Mental First Aid & De-escalation Notes

Overview of Mental First Aid for Security Professionals

• This presentation helps security professionals understand and use Maslow's Hierarchy of Needs for de-escalation by understanding psychological drivers behind difficult behavior and responding with targeted techniques.
• The aim is practical application while maintaining professional standards and safety priorities.

Timetable

• The proposed timetable includes breakfast from 0700-0730, commencement from 0730-0800, lunch break from 1200-1230, continuation from 1230-1300, assessment from 1300-1400, and finish at 1415.

Resilience

• The first step towards getting somewhere is to decide that you are not going to stay where you are.
• Resilience is important: tough times don’t last, but tough people do.

Importance of Names

• The most important thing to a person is their name.

Maslow's Hierarchy of Needs

• Maslow's Hierarchy of Needs, applied to employee engagement, includes physiological, safety, belonging, importance, and self-actualization levels.
• On average, less than 15% reach the self-actualization level.
• Levels 2 (Importance) and 3 (Belonging) have a direct impact on engagement and can be moved up by the 4 enablers of engagement (motivators).
• Levels 4 (Not Engaged) and 5 (Disengaged) are de-motivators.

Contents

The presentation covers:

• Introduction
• Maslow's Hierarchy - The Foundation
• Level 1 - Physiological Needs
• Level 2 - Safety Needs
• Level 3 - Love & Belonging
• Level 4 - Esteem Needs
• Level 5 - Self-Actualization
• The De-escalation Framework
• Practical Techniques by Need Level
• Case Study Analysis
• Common Mistakes to Avoid
• Cultural Considerations
• Team Coordination
• Measuring Success
• Practice Scenarios
• Building Your Toolkit
• Implementation Plan
• Ongoing Development
• Special Populations

Maslow's Hierarchy - The Foundation

The five levels of human needs are:

• Physiological: Food, water, shelter, sleep.
• Safety: Security, stability, order.
• Love & Belonging: Relationships, acceptance.
• Esteem: Recognition, respect, status.
• Self-Actualization: Personal growth, creativity.

Level 1 - Physiological Needs

• The foundation of human behavior includes food and water, sleep and rest, physical comfort, and basic health needs and temperature regulation.
• Security scenarios include intoxicated individuals and hungry/tired event attendees.
• Key de-escalation phrases: "Let's get you somewhere comfortable," "When did you last have something to eat/drink?," "I can see you're not feeling well, let's sort this out."

Level 2 - Safety Needs

• Safety needs include physical safety, financial security, health and wellbeing, protection from harm, predictability and order.
• Security scenarios include panicked individuals in emergencies and someone refusing to follow security procedures.
• Key de-escalation phrases: "Your safety is my priority," "I'm here to make sure everyone stays safe," "Let me explain why we have this procedure," "What can I do to help you feel more secure?"

Level 3 - Love & Belonging

• Love and belonging needs include relationships and friendships, family connections, a sense of belonging, acceptance by others, and being part of a group.
• Security scenarios include separation from friends/family and feeling excluded or discriminated against.
• Key de-escalation phrases: "I understand how important it is to find your friends," "Let's work together to solve this," "Your concerns are valid and important," "I want to make sure you feel welcome here."

Level 4 - Esteem Needs

• Esteem needs include respect and recognition, self-respect and confidence, recognition from others, status and reputation, a sense of accomplishment, dignity and worth.
• Security scenarios include public embarrassment situations and authority challenges.
• Key de-escalation phrases: "I respect that you have a different view," "Can we step aside and discuss this privately?," "I appreciate your cooperation," "Help me understand your perspective."

Level 5 - Self-Actualization

• Self-actualization includes personal growth, creativity and self-expression, achieving potential, meaningful experiences, and moral and ethical behavior.
• Security scenarios include passionate activists or protesters and creative individuals facing restrictions.
• Key de-escalation phrases: "I can see this is really important to you," "How can we find a way that works for everyone?," "I respect your commitment to your beliefs," "Let's see if there's a creative solution here."

The Mental Health Framework

• Step 1: Assess which need is being threatened.
• Step 2: Acknowledge and validate their need.
• Step 3: Address and target your response to their need level.
• Step 4: Adapt and adjust as the situation evolves.

