Barriers to De-escalation in Several Cultural Communities

1. Barriers to De-escalation in Several Cultural Communities Summary of suggestions from focus groups identifying barriers to effective mental health crisis response in the African American, American Indian, Hmong, Latino, and Somali communities in Minnesota. How can officers overcome these barriers?

2. Community partners • African American Women/Men in Need • American Indian Family Center • Comunidades Latinas Unidas En Servicio • Cultural Wellness Center • Hmong American Partnership • Nawayee Center School • One T Consulting • Somali Cultural and Human Services • Urban Strategies • White Bear Lake Police Department • St Paul Foundation • Bigalow Foundation

3. What is Culture • Culture is behavior that benefits the individual and the group in a particular environment • Humans create culture and are the products of culture In a culture other than your own: • Listen, respect, learn • Tolerance within universal laws of human rights • To communicate, not necessarily to endorse

4. A Few Examples of Culture • bodily adornment • cooking • courtship • division of labor • dream interpretation • etiquette • folklore • community organization • government • greetings • hospitality • housing • language • law • penal sanctions • spirituality

5. My culture and other cultures • What is my culture? • What other cultures do I interact with on a regular basis? • When there is no crisis: • Learn the sources of their historical trauma • Learn about their culture • Get to know their elders and healers • Learn how their community views mental health and how they respond to mental illness? • Make connections to their community to increase credibility in the crisis moment

6. Ways of Interacting Seeing culture as a resource for recovery from mental illness • Traditions: ways of responding to illness and recovery • Knowledge and insights • Practices: ways of providing support, care, and healing Interacting with different cultures • Non-verbal: can be the same or different across cultures including respectful eye contact and comfortable distance • Language and English usage may be different • Family structure: respect leadership within the family • Ideas about mental illness and criminal justice vary • Ideas about the broader world, historical or personal experience with abusive authority figures all impact you • Any one race, nationality or population can contain many different cultures

7. Barriers Identified • What is Trauma? • Physical (serious injury and threat) • Brain Injury • War/Terrorism/Political Violence • Victim/ Witness to Community Violence • Mental (frightening thoughts and painful feelings) • Racial experience and trauma (system induced trauma, internalized oppression, domestic violence, poverty) • Mental illness and trauma (incarceration, loss of family and friends) • Cultural trauma (forced displacement, natural disaster, unresolved grief) • Historical trauma (genocide, forced sterilization and adoptions) • Secondary trauma

8. Signs and Symptoms of Trauma • Intense fear or helplessness • Aggression • Hypervigilance • Flashbacks • Withdrawal or detachment • Lack of concentration • Irritability • Loss of emotional regulation • Lack of calm • Sleep disturbance • Hypersensitivity to emotion • High heart rate at rest, high blood pressure • Defense is disassociation

9. Barriers Identified (cont.) •  What is Stress? • From lack of safe housing or employment, community violence • Behavior may be from underlying untreated trauma or mental illness • Childhood trauma imposes un-named pain • Desire for response that is respectful of their culture and community • Want to cooperate with police but see possibility of good or bad coming from police response • Loss of rights, resources, culture, life and health • Stress makes responders forget their skills • Stress inhibits community member’s skills

10. Signs and Symptoms of Stress • Memory problems • Inability to concentrate • Poor judgment • Sees only the negative • Anxious or racing thoughts • Chest pain, rapid heartbeat • Irritability, short temper • Agitation, inability to relax • Sense of loneliness, isolation • Overwhelmed • Using alcohol, cigarettes, or drugs to relax

11. Barriers Identified (cont.) • Misunderstanding, lack of knowledge • You can’t resolve a problem until you first name it: MI, trauma, stress, abuse • Person feeling oppressed and not understanding you are there to help • Some community members don’t understand what mental health and mental health problems are • Lack of understanding of the justice system • Parents put up a front to protect kids, fear of child protection, family breakup • Lack of familiarity with clinical or legal terminology • The child is small in the big world and doesn’t understand what is happening or how to respond • Survival requires defense from the un-understood threat • Generalized response produces aggressive and depressed behaviors • Elders expect deference and humility from responders

12. Barriers Identified (cont.) • Lack of Trust • Stress of meeting a peace officer • Don’t know what to expect from first responder • Fear for the worst response, defensive posture • Officer trauma • Citizen as a threat, potential or real • Expectations affect the outcome in mental health response and in cultural response • Past abuse colors current interactions

13. Stress and Trauma impact officers and community members alike • “…any time the causal factor of a stressor is human in nature, the degree of trauma is usually more severe and longer lasing. In other words, when it is another human being who causes our fear, pain and suffering, it shatters, destroys and devastates us. • “It chews hungrily on so many of our law enforcement officers. • “It affects their job performance, their relationships and ultimately their health.” Lt Col David Grossman, On Combat

14. Fuselier Behavioral Change Stairway BEHAVIORAL CHANGE TRUST INFLUENCE RAPPORT EMPATHY ACTIVE LISTENING SKILLS TIME G. Dwayne Fuselier, Ph.D., is a Clinical Psychologist and a retired FBI Supervisor who was part of the Columbine Investigative Team Task Force. Adapted from “Lessons from Columbine: What Parents can do to get their teenagers to talk with them.”De-escalation • Stairstep model

15. Active Listening • Separate person from problem (difficult behaviors, signs and symptoms of a disorder) • Open ended questions- “Tell me more about what happened here before I arrived. ” • Make a human connection. • Clarify your understanding of the person’s mental and physical state: • Have you been drinking? • Are you taking any drugs or medications? • Have you been diagnosed with a mental illness? • Do you have a family member or friend I can contact? • Do you have a doctor or clinic I can call? Know the resources that practices in their cultural group.

16. Empathy and Building Rapport • Be careful of what you say and how you say it so it is not misinterpreted. For example: • “ I understand how you feel.” • “Can I help you get what you need?” • “You can stop in any time you want.” • “Anything I can do to make you feel more comfortable?” • Set boundaries and give clear directions. • “You are too close. You have to stand there.” • “Pace in this area if you must pace.” • “You have to go the hospital because I am concerned about your health and safety.”

17. Questions? Mark Anderson Executive Director Barbara Schneider Foundation 2419 Nicollet Av Minneapolis, MN 55404 612 801 8572 admin@thebarbaraschneiderfoundation.org www.thebarbaraschneiderfoundation.org