Performance as mental health crisis intervention: an interview with Natalie Alvarez

Friends, once more I’m thrilled to be able to share with you the full text of a piece published in my new (August 2019) special issue of Research in Drama Education. (If you missed the last two freebies, please click here and here.) In this interview, Ryerson University Performance Studies professor Natalie Alvarez talks about an extraordinary research and development project she is currently helming in southern Ontario, and reflects on how that project debunks some of the persistent myths theatre and performance scholars carry with us about what performance-led interdisciplinary work should look like. I learned a huge amount from conducting this interview with Natalie and, although it’s long for a post on this blog (4500 words), I hope you can make the time to read it. It will be worth it.

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Natalie Alvarez, Ryerson University professor and investigative lead on the SSHRC-funded four-year project, “Scenario Training to Improve Interactions Between Police and Individuals in Mental Crisis: Impacts and Efficacy”

Living the interdiscipline: Natalie Alvarez speaks with Kim Solga about conceiving, developing, managing, and learning from a large-scale, multidisciplinary, scenario-based project supporting police de-escalation training in Ontario

(Published in RiDE 24.3 [2019]; click here for a free download of the published interview.)

Ryerson University theatre and performance professor Natalie Alvarez is currently helming a large, interdisciplinary team of forensic psychologists, mental health clinicians, Applied Theatre practitioners, police trainers, and community stakeholders with lived experience of mental illness in southern Ontario that is testing the power of Forum theatre to build better, more responsive scenarios for police officer training in de-escalation and mental crisis response. Funded by a four-year Insight Grant from the Social Sciences and Humanities Research Council of Canada (SSHRC), the project, titled ‘Scenario Training to Improve Interactions Between Police and Individuals in Mental Crisis: Impacts and Efficacy’, is already significantly changing the paradigm for police training in response to persons in mental crisis in the province.

In this interview, Alvarez sits down with issue editor Kim Solga to talk about where this project came from, what challenges arise when working in an intensively interdisciplinary way—and how theatre and performance can serve effectively as a methodology at the heart of a wide range of scholarly investigations, both inside and outside of the arts and humanities.

KS: To begin, can you say a few brief words about your own training and background? As a scholar, how do you ‘identify’?

NA: I would have to say that I identify now as a performance studies researcher since I am most interested in how performance can be used as an optic and method of analysis to examine cultural practices both onstage and in the public sphere. But my training, formally, has moved from English and dramatic literature with a focus on discourse analysis and critical theory as an undergraduate student to theatre and performance studies as a graduate student.

KS: Can you give us the project’s ‘elevator pitch’, and tell us what stage of the project you are at right now?

NA: The project is tough to distill in two to three sentences—you are testing my pitching skills!—but in short: it’s a four-year, evidenced-based study that brings together theatre practitioners, forensic psychologists, mental health clinicians, people with lived experience of mental illness, mental health advocates, and police trainers to develop a scenario-based training program designed to improve police response to individuals in mental crisis. I realize I squeezed a lot into that first sentence. Sentence two: We are using a mixed methods approach that is longitudinal, with quantitative and qualitative measures, to determine whether a scenario-based program can improve skills in effective de-escalation and reduce stigmatizing attitudes towards individuals living with mental illness. We are in year two of four of the study.

KS: Where did the inspiration for this project originally come from?

NA: It emerged from the field research I did for my book, Immersions in Cultural Difference: Tourism, War, Performance(Michigan, 2018), which took me to military training sites in Canada, the US, and the UK. I was struck by how these large-scale, pre-deployment training environments of simulated Afghan villages were using high intensity scenarios to test soldiers’ capacities to engage in ethical decision-making while under extreme stress.