Practical Techniques by Need Level

• Physiological Needs: Air, water, food, shelter, clothing, sleep, warmth.
• Safety Needs: Physical safety, financial security, emotional security, job security, health and well-being, freedom from fear, social stability.
• Love & Belonging: Friendships, romantic attachments, family relationships, social groups, community groups, acceptance, expressing affection, shared values.
• Esteem Needs: Self-esteem, respect from others, achievement, independence and freedom, recognition, status, and prestige.
• Self-Actualization: Staying true to one's values, embracing challenges, understanding personal needs for fulfillment, feeling secure and unashamed in one's identity, developing a strong sense of purpose, being spontaneous and natural, being autonomous and independent, being able to appreciate the simple things in life, being able to accept oneself and others.

Case Study Analysis

• Real-World Application Scenario: A music event at a licensed premises, at 0200 hours, an intoxicated patron becomes aggressive when denied re-entry after leaving the venue.

Common Mistakes to Avoid

• Ignoring basic needs.
• Threatening safety needs.
• Isolating people.
• Attacking dignity.
• Dismissing values.

Cultural Considerations

• Cultural variations in need expression require adaptation strategies based on universal principles.

Team Coordination

• Sharing need assessments, role specialization, and escalation decisions are important aspects of team coordination.

Measuring Success

• Evaluation criteria include immediate success indicators, longer-term indicators, and personal development.

Practice Scenarios

• Scenario 1: Concert venue, person claims their expensive jacket was stolen from coat check, becoming increasingly agitated with staff.
• Scenario 2: Sports event, fan from visiting team being harassed by home team supporters, security called to intervene.
• Scenario 3: A homeless person confronts security about not being allowed to sleep near a park monument

Building Your Toolkit

• Essential skills development includes observation skills, emotional regulation, communication skills, and problem-solving skills.

Implementation Plan

• The implementation plan includes an observation phase, integration, and application.

Ongoing Development

• Ongoing development includes monthly team reviews, quarterly skill assessments, annual training updates, and professional development opportunities.

Special Populations

• Adapting for vulnerable groups includes elderly individuals, people with disabilities, youth and adolescents, and individuals in crisis.

Responsibilities

• Responsibilities lie with staff, students, contractors, visitors, heads of administrative units, supervisors, stakeholders, faculties, and security.

How to Respond to Threatening or Inappropriate Behaviour

• Intervene (security staff) when the incident is inappropriate or threatening (mental health issue) or if there are threats to self-harm or suicide.

Follow-up Management

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Types of Issues

• General misconduct.
• Suspected Mental Health Issues
• Exclusion

Safety Plans

• A coordinated response when disturbing behaviour is identified as ‘at risk’ to self or others and is ongoing.
• Supports risk management, harm minimization, early intervention, duty of care, community wellbeing.

Confidentiality and Privacy

• Important to maintain privacy and confidentiality.
• Disclose only if there is a serious and imminent threat to an individual’s life, health, safety or welfare; or a serious threat to public health, public safety or public welfare.

Support Services

• Need to identify what support services are needed.

Emotionally Disturbed People

• Can be due to mental illness, medical conditions, substance abuse, or situational stress.

What is Empathy?

• The ability to understand and share the feelings of another.

What is Apathy?

• Apathy is defined as “a lack of interest, enthusiasm or concern."

Assessment

• Assessment is not intended to make a diagnosis but to determine urgency and identify immediate needs for assistance.
• Common mental health presentations at triage: psychotic illness, depressive illness, attempted suicide, suicidal thoughts, anxiety, acute situational crisis, substance-induced disorders, and physical symptoms in the absence of illness.

Safety First

• Always maintain your safety and the safety of others.
• If a person’s behaviour escalates, withdraw and seek further assistance immediately.

The ABCs of a Mental Health Assessment

• Appearance: What does the person look like?
• Affect: What is your observation of the person's current emotional state?
• Behavior: How is the patient behaving?

Appearance

• Are they dishevelled, unkempt, or well-presented?
• Are they wearing clothing appropriate for the weather?
• Do they look malnourished or dehydrated?
• Are they showing any visible injuries?
• Do they appear intoxicated, flushed, with dilated or pinpoint pupils?
• Are they tense, slumped over, displaying bizarre postures or facial grimaces?

Affect

• Are they flat, downcast, tearful, distressed or anxious?
• Is their expression of emotion changing rapidly?
• Is their emotion inconsistent with what they are talking about?
• Are they excessively happy?

Behavior

• Are they restless, agitated, or hyperventilating?
• Are they displaying bizarre, odd or unpredictable actions?
• Are they oriented?

How is the Person Reacting?

• Are they angry, hostile, uncooperative, over-familiar, suspicious, guarded, withdrawn, inappropriate, or fearful?
• Are they responding to unheard voices or sounds or unseen people or objects?
• Are they attentive or refusing to talk?

