Download Intermediate CIT - TCOLE Course #3841

Intermediate CIT
Course TCOLE
Course # 3841
Texas Commission On Law Enforcement
AND
BCCO PCT #4 PowerPoint
UNIT ONE
ADMINISTRATIVE
• Please complete the BCCO PCT #4
Registration form and turn it in now.
• Make sure you sign TCOLE Report of
Training (PID#, Full Name and DOB).
• All cell phones off please – pay
attention to course materials and show
common respect & courtesy.
Your Instructor – Course Facilitator
and Mentor Trainer
Deputy Chief George D. Little
A.S. & B.S. Criminal Justice & Sociology
B.S.CJ Wayland Baptist University, San Antonio
M.S. Criminology & Counter-Terrorism University of the State of New York(P)
2012 T.C.O.L.E. Professional Achievement Award
Certified Crime Prevention Specialist (C.C.P.S.)
FAMS
TCOLE Basic Instructor Certificate 1984
CERTIFIED
TCOLE Advanced Instructor 2012
INSTRUCTOR
TCOLE Master Peace Officer 1991
MP Special Operations Operator Counter-Terrorism 1988
Military Police Investigations (MPI) & Criminal Investigation Division
(CID) Special Agent
Graduate Drug Enforcement Administration Academy 1977
43- years Law Enforcement Experience
39-Years Teaching & Instructor Experience
5/24/2017
3
Learning Objectives
See your Participant
Handout for complete list of
all goals established in this
course with each individual
learning objective listed
under each unit (goal)
Opening Statement
With increasing frequency, law
enforcement is being called upon
to respond to individuals in
serious mental health crises
COURSE/LESSON
OVERVIEW – Cont’d
It is necessary for the law
enforcement personnel to
understand mental illness, and the
tactics and techniques that have
been proven to work most
effectively when responding to
individuals in these situations.
COURSE/LESSON
OVERVIEW – Cont’d
These tactics and techniques are
different than those routinely taught
to officers to control conflict
which, due to the underlying elements
behind the behavior, is usually not of
a criminal or malicious intent.
COURSE/LESSON
OVERVIEW – Cont’d
This information can help keep the
officer safe, keep the mental
health consumer safe, and
greatly reduce liability on the part
of the officer and the agency
Crisis Intervention
Training
Intermediate CIT Course Number 3841
Texas Commission On Law Enforcement
9
Unit Goal 1.0
To develop a basic understanding
and respect for the fundamental
rights of and proficiency in
interacting with people with
mental illness.
10
Top Cop Video
(View ‘Top Cop’ video from “Train the Trainer” course materials
11
1.1.
• Discuss the impetus for crisis
intervention training and why it
is so important to the law
enforcement community.
12
Origin of the Training
• Memphis (TN) officers shot and
killed a 26-year-old male
who was cutting himself with a
knife and threatening suicide
• The public outcry in the
aftermath of the shooting caused
the mayor to establish a
task force
13
Origin of the Training
•Crisis Intervention
Training (CIT) was
created
-Practitioner Perspective
-Bureau of Justice Assistance
July 2012
14
Similar Situations Today
• “The San Francisco Police
Commission approved a $500,000
legal settlement with the family
of a mentally disturbed man
who was shot and killed in 2001
by police as he waved a knife at
them in a theater.”
— Jaxon Van Derbeken
— San Francisco Chronicle
June 5, 2003
15
New YORK PD – Detective who
attempted to disarm a
mentally challenged individual
Similar Situations Today
Continued
• “The fatal shooting of a mentally
ill man on Thursday marked the
third time in six months that
Philadelphia police have used
deadly force to subdue an unruly
person in need of psychiatric
help.”
“Police Shootings of Mentally Ill Show Training Needed”
17
www.HealthyPlace.com February 21, 2004
Similar Situations Today
Continued
• “The Miami-Dade police department
in southern Florida began sending
every officer to a two-day class
entitled ‘Managing Encounters
with the Mentally Ill’ … after
officers killed a 19-year-old man
suffering from bipolar disorder.”
“Police Shootings of Mentally Ill
Show Training Needed”
 www.HealthyPlace.com
 February 21, 2004
18
Similar Situations Today
Continued
• “A 16-year Austin police officer used
deadly force Tuesday morning,
killing an east Austin woman as she
apparently tried to attack a housing
manager with a butcher knife. …
within moments of the shooting, east
Austin residents were questioning
whether the woman’s death could
—www.news8austin.com
have been avoided.”
— Incident occurred in 2002
19
Similar Situations Today
Continued
• The treatment advocacy center in
Washington, D.C. reported that
people with psychiatric
disabilities are four times as
likely to die in encounters with
police as members of the general
population.
20
 Treatment Advocacy Center
Washington DC
Headlines…
“Crisis Skills Advised for Local
 Los Angeles Times
Police”  Ventura County Edition
 February 27, 2002
“Report: Grand jury finds that most
fatal shootings by law
enforcement officers in last
decade involved a mentally ill
person”
21
Headlines…”Cont’d”
“Training urged after police
shooting”
“The weekend death of a mentally
disabled man shot by a MiamiDade police officer… department to
offer its officers more intensive
training.”
The Miami Herald
Herald.com
Posted Thursday,
October 28, 2004
22
1.2.
Recognize the community mindset
as it relates to the mentally ill’s
relationship with law
enforcement personnel
23
Community Mindset
• Individuals with mental illness
are traditionally not hardened
criminals and should not be
treated as such.
• Law enforcement should respond
differently to individuals in mental
health crises.
• Force, in these situations, is highly
scrutinized.
24
The Problem
• Re-occurring situations in which law
enforcement uses deadly force
during encounters with individuals
in serious mental health crisis
25
Aspects of the Problem
• “There is no question that law
enforcement officers are
increasingly the ones responding to
people with mental illnesses
who are in crisis.”
 Treatment Advocacy Center
Briefing Paper
 www.psychlaws.org
26
 10/2004
Results
• Lawsuits/Liability
• Lack of trust/confidence in law
enforcement by mental health
consumers and their families
• Frustration of law
enforcement due to uncertainty of
how to handle these calls
27
Analysis of the Problem
• Lack of education - understanding
of mental illness by law
enforcement
• The same physical, authoritative,
command tactics employed to
take a criminal suspect into
custody are used in responses to
individuals in mental health crises
28
Analysis…Cont’d
• Individuals with mental illness
are traditionally not hardened
criminals.
• The public views these
individuals as ill, not
criminal. The public expects law
enforcement personnel to help not
hurt.
29
Analysis…Cont’d
• An analysis of 1439 CIT calls
revealed that only 1% of the
individuals in a mental health
crisis were arrested.
• Of the remaining 99% of the
incidents, no crime or a petty class
C crime was committed without
arrest.
30
Houston Police Department 2004
Analysis…Cont’d
• Response to individuals in a
mental health crisis constitutes
a more refined usage of the
officer’s expertise in
communication.
31
Analysis…Cont’d
• “If police perform their role
effectively, our society benefits
immeasurably;
• if the police perform their role
poorly, the damage to public
confidence and democratic
principles can be irreparable.”
(Louis/Resendez, 1997)
The Responses: 3 Models
• Police-based specialized
police response (CIT)
• Police-based specialized
mental health response
• Mental-health-based
specialized mental health
response
33
1.3
• Illustrate the paradox of Crisis
Intervention Training for the
law enforcement officer.
34
The Paradox
• By taking a less physical, less
authoritative, less controlling, less
confrontational approach the officer
usually has more authority and
control over the person in a
mental health crisis.
