Article Figures & Data
Figures
- Figure 1.
The change in the degree of satisfaction for each of the 19 training sessions is shown over time. The actor satisfaction is shown as a dashed line, and the police satisfaction is shown as a solid line. Satisfaction was based on a Likert scale measuring how much they were satisfied with the training: 4, strongly satisfied; 3, somewhat satisfied; 2, somewhat dissatisfied; and 1, strongly dissatisfied.
Tables
Sex, n (%)* Male 253 (81.6) Female 57 (18.4) Age at time of first questionnaire, M (SD) 31.96 (6.31); range, 21–57 years Education, n (%)† High school 82 (27) Post secondary 180 (58) Graduate 48 (15.5) Years of experience as a police officer, M (SD) 3.98 (3.92); range, 1–31 years Years of experience as a police officer, n (%)‡ 0–2 years 140 (45.6) 3–5 years 111 (36.2) 6–10 years 46 (15) 11–15 years 5 (1.6) Over 15 years 5 (1.6) Depressed female
Police respond to a call from a man stating that his ex-girlfriend called him and said she was going to take an overdose. She then hung up the phone. According to the ex-boyfriend they broke up one week ago, after she found out he was cheating on her. They had been together for one year before that. He had found her moody during their relationship, and he knew that when she was younger she had taken an overdose. Her parents, who normally call or visit daily, have just left on a long-planned vacation and are currently out of town. He wants the police to check on her, as she has no other family around and has no roommates.Alcohol intoxication with likely medical problems
Police have been called to a shop on a busy street, as there is a man lying on the street outside in the early evening. The shopkeeper says that the subject looks as though he is intoxicated. No other information about the subject is available, except that the subject just moved to the city recently.Possible psychosis
Police attend to a noise complaint at an apartment. The neighbors have called in that somebody is being extremely loud in the apartment above them, and they are concerned for their safety. The neighbors have left the premises because they have felt threatened in the past by this individual.Depressed and actively suicidal individual
Police get a call from a concerned individual stating that his friend is severely depressed and is contemplating suicide. The friend lost his job two months ago and his wife left him a week ago, taking their two children. The reporter states that the subject was at the reporter's home making threats that he was going to kill himself on account of his not being able to provide for anyone in this economic crisis, his concern about losing his wife and family, and his feeling that there was no point in living. The reporter also states that the subject may have a weapon at his house. The police are told that the subject is still at the reporter's home. When they arrive, the door to the reporter's home is wide open but the reporter is gone.Mania with possible drug use and physical symptoms
A call has been made to the police by a shopkeeper about a young woman (or man) who is outside their store and is disruptive. The shopkeeper also states that there is a known drug house just down the street. The person looks high and is also disrupting traffic by walking in the middle of the road. Police are met by a loud and very talkative subject.Domestic dispute precipitated by problem gambling
The police are asked to attend to a disturbance. The dispatcher informs the police that a domestic dispute is occurring and that the neighbor reported it. The police enter the scene and find a man and woman screaming at each other. Swearing is persistent, and aggressive verbal behavior is evident on arrival, but there is no evidence of physical contact or violence. The couple seem to be arguing over a gambling problem. The police knock and ask to come inside.Scenario: Depressed Female
Police respond to a call from a man stating that his ex-girlfriend called him and said she was going to take an overdose. She then hung up the phone. According to the ex-boyfriend they broke up one week ago after she found out he was cheating on her. They had been together for one year before that. He had found her moody during their relationship, and he knew that when she was younger she had taken an overdose. Her parents, who normally call or visit daily, have just left on a long-planned vacation and are currently out of town. He wants the police to go check on her, as she has no other family around and has no roommates.Subject
The subject is disheveled, possibly having drunk alcohol, as there are empty bottles around. She has poor hygiene (dirty clothes, messy hair, no makeup) and takes a minute to open the door. Upon opening the door and letting the police in, the subject exhibits a depressed mood and seems not to care about anything going on around her. She will only respond to empathetic questions but constantly insists that she is fine and there is nothing to worry about. She admits that she took some pills, but says that she had taken only a couple of Tylenol and nothing else. There are two half-empty pill bottles lying around, but none is completely empty, and she says that they weren't taken as part of the overdose. There is a note on the subject's bedside saying goodbye to her parents. She will not want to go to the hospital and if directly asked, the subject admits that she has attempted suicide before. She makes vague utterances, such as “I will never have to worry about that anymore,” and “You will not have to try and help me much longer.” She refuses to be future oriented. She also gives indications of major depressive disorder (low mood, increased crying, poor sleep, decreased appetite, loss of energy, poor concentration, social withdrawal, low self-esteem, feeling worthless, no view of the future, being fed up with life, and suicidal ideation), with the exact symptoms described depending on the questions asked. She also answers specific questions on these topics. If the subject senses true concern from the officers she will admit to taking 20 Tylenol.Police objectives
Recognition of elements of depression and gaining knowledge of symptoms.