Possible Questions You Can Use

• This must be distressing for you. Can you tell me what is happening?’
• ‘I can see that you are very anxious. Do you feel safe?’
• ‘I can see that you are angry. Can you tell me why?’
• ‘Are your thoughts making sense to you?’

A Mental Health Primer: Clinical Disorders

• Schizophrenia and other psychotic disorders
• Mood disorders: Depression, Bipolar disorder
• Anxiety disorders: Acute anxiety, Generalised anxiety, Panic attacks, Phobias, Performance anxiety, P.T.S.D, O.C.D

Depression

• Depression is diagnosed when someone has experienced a minimum of two weeks of:
  • Depressed mood
  • Loss of interest or pleasure
  • Weight loss or gain
  • Insomnia or hypersomnia nearly every day
  • Observable hypermotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness
  • Diminished ability to think or concentrate
  • Indecisiveness
  • Suicidal ideation with or without a plan

Anxiety

• The physical symptoms of anxiety are caused by the brain sending messages to parts of the body to prepare for the “fight or flight” response
  • Abdominal discomfort
  • Diarrhoea
  • Dry mouth
  • Rapid heartbeat or palpitations
  • Tightness or pain in the chest
  • Shortness of breath
  • Dizziness
  • Frequent urination
  • Difficulty swallowing
  • Insomnia
  • Irritability or anger
  • Inability to concentrate
  • Fear of madness
  • Feeling unreal and not in control of your actions (depersonalisation)

Mental First Aid Strategies

• The five steps in providing Mental Health First Aid are:
  1. Assess the risk of harm to a person or others.
  2. Listen non-judgmentally.
  3. Give reassurance and information.
  4. Encourage the person to get appropriate professional help if needed.
  5. Encourage self-help strategies.

How to Help Someone Going Through a Mental Health Crisis

• Common types of mental health issues:
  1. Suicidal
  2. Anxiety attack
  3. Acute stress reaction
  4. Psychotic state, out of touch with reality

General Guidelines

• Introduce yourself and explain why you are present.
• Remain courteous and non-threatening, but be honest and direct.
• Listen to the person in a non-judgemental way.
• Avoid confrontation at all costs – be prepared to “agree to differ”.

Mental Health First Aid for Threats to Self-Harm or Suicide

• Do not get involved physically
• Do not leave them alone
• Seek immediate help: Phone the nearest hospital, who will provide appropriate crisis team number Phone Emergency 000 If possible have the person taken to an Emergency department of hospital
• If consuming alcohol or drugs at that time, try and convince them to stop.

What To Do

• Try to ensure they do not have access to lethal means.
• Encourage them to talk. Listen non-judgmentally. Do not deny the person’s feelings. Do not give advice beyond encouragement to get help.
• Give reassurance about this being a real medical condition and there are effective treatments for depression; and
• That the sooner they get help, the faster their situation will get better.

Panic Attack

1. The symptoms of a panic attack and a heart attack can be similar. If you do not know what is wrong, call Police or Ambulance for assistance
2. If possible, help remove person to a quiet, safe place.
3. Help to calm the person by encouraging slow, relaxed breathing in unison with your own.
4. Be a good listener, without judging.
5. If you know the person is having a panic attack and not a heart attack, reassure them with this information.
6. Explain that the attack will soon stop and they will recover fully.
7. Assure the person you will stay with them and keep them safe until the attack stops.
8. Encourage them to talk to a counsellor about strategies for managing panic attacks.

Psychotic Behaviour

1. If someone is at risk of being hurt, call for additional Security, Police/Ambulance or on-site medical teams
2. Do not approach person if it is unsafe to do so.
3. If you judge it safe, approach the person and introduce yourself, offering to help.
4. Stay calm and positive.
5. Remain respectful of the person
6. Do not try to manhandle them or force them to do anything.
7. Listen to person and do not confront them or argue with them, even if they are saying irrational things.
8. Accept their reality.
9. These experiences are often distressing. Counselling staff can assist in the aftermath.

Dealing with “Difficult People”: Understanding Anger

• What is anger?
  • Neurochemical process which makes the body ready for fight against perceived danger.
• What is danger? Perceived
  • violation of rights
  • threat of loss
  • feeling powerless
  • treated with disrespect

What Does an Angry Person Want?