35
Police Magazine (March
2000)
• “The essential difference between
suspect encounter training, that
officers traditionally receive, and
how to approach the mentally ill is
the need to be non-confrontational.
36
Police Magazine (March
2000) – Cont’d
• Such a requirement to, in effect,
switch gears is diametrically
opposed to the way officers are
routinely expected to control
conflict.”
Police Magazine (March
2000) – Cont’d
• “The same command techniques
that are employed to take a criminal
suspect into custody can only
service to escalate a contact
with the mentally ill into
violence.”
38
1.4.
• Explain Crisis Intervention’s role
in Officer
39
CIT Model
• “CIT has been shown to
positively impact officer
perceptions, decrease the
need for higher levels of police
intervention, decrease officer
injuries, and re-direct those in
crisis from the criminal justice to
the health care system.”
Randolph Dupont, PhD. and Sam Cochran, 40
MS
J Am Acad Psychiatry Law 28:338-44, 2000
This Training…
• Is officer safety training that
is proven to help keep YOU and
the mentally ill consumer safe.
• Is NOT in conflict with any
tactical training you have
received
• Instills confidence in officers
regarding their ability to handle
crisis situations
41
This Training…Cont’d
• Is proven to be effective in helping
you verbally de-escalate
these situations
• Reduces lawsuits
• Is designed for calls involving
individuals with mental illness
but is applicable in many other
areas of law enforcement
42
This Training…Cont’d
• Is one more tool to add to your
tool belt, one more skill to add
to your repertoire of skills.
43
Officer Safety
• The Phoenix, Arizona Police
Department reported that CIT
training increased their
officer safety by 70%
— Phoenix Police Department 2004
44
Officer Safety – Cont’d
• FBI statistics state that mentally ill
consumers are no more prone to
violence than any other area of the
population.
45
Officer Safety – Cont’d
• HOWEVER, the variables (mental
instability, high emotions, possible
paranoia/delusions and substance
abuse) can be very dangerous if not
handled appropriately.
Officer Safety – Cont’d
• When a person feels cornered,
especially if psychotic, chances
are high their response would be
violent.
• In crisis, reason takes a back
seat to emotion.
47
Law Enforcement
Policy Center
• “It is helpful for officers to
understand the symptomatic
behavior of persons who are
afflicted with a form of mental
illness. In this way, officers are in a
better position to formulate
appropriate strategies for gaining
the individual’s compliance.”
48
Law Enforcement Policy
Center – Cont’d
• “Officers should first take time, if
possible, to survey the
situation in order to gather
necessary information and
avoid hasty and potentially
counterproductive decisions
and actions.”
49
Law Enforcement Policy
Center – Cont’d
• “Officers should avoid approaching the
subject until a degree of rapport has been
developed.”
• “All attempts should be used to
communicate with the person first by
allowing him to ventilate.”
50
Police Ex. Research Forum
• “Do not rush the person or crowd
his personal space. Any attempt to
force an issue may quickly backfire
in the form of violence.”
• “He may be waving his fists, or a
knife, or yelling. If the situation is
secure, and if no one can be
accidentally harmed by the
individual, you should adopt a nonconfrontational stance with the
subject.”
51
FBI Law Enforcement Bulletin
• What is considered an area of
specialized training may soon
become standard training curriculum
• Law enforcement agencies must
identify methods to safeguard
their officers while, at the same
time, protecting Consumers
from themselves and others
52
CIT Programs Nationally
• Akron (OH) Delray Beach
(FL)
• Knoxville (TN) Minneapolis
(MN)
• Ft. Wayne (IN)
• Montgomery County (MD)
• Houston (TX)
• New London (CT)
• Jackson County (MO)
• San Jose (CA)
• Kansas City (MO)
• Seattle (WA)
• Albuquerque (NM)
• Lee’s Summit (MO)
• Arlington (TX)
• Lincoln (NE)
• Athens-Clarke County (GA)
• Little Rock (AR)
• Austin (TX)
• Memphis (TN)
53
Additionally, this training…
• Instills confidence in the
community regarding officers’
ability to handle crisis situations
• Brings law enforcement and
mental health together
54
However, this training
• Is not infallible…
but is proven to
be highly effective
55
Force
• Force may be needed, even
deadly force
• It should be used as a last resort
• It will be highly scrutinized
• If force is used, most people will
respond in kind, especially in
these situations
56
Force – Cont’d
• Remember, in many instances
the person has committed no
crime
• You will fare much better if you
can demonstrate you
attempted to use other
tactics before using deadly
force
57
1.5.
• Identify the parameters of
an officer’s qualification
after receiving this
training.
58
This training…
• Does not make you a
therapist. Understand your
professional boundaries.
59
No CIT
(View ‘Psychosis I’ video from “Train the Trainer” resource material)
60
After CIT
(View ‘Psychosis 2’ video from “Train the Trainer” resource material)
61
Unit Goal: 2.1.
• To sensitize the participant
to the adversity of mental
illness.
62
2.1.
• Define the term “mental
illness”.
63
Definitions:
• General Definition of
Mental Illness.
• Professional Definition of
Mental Illness.
• Definition of Insanity.
• Abnormal vs. Normal
Behavior.
64
General Definition
“Illness, disease, or condition that
either substantially impacts a
person’s thought, perception
of reality, emotional process,
or judgment, or grossly
impairs a person’s behavior, as
manifested by recent
disturbance behavior.”
Professional Definition
Mental illness is diagnosed based
on behaviors and thinking as
evaluated by a psychiatrist,
psychologist, licensed
professional counselor, licensed
social worker, or other qualified
professionals using a tool known
as the Diagnostic and Statistical
Manual of Mental Disorders.
Fourth Edition, most
commonly called the
DSM-IV. (American
Psychiatric Association,
Updated, 1999)
Insanity Legal Term
Insanity is considered “a
diminished capacity and inability
to tell right from wrong.” This is not
a psychological term. The definition
varies from state to state. It is
generally used by the court with
regard to an individual’s
competency to stand trial.
Abnormal Versus Normal
Behavior
A sharp dividing line between
“normal” and “abnormal” behavior
does not exist. Adjustment seems to
follow what is called a “normal
distribution,” with most people
clustered around the center and the
rest spreading out toward the
extremes.
Basic Facts
• There are two distinct types of
mental illnesses
Serious to persistent mental
illnesses which are caused by
psychological, biological,
genetic, or environmental
conditions
Situational mental illnesses
due to severe stress which may
be only temporary
70
Basic Facts – Cont’d
• Anyone can have a mental
illness, regardless of age, gender,
race or socio-economic level.
• Mental illnesses are more
common than cancer, diabetes,
heart disease or AIDS.
• Mental illness can occur at any
age.
71
Basic Facts – Cont’d
• 20 - 25% of individuals may be
affected by mental illness.
• 7.5 million children are affected
by mental, developmental or
behavioral disorders.
72
Basic Facts – Cont’d
• Nearly two-thirds of all people
with a diagnosable mental
disorder do not seek treatment.
73
Basic Facts – Cont’d
• With proper treatment, many
people affected with mental
illness can return to normal,
productive lives.
• Mental illness can - and should
- be treated.
74
— Basic Facts About Mental Illness
— NAMI Texas
OCD Video
(View video newscast from “Train the Trainer” materials-updated version ))
75
2.2.
List four prominent
categories of mental illness.
