medical, supervisor, and CIT officer to respond immediately, if they have not already been dispatched
3. Establish containment of the area
4. Formulate a custody plan with other officers
5. Observe the subject and communicate observations on the subject’s condition to medical personnel
6. Execute the custody plan quickly once sufficient officers are present to prevent the escalation of the excited physical state of the person. If possible, the plan should be executed after medical personnel have arrived
7. Take appropriate steps to care for the individual
8. Reposnd to the medical facility to complete paperwork which may include a Legal 2000 or DOAR

Question 28

The custody plan of a CIT call will include a designated officer to ______________________.

Answer 28

Monitor the subject’s breathing

Question 29

When executing the custody plan of a CIT call, it will be done quickly once sufficient officers are present to prevent the escalation of the excited physical state of the person. If possible, the plan should be executed after ___________________ have arrived.

Answer 29

Medical personnel

Question 30

Once the subject is in custody on a CIT call, the officers must take appropriate care of the individual by:

Answer 30

1. Place the subject in the recovery position
2. Consider the use of 2 sets of handcuffs
3. Monitor the subjects breathing. A subject who becomes quiet or who no longer offers resistance should be immediately assessed to ensure the subject is breathing and has a pulse.
4. Coordinate with medical personnel to transfer custody of the subject to them, assisting to avoid delay in transportation

Question 31

On a CIT call, when the subject is being transported by medical, Prior to transport, if a subject is combative and removing the handcuffs has the potential to place those present in danger, the handcuffs will remain on the subject. In this circumstance, the officer will escort the subject ____________________ to assist in the removal of the handcuffs.

Answer 31

In the ambulance

Question 32

On a CIT call, the supervisor will:

Answer 32

1. Ensure incident is handed per policy
2. If present, oversee the custody plan and confirm that an officer has been designated to monitor the subject’s breathing
3. Ensure all necessary forms and reports are completed
4. Notify BHU supervisor and submit a service request to OCE/BHU via the BHU Sharepoint site

Question 33

Persons who have a known history of drug abuse will be eligible for diversion into LIMA when probable cause exists that the individual committed any of the following offenses:

Answer 33

1. Non-violent misdemeanors
2. Non-violent drug-related felonies, with the following exceptions
   -PCS WITS
   -Sale or transport of a CS
   -Trafficking offenses
3. Non-violent city/county and/or ordinances; and
   -the individual committed the offense in relation to drug abuse
   -In cases where a victim exists, they must be willing to decline prosecution in order to allow the individual access to LIMA

Question 34

Any ____________________ at the time of contact, will disqualify the individual from participating in the LIMA program. Officer discretion will be utilized when assisting individuals with prior
criminal history.

Answer 34

Gross misdemeanor or felony warrants

Question 35

If a subject has an outstanding ________________ at the time of contact, the subject is eligible to participate in the LIMA program.

Answer 35

Misdemeanor warrant

Question 36

In the following circumstances, the individual will not be considered a LIMA participant:

Answer 36

1. The individual does not appear amenable to diversion.
2. The individual is unable to give consent.
3. The suspected drug activity includes the sale of drugs.
4. The individual is suspected of promoting prostitution.
5. The individual is a registered sex offender.
6. The individual needs acute emergency care due to being a danger to themselves or others.
7. The individual has been convicted of any of the following (including attempts):
   a. Murder; arson; robbery with a deadly weapon; any violent crime, assault, or battery constituted
   as a felony; or any sex crime.

Question 37

To divert an individual to LIMA, the officer will:

Answer 37

1. Determine if the individual is eligible for a diversion to LIMA when probable cause exists that the individual committed a criminal offense.
2. After confirming eligibility, offer the individual diversion to LIMA. This should be done in a non-coercive fashion in which the officer explains the program.
   a. Upon agreement, contact an on-duty BHU supervisor.
   b. Outside normal business hours submit a service request on the OCE/BHU SharePoint site and send an email to the BHU supervisor that the request has been submitted.
   c. Place the individual under arrest, at the officer’s discretion, if the individual declines diversion.
3. Provide a brief overview of the incident and consult with the on-duty LIMA officer or supervisor for direction.
   a. Transport participants if a location is provided by the LIMA officer.
   b. Officers will adhere to LVMPD 4.108, Transporting Arrestees. All evidence (including narcotics and paraphernalia) will be impounded according to LVMPD 7.310, Impounding Evidence and
   Property.
   c. When handling personal property of unhoused individuals, adhere to LVMPD 4.112, Interacting with the Unhoused.
4. Complete an Officer’s Report detailing the incident. Include in the details that the individual was diverted into LIMA.
   a. Copies of all documentation will be forwarded to LIMA@lvmpd.com by the end of the officer’s
   shift.
5. Clear the call with the disposition K-King (Report Taken Other than Incident/Crime Report) and notate that the participant was diverted to LIMA.

Question 38

If a subject is diverted into the LIMA program, how does the officer clear the call?

