- When Veterans experiencing PTSD symptoms are agitated and/or in crisis situations, they are experiencing heightened activation of their natural "fight or flight" responses. Their primary concern at that point is for personal safety, a goal they likely share with responding police officers. Because it helps their "fight or flight" response, Veterans in crisis situations are particularly attuned to things going on in their immediate environment. If anything happens that is ambiguous, a Veteran in crisis may default to a negative interpretation. For example, if another police officer arrives for backup, a Veteran in crisis may think, "They're here to gang up on me," even if the new officer is actually present to help ensure safety.
- As part of their military training, Veterans have been taught how to use physical aggression as a tool in dangerous situations. However, because of this training and experience, Veterans may also be in better control of their own use of aggression. This gives officers an opportunity to "team up" with the Veteran to reduce the need for anyone to make use of aggression.
- Veterans with tactical military training are aware of most, if not all, of the tactics and techniques that police officers employ in a crisis situation. When left to make their own interpretation of police officer behavior, Veterans in crisis may default to seeing the officers as hostile and aggressive.
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Strategies: PTSD in Others
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Strategies: PTSD in Others
Police Officer Toolkit
Strategies: PTSD in Others
The techniques described in this section are tools that you may find helpful for dealing with many individuals who are reacting to stress, and particularly those who have PTSD. Each of these techniques is commonly used by mental health providers when working with people in crisis situations.These suggestions may not be useful in all circumstances. You are encouraged to practice these skills and use your own judgment as to whether or not these techniques will be useful in a given situation.
Keep the following in mind when making a decision about using these techniques:
Increasing Understanding of Police Actions: Tactical Transparency
Tactical transparency means explaining actions before making a move so that the person you are dealing with knows what to expect. Tactical transparency may be particularly helpful for working with Veterans who are prone to making negative interpretations when things going on in their immediate environment are ambiguous to them. The purpose of these tactical actions is to provide them with a clearer interpretation of your behavior as a police officer, and to convey your mutual interest in assuring the safety of all involved.Non-Verbal Communication
Adjusting your non-verbal communication can make a difference in the way Veterans with PTSD interpret your intent. Most experts agree that non-verbal communication is at least as important as the actual words that are spoken. It may be helpful to think of these behaviors as falling into three different categories:- Friendly/helpful:
These are behaviors that clearly communicate safety, respect, a desire to help, or other attitudes that build a connection with someone (e.g., a handshake and smile). - Aggressive/hostile:
These are behaviors that communicate a distance from or even a danger to another individual (e.g., having one hand on your firearm). - Ambiguous:
These are behaviors that are open to interpretation and may have a wide range of meanings (e.g., facing someone with one shoulder angled away). They are often interpreted as aggressive by individuals in crisis situations.
When attending to your non-verbal communication, take care to note the following body language. Click the images below to learn more.
Posture
Crisis situations often require you to be physically prepared for aggressive behavior. This may take the form of keeping physical distance from the person in crisis, placing your feet in a position to be able to move away quickly, and orienting your body to one side to reduce your size as a target and keep weapons at a maximum distance. For better or worse, all of these behaviors clearly communicate a readiness to be aggressive, especially to Veterans who have combat training. If you can do so without compromising your safety, consider changing one or more of these behaviors. This may reduce your communication of aggression when unintended. Any moves by you to close off exit routes will also be perceived in a negative manner.Hands
Some hand gestures, such as pointing or holding a flat palm up to someone, can be interpreted as directly aggressive.You might be able to employ neutral or positive hand gestures as a way to offset an aggressive body stance while still maximizing your safety and readiness to respond.
Face
Facial cues represent the biggest challenge in nonverbal communication. They are the most difficult to alter, easily misinterpreted, and largely out of our direct control. Perhaps the most important distinction that can be given away by facial cues is that between honesty and insincerity. Choose only verbal statements (e.g., "I appreciate your service to our military") that you actually believe. If you genuinely believe these statements, your sincerity will show in your facial cues.Verbal Communication
First and foremost, make an effort to describe and explain your actions. Try to convey respect, ask and give information in a calming way, and give directions that will distract and focus behavior in the person:Approach
- Ask for and use the person's name whenever possible.
- Expect and, when possible, accommodate rather than react to strong emotional responses.
Giving and Requesting Information
- Ask about the person's immediate concerns.
- Collect information in a way that is calming, for example:
- Encourage the person to answer a series of simple and direct questions to help focus attention.