1.Personality Disorders
2.Mood Disorders
3.Psychosis
4.Developmental Disorders
76
2.3. Personality Disorders
Disorders as they relate to law
enforcement officer contact.
77
2.3 Personality Disorders
Many individuals who are functioning
well in their lives may display
characteristics of what are known as
personality disorders
Personality Disorders
Continued
Individuals experiencing these
disorders show personality traits that
are inflexible, maladaptive, or
inappropriate for the situation, and this
causes significant problems in their
lives.
Personality Disorders
Continued
Those individuals who have
personality disorders usually have
very little insight that they have a
problem, and tend to believe that the
problems are caused by other people,
the “system,” or the world at large.
Personality Disorders
Continued
These traits are often accompanied by
some form of depression and may
also be seen in those with chemical
dependency problems.
Personality Disorders
Continued
Persons with personality disorders are
not usually treated like those with
other mental illnesses, but are taught
a variety of communication and
coping skills, or treated for other
problems such as chemical
dependency or depression.
Personality Disorders
CAUSES
Although the causes for these
disorders may not seem relevant for
the officer dealing with these
individuals, their backgrounds are
significant
Personality Disorders
CAUSES – Cont’d
It is believed that most personality
disorders are caused by a family
history - usually beginning at a young
age -of physical or emotional abuse,
lack of structure and responsibility,
poor relationships with one or both
parents, and alcohol or drug abuse.
Personality Disorders
CAUSES – Cont’d
Common personality disorders that
may be encountered by peace officers
include;
• paranoid personality disorder,
• antisocial personality disorder, and
• borderline personality disorder.
2.4.
The three most common
personality disorders
encountered by law enforcement
officers.
1.Paranoid
2.Antisocial
3.Borderline
86
Personality disorders
encountered by law
enforcement officers.
1. Paranoid:
A. Tendency to interpret the actions
of others as deliberately threatening
or demeaning
B. Foresee being in position to be
used or harmed by others
Personality disorders encountered by
law enforcement officers – Cont’d
1. Paranoid:
C. Perceive dismissiveness from
other people
2. Antisocial:
A. Most commonly recognized in
males
Personality disorders encountered by
law enforcement officers – Cont’d
2. Antisocial:
B. A pattern of irresponsible and
antisocial behavior diagnosed at or
after age 18
C. May have one or more of the
following:
Personality disorders encountered by
law enforcement officers – Cont’d
2. Antisocial C:
1.) History of truancy as a child or
adolescent, may have run away
from home
2.) Starting fights
3.) Using weapons
Personality disorders encountered by
law enforcement officers – Cont’d
2. Antisocial C:
4.) Physically abusing animals or
other people
5.) Deliberately destroying others’
property
6.) Lying
Personality disorders encountered by
law enforcement officers – Cont’d
2. Antisocial C:
7.) Stealing
8.) Other illegal behavior
D. As adults, these people often have
trouble with authority and are
reluctant or unwilling to conform to
society’s expectations of family and
work
Personality disorders encountered by
law enforcement officers – Cont’d
2. Antisocial:
E. These individuals know that what
they are doing is wrong, but do it
anyway
Personality disorders encountered by
law enforcement officers – Cont’d
3. Borderline:
A. Most commonly recognized in
females
B. May have one or more of the
following:
1.) unstable and intense personal
relationships
Personality disorders encountered by
law enforcement officers – Cont’d
3. Borderline B:
2.) impulsiveness with relationships,
spending, food, drugs, sex
3.) intense anger or lack of control
of anger
4.) recurrent suicidal threats
Personality disorders encountered by
law enforcement officers – Cont’d
3. Borderline B:
5.) chronic feelings of emptiness or
boredom
6.) feelings of abandonment
2.5.
Prevalent behaviors
associated with personality
disorders.
97
Behaviors associated
with personality disorders
People with personality disorders
usually will not seek treatment
because they don’t think they have a
problem
Behaviors associated with
personality disorders – Cont’d
They may end up in the criminal
justice system because their disorder
may lead them to break laws and
come to the attention of law
enforcement (i.e., by theft, hot-check
writing, fraud, etc
Behaviors associated with
personality disorders – Cont’d
They may use alcohol and illegal
substances as a form of selfmedication, due to the stress and the
consequences of their behaviors.
They often need treatment for
chemical dependency or depression.
Behaviors
• Usually do not seek treatment because
they do not think there is a problem.
• ‘Normal’ functioning, but display specific
personality traits (inflexible, maladaptive,
situational inappropriateness).
• Believe problems are caused by outside
sources or ‘system’ at large.
101
Behaviors…continued
• Behavior may lead to breaking laws (theft,
hot-check writing, fraud etc.) and activity in
the criminal justice system.
• Alcohol and illegal drugs are commonly
used to ‘self medicate’ as a result of stress
and behavioral consequences.
• Often need treatment for chemical
dependency or depression.
102
2.6.
Mood Disorders
Mood Disorders as they relate
to officer contact.
103
Discuss Mood Disorders as
they relate to officer contact
A. A mood disorder is another type of
mental illness demonstrated by
disturbances in one’s emotional
reactions and feelings.
B. Severe depression and bipolar
disorder, also known as manic
depression, are referred to as mood
disorders.
Discuss Mood Disorders as they
relate to officer contact – Cont’d
C. Recognizable behaviors that
associate with mood disorders could
include:
1.) lack of interest and pleasure in
activities,
2.) extreme and rapid mood swings,
Discuss Mood Disorders as they
relate to officer contact – Cont’d
C. :
3.) impaired judgment,
4.) explosive temper,
5.) increased spending and
6.) delusions
Discuss Mood Disorders as they
relate to officer contact – Cont’d
D. Causes: Researchers (see
SAMHSA in references) believe that a
complex imbalance in the brain’s
chemical activity plays a prominent
role in mental illness selectivity in the
individual.
E. Environmental factors can also be
a trigger or buffer against the onset.
2.7.
Two most common mood disorders
encountered by law enforcement
officers.
• Depression
• Bipolar Disorder
108
2.7 Depression
Depression is a common, widespread
disorder.
Most people have experienced some
form of depression in their lifetime or
even had repeated bouts with
depression.
2.7 Depression – Cont’d
Depression is a natural reaction to
trauma, loss, death, or change.
Major depression is not just a bad
mood or feeling “blue” but a disorder
that affects thinking and behavior not
caused by any other physical or
mental disorder.
2.7 Depression – Cont’d
A major depressive syndrome is
defined as a depressed mood or loss
of interest of at least two weeks
duration accompanied by symptoms
such as weight loss/gain and difficulty
concentrating.
2.7 Depression – Cont’d
Five or more symptoms are generally
present during the same two-week
period and are represented by a
change from previous functioning.
Depressed mood or loss of interest
must also be included as a symptom.
2.7 Depression – Cont’d
Other symptoms of depression:
Prolonged feelings of hopelessness
or excessive guilt
Loss of interest in usual activities
Difficulty concentrating or making
decisions
2.7 Depression – Cont’d
Other symptoms of depression:
Low energy/fatigue
Changes in activity level
An inability to enjoy usual activities
2.7 Depression – Cont’d
Other symptoms of depression:
Changes in sleeping habits
(sleeping more or less; an inability
to fall asleep, or waking up early in
the morning and not being able to
go back to sleep).
2.7 Depression – Cont’d
Depression and suicide: The single
most common factor in suicidal
behavior or death by suicide is that
the individual is experiencing
depression. (See section goal 1.3,
concerning Suicide)
2.7 Depression – Cont’d
Treatment for Depression: A number
of non-addictive medications are used
in treating depression, if needed.