Answer 38

K-King and notate the participant was diverted to LIMA

Question 39

The department respects the rights of persons with mental illness and will protect their right to be left alone unless ________________________.

Answer 39

They present a danger to themselves or others.

Question 40

A person is deemed to present a substantial likelihood of serious harm to themselves or others if, without care or treatment, the person is at serious risk of:

Answer 40

1. Attempting suicide or homicide.
2. Causing bodily injury to themselves or others, including death, unconsciousness, extreme physical
   pain, protracted and obvious disfigurement or a protracted loss or impairment of a body part, organ, or mental functioning.
3. Incurring a serious injury, illness, or death resulting from complete neglect of basic needs for food, clothing, shelter, or personal safety (see NRS 433A.0195).

Question 41

Before a person with an alleged mental illness may be transported to a treatment facility, the person must:

Answer 41

1. Be examined at a licensed hospital to determine whether they have a medical problem,
   other than a psychiatric problem, which requires immediate treatment; and
2. If treatment is required, be admitted to a hospital or appropriate medical facility for medical care (see NRS 433A.165).

Question 42

Emergency admissions to care facilities, officer will:

Answer 42

1. Respond to the event and, when appropriate, requests CIT officer through Dispatch if one was not
   previously assigned.
2. Determine that subject is in need of emergency hospitalization based on the criteria for emergency
   admission of a person with mental illness as stated on a Legal 2000 form and complete the form.
3. Request ambulance service to transport to any available hospital for medical examination. Officer
   will not obligate the department to pay for ambulance service.
4. Assist in restraining violent subjects. (Holding cells will not be used for restraining persons with
   mental illness. See LVMPD 3.110, Use of Force, “Medical Attention.”)
5. If subject is not to be admitted to a hospital, take appropriate police action, which could include
   arrest, citation, or release.
6. Fax a copy of the completed Legal 2000 form to the SCOPE Section of the Records and Fingerprint
   Bureau at (702) 828-1559, prior to end of shift.
7. Turn in the completed Legal 2000 form to the area command for supervisor review.

Question 43

Emergency admissions to care facilities, supervisor will:

Answer 43

Ensure the Legal 2000 form is reviewed, completed, and turned in by the end of the shifter scanning into OnBase.

Question 44

When a Legal 2000 has been completed, the _____________ will update Legal 2000 information in SCOPE.

Answer 44

BHU CIT coordinator

Question 45

SCOPE - CIT 1

Answer 45

Previous Legal 2000

Question 46

SCOPE - CIT 2

Answer 46

Previous violence toward officers and/or others

Question 47

SCOPE - CIT 3

Answer 47

Weapon impounded from or taken off subject

Question 48

SCOPE - CIT 3.1

Answer 48

Knife

Question 49

SCOPE - CIT 3.2

Answer 49

Firearm

Question 50

SCOPE - CIT 3.3

Answer 50

Other weapon

Question 51

SCOPE - CIT 4

Answer 51

Self or doctor diagnosed mental disorder

Question 52

SCOPE - CIT 4.1

Answer 52

Psychosis

Question 53

SCOPE - CIT 4.2

Answer 53

Bipolar

Question 54

SCOPE - CIT 4.3

Answer 54

Schizophrenia

Question 55

SCOPE - CIT 4.4

Answer 55

PTSD

Question 56

SCOPE - CIT 4.5

Answer 56

Depression

Question 57

Department policies and procedures that apply to all subject interviews and/or interrogations, do they apply to interviews with subjects who have mental illness.

Answer 57

Yes

Question 58

Armed department personnel are required to secure all weapons (including ECD and baton) prior to routine
entry to any mental health hospital for investigative purposes.

When an emergency exists at a secured mental health facility, responding officers will not be required to disarm in the secure areas of a facility that
normally require removal of weapons. If requested to disarm by facility personnel in an emergency situation,
officers will contact _________________________.

Answer 58

Their supervisor immediately to respond to the scene.

Question 59

Response to crimes committed by patients at mental health facilities, officer will:

Answer 59

1. Make appropriate contact with medical personnel
2. Determine if a crime has been committed
3. Complete all paperwork and, if an arrest is made, notify the on-duty BHU supervisor prior to end of shift by email

Question 60

Responses to crimes committed by patients at mental health facilities, when determining if a crime has been committed, what will the officer do?

Answer 60

1. Take action (complete crime report or make an arrest) if a crime has been committed.
2. Make an arrest only if the supervising physician will complete a voluntary statement indicating the crime committed was not a result of the mental illness, but of a criminal action independent of the subject’s mental illness and is willing to discharge the patient.
3. Complete the appropriate incident report, but no arrest will be made without prior notification to the court issuing the order in cases involving juveniles.

Question 61

If an arrest is made when responding to crimes committed by patients at mental health facilities, who will the supervisor notify?

Answer 61

The on-duty CCDC watch commander