- Ask questions about the order of what happened in a structured way to help organize a person's thinking.
- If talking about the situation increases distress in the person, ask unrelated questions to distract the person from his or her reactions.
- Use reflective, clarifying or summarizing statements to communicate that you understand the person correctly.
- Convey that you are there to help the situation and to keep the person safe.
- Let the person know that in these circumstances, stress reactions, while they may be alarming, are understandable.
Giving Direction
- Ensure that the person is moved to a safe location, if warranted.
- Whenever possible, protect the person from unnecessary exposure to additional circumstances that could cause additional distress (e.g., disturbing sensory input, media, curious onlookers or other involved individuals who are distressed or angry).
- Provide direction that is clear and positive, oriented toward directing the person in what to do, rather than what not to do. For example, instead of yelling, "Get out of the way," try, "I need you to move over here so you don't get hurt."
- Give the person something to do that distracts him or her.
- If you have to act firmly or abruptly, moderate the impact at your first opportunity by returning to a calm tone, explaining the importance of compliance with your instructions and emphasizing that the person's safety and protection are your foremost concern.
- Reinforce compliance by promptly and positively acknowledging actions that follow your instructions.
Example: Disturbance Call at a Local Hospital
Officers Jones and Wilkins respond to a call from a reception staff member near the front lobby of a busy local hospital. Upon arrival, they witness a man in his mid to late 50's, yelling and waving his arms at hospital staff. Officer Jones asks the man to calm down and tell him what happened.Minimal Transparency
While the man explains the situation to Officer Jones, Officer Wilkins begins gradually working his way around the side of the scene to check the man's back pockets for signs of weapons. Seeing Officer Wilkins' maneuver, the man moves to keep Officer Wilkins from getting behind him. He seems clearly agitated by the move and loses rapport with Officer Jones. The officers both begin asking the man to stand still, but the man gets increasingly agitated to the point that the officers become concerned for the safety of staff and other hospital visitors in the area.Tactical Transparency
Officer Jones recognizes a military tattoo on the man's forearm and realizes that this man may be acutely aware of police training and tactics. Officer Jones knows that his partner will begin gradually working around the side of the scene to check the man's back pockets for signs of weapons. Knowing that any advantage to keeping the maneuver covert may not exist, he tells the man, "My partner here is just walking around to see if you have any weapons on you, so that we can make sure everybody here stays safe." The man replies, "I saw what you're doing. I don't want you sneaking around behind me, and anyway I don't have any weapons on me." He turns and shows Officer Wilkins the back of his pants, and the conversation continues between the man and Officer Jones.Increasing Situational Awareness: The Grounding Technique
The grounding technique may be useful in addressing intrusive thoughts and flashbacks related to a prior traumatic event. The purpose of this technique is to help an agitated person to focus on the current situation with the police officer, rather than thinking about and responding to events in his or her own head.While useful with Veterans experiencing PTSD symptoms, this technique can be used in many situations in which individuals would benefit from an increased attention to current circumstances. For example, you may use it to help an acutely suicidal person who is experiencing extreme hopelessness.
As with any technique, this one could also be counterproductive. At any sign that this grounding is further frustrating the person, stop and give something else a try.
The Grounding Technique Actions
This technique works best when kept simple. It is described in full below, and illustrated with examples afterward to demonstrate how it may actually be employed in the field. The technique has three basic elements: assessment, introduction and questioning.Assessment
This technique may be useful when a person is responding to things, such as a flashback, that are not actually present in the immediate environment. In typical communication, people maintain eye contact about 80% of the time, respond to questions with answers that make sense, and pause while thinking about the immediate question at hand. If a person's ability to carry on a conversation appears to be impaired or if they don't appear to know what is going on around them, grounding may be appropriate.Introduction
Begin with a statement such as, "I'm going to ask you a few very simple questions, just to check in with you." A more elaborate script follows, but you are encouraged to adopt an introduction that suits your personal style:"I've noticed that you're upset. I'm going to ask you some questions just to see that you're with me, and then we are going to address your concerns."
Questioning
In this stage, you will proceed through progressively more difficult questions that require the individual to attend to sensory stimuli in the immediate environment:
Phase I:
Start here. This is the simplest form of question and any answer requires attention to the immediate environment. The questions are:
If the questions in Phase I appear to be helping, but you are uncertain that the person is sufficiently oriented to the present, you can increase the difficulty of the task by proceeding to the following questions:
The Questioning step can be adjusted as needed. It is critical to ask questions over a range of sensory modalities (visual, auditory, tactile) as the internal stimuli that you are trying to override may come in any form. It may be obvious after your very first question that the person is now alert, oriented and responding to the current situation. In other cases you may you need to go farther into the question list to get the person to attend to you and to the situation at hand.