1. Acknowledgement
2. Empathy and understanding
3. Validation of feelings even if you disagree with their perception
4. A solution
5. Follow-up

Dealing with “Difficult People” - Do

• De-escalate
• Continuously assess for danger
• Maintain adequate personal space between you and the person
• Be calm
• Give firm, clear directions
  • The person is probably already confused and may have trouble making even the simplest decision.
  • If possible only one person should talk to the person
• Respond to apparent feelings, rather than content (i.e. “you look/sound scared”);
• Respond to DELUSIONS and HALLUCINATIONS by talking about the person’s FEELINGS rather than what he is saying (i.e. “That sounds frightening,” “I can see why you are angry”)

More Tips

• Be helpful
  • In most cases, people will respond to questions concerning their basic needs (e.g. safety). “What would make you feel safer/calmer?”
• Take a break – “time out”
• Use distractions (e.g. ask for routine information)
• Show of force if necessary

Dealing with “Difficult People” - Don't

• Escalate
• Don’t Join into behaviour related to the person’s mental illness (e.g. agreeing/disagreeing with irrational/angry statements or thoughts)
• Don’t STARE at client - this may be interpreted as a threat
• Don’t CONFUSE the client – one person should interact with the client.
• Don’t GIVE MULTIPLE CHOICES – increases the person’s confusion
• Don’t WHISPER, JOKE, or LAUGH
  • Increases the person’s suspiciousness with potential for violence
• Don’t DECEIVE the person
  • Being dishonest (or patronising) increases fear and suspicion; the person will likely discover the dishonesty and remember it in any subsequent contacts
• Don’t TOUCH the person
  • Although touching can be helpful to some people who are upset, for others it can increase anxiety, elicit fear, and could lead to violence

High Risk Situation

• Maintain position of safety
• Notify someone to request additional security
• Confine and isolate the situation
• Avoid rapid actions
• Remain calm
• Be aware of environment
• Note entrances and exits
• Observe person’s body language

What Actions to Take

• Separate people who are in conflict
• Move dangerous objects out of reach/view of client
• Remove people/objects that upset client
• Utilise people/objects that have positive effect on client
• Do not violate client’s personal space
• Move slowly, if necessary, and explain actions

Effective Communication Skills: Encouraging Response

• Calm, direct instructions
• Simple acknowledgements
• General leads
• Broad openings in questions or comments
• Seek clarification
• Positive use of authority: not patronising or controlling
• Keep the person talking
• Stress positives
• Remain objective
• Discuss alternatives
• Convey respect and attentiveness
• Be an active listener

Effective Communication Skills: Asking Questions

• Simple and direct
• Open ended
• Seek reasons for client’s actions
• Focus on “healthy” aspects of client
• Be honest
• Develop rapport

Communication to Avoid

• Do not use analogies – be concrete
• Do not challenge delusions
• Do not be manipulated
• Do not legalise
• Do not overreact to language or gestures aimed at you
• Do not order, command, warn, or threaten
• Do not moralise
• Do not name call or ridicule

Applying Maslow's Hierarchy of Needs

• Maslow's Hierarchy of Needs can be a helpful framework for security officers to understand and address conflict situations by considering the underlying needs of individuals involved. By understanding the needs at play, officers can better de-escalate and stabilize situations, eventually leading to effective conflict resolution

A Summary of Applying the Hierarchy in Conflict Situations

• Assess the Situation: As a security officer, start by understanding the context of the conflict. Consider the individual's immediate needs and how they might be unmet.
• Mental Health First Aid can assist to De-escalate: Focus on addressing the immediate threats and unmet needs. This might involve ensuring basic safety, providing emotional support, or helping individuals feel understood.
• Build Trust and Rapport: By understanding and addressing the individual's needs, officers can build trust and establish a positive rapport, making it easier to de-escalate and resolve the conflict
• Promote Solutions: Once the immediate situation is stabilised, focus on finding solutions that address the underlying needs. This might involve mediation, conflict resolution strategies, or helping individuals find resources to meet their needs

Practical Considerations for Applying the Hierarchy

• Empathy: Understanding and sharing the feelings of others is crucial in conflict resolution. By adopting an empathetic approach, officers can better understand the individual's perspective and address their needs.
• Clear Communication: Effective communication, including clear and non-confrontational language, is essential for de-escalation and finding solutions.
• Cultural Sensitivity: Be mindful of cultural differences that may influence how individuals perceive and respond to conflict.
• Professionalism: Maintain a professional demeanour and avoid escalating the situation with aggressive or confrontational behavior

Employee Engagement - Maslow's Hierarchy Application

• Illustrates the levels of employee engagement in relation to Maslow's hierarchy, from survival and security to belonging, importance, and self-actualization.
• Highlights motivators and de-motivators at different engagement levels.