It is recommended that persons taking
medications for depression not use
alcohol
2.7 Depression – Cont’d
Alcohol can interact with the
medications and increase alcohol’s
effects or create problems in reaction
time and judgment.
2.7 Depression – Cont’d
Many people self medicate their
depression with alcohol or other nonprescribed drugs that may give them
temporary relief but tends to only
increase the depressive symptoms.
(See objective 1.2.11. on Substance
Abuse Disorder)
2.7 BIPOLAR DISORDER
A mental illness involving mania (an
intense enthusiasm) and depression
(see above)
2.7 BIPOLAR DISORDER
Continued
Mania Phase may include:
Abnormally high, expansive or
irritated mood
Inflated self-esteem
Decreased need for sleep
More talkative than usual
2.7 BIPOLAR DISORDER
Continued
Mania Phase may include:
Flight of ideas or feeling of thoughts
racing
Excessive risk-taking
2.7 BIPOLAR DISORDER
Continued
Depressive Phase may include:
Prolonged feelings of sadness or
hopelessness
Feelings of guilt and worthlessness
Difficulty concentrating or deciding
Lack of interest
2.7 BIPOLAR DISORDER
Continued
Depressive Phase may include:
Low energy
Changes in activity level
Inability to enjoy usual activities
Fatigue
2.7 BIPOLAR DISORDER
Continued
An individual may quickly swing from
the manic phase to the depressed
stage.
An individual cannot maintain the
level of activity normally associated
with mania for a long period of time.
2.8 Psychosis and how it
relates to officer contact
Definition of Psychosis:
“A group of serious and often
debilitating mental disorders that may
be of organic or psychological origin
and are characterized by some or all
of the following symptoms: impaired
thinking and reasoning ability,
Definition of Psychosis(Cont’d)
perceptual distortions, inappropriate
emotional responses, inappropriate
affect, regressive behavior, reduced
impulse control and impaired
reasoning of reality.” (Social Work
Dictionary, 2nd Edition, by Robert L.
Baker)
Psychosis is an illness involving a
distortion of reality that may be
accompanied by delusions and/or
hallucinations
The person may be hearing voices, he
may look at a person and see a
demon, he may think people are after
him, or he may believe himself to be
Jesus Christ.
To the person, these hallucinations
and delusions are real.
These are most commonly seen in
persons with schizophrenia, bipolar
disorder, severe depression or drug
induced disorders.
Physical circumstances can also
induce a psychotic state.
Potential conditions include:
• organic brain disorders (brain injury
or infections to the brain),
• electrolyte disorder,
• pain syndromes, and
• drug withdrawal.
Definition of Delusion:
False beliefs not based on factual
information.
Definition of Delusion(Cont’d)
The person may overreact to the
situations or may appear to have what
is called a “flat affect,” where he
shows no emotion or does not seem
to care about what is going on around
him. (e.g., social isolation,
inappropriate emotions, odd beliefs,
magical thinking)
Definition of Hallucinations:
Distortions in the senses, causing the
individual to experience hearing or
seeing something that is not there.
There is poor processing of
information and illogical thinking that
can result in disorganized and
rambling speech and/or delusions
Definition of Hallucinations(Cont’d)
It is not uncommon for a person
hearing voices to hear two or more at
a time.
If you approach the person and start
yelling at him, you are only adding to
his confusion
Definition of Hallucinations(Cont’d)
Imagine having two or three people
shouting at you all at once while an
officer is trying to give you directions.
Mood Disorders
• Depression
• Bipolar Disorder
138
Depression
• Depression is a natural reaction to trauma,
loss, death or change.
• A major depressive syndrome is defined
as a depressed mood or loss of interest at
least two weeks in duration.
139
Major Depression
• Unlike normal emotional experiences of
sadness, loss, or passing mood states,
major depression is persistent and can
significantly interfere with an individual’s
thoughts, behavior, mood, activity, and
physical health.
140
Symptoms of Major Depression
• Profoundly sad or irritable mood
• Pronounced changes in sleep, appetite,
and energy
• Difficulty thinking, concentrating, and
remembering
141
Symptoms continued…
• Physical slowing or agitation
• Loss of interest in usual activities
• Feelings of hopelessness or excessive
guilt
• Recurrent thoughts of death or suicide
142
Symptoms continued…
• Persistent physical symptoms that do
not respond to treatment, such as
headaches, digestive disorders, and
chronic pain.
143
Causes
• There is no one single cause of major
depression. Psychological, biological,
genetic, and environmental factors may
all contribute to its development.
144
Major Depression
• Affects approximately 9.9 million American
adults, or about 5.0 percent of the U.S.
population age 18 and older in a given
year.
145
Major Depression
• Nearly twice as many women as men
suffer from major depression
• While major depressive disorder can
develop at any age, the average age at
onset is the mid-twenties.
146
Manic Depression Video
(View ‘Manic Depression’ video from “Train the Trainer” (updated version)
course materials)
147
Bipolar Disorder
• Mental Illness involving mania (an intense
enthusiasm) and depression (as discussed
previously).
• Bipolar disorder causes extreme shifts in
mood, energy, and functioning.
• Chronic disease affecting more than two
million individuals in the U.S.
148
Symptoms of Mania
• Elated, happy mood or irritable, angry,
unpleasant mood
• Increased activity or energy
• Inflated self-esteem
• Decreased need for sleep
149
Symptoms…continued
• Streaming ideas or feeling of thoughts
racing
• More talkative than usual
• Excessive risk-taking
• Ambitious often grandiose plans
• Increased sexual interest and activity
150
Symptoms of Depression
• Prolonged feelings of sadness or
hopelessness
• Fatigue/low energy
• Difficulty concentrating or deciding
• Lack of interest
151
Causes
• While the exact cause of bipolar disorder
is not known, researchers believe it is the
result of a chemical imbalance of the
brain. Scientists have found evidence of a
genetic predisposition to the illness.
152
Causes continued…
• Sometimes serious life events such as a
serious loss, chronic illness, or financial
problem, may trigger an episode in
individuals with a predisposition to the
disorder.
153
Bipolar Disorder
• Affects approximately 2.3 million American
adults, or about 1.2 percent of the U.S.
population age 18 and older in a given
year.
154
Bipolar Disorder
• The average age at onset for a first manic
episode is the early twenties.
• Men and women are equally likely to
develop bipolar disorder.
155
2.8.
Psychosis
• Discuss Psychosis and how it relates to
officer contact.
156
Definition
• “A group of serious and often debilitating
mental disorders that may be of organic or
psychological origin and are characterized
by some or all of the following symptoms:
- impaired thinking and reasoning ability
- Perceptual distortions
- Inappropriate emotional responses
157
Definition continued…
- Inappropriate affect
- Regressive behavior
- Reduced impulse control and
- Impaired reasoning of reality.”
Social Work Dictionary, 2nd Edition,
by Robert L. Baker
158
Continued…
• A distortion of reality that may be
accompanied by delusions and
hallucinations.
• Delusion: False beliefs not based on factual information.
• Hallucination: Distortion in the senses….experiencing
auditory or visual feedback that is not there.
159
2.9.
• Briefly illustrate a psychotic episode from a
consumer’s perspective.
160
Psychosis Video
(View ‘’20/20 newscast’ from “Train the Trainer” materials)
161
Common experiences
• Hearing voices: ‘Die, die, die’, ‘Kill
yourself’, ‘You’re no good’, ‘They are going
to get you’.