Empathetic communication to increase bonding and trust.Building skill in interviewing subject to extract key knowledge. Obtaining knowledge of the Mental Health Act, specifically whether use of it is appropriate. Required equipment
Baggy clothes
Blanket
Empty pill bottlesWhat would be expected from background information check?
There is a history of one suicide attempt, and police were called when it occurred.Scenario questions: given to each pair by the facilitator Which mental illness, if any, are you dealing with? What specific factors signify that it is this illness? Are there any factors in this situation that suggest it may be a high-risk or a low-risk situation? If so, what are they?
Does the presence of empty alcohol bottles signify anything about the risk level? Should the subject be hospitalized, and if so for what reasons?Scenario answers Major depressive disorder, with thoughts of suicide. Answers to questions (if these questions are asked by the officers): they may not have asked any of the questions regarding low mood, increased crying, poor sleep, decreased appetite, loss of energy, poor concentration, social withdrawal, low self-esteem, feeling worthless, no view of the future, being fed up with life, suicidal ideation High risk or low risk: this is an individual at high risk of completing a suicide. The risk is indicated by the following factors: A note was left behind to say goodbye.
If a note is left behind, then the individual has taken the time to tell the people she cares about that she will no longer be around and has clearly planned the attempt to some degree. Her planning may make it a higher risk situation, more likely to succeed, and most likely indicates the need for examination in a hospital.Suicide attempt appears to have been planned to occur when no one was around.
If she plans to commit suicide when no one is around, it can suggest a higher degree of planning and greater determination. In contrast, if a suicide attempt is spontaneous or occurs while others are around, it may lower the risk of a successful attempt.Suicide has been attempted before, according to background information check and history obtained from boyfriend.
If suicide has been attempted before, chances are it will be attempted again. One of the most accurate predictors of a successful suicide is past attempts. Therefore, always note a history of attempted suicide as an important risk factor.The presence of alcohol may not indicate, by itself, a lower or higher risk, although some studies have shown suicides in which no alcohol was present have a higher risk of death. Therefore, the presence of alcohol should not be taken as a sign of risk for suicide. Additionally, this subject should be taken to hospital under the Mental Health Act, as she is a threat to herself for the reasons given. Also, Tylenol overdose is a common cause of death due to liver toxicity, so that alone would be a reason to take her for a medical opinion. Facilitator checklist and facilitator feedback to officers (10–15 minutes including answers above) How well did the officers ask questions to promote a positive interaction? Specifically, did they ask questions to try to promote bonding with the individual as a person (i.e., What is your name? Where are you from? Do you have any family and friends?)? Did the officers effectively communicate so as to de-escalate the situation? (Was the situation resolved?) Were active listening and empathy used in interaction with the subject? Were the officers aware of their own body language? Did you see the officers use appropriate body language? How did the officers answer the scenario questions? Objective feedback from actor playing girl attempting suicide
Observation of language used by the officers
Observation of feelings elicited by interaction with the officersScenario questions for actor (given as feedback to officers, 5–10 minutes) How did the police make you feel? Were the officers empathetic toward you? Were you more agitated by this interaction or did you gain reassurance that the officers had confidence in what was being done? How could the situation be executed better? Objectives of observing actor
Observation of body language
Observation of language used by officersScenario questions for observing actor (given as feedback to officers, 5–10 minutes)
What did the body language of the police tell you?