In this training designed to prepare soldiers for deployment in Afghanistan, military training personnel worked with special effects teams largely drawn from the film industry to create scenarios that would expose soldiers to what would be, in many cases, their worst possible day in theatre: surprise insurgent attacks requiring them to rehearse their tactical responses and rules of engagement. But in the context of a mock Afghan village, scenarios were also designed to build soldiers’ ‘Cultural Intelligence’ (or CQ) about local populations in Afghanistan to better establish working relationships for the purposes of a counterinsurgency mission. Scenarios would unfold 24 hours a day, seven days a week in a large-scale environment: in the case of CFB Wainright, outside of Edmonton, Alberta, for example, four small Afghan villages were set up across a wide swath of Alberta prairie to create this sense of full immersion. This fully immersive, 24-7 form of scenario-based training is a far cry from the short, discrete scenarios in contained environments that we now design for police, but it’s nevertheless instructive since it shares many of the same principles that underlie scenario-based learning in police training contexts: the creation of high-fidelity scenarios designed to capture the stress of the encounter and develop trainees’ capacities to think critically, responsibly, and ethically in the heat of the moment.  

There was one debrief I witnessed during pre-deployment training at Wainright for soldiers headed to Afghanistan that made a particular impression on me, and sparked the idea for this current study. It happened after a mass-casualty scenario involving actors in-role as Afghans in a village that had just been struck by an IED, which killed a member of the Afghan National Police who was well known to villagers. It called on soldiers in training to manage frightened and grieving villagers while following through with their protocols to establish a safety cordon and contain the area.

The scenario debrief was impressively led by a staff sergeant and I found myself struck by his teaching skills: he asked soldiers to replay the scene in their minds and hit the ‘pause’ button at key moments in their recounting—effectively, to ‘rewind’, replay, and reconsider their courses of action and decision-making. The moment made me think of how useful it would be if soldiers had this opportunity to pause, rewind, and reconsider on their feet, in an embodied way, in a kind of modified, Boal-inspired use of Forum Theatre.

It was around that time that the Sammy Yatim incident occurred on a streetcar near my home in Toronto on the night of 27 July 2013. Yatim was armed with a switchblade and behaving erratically, exhibiting signs of mental distress, and he was alone on the streetcar by the time Constable James Forcillo arrived on scene with his partner. Forcillo fired two volleys of shots, nine in total, to subdue Yatim. Forensics revealed that the first three shots killed Yatim almost instantly. Forcillo was later convicted of attempted murder and sentenced to six years in prison.

After that incident, which made headlines around the world, the Ontario Ombudsman, Paul Dubé,issued a report investigating the state of police training in Ontario with respect to de-escalation in cases where mental illness or distress is a factor. I have an elder sister who lives with schizoaffective disorder, and so I find these incidents of lethal force in response to people in mental crisis harrowing and deeply concerning. As I was bringing the book to completion, I kept thinking about the Ombudsman report and whether the discoveries I had made in my field research could evolve into a new context of police training.   

Auspiciously, around this same time my former department, the Department of Dramatic Arts at Brock University, hired Dr. Yasmine Kandil, a specialist in Applied Theatre. Shortly after her hire, I cornered her in the university cafeteria and pitched the idea of this project that would aim to realize many of the recommendations that had come out of the Ombudsman report. The vision I had was to take officers in training through a spectrum of scenario-based training—from the stop-playback method of Forum-inspired scenario training to a high intensity circuit of scenarios that would assess officers’ critical decision-making while under stress—and gather a multidisciplinary team from across the humanities and social sciences alongside community stakeholders to design, execute, and measure it.

KS: I hear you saying that police and armed forces already use complex scenario training—hence your work embedding with and observing them for your 2018 book. Can you speak briefly about how the scenario work you envisioned for this project differs from existing scenario training models for police officers?

NA: Our stop-playback method of Forum-inspired scenarios, which allows a multidisciplinary team to ‘press the pause button’ and offer feedback to a trainee in the moment, is a significant departure from how police training typically unfolds. In general, mental crisis response knowledge is most commonly conveyed in a de-contextualized classroom context with guest lecturers often delivering information about signs and symptoms of mental illness with minimal scenario-based learning. Scenario-based learning is most often used in police Use of Force ‘block’ training contexts, which don’t necessarily prioritize cases of mental crisis and are comprised of five- to ten-minute uninterrupted scenarios that are led by and debriefed with police trainers only.

