Policy: Mental Health Guidelines

PURPOSE

The purpose of this order is to establish guidelines to be followed by members of the Michigan State University Police Department (Department) when responding to or encountering persons experiencing a mental health crisis. For the purposes of this document, the term person in crisis (PIC) will be used.

POLICY

It is the policy of this Department that officers are provided training to determine whether a person’s behavior is indicative of a mental health crisis and trained in guidance techniques, response options, and resources so that the situation may be resolved in as constructive, safe, and humane a manner as possible. Further, it is the policy of this Department to manage persons exhibiting mental health concerns under the policy, administrative rules and laws of the University, this county, state and federal government.

DEFINITIONS

Person in (Mental Health) Crisis (PIC): An event or experience in which an individual’s normal coping mechanisms are overwhelmed, causing them to have an extreme emotional, physical, mental, and/or behavioral response.

Mental Illness: An impairment of an individual’s normal cognitive, emotional, or behavioral functioning, caused by physiological or psychosocial factors. A person may be affected by mental illness if they display an inability to think rationally (e.g., delusions or hallucinations); exercise inadequate control over behavior or impulses (e.g., aggressive, suicidal, homicidal, sexual); and/or failure to take reasonable care of their welfare with regard to basic provisions for clothing, food, shelter, or safety.

Community Mental Health (CMH): The Community Mental Health Authority of Clinton, Eaton, and Ingham Counties (CMH) is the official screening agency for the state hospital system in this area. The CMH Crisis Services Department provides 24 hours a day, seven days per week triage for persons experiencing a psychiatric emergency. The Crisis Services Department provides evaluation and screening for inpatient psychiatric hospital admission for persons with Medicaid, those who are uninsured, or those whose insurance status is unknown.

PROCEDURES

Response

Responding to situations involving individuals reasonably believed to be a PIC necessitates that an officer makes judgments about the mental state and intent of the individual. It also necessitates the use of special skills, techniques, and abilities to effectively and appropriately resolve the situation; while minimizing violence. The goal is to de-escalate the situation safely for all individuals involved when reasonable and consistent with established safety priorities; and follow any applicable laws to guide the detention of PIC.

Recognizing Atypical Behavior

Only a trained mental health professional can diagnose mental illness.

Officers are not expected to diagnose mental or emotional conditions, but rather to recognize behaviors that are potentially indicative of PIC, with special emphasis on those that suggest potential violence and/or danger.

Officers should not rule out other potential causes, such as effects of alcohol or psychoactive drugs, temporary emotional disturbances that are situational, or medical conditions.

Assessing Risk

Most PIC are not violent and some may present dangerous behavior only under certain circumstances or conditions. Officers may use several indicators to assess whether a PIC represents potential danger to themselves, the officer, or others.

Context is crucial in the accurate assessment of behavior. Officers should take into account the totality of circumstances requiring their presence and overall need for intervention.

Response to a PIC

If the officer determines that an individual is experiencing a mental health crisis and is a potential threat to themselves, the officer, or others; law enforcement intervention may be required by statute.

All necessary measures should be employed to resolve any conflict safely using the appropriate intervention tactics learned in training to resolve the issue.

The following responses should be considered:

Request a backup officer for an individual taken into custody

Request assistance from individuals with specialized training in dealing with mental illness or crisis situations (e.g., Crisis Intervention Team (CIT) officers, community crisis mental health personnel, or crisis negotiator)

Utilize current Department training in communicating, i.e., trauma-informed interviewing, de-escalation techniques, quiet non-threatening communication, etc.

Exchange information with a treating clinician or mental health resource for assistance

Officers should operate with the understanding that time is an ally and there is no need to rush or force the situation

Taking Custody or Making Referrals to Mental Health Professionals

Based upon the situation, any applicable law and statutes, or Department policy; an officer may take one of several courses of action when responding to a PIC.