What could they have done better?Scenario No.: _________Date: _________ Actor/Observer: Actor: Group 1 (circle correct answers) Primary Officer Secondary Officer How did police make you feel? Angry Same Angry Same Scared Better Scared Better Agitated Reassured Agitated Reassured Safe Safe Why? Did they ask your name/where you're from? etc. Yes No Yes No Was empathy shown? Yes No Yes No How could it be better executed? Observations or comments: Observing Actor: Group 1: Body Language Primary Officer Secondary Officer Active listening? Observed Not observed Observed Not observed Body language? Open Closed Open Closed Came to your level? Large in size Came to your level? Large in size Facial Language? Relaxed Bored Relaxed Bored Concerned Stern/angry Concerned Stern/angry How could it be better executed? Actor observations or comments: Communication/active listening skills Primary Officer Secondary Officer Paraphrasing Observed Not observed Observed Not observed Emotional labeling Observed Not observed Observed Not observed Mirroring Observed Not observed Observed Not observed Minimal encouragers Observed Not observed Observed Not observed Summarizing Observed Not observed Observed Not observed Silence Observed Not observed Observed Not observed Facilitator observations or comments: Interpersonal Primary Officer Secondary Officer Developed rapport with the subject Observed Not observed Observed Not observed De-escalated the situation Observed Not observed Observed Not observed Used appropriate body language Observed Not observed Observed Not observed Demonstrated empathy Observed Not observed Observed Not observed Facilitator observations or comments: Topic Mean Rating % Responding Strongly Agree Facilitators were professional, treating everyone with respect 3.63 78 Learning objectives were clear to me 3.52 59 The facilitators helped in my learning 3.41 57 The training day was successful in explaining the subject matter to me 3.47 56 I will implement the knowledge and skills learned from this course in my everyday duties 3.35 48 The training met my expectations 3.36 47 The scenarios gave me sufficient practice and feedback 3.07 33 The scenarios gave me an opportunity to learn about mental health, active listening, and body language 3.04 29 The scenario facilitated my learning, allowing me to apply new concepts 2.84 22 n = 381.
Based on Likert-type scale: 4, strongly agree; 3, somewhat agree; 2, somewhat disagree; 1, strongly disagree.
Topic Mean Rating % Responding Strongly Agree The officers treated me with respect throughout the training 3.78 78 The facilitators were professional and treated all of the actors with respect 3.80 78 I feel that most officers regarded me and my fellow actors as a crucial part of the training 3.67 67 I have an overall positive outlook on police after being in contact with police for approximately 2 months 3.69 63 The training days were a success when looking at the overall outcome of every day in its entirety. 3.50 44 It was easy to give feedback to the police because I felt prepared and knowledgeable in what I was wanting to say 2.89 33 n = 9.
Based on Likert-type scale: 4, strongly agree; 3, somewhat agree; 2, somewhat disagree; 1, strongly disagree.
Depressed female
Immediate arrest and ambulance called
No time taken to talk to the individual
Solution: If an arrest is made immediately, informing the officers that the ambulance will not arrive for 10 minutes will instigate communication with the subject.Alcohol intoxication with likely medical problems
Officers did not believe that they needed to be aware of alcohol withdrawal and claimed not to be doctors
Solution: Inform officers that it is crucial that they know about this medical problem, as it could save lives if caught early enough.Possible psychosis
Deciding whether to take the individual to the hospital
Actor feedback about how an individual with schizophrenia feels versus how an actor feels was questioned
Solution: Have a constant facilitator in this scenario.Depressed and actively suicidal individual
Immediate arrest, even though individual was in an enclosed corner with a barricade in front
Solution: suggest that this individual cannot escape and therefore there is no need to arrest immediately and cause further stress in the situation.Mania with possible drug use and physical symptoms
Immediate arrest, more experienced officers handcuffed sooner because of the threat that the subject was walking in the street
Solution: Change the scene to a different location following the complaint of walking on the street.Domestic dispute precipitated by problem gambling
Complaint that the scenario was unrealistic, since the couple would re-escalate following all the attempts to de-escalate
Immediate arrest
Lack of solution
Solution: Active listening and patience can divulge more information than if the situation is aggravated by an arrest.
