2. NAMI Maine Online Data Sheet
3. Updated 10/31/2022
5. Officer*
   -- Select One --Adam HubbardAlec ThompsonAndrew ShortillAnthony CiampiBrian MillsChristopher KlangosChristopher OuelletteCodie DubeDerek McDonaldDerek MooreElizabeth ColemanEric LundGeorge MonteithHaley MaguireHayleigh LathropJacob WolterbeekJaimes PlamondonJames PenneyJason PelletierJohn QuarlesJonathan CottonJustin LavertueKayla ReussKyle CutlerLawrence AngisMark McShaneMatthew BaldwinMatthew DitollaMatthew GilmanMatthew RousseauMichael RealiNormand AllairePeter GilmanPhilip GreenwoodRandall MedeirosRandy CharlandRicky DoyonRobert ByrneRobert PerkinsRobert SimmonsRonald PhillipsSamantha PriorScott LaBrecqueShara GuzelianShawn LaBrecqueSteven GortonThomas LapierreTrenton Lucas-BishopVictor ParkerWilliam BuheltZachary Quadland
6. Dispatch #:*
7. Date*
   Date
11. CRISIS CAUSED BY

    1. MENTAL HEALTH - the primary reason for police contact is related to mental health such as reports of suicidal, homicidal, experiencing psychosis, in need of de-escalating, etc.
    2. SUBSTANCE USE: this is if the primary reason for police contact is due to an individual’s substance use such as intoxication, over dose, needing treatment.
    3. BOTH: police contact is related to someone struggling with depression or suicidal thoughts, etc. while intoxicated or related to their substance use.
    4. UNKNOWN: if it is unclear the reason for the police contact.
    5. UNREPORTED: it was not noted or documented if the reason for police contact was related to mental health or substance use.
15. DISPOSITION OF THE CALL

    1. ED/ER (Voluntary): individual was brought to the hospital voluntarily.
    2. ED/ER (Involuntary): individual was brought to the hospital involuntarily.
    3. STABILIZED ON SCENE: individual de-escalated once officer spoke with them and there was no reason to transport or make referrals.
    4. JAIL: individual was taken into custody and brought to the jail.
    5. CRISIS: crisis was contacted and either met with the individual or was able to make a plan to support the individual.
    6. COMMUNITY PROVIDER: individual is already connected to services and supports in the community and they were able to work with the individual either in facility or make arrangements to see them.
19. REASON FOR ARREST

    1. MANDATORY: individual was taken into custody for mandatory arrest such as domestic violence, warrant, violation of a PFA.
    2. NON-MANDATORY: individual was taken into custody based on officer’s discretion.
    3. SUMMONS: individual was not taken into custody but was issued a citation.
    4. NO CHARGES: the individual was not charged.
23. REFERRALS MADE: (These are any referrals or information for resources that you gave the individual).

    1. CRISIS: you connected the individual to the crisis services to receive support.
    2. COMMUNITY MENTAL HEALTH PROVIDER: you connected the individual or gave them information regarding community resources in your area.
    3. COMMUNITY RESOURCES: you provided information regarding financial, housing, food, etc. resources in the community.
    4. SUBSTANCE USE SERVICES: you provided information regarding substance use supports such as counseling, AA, detox programs, treatment programs, etc.
    5. RECOVERY/PEER CENTER: providing information or contacts for a recovery or peer center, or connecting them in the moment of crisis.
    6. NAMI MAINE: connecting them with or reaching out to the NAMI Maine helpline, affiliate program, or another connection to NAMI Maine.
    7. DECLINED SERVICES OR REFERRALS: you offered or attempted to connect the individual to services or resources and they declined.
    8. NONE: you were not able to offer any referrals at the time of the call or in follow up.
25. OTHER REFERRALS: If there was more than one you are provided additional space to enter.
29. INJURY INCURRED

    1. NO INJURIES: no one experienced injuries during call.
    2. OFFICER: one of the responding officers experienced an injury.
    3. INDIVIDUAL IN CRISIS: the individual in crisis experienced an injury during call (after officer arrived).
    4. BOTH: both the individual in crisis and the officer sustained an injury during the call.
    5. INDIVIDUAL IN CRISIS PRIOR TO POLICE ARRIVING: if the individual in crisis received an injury prior to the officers arriving on scene.
    6. UNKNOWN: it is unknown by the person reporting the data if an injury occurred.
33. RESPONDING OFFICER CIT CERTIFIED: (Was the primary officer on scene CIT trained - yes or no?)

    1. YES
    2. NO
37. REFERRAL SOURCE OF THE CALL: (This is the initial call that was placed to dispatch requesting a response.)

    1. SELF: the individual in crisis called 9-1-1 requesting a response due to being in crisis.
    2. FAMILY/FRIEND: the call for an officer response was made by a concerned family, friend, neighbor, etc.
    3. COMMUNITY MEMBER: the call made requesting response was made by a member of the community who observed something concerning.
    4. VETERAN’S CRISIS LINE: the national veteran’s crisis line made the initial contact requesting response.
    5. STATE CRISIS LINE: this is the state 1-888-568-1112 number run out of Opportunity Alliance.
    6. CRISIS MOBILE TRIAGE: this is the mobile triage providers in each area including- Sweetser, Opportunity Alliance, Western Maine Behavioral Health, Crisis and Counseling, Aroostook Mental Health (AMHC)
    7. COMMUNITY MH PROVIDER: non-crisis mental health providers including case managers, therapists, counselors, psychologists, psychiatrists, ACT teams, group homes, etc.
    8. OTHER COMMUNITY PROVIDERS: these are other community service providers such as PCP officers, food banks, homeless shelters, etc.
41. RESPONDENT (check all that apply):*

    1. Suicidal
    2. Homicidal
    3. Aggressive
    4. Self-Injury
    5. Unknown
    6. None
45. COMMUNITY CO-RESPONSE: (Was there a co-response by community providers such as crisis, case managers, etc.?)

    1. YES
    2. NO
49. OFFICER'S TIME ON THE CALL (estimate in minutes)*
52. Updated 10/31/2022
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