Offer mental health referral information to the individual and/or family members

Assist in accommodating a courtesy transport for the individual

Take the individual into custody and provide transportation to a mental health facility for an involuntary psychiatric evaluation

Make an arrest based on violation of law, statute or ordinance

Commitments Due to Officer Observation

The individual must be a “person requiring treatment” (PRT) as outlined in the Mental Health Code. To qualify, an officer must observe the individual and articulate they meet one of the following three criteria:

Be mentally ill, and as a result of that mental illness can reasonably be expected within the near future to intentionally or unintentionally seriously physically injure self or another person, and who has engaged in an act or acts or made significant threats that are substantially supportive of the expectation to injure self or another person.

Be mentally ill, and as a result of that mental illness is unable to attend to those basic physical needs such as food, clothing, or shelter that must be attended to in order to avoid serious harm in the near future, and who has demonstrated that inability to attend to those basic physical needs.

Be mentally ill, with judgment so impaired that the person is unable to understand the need for treatment and whose continued behavior as the result of this mental illness can reasonably be expected, on the basis of competent medical opinion, to result in significant physical harm to himself or others. NOTE: This one requires a court order.

Commitments Due to Application and Accompanying for Clinical Certificate

Step One: The Mental Health Code direct the circumstances for someone known to the subject to complete the Application for Hospitalization (Application) or otherwise known as a “Person Requiring Treatment” (PRT) form.

This can be completed by a family member, friend, physician, therapist, resident assistant, staff member, etc.

That person must articulate their belief that the individual meets the criteria set forth in this policy (see above).

Step Two: A licensed psychologist or physician, other than the person who completed the Application, meets with the individual to evaluate and complete a Clinical Certificate in support of the Application.

These two forms together, give the officer ability to take an individual into protective custody and transport that person to a mental health facility for an involuntary commitment/assessment.

On occasion, staff at MSU Counseling and Psychiatric Services (CAPS) may make pre-arrangements for an individual to go directly to St. Lawrence Campus’ 4th floor Psychiatric Unit.

This is rare, but if arrangements for this are made, you should take the patient there. Otherwise, follow transport procedures below.

Procedures for Involuntary Transports

When an officer contacts an adult who falls within the guidelines of the Mental Health Code that should be assessed, the officer should complete the following steps.

Take the individual into protective custody as provided for under the Mental Health Code. That Code allows an officer to detain an individual whom they believe is a PRT into custody for assessment.

The Mental Health Code allows when a peace officer takes an individual into protective custody, that officer may use that kind and degree of force that would be lawful if the peace officer were affecting an arrest for a misdemeanor without a warrant.

In taking the individual into custody, a peace officer may take reasonable steps for self-protection. This includes patting down for weapons, searching bags or similar, and securing with handcuffs.

Insurance Protocols

If the individual is on Medicaid, is uninsured, or the person’s insurance status is unknown; notify CMH that the individual has been taken into protective custody and provide them with the name, age and a brief synopsis of the circumstances.

This information will allow CMH to check for a prior record and make any special arrangements that may be needed, as described in this policy.

There is always at least one emergency services worker on duty at CMH.

If the individual has private insurance, CMH has directed us to deliver the individual to a Sparrow Hospital Emergency Room.

Make contact with the Emergency Room (ER) Admitting desk.

Explain that you have an individual in protective custody under the Mental Health Code.

Submit the required paperwork as outlined in this policy.

In most cases, officers will spend a minimum amount of time at the ER once custody of the individual is turned over to ER personnel.

Officers may be asked to continue custody if security staff is unavailable to maintain custody waiting for a physician to evaluate them.

Transport the individual to the appropriate facility using a marked patrol vehicle.

Use the southwest door of the Community Mental Health Building.

Regardless of the time of day, ask to speak with a Crisis Service Therapist upon arrival.

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Documentation

Officers shall:

Document the incident, regardless of whether or not the individual is taken into custody.

When the individual is taken into custody or referred to other agencies, officers should detail the reasons why in the report.