• Feelings of Paranoia
• Visual hallucinations
• Heightening of senses
162
2.10.
• Inventory the behavioral/emotional cues a
person displays when experiencing a
psychotic episode.
163
Cues
• Behavioral Cues: Inappropriate dress,
impulsive body movements, causing injury
to self.
• Emotional Cues: Lack of emotional
response, inappropriate emotional
reactions.
164
Class Exercise
(Refer to Instructor Resource Guide)
165
2.11. Substance Abuse
Cognitive Disorders
• Explain how substance abuse and
cognitive disorders relate to psychosis.
166
167
Substance Abuse/Cognitive Disorders’
Relationship to Psychosis
• Prolonged use of drugs may cause
symptoms of psychosis. (To include alcohol, prescriptions or
‘street drugs’)
• Due to damage to the central nervous
system
• Could create defects in perception,
language, memory, and cognition.
• Addiction possible and Treatment may be
needed
168
Drug Specific
• Smoking a stimulant like crack cocaine
can cause paranoid symptoms.
• Acute intoxication as well as withdrawal
from alcohol can produce hallucinations.
• Prolonged use of alcohol can also produce
depressive symptoms.
169
Cautions
(for mental illness and substance usage)
• Illegal drugs and alcohol usage can have
an adverse effect when used in
combination with prescribed medications.
• ‘Masking Effect’ of more severe
symptoms.
• Risk of dependency and ‘roller coaster’
170
Referrals
• Substance Abuse treatment is a critical
element in a comprehensive system of
care.
• The most successful models of treatment
for persons with co-occurring disorders
contain integrated mental health and
substance abuse services.
171
Tartive Dyskensia
• A neuromuscular disorder caused by
long-term use of neuroleptic drugs,
which are prescribed for psychiatric
disorders
• Not considered a mental illness within
itself…drugs utilized to treat can lead to
TD
172
Continued…
• Treatment is highly individualized and
should be monitored by the physician for a
plan of action
• Excessive, quick movement is common.
Note: This movement may distract or trigger defensive actions from
the officer when not needed, which could escalate a situation
unknowingly.
173
2.12. Schizophrenia
• Discuss Schizophrenia as it relates to
psychosis.
174
Schizophrenia
• Group of psychotic disorders
characterized by changes in perception.
• Affects a person’s ability to think clearly,
manage his or her emotions, make
decisions, relate to others, and distinguish
fact from fiction.
175
Distorted thinking…
• Results in:
- Hallucinations
- Poor processing of information/Attention
deficit
- Illogical thinking that can result in
disorganized and rambling speech and
delusions.
176
Changes in Emotion…
• May overreact to situation.
• Have “flat effect” (Decreased emotional
expressiveness, diminished facial
expression and apathetic appearance).
177
Changes in Emotion…continued
• Anhedonia: Lacking pleasure or interest in
activities that were once enjoyable.
• Withdrawn: Media tends to portray as
violent which is very rare.
178
Causes of Schizophrenia
• Like many other medical illnesses,
schizophrenia appears to be caused by
genetic vulnerability and environmental
factors that occur during a person’s
prenatal development.
179
Schizophrenia
• It affects approximately 2.2 million
individuals in the U.S. age 18 and older in
a given year.
• Ranks among the top 10 causes of
disability in developed countries
worldwide.
180
2.13. Alzheimer’s
• Discuss Alzheimer’s disease and its
involvement with psychosis.
181
Alzheimer’s Disease
• The most common organic disorder of
older people.
• Affects an estimated 2-3 million Americans
with over 11,000 dying per year.
• Duration of illness; from onset of
symptoms to death, averages 8 to 10
years
182
Symptoms of Alzheimer’s
•
•
•
•
•
Symptoms of disease are progressive
The individual may get lost easily.
Memory decreases over time.
Becomes easily agitated.
Symptoms can be psychotic-like in nature.
183
Alzheimer’s - Additional Facts
• Alzheimer’s is a form of dementia.
• NOT considered a mental illness and most
mental health facilities do not accept as
patients.
• Drugs can help the progression of the
disease but there is no cure.
184
2.14.
Psychotic Episode
• Demonstrate the communicative approach
an officer should take when confronting a
person in a psychotic episode.
185
Communicative Approach
• Be cautious
• Never startle the person
• Be patient, you may have to repeat
several times
• Try to learn the persons name and use it
• Talk in a calm, soft tone of voice
186
Continued…
•
•
•
•
Allow person to verbally ventilate
Be aware of individuals ‘personal space’
Introduce self
Assure person of officers intentions to
help, not hurt
187
2.15.
• Appraise personal impressions of mental
illness after viewing the consumer
presentation.
188
Consumer Presentation
(View ‘Jack Callahan’ video from “Train the Trainer” course materials)
189
2.16.
Developmental Disorders
• List the two most common developmental
disorders that relate to officer contact.
190
Developmental Disorders
Two most common:
• Autism
• Mental Retardation
191
Autism:
• Affects 1 to 2 in 1,000 Americans.
• Appears before age 3.
• Characteristics: abnormal speech
patterns, lack of eye contact, obsessive
body movements, social isolation,
ritualistic or habitual behavior, attachment
to objects, resistance to change and
sensory disorders.
192
Autism…Communication Behaviors
• May be verbally limited
• Abnormal pitch, rate or volume when
speaking
• Difficulty expressing needs, ideas or
abstract concepts
• Reversal of pronouns or other parts of
speech
193
Autism…Other Behaviors
•
•
•
•
Matching, pairing and ordering objects
Blinking compulsively
Switching lights on and off
Jumping, rocking, clapping, chin-tapping,
head-banging, spinning
• Fascination with colorful and shiny objects
194
Autism Video
(View ‘Autism’ video from “Train the Trainer” (updated version) course
materials))
195
Mental Retardation
• Refers to a range of substantial limitations
in mental functioning manifested in
persons before the age of 18.
196
Most common Characteristics
• Significantly sub-average intellectual
functioning
• Limitations in two or more adaptive skill
areas, such as; communication, self-care,
home living, safety, academic functioning
and work
• Deficits in adaptive behavior
197
Degrees of Mental Retardation
• Moderate: IQ 54-40
• Severe: IQ 39-25
• Profound: IQ Below 25
198
Methods for Questioning
• Be patient for a reply
• Repeat question as needed
• Ask short, simple questions using simple
language
• Speak slowly
199
Methods…continued
• Move to a less disruptive location to assist
with focusing
• Be non-threatening, but firm and persistent
• Be highly aware of questioning techniques
200
Areas to Consider to Assist in
Identification
•
•
•
•
•
•
Criminal Activity
Educational History
Physical Appearance
Speech/Language
Social Behavior
Performance Tasks
201
Strategies for Identification:
Criminal Activity
• Noticeably older than others involved in
offense
• Follower
• Ready to Confess
• Remained at scene while others ran
202
Strategies for Identification:
Educational History
• Below usual grade level
• ID states mental impairments
• Check MHMR records
203
Strategies for Identification:
Physical Appearance
• Inappropriately dressed for season
• Unusual physical structure
• Awkwardness of movement/poor motor
skills
• Difficulty writing
204
Strategies for Identification:
Speech/Language
• Obvious speech defects
• Limited response or understanding
• Inattentiveness
• Difficulty describing facts in detail
205
Strategies for Identification:
Social Behavior
• Adult associating with children or
adolescents
• Eager to please
• Non-age appropriate behavior
• Easily influenced by others
206
Strategies of Identification:
Performance Tasks to Utilize
• Read/Write simple phrases
• Give directions to their home
• Tell time
• Count to 100 by multiples of five
• Explain how to make change for a dollar
207
Mental Illness (MI) vs.