Grounding should help the person focus on the here and now. If your attempt at this technique yields no improvement or a worsening of symptoms, then you may abandon this technique for the current situation or you may make another attempt later.
Start here. This is the simplest form of question and any answer requires attention to the immediate environment. The questions are:
- Tell me something you see here right now.
- Tell me something you hear right now.
- Tell me something you can touch/feel right now.
If the questions in Phase I appear to be helping, but you are uncertain that the person is sufficiently oriented to the present, you can increase the difficulty of the task by proceeding to the following questions:
- Tell me two new things that you see here right now.
- Tell me two new things that you hear right now.
- Tell me two new things that you can touch/feel right now.
The Questioning step can be adjusted as needed. It is critical to ask questions over a range of sensory modalities (visual, auditory, tactile) as the internal stimuli that you are trying to override may come in any form. It may be obvious after your very first question that the person is now alert, oriented and responding to the current situation. In other cases you may you need to go farther into the question list to get the person to attend to you and to the situation at hand.
Grounding should help the person focus on the here and now. If your attempt at this technique yields no improvement or a worsening of symptoms, then you may abandon this technique for the current situation or you may make another attempt later.
Example: Disturbance Call in a Public Parking Lot
Officers respond to a disturbance call in a public parking lot. A disheveled man is pacing in the lot and he approaches officers when they arrive. The man answers some questions that officers ask, but not all. He appears to be thinking about things unrelated to his conversation with the officers, but begins to describe a situation where some "kids" threw a cup of ice at him in the parking lot. As he tells his story, he becomes increasingly agitated beyond what is reasonable for the events described.The primary officers attempt the grounding technique, stating, "I'm going to ask you a few simple questions just to check in with you, ok?" The man is pacing back and forth, and grabbing at his hair, but says "yeah" to the officer's inquiry.
"Tell me something you can see right here in the parking lot." Pacing back and forth the man does not respond. "Just tell me one thing you see right here in the parking lot," repeats the officer. "I see you," says the man. Seeing the improvement, the officer moves on, "Great, now tell me something you can hear right now," to which the man replies, "I hear the traffic going by." The officer continues to ask questions of increasing difficulty (e.g., "Now tell me two new things..."), and finally asks the man, "Are you doing ok enough that we can talk about what happened again?" The man affirms, and is able to continue with some questioning without increased agitation.
Making a Referral to Treatment: A Longer-Term Investment in the Veteran
Depending on the policy of your department, you may be able to provide Veterans with information about hotlines, treatment options, and other resources available in the local area. Some departments allow or even encourage officers to transport Veterans directly to a site. Resources available differ by geographic region. Some areas may have a single point of contact for Veterans to seek treatment (e.g., a local clinic), while others may have an array of options.Types of Sites
Many different Veteran-specific treatment options exist. Most communities have access to a Department of Veterans Affairs (VA) health care facility. Since 2009, every VA medical center has had a Veterans Justice Outreach (VJO) Coordinator to spearhead local efforts directed towards Veterans who come into contact with the legal system.Other types of sites may include those specifically for women Veterans, for Veterans who served in combat, or for Veterans needing acute substance detoxification. While some agencies are funded and run as government entities (state, county), many other excellent options exist in the form of non-profit treatment and advocacy agencies specifically dedicated to improving the lives of America's Veterans.
CIT Training: Advanced Skills in De-Escalation
Hopefully you find the techniques above useful. The main goal was to introduce you to some of the specific techniques commonly employed by mental health professionals with the hope that some may prove useful to police officers in the field. For those interested, we highly recommend getting additional didactic and hands-on training in these and similar techniques. The Crisis Intervention Team (CIT) model (a.k.a. the "Memphis model") is widely accepted as the gold standard of police training in crisis intervention.
While it includes additional detailed training in mental health issues and de-escalation techniques, CIT is also a model for integrating police and other community resources to increase officer and public safety and improve the lives of all. In fact, not only is CIT touted in the police community, but it is also highly regarded and recommended by the mental health advocacy group, National Alliance on Mental Illness (NAMI).