Ensure that the report is as specific and explicit as possible concerning the circumstances of the incident and the type of behavior that was observed.

Terms such as “out of control” or “mentally disturbed” should be replaced with descriptions of the specific behaviors, statements, and actions exhibited by the person.

When an individual is transported to a mental health facility for a psychiatric evaluation and Department policy permits, provide documentation to the examining clinicians detailing the circumstances and behavior leading to the transport.

Required Paperwork

If the individual was placed into protective custody due to the officer’s personal observations, that officer will be required to complete a PRT form in black ink and give the original signed copy to a staff person before leaving. Ask for a copy to include in your report.

If the individual was placed into protective custody due to an Application/Clinical Certificate, you will need to provide those documents to staff and also retain a copy of those documents to attach to your police report.

Document the incident using the classification, “Mental Investigation” or “Suicide Attempt,” depending on the circumstances to report.

Retain a copy of the PRT and other associated paperwork to attach to your police report.

Notify the Department’s Behavioral Threat Assessment Unit (BTAU) using the email assigned for that team.

Procedures for Courtesy Transports

The Department provides a courtesy transport service using marked patrol vehicles to members of our community who are seeking mental health treatment while in a crisis situation.

These are involving cases where the individual at no time meets the requirements for a PRT or when requested by a campus mental health professional.

Another circumstance is when the individual indicates to the officer that they need mental health assistance and are in need of transportation to a mental health facility.

Use the details outlined in this policy to determine the location you will transport based on the insurance details known.

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The individual can decide at any time to be released, unless the officer believes the person being transported meets the requirements under the Mental Health Code for an involuntary transport as outlined in this policy.

Once you arrive at the appropriate location, make contact with the intake staff at the destination and help the transported individual with the intake process.

You do not need to stay with the person once the person is turned over to facility staff.

Document the incident using the classification “Mental Investigation” for your report.

Notify BTAU using the email assigned for that team.

Suicide Attempts

In general, East Lansing Fire Department (ELFD) medics will transport persons attempting suicide to the Sparrow Hospital ER on their Main Campus.

An officer will need to complete a PRT form detailing the suicide attempt. That officer will also retain a copy of the PRT to attach to the police report.

Give the original PRT form to the ER staff treating the PIC and indicate the person will need to be evaluated under the Mental Health Code. Obtain a copy of that PRT form for your report.

Document the incident using the classification “Suicide Attempt.”

Notify BTAU using the Department email assigned.

Juveniles

Juveniles can be taken into custody the same as adults under the Mental Health Code, because there is no age specified in the Mental Health Code.

If a juvenile is taken into custody, the parents must be contacted to authorize treatment and should accompany the juvenile during this process. The rules in this policy about the type of insurance the individual has still applies to juveniles.

If no parent is available, officers must stay with the juvenile until Child Protective Services (CPS) is contacted and arrives to relieve the officer.

If we take a person under 18 years of age into protective custody for an involuntary commitment, and they are either: on Medicaid, have no insurance or their insurance provider is unknown; the officer must contact Community Mental Health and advise them of the situation.

CMH will decide over the phone whether the officer should transport the person to the Children’s Emergency Services on South Cedar Street in Lansing.

If the juvenile has private insurance, officers should transport the individual to Sparrow Hospital or McLaren Hospital ER.

When considering courtesy transports of juveniles, an officer must have parental involvement for either CMH or the ER to provide any services.

Other Investigations

When officers are called to a scene of a person in crisis and are unable to elicit statements justifying protective custody under the Mental Health Code, the following resources shall be provided. This is also when an officer is unable to get the person to agree to receive treatment:

Give them referral information for MSU CAPS, provide the person with the BTAU Resources Guide found on the Department’s technology site and document this in the report under the heading “Resources Provided.”

Connect the individual to Residential Education Housing Services (REHS) contacts, if the person lives in a residence hall.

Document your contacts made in an “Admin Info-Mental” report and notify BTAU using the designated email about actions you have taken.