Mental Retardation (MR)
• American Population Statistics: 3% MR, 22.1% MI.
• MI unrelated to intelligence, while MR is below-level
intellectual functioning.
• MI develops at any point in life, MR prior to age 18.
• No cure for either however, medications can help MI.
Reference: Special Olympics (http://www.specialolympics .org)
208
2.17.
Developmental Disorders
• Discuss Developmental Disorders as they
relate to officer contact.
209
Definition
• A developmental disability is a severe,
chronic disability of a person five years of
age or older.
• Such a disability:
- Is attributable to a mental or physical
impairment or combination of the two.
210
Definition Continued…
• Is manifested prior to the age of 22.
• Is likely to continue indefinitely.
• Displayed through substantial limitation of
three or more life activities.
211
Needs
• For lifelong or extended care, treatment
or other services which are planned
according to persons needs.
• Infants and children with developmental
disabilities, have substantially delayed
development, or congenial or acquired
conditions and are likely to have limited
life involvement if services are not
provided to them.
212
2.18.
• Identify behaviors associated with
Developmental Disorders as they relate to
officer contact.
213
Behaviors
• May be overwhelmed by police presence
• May attempt to run out of fear of uniform
• May confess to a crime to please officer
and end uncomfortable questioning
• Is a concrete thinker
214
Behaviors…continued
• Needs visual cues to assist in
understanding
• May need a more in-depth explanation of
their rights
• May be sensitive to touch, creating ‘fight or
flight’ reaction
215
Unit Goal 3.0
• To develop a knowledge base concerning
suicide and the evaluation of danger
levels.
216
3.1
Suicide
• Verbalize commonly stated myths about
suicide:
217
Myths…
• People who talk about suicide won’t
commit suicide.
• People who commit suicide are “crazy.”
• Once the person begins to improve, the
risk has ended.
• Prior unsuccessful suicide attempts means
there will never be a successful suicide.
218
Fact
 “There is no typical suicide victim. It
happens to young and old, rich and
poor.”
American Association of Suicidology
219
3.2.
• Discuss suicide and its relationship with
mental illness.
220
Suicide and Mental Illness
• 90% of suicides are reportedly related to
untreated or under-treated mental illness
• The most common mental illness
associated with suicide is depression
221
Continued…
• Nearly 20% of people diagnosed with
bipolar disorder die from suicide
• Nearly 15% of people diagnosed with
Schizophrenia die from suicide
222
3.3.
• Explain the phrase “suicide by cop”.
223
“Suicide by Cop”
• “People with severe mental illness are
killed by police in justifiable homicides at a
rate nearly four times greater than the
general public”
224
Continued…
• “One study…found that incidents
determined to be suicide by cop
accounted for 11% of all police
shootings and 13% of all fatal
shootings. The study found that
suspects involved in such cases
intended to commit suicide, specifically
wanted to be shot by the
police…provoking law enforcement
Treatment Advocacy Center
officers into shooting them.”
225
3.4.
• Record questions that will assist in
evaluating an individual‘s current level of
suicidal danger.
226
Evaluating Level of
Suicidal Danger
• Symptoms?
• Nature of current stressor?
• Method and degree?
• Prior attempt?
227
Levels of danger…continued
• Acute vs. chronic?
• Medical status?
• Chance of rescue?
• Social resources?
228
Danger to Self
• Intent (actions/words)
• Gross neglect for personal safety
• Specific plan (action/words)
• Plans/means available
229
Danger to Others
• Intent (actions/words)
• Specific person identified
• Agitated, angry, explosive
• Irrational, impulsive, reckless
(intent/actual)
230
Statistics
Males
Method
Females
66%
Firearms
39%
13%
Poison
40%
15%
Strangulation
10%
1%
Cutting
1%
5%
Other
10%
231
Statistics
Rank
State
Rate
1
5
14
39
50
51
Nevada
Alaska
Florida
Texas
New York
Wash. D.C.
22.3
15.5
13.4
10.0
6.6
5.8
232
Suicide Video #1
(View #1 ‘Depression, Suicide’ video from “Train the Trainer” course materials)
233
Suicide Video #2
(View #2 ‘Depression, suicide’ video from “Train the Trainer ‘course materials)
234
Unit Goal: 4.0
• Discuss Psychopharmacology as it relates
to medications prescribed and prominent
side effects in persons with a mental
illness.
235
4.1.
• Name four categories of medications
utilized in controlling the symptoms of
mental illness.
236
Categories of drugs
• Anti-psychotic
– Thorazine, Mellaril, Haldol
– Controls hallucinations
– Ex: Schizophrenia
237
Categories…continued
• Antidepressants
– Elavil, Prozac, Zoloft
– Control feelings of sadness, hopelessness,
suicidal thoughts
– Ex: depression
238
Categories…continued
• Mood Stabilizers
– Tegratol, Lithium, Depakote
– Control mood swings
– Ex: bipolar disorder
239
Categories…continued
• Anti-anxiety drugs
– Xanax, Valium, Buspar
– Feeling of powerlessness, extreme
apprehension, panic
– Ex: Phobia’s, Post Traumatic Stress Disorder
240
4.2.
• List possible side effects with the use of
psychotropic medications.
241
Examples of side effects
•
•
•
•
•
•
Muscle spasms
Protruding tongue
Eyes rolled back
Constant leg movement
Tremors
Uncoordinated
movements
• Impotence
•
•
•
•
•
•
Nausea
Headache
Blurred vision
Weight gain
Fatigue
Liver toxicity
242
Side effects can be…
• Uncomfortable
• Dehumanizing
• Often irreversible
243
Side effects….continued
• Some side effects are permanent, even
after medications are stopped
• Some of these medications are associated
with neurological damage
• Some of these medications can be lethal
244
4.3.
• Discuss “old” vs. “new” medications.
245
‘Old’ vs. ‘New’ Medications
• ‘New’ Drugs have significantly fewer side
effects
• ‘Old ’ Drugs still used today especially with
indigent, jail populations etc. due to lower
cost
246
4.4.
• Recognize three primary reasons why
consumers do not take their medications
as prescribed.
247
Why medications are not taken
• Side effects
• Sigma
• Start feeling better
• Continuous problem for law
enforcement…the above deviations are
the primary cause of crisis concerns.
248
Note: Right to Refuse
Treatment
• May not administer a psychotropic
medication to a person that refuses to take
voluntarily unless related to an emergency
or court order
• Would you want to take these
medications?
249
Unit Goal: 5.0
• To orient students to a variety of advanced
modes of communication.
250
5.1.
• List the components of the “first three
minute assessment”.
251
First Three Minute Assessment:
Four Components
• Elements of Evaluation
• Intellectual Functioning
• Behavioral Reactions
• Emotional Reactions
252
Elements of Evaluation
• Appearance and
Behavior
• Affect-prevailing
emotional tone
• Stream of Talk
• Concentration
• Thought Content
• Cognitive-intellectual
functions
• Perceptual Abnormalities
253
Intellectual Functioning
•
•
•
•
•
Clear/Alert vs. Foggy/Confused
Difficulty in Understanding
Stream of Mental Activity
Over Productive
Delusions/Hallucinations
254
Behavioral Reactions
•
•
•
•
•
Attitude
Controlled Behavior
Coordination/Gait
Distrusting/Withdrawn/Isolates Self
Shy/Meek/Introverted
255
Emotional Reactions
•
•
•
•
•
•
•
Low/Depressed/Sad
Volatile/Emotional swings
Helpful/Motivated/Caring
Suspicious
Irritable/Annoyed/Angry
Bitter
Bullying
256
5.2.