Our study, by contrast, uses scenarios as the primary method of content delivery, so that material that would otherwise be delivered in a lecture format becomes immediately demonstrable and experiential. And we’ve designed the forum scenarios to have a host of built-in ‘what ifs’ or hypothetical circumstances, so that trainees can discuss and practice a range of de-escalation strategies in fluid situations with minimal to significant complexity and discuss the potential circumstances leading to that crisis situation. Trainees then receive feedback from multiple perspectives: a mental health clinician, a person with lived experience of mental illness, and a police trainer.

KS: This is clearly a very larger project with lots of people of very different backgrounds and skill sets involved. Who are your collaborators? How did you go about realizing you needed them, and then finding them?

NA: The research team formed over the course of two years, as reading one publication led me to a particular researcher who then suggested another publication that led to another researcher…and so it went. I began with Dr. Terry Coleman and Dr. Dorothy Coleman’s 2014 Mental Health Commission of Canada report on the state of police training in mental crisis response, Ontario Ombudsman Paul Dubé’s 2016 investigation into police training, and the Hon. Frank Iacobucci’s 2014 independent review of police response to individuals in crisis. And I read through their works cited lists to follow the trail on the existing research on scenario-based police training, de-escalation, and mental crisis response. I visited the Ontario Police College several times to meet with trainers and curriculum designers and observe their scenario-based training.

All of this reading and all of these meetings made clear to me the fact that training of this kind exceeds the insights and capacity of any one discipline and any one individual. It demands a multidisciplinary team: we needed mental health clinicians who could offer insight on signs and symptoms and best practices on how to engage effectively with persons in mental health crisis; we needed police trainers to marry those best practices with police de-escalation training that prioritizes safety and the sanctity of life; and we needed people with lived experience of mental illness who have had encounters with police to be at the table in both the design and delivery of the training in order to help guide officers on how best to realize consumer-centered decision-making. We also required individuals who specialize in intercultural communication, and who can support an intersectional understanding of the experience of mental illness as informed by ethnicity, gender, class, age, and thus help develop trauma-informed approaches to persons in mental crisis. Many, many phone calls with experts in these areas and many, many meetings later, I had assembled our core team of 12 research collaborators and partnered with a police service in southern Ontario. We have since added 6 trainers and instructors and have developed 7 scenarios that involve over 26 actors.

And, of course, we required theatre practitioners who know how to craft and direct effective scenarios that have complex and credible levels of challenge and escalation for officers-in-training to practice a range of de-escalation strategies in a host of possible ‘what ifs’. This project also requires theatre practitioners who know how to direct and work with actors who have a very particular kind of skill set: our actors need to be able to toggle between the role of actor and that of educator as they navigate high-affect scenes while improvising within certain parameters set by the scenario and guiding trainees through various rewards or redirects based on the choices the trainee is making.

Iacobucci’s report in particular made evident to me the need for partnerships between researchers and police services. His report emphasizes the need to measure the efficacy of de-escalation training and the impacts that training is having on the person in crisis’s experience in the encounter with police. For this study to impact police training standards or make a persuasive case for more robust mental crisis response training in the province, generating meaningful and reliable data is imperative. That’s what brought my co-investigator Dr. Jennifer Lavoie to the project. Alongside Yasmine, Jennifer has been pivotal to the success of this project. She isa forensic psychologist in the Department of Criminology at Wilfrid Laurier University who specializes in policing and mental crisis response; she has spent over 250 hours in ride-alongs observing police response to individuals in mental crisis. She designed the qualitative and quantitative methods for data collection and analysis for our study. Critically, she led the team in the design of a tool to assess police performance in de-escalation strategies, which I feel is a key contribution this study has made to public culture. As a humanities scholar, I never thought I’d find myself thisexcited about an assessment instrument, but it’s truly a beautiful thing. It’s the product of input from people with lived experience, advocates, psychologists, police trainers, and performance practitioners… . It’s basically the first, validated assessment tool in Canada, to our knowledge, that sets a measurable, observable standard for effective de-escalation in police training.

