Emergency Response to Individuals with Developmental and/or Intellectual Disabilities Experiencing a Behavioral Health Crisis

Abstract

First responders and clinicians often must engage individuals who are experiencing a behavioral crisis. The nature and origins of such behavioral crises widely vary. This paper explores the challenges faced by first responders responding to behavioral crises experienced by individuals with I/DD. We begin by describing the tragedy that befell Robert Ethan Saylor, a young man with down syndrome, who died after a confrontation with police over a $12 movie ticket. We then describe crisis intervention team (CIT) approaches to serving individuals in behavioral crisis. We then draw on our work and others in the city of Chicago to explore organizational and policy obstacles to more effective interventions for individuals with I/DD who experience behavioral crisis.

Background and Purpose

First responders and clinicians often engage individuals who are experiencing some form of behavioral crisis. The nature and origins of such crises vary from an individual experiencing severe mental illness to an individual living with an I/DD who does not respond to police officers or emergency medical technicians as expected during a service call to a private home.

While first-responders report that they often encounter people with I/DD during crisis response, the majority of crisis response training focuses on mental illness. This paper addresses this gap in training and research and examines practice implications to offer suggestions for more effective intervention for police response to people with I/DD experiencing a behavioral crisis.

Methods

In addition to a review of current literature addressing emergency response to individuals with I/DD, we draw on our study evaluating Chicago’s emergency response to individuals experiencing a behavioral crisis. Thirty-three respondents participated in in-depth, semi-structured interviews and focus groups addressing emergency response to individuals experiencing a behavioral crisis. The target sample includes professional stakeholders who are involved with the process through which a person experiencing a behavioral crisis becomes involved with the criminal justice system including Chicago police officers, emergency medical technicians, dispatchers, and health professionals.

Findings

The findings from this study reveal themes in emergency response to people with I/DD including challenges with interorganizational implementation, training, and manpower and resource investment. Practice implications to address some of these challenges include improved information flow and training for both the community and first-responders. Also, cultural commitment from police departments to support de-escalation tactics versus tactical approaches of police response. Finally, a focus on preventative and follow-up measures involving comprehensive treatment and recovery support may help to address challenges related to the “revolving door” of crisis treatment.

Conclusions and Implications

Emergency first responders must frequently engage people in behavioral crisis. High-profile tragedies underscore that such encounters can end poorly due to a myriad of preventable failures. Although specific successes and failures depend on specific context, first-response agencies can prevent many tragedies by valuing de-escalation as a core principle and by imparting basic CIT time and distance principles over tactical intervention in the management of behavioral crisis. Also, law enforcement and health care systems must consider several cultural, structural, and financial investments to improve both first response and subsequent follow-through.