• Summarize the usage of the L.E.A.P.S.
concept of interaction.
257
L.E.A.P.S.
• L isten
• E mpathize
• A sk
• P araphrase
• S ummarize
258
5.3.
• Demonstrate the process of modeling.
259
Process of Modeling
• Learning through observation
• Communication/Contribute or Interfere
• Intervention/Communication strategies
260
5.4.
• Discuss the characteristics that contribute
to a positive communication experience.
261
Characteristics to Positive
Communication
•
•
•
•
•
Introductions
Opening Statements
Reflecting Statements
Methods for Gaining Trust
Communication to Defuse
262
Introduction of officer to
consumer/suspect
• Identify self as officer
• Utilize Identifying Statements
“I am (name) and I am with the (location)
Department. I understand there is a problem
and I would like to help you. Could you tell me
about what happened today.”
263
Opening Statements
• Initial contact does several things:
– Establishes leadership role in conversation
– Identifies ultimate goal to resolve situation
– Allows consumer/suspect to respond with
immediate thoughts creating dialogue
264
Continued…examples
• “Tell me what your problems are?”
• “I want to understand what you need”.
• “I understand what has happened and I
want to help you understand the
consequences.”
265
Reflecting Statements
• Encourage Communication
• Neutral Responses/Encourage Talking
• Examples:
–
–
–
–
“I see…”
“Tell me about it…”
“That would be one solution…”
“What other options do you have…”
266
Methods for Gaining Trust
• Honesty/Sincerity
• Follow Through
• Validation of Positive Actions
• Forewarn
267
Examples…
• “I’m not going to lie to you. You will
probably be going to jail.”
• “You have been straightforward with me,
so I am going to be straightforward with
you…”
• “You are going to have to be handcuffed
268
Communication to Defuse
• Show understanding/empathy
• Use modeling
• Reassure
• Allow ventilation
269
5.5.
• List barriers to active communication.
270
Level of Communication
• Communicate on a level that is easy for
the consumer to understand and respond
• Keep vocabulary simple
• Example:
– “At this time, you are required to exit the
vehicle.”
OR
– “I need you to step out of the car.”
271
Lack of Active Listening
• Arguing
• Derailing
• Criticizing
• Moralizing
• Jumping to Conclusions
• Name-Calling
• Pacifying
• Ordering
272
5.6.
• Discuss three levels of active listening.
273
Three Levels of Active Listening
• Listening to Words
• Listening to Whole Messages
• Reflecting the Whole Message
274
5.7.
• Briefly explain the techniques: repeating,
paraphrasing, and reflection of feelings as
they relate to active listening.
275
Techniques to Active Listening
• Repeating
• Paraphrasing
• Reflection of Feelings
276
Repeating
• Simply restate what the person has said in
his words
• This helps ensure you heard what you
think you heard
• If possible…use less provocative language
to defuse a situation
“Blowing someone away” vs.
“Harming someone”
277
Paraphrasing
• Go beyond what was stated in an attempt
to understand the meaning behind the
words
• Be careful not to lead with your own
feelings
• Example:
“It sounds like you are really worried about
278
Reflection of Feelings
• Express awareness of other persons
feelings
• Example:
“You sound depressed….”
279
Additional Techniques…
• Re-wording:
– Use this to verify shared meaning of word or
phrase
– Redefine the situation to create the option you
want
– Don’t be afraid to say…
“I don’t know what you mean…”
280
Continued…
• Minimal Encouragers:
– Encourage communication and reinforce that
you are listening with words like,
“uh huh”, “yes”, “I understand” etc.
– A mixture of words and silence invites the
dialogue to continue
281
5.8.
• Verbally illustrate examples of “You” vs. “I”
statements.
282
“You” statements vs. “I” statements
• “You” statements point a verbal finger of
accusation
“You do not have a headache from a
computer chip planted in your brain…”
• “I” statements establish a non-blaming
tone
“I understand your head is hurting…”
283
Unit Goal: 6.0
• To internalize the crisis intervention skills
involved in communicating with individuals
with a mental illness.
284
6.1.
• List the basic strategies that are necessary
when communicating in crisis situations.
285
Strategies
•
•
•
•
•
Stay calm
Avoid “crowding”
Restate
Use persons name
Give instructions one at a
time
• Engagement is pivotal
• Don’t underestimate the
power of hallucinations or
delusions
• Ask about treatment
history
• Don’t express disapproval
286
6.2.
• Describe at least four effective
communication/interaction skills used
when dealing with persons with a mental
illness.
287
Communication/Interaction Skills
• Safety
• Crisis Facts
• Language
• Movements
288
Safety
• Your personal safety comes first
• Control the surroundings
• Remove harmful obstacles from the
surroundings
289
Crisis Facts
• Person in distress is usually excited,
alarmed or confused
• Control is very important to persons in
crisis
• When a person feels cornered, which
translates to lack of control, they may
290
Language
• Use person’s name
frequently
• Avoid direct
confrontation, labels and
acronyms
• Be patient and consistent
• Be aware of slower
reaction time…
responses may be given
slower than you expect
• Limit number of
instructions
291
Movements
• Be aware of body movements
• People in crisis often need more personal
space
• Keep movements slow and deliberate
292
6.3.
• Apply knowledge obtained in coursework
to class exercises and scenarios for role
play.
293
Unit Goal: 7.0
• Develop an increased understanding of
the legal process; evaluation and
techniques for appropriateness of
apprehension.
294
7.1.
• List the process in evaluating the
appropriateness of a warrentless
apprehension.
295
“Least Restrictive Alternative”
The treatment that…
• Provides the consumer with the greatest
possibility of improvement
296
Continued…
The treatment that…
• Is no more restrictive of consumer’s
physical or social liberties than is
necessary to provide the consumer with
the most effective treatment and to protect
adequately against any danger the
consumer poses to himself or others.
297
7.2.
• Describe the step by step process for
obtaining an emergency detention order.
298
Emergency Detention Order
• A statement that the officer has reason to
believe that the risk of harm is imminent
unless restrained.
• A statement that the officer’s beliefs are
derived from specific recent behavior,
overt acts, attempts or threats that were
observed or reliably reported.
299
Continued…
• A detailed description of the specific
behavior, acts, attempts or threats. List
who, what, where, when, why and how.
• List the persons name who reported
observing the behavior and the
relationship to the apprehended person
300
Emergency Detention Order
• Serves as a magistrates order for
emergency apprehension and detention
• Is a civil court order issued by a magistrate
• Provides for emergency apprehension and
transportation for evaluation
301
7.3.
• Explain the criteria an officer must meet in
order to take a person with a mental
illness, who has committed no crime, into
custody involuntarily for emergency mental
health evaluation.
302
Criteria…
• If the officer believes the person is
mentally ill and as a result there is
substantial risk of harm
• If the officer believes that if the person is
not immediately restrained harm may
occur
• Believes there is not sufficient time to
303
7.4.
• Propose justification in assessing proper
use of force options.