KS: As the performance-trained scholar at the centre of this interdisciplinary team, how much did you have to bend or flex your scholarly perspective—and maybe even your identity?—to enable the shaping of the project? Has your sense of the work you do as a performance scholar shifted over time to accommodate interdisciplinary methods and perspectives, as per your work with the military?

NA: I’ve had to adapt to new vocabularies and certainly new paradigms of engagement, to be sure. But that remains true for every research project I engage in because, predominantly, the studies I work on require some form of field research and therefore an ‘embedding’ in different worlds of experience, discourses, and fields of inquiry. The question that remains constant for me is this: what does performance have to say within these worlds, and what will performance unveil there?I think of performance as a kind of hermeneutical method through which we can examine a host of cultural phenomena—this is, of course, influenced by and related to the ‘broad spectrum’ approach to performance studies (championed by Richard Schechner, Barabara Kirschenblatt-Gimblett, Diana Taylor, Dwight Conquergood, among many others), but it also exceeds it. Performance, for me, is above all a methodology, and as such it is always bending, flexing, and shifting—its site-responsiveness is what is most exciting to me.

What’s become clear to me over the course of this particular project—and I would say that this is a recent development—is the way in which performance can serve as a nexus or meeting point for different disciplinary perspectives that can work in concert toward social justice initiatives. Looking back, I realize now that the seeds of this idea were planted at the ‘conversatorios’ I curated with Aluna Theatre for their 2014 RUTAS/ROUTES festival, which formed research ‘clusters’ that brought scholars from different disciplines together with actors, directors, activists, elders, and students for conversations with the public on the social justice issues raised in the festival performances. But this is the first time I have led a project of this scale that draws on a multidisciplinary team toward a shared set of research aims.

KS: I’m really interested in the place of theatre and performance within this complex interdisciplinary work, given how many science-side stakeholders are involved here. For example, in your description of collaborators above, I get the sense that theatre is both central, yet also somewhat marginalized, in the project, given your (necessarily) heavy focus on assessment and measurement. Can you talk about this tension?

NA: The reality in practice is that roughly 80%-90% of our time is spent developing scenarios—writing them, structuring them, rehearsing them with actors, and testing them over a period of months with our actors, police-in-role, and our multidisciplinary team—and delivering them in the training week, which is comprised almost exclusively of scenarios. Performance is, then, the core methodology and the substance of the project, without which the project would not exist. I would say the qualitative and quantitative methodologies we have developed to build the evidence-base could be described as theatre’s indispensable partner in this project, since they help us answer the question, ‘Does scenario training actually work and, if so, how?’

The tension you describe—performance as ‘both central, yet marginalized’—is something I simply don’t experience in this project. But I wonder if what you’re picking up on is not so much a tension but a movement, the kind of movement that happens when performance is used as a methodology that flexes and bends with the project’s demands, a movement that goes between being ‘central andmarginal’ (rather than ‘central, yet marginal’). This central-marginal movement, in my mind, describes the exigencies of multidisciplinary work, especially in an intensely collaborative and multifaceted project of this kind. As a methodology, performance provides the container for the research, which allows, in turn, points of emphasis from all of the contributing disciplinary perspectives to become centralized as needed, moment to moment, as circumstances and project demands require.

It’s a fascinating question, though, and it makes me wonder whether it’s revealing of certain assumptions about performance studies as a bounded discipline that makes itself visible, central, or ‘less marginal’ on certain terms. Or, to put it differently, and perhaps more importantly for the concerns of this issue: I wonder whether it reveals certain assumptions that performance needsto be positioned as a bounded discipline in order to make itself visible, central, or ‘less marginal’. But what happens to these assumptions, and this sense of boundedness, if we follow, in earnest, the notion that performance studies is an interdiscipline and performance a kind of hermeneutical method? The enormous potential of performance studies in these collaborative research contexts lies, for me, in the fact that it is not a discrete, circumscribed field of study but a mode of investigation that reorients other fields to uncover new pathways of inquiry. For me, it’s less about proceeding with a systematic core that is then applied to other fields, which would only be a form of analogical thinking, and more about flexing performance across fields to reveal otherwise-invisible structures and paradigms within those fields.

To illustrate what I mean here: at the risk of severely over-simplifying, Judith Butler’s notion of the ‘performative’, for example, is not a metaphor; it does not say we operate ‘as if’ we are in a performance. It highlights something configured into our everyday behaviours that would have otherwise gone unnoticed had we not deployed performance as a means of thinking it through, allowing us the opportunity to reconfigure what is otherwise taken for granted.

I guess I’d like to hear more about how this project would unfold—or what it would sound like—if performance was more ‘central’?

KS: That’s an incredibly useful response. One of the reasons I posed the question is because we theatre workers often risk, in interdisciplinary projects where performance is not the core method or framing paradigm, feeling marginalized or undervalued; it’s one of the concerns of this issue to unpack when and how much theatre and performance scholars and makers need to bend and flex on others’ terms in order to survive the STEM (or even the STEAM) turn. But you’ve created a project that implies something very different: you’ve centred performance as method, as paradigm, and then grouped others’ needs and concerns around it, allowing the hermeneutic power of performance to become evident for a wide range of collaborators and to a wide range of practices. That’s exciting!

Given the wide multidisciplinary range of labour at work here, I’m curious to know if the project looks today more or less like you conceived it to start. How have your collaborators helped to shape its development, through the process of grant applications and beyond into training proper?

NA: In terms of the general structure of the training program—with respect to a spectrum of scenarios moving from Forum to circuit—it remains more or less as I had envisioned it at the outset. But it crystallized into its current form over many conversations with Yasmine. On the ground, the program has continued to develop to include additional types of scenarios: what we’ve called ‘What If’ scenarios, where study participants (or officer-trainees) develop their own scenarios in collaboration with our actors that re-enact a mental crisis call trainees themselves have already encountered in the real world as an opportunity to ‘replay’ it and get feedback from our multidisciplinary training team. Further, the exact structure and management of the high-intensity scenarios (this is the point in the program’s training week where officers’ de-escalation skills are assessed) took shape over many conversations with Yasmine and one of our trainers and scenario-writers, LJ Nelles, both of whom have extensive former experience running OSCEs or exam circuits with actors/Simulated Patients in medical training contexts.

What developed most from my initial vision, and over the course of many discussions, was the method to build an evidence-base for the study. Jennifer designed a sophisticated plan of data collection to ensure we were getting reliable data that would allow us to measure intra-officer changes pre- and post-training. She also designed a consumer satisfaction survey to measure whether there are changes in the region of our partnering police service in terms of people’s perceptions of and satisfaction with police response to mental crisis. We plan to track these consumer responses as officers move through the training over the four years of our study.

With Yasmine’s guidance, we’ve continued to fine-tune the structure of what we’re calling the ‘Forum Scenarios’—the stop-and-playback method that allows officer-trainees to step in and try a host of de-escalation tactics and communication skills while receiving feedback from a multidisciplinary team of instructors: a mental health clinician, a person with lived experience of mental illness, a police trainer, and an intercultural communications expert. Yasmine is very skilled at facilitating Forum Theatre, drawing on her years of experience using Applied Theatre methods with vulnerable populations, and she’s very attuned to how delicately these Forum Theatre experiences need to be structured. Trainees can easily feel overwhelmed and vulnerable, with all eyes on them, scrutinized by their peers and a team of instructors, so Yasmine developed a nuanced facilitation structure that addresses the power imbalances in the room and ensures that the multiple perspectives at play have sufficient room to be heard.

KS: What lessons about interdisciplinary, cross-platform collaboration have you learned that would be worth sharing with other T&P academics?

NA: I think in this political moment, we have an opportunity to harness performance’s potential to foster genuine interdisciplinary, cross-platform collaboration, especially if we take in earnest Barbara Kirshenblatt Gimblett’s claim that performance is an ‘organizing concept’.[1]Think about the potential in that. What if we work seriously to understand performance studies as an inter-discipline, one that at its best becomes a means of organizing and bringing together multiple perspectives around the core principles we as researchers value in performance—the doing, the behaving, the embodying; attempting to inhabit different vantage points and constructing hypothetical visions of the world to imagine what’s possible. These principles are integral and foundational to allinvestigative research, but theatre and performance researchers are the ones with the expert insight to support their broad-spectrum application. I think T&P academics have much to offer when we think of performance as a kind of methodological container for interdisciplinary research—a container that holds the research but whose shape is plastic and responsive to those working within it.

KS: Our issue is about the role that theatre and performance already plays—but also could better play—in the neoliberal university, and it’s dedicated to strategizing around impact on our own terms (or, perhaps, on terms framed by performance, to pick up on the spirit of your comments above). When you talk to administrators, industry partners, or others outside our field, how do you describe this project? Is ‘theatre’ as a mobile learning platform part of your description?

NA: I describe it as ‘scenario-based, de-escalation training’ and the scenario-based approach instantly makes the connection for people between theatre/performance and this project. I talk about theatre in terms of the methodology it offers of scenario-based thinking, planning, and learning, which lies at the core of this study. I think that approach best—and most readily, for non-specialists—conveys what performance has to offer across disciplines.

Scenario planning is, I think, one of the most viable ways in which we can transmit what performance has to offer to other areas of public life—and areas that sorely need our support! Scenario planning has, since the 1990s, acquired much traction (and scrutiny) across a host of industries as a way of anticipating and imagining all possible futures—a core theme that ran through my 2018 book, which this current project extends. Scenario planning immediately conveys the centrality of performance as integral to these kinds of ‘logic modelling’ exercises that require environments to be created and ideas to be tested in hypothetical, high-fidelity contexts. I think this is what theatre does best. Scenario planning is actually a kind of neo-naturalist approach to the idea of theatre-as-laboratory, one taken beyond the stage proper to address social justice issues with all of the necessary community stakeholders at the table.

KS: How has the work on this project shaped the way you think about the role of T&P in your individual institution? Are you thinking differently at all? Have you caught the eye of administrators or other change-agents who are now beginning to think differently about the work we do as ‘theatre’ scholars?

NA: Since moving to Ryerson University (in Toronto) in 2018, I was very pleased to hear my Dean, Charles Falzon, in one of our very first meetings, key in to what this project suggests about the potential of performance in ways he hadn’t considered before. He acknowledged that ‘theatre’ for most people tends to invoke this idea of actors on a stage performing for an audience in a discrete/contained environment. And while he was careful not to diminish the power that theatre proper has in these contexts, he also expressed his excitement about what, for him, was this new and comparatively under-explored idea of performance’s potential in the public sphere—as a paradigm for thinking and a nexus for cross-disciplinary collaboration. For my Dean, it allowed him to understand how performance fits within his broader vision for the Faculty of Communication and Design, which is heavily invested in the idea of creative innovation. I left that meeting with the distinct impression that the project had already changed preconceived notions of what performance does and can do for someone in a senior position at a university that is at the forefront of thinking about new ways university students and researchers can contribute to important community and industry conversations in Canada. And I get the distinct sense that it’s opened up the scope in administrators’ minds here of the reach of performance-based research, particularly in terms of its social impact.

[1]See Barbara Kirshenblatt-Gimblett’s allusion to the idea of performance ‘as an organizing concept for a wide range of behaviour’ (2002, 25) in her essay, ‘Performance studies’ in The Performance Studies Reader.

 

1 thought on “Performance as mental health crisis intervention: an interview with Natalie Alvarez

  1. Pingback: An Interview with Our Very Own Kim Solga | The Activist Classroom

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