304
Use of Force
• Keep the situation in perspective
• Force used compatible to any other
person resisting arrest
• Force must be reasonable
• Goal is to obtain care and treatment for
the mentally ill person
305
Continued…
• Changes in behavior intensity level are
indicators of possible violent behavior
– Agitated Behavior
– Disruptive Behavior
– Destructive Behavior
– Out of Control
306
7.5.
• Explain an officer’s limitation of liability.
307
Limitation of Liability
• People acting in good faith, reasonably and without
negligence are not civilly or criminally liable.
Texas health and Safety Code, Sec. 571.019(a)
308
Confidentiality
• Communication between a patient and
a professional, and records of the
identity, diagnosis, evaluation, or
treatment of a patient that is created or
maintained by a professional are
confidential.
Texas Health and Safety Code, Sec. 611.002, 611.004
309
Exceptions to confidentiality rule:
• Medical or law enforcement per incident
• Patient consent
• Health care personnel at Jail facility
• ‘Memorandum of Understanding’
310
7.6.
• Identify factors to be considered in
determining whether assistance should be
requested during an approach.
311
Assistance Request Factors
• Request assistance as needed to insure
safety of officer, consumer and public
• Contact the Mental Health Authority for
appropriate resources and referrals
312
7.7.
• Research departmental policies in
requesting assistance.
313
7.8.
• Identify factors considered in determining
appropriate method of transporting
consumer.
314
Method of Transport
• Follow departmental policy
• Be aware of distances to nearest facilities
• Evaluate behavior or physical condition
315
Unit Goal: 8.0
• To explore the world of the mentally ill
through discussion of legal and societal
concerns and perspectives.
316
8.1.
• Discuss the mentally ill person in a
situation of being homeless.
317
Homeless and Mentally Ill
• Two million people are homeless per year
• On any given night, 600,000 Americans
are homeless
• Conservative estimates state, more than
one-third of homeless have a serious
mental illness
• More than one-half of homeless have a
substance abuse disorder
318
New Wave of Homeless
• Emerging due to deinstitutionalization
• Emerging due to denial of services due to
funding
• Emerging due to premature discharge due
to managed care.
319
8.2.
• Discuss the mentally ill individual as a
victim of crime.
320
Crime Victim and Mentally Ill
• “People with mental illness are more likely
to be victims than perpetrators of
violence.”
National Institute of Justice, 1996
• Why then is…Thirteen times more
research compiled concerning the
mentally ill as perpetrators of violent acts
rather than victims of violent acts?
321
Victims…continued
• Between 4-13% are perpetrators of crime
• 140 times more likely to be a victim of theft
• Three million estimated victimized each
year
• More than one-quarter MI persons say
they are victimized in a year
• Eleven times higher risk than general
population
322
Victims…
• “We don’t think about their vulnerability to
victimization.”
Alison Cook, Reuters Health
• “The effect of crime is also more
destabilizing for a person with a mental
illness.”
Dr. Linda A. Teplin
323
Responding to Victim Needs
• Victim’s need to feel safe
• Victim's need to express his/her emotions
• Victim’s need to know what comes next
324
Common Crimes
• MI children more commonly molested or
abused
• MI adults more commonly robbed or victim
of con artist
• MI have reportedly less chance of a
successful prosecution
325
Victim as Mentally Retarded
• Special consideration needed upon
approach
• May not even know they have been
victimized
• Easily fooled and easily vulnerable
• Need to be treated with extreme
326
8.3.
• Evaluate the stigma and societal concerns
from a mental health consumer’s vantage
point.
327
Stigma
• Stigma is a mark of disgrace or shame
• Such as:
– Labeling someone with a condition
– Stereotyping people with a condition
– Creating a division
– Discrimination based on a label
328
Stigma Facts
• Stigmas encourage inaccurate
perceptions
• The term “mental (illness)” suggests an
illegitimate medical condition and a
separation from a physical (illness)
condition
• Stereotypes: that persons with a mental
329
Facts…continued
• Stigma’s fuel fear and mistrust and
reinforce distorted perceptions
• Some people refuse treatment for “fear” of
being labeled
• Health insurance is even more limited for
mental illnesses than for physical illnesses
330
Myths That Support Sigma’s
• Mental Illnesses do not effect the average
person
• Mental Illness is an indicator of a weak
character
• A person with a mental illness is also
mentally retarded
331
Continued…
• If you have a mental illness you are
“crazy” all of the time
• If people with physical disabilities can
cope on their own, people with mental
illnesses should be able to as well
• Most people who struggle with mental
illness live on the streets or are in mental
332
8.4.
• Discuss legal and societal concerns from a
mental health consumer’s vantage point.
333
8.5.
• Participate in a discussion of the family
member perspective on mental illness.
334
Unit Goal: 9.0
• Gain an understanding of mental health
referrals/resources in the student’s
community.
335
9.1.
• List the Mental Health Facilities in your
area that can be utilized as a resource
when encountering a subject/suspect you
identify as having possible mental health
issues.
336
9.2.
• Investigate possible referral/treatment
challenges in your community.
337
Referrals/Resources
• Quality and availability of programs vary
by community
• Willingness of mental health providers to
participate in criminal justice initiated
programs
• There may be a lack of services which will
make the referral process time consuming
338
Challenge
• Be aware of the potential referral
challenge, but don’t let it detract you from
your goal of responding professionally and
appropriately to any given situation
339
Unit Goal: 10.0
• To understand how CIT techniques apply
to all areas of crisis communication.
340
What constitutes a crisis?
• According to Webster…
– “An unstable or crucial time or state of affairs
whose outcome will make a decisive
difference for better or worse.”
– “…takes people out of their comfort zones
and normal coping patterns.”
341
Continued…
• “Often a crisis is precipitated by a loss of
some sort, or a situation that threatens
normalcy or expectations. The greater the
threat, the more severe the crisis will be.”
• “…the crisis is the instability and threat the
event produces. A persons response to
the upheaval will determine in large part,
the outcome of it.”
342
Discussion Questions:
• Is it the event itself that is the crisis or the
person’s response to the situation?
• What can turn the issue into a crisis?
• What makes an issue, loss, tragedy or
stress seem like a crisis to one person but
not to another person?
343
Contributing Factors to Crisis
• Negative personality traits
• Poor coping mechanisms
due to background
• Unrealistic expectations
• Faulty belief system
• Faulty sense of identity
• Disconnectedness
344
Discussion Question
• Do you have to have a mental illness to
possess the preceding factors?
345
How can officers assist?
• Acknowledge consumers
feelings
• Investigate available
referral sources
• Avoid being judgmental
• Assist in focusing on the
positive….be solution
oriented
• Assist in maintaining
realistic view
346
10.1.
• Define Crisis Behavior and its relevance to
CIT training.
347
Definition of Crisis Behavior
• A person suffering from a temporary
breakdown in coping skills
• Crisis behavior differs by individual
response
• Examples of Crisis Situations:
– Locked out of house
– Lose of job
Divorce
Traffic stop
348
10.2.
• Demonstrate how Crisis Intervention
Techniques can be utilized in domestic
disturbance situations.
349
Domestic Disturbance Scenario #1
(View #5 “Disturbance” video from “Train the Trainer” course material.)
350
Domestic Disturbance Scenario #2
(View #6 ‘Disturbance’ video from “Train the Trainer” course materials)
351
10.3.
• Dramatize how an intensified traffic stop
could be better controlled by the utilization
of crisis communication techniques
352
Scenario
Class Role-play exercise
353
Unit Goal: 11.0
• To understand jail/court related
alternatives and referrals for persons with
a mental illness.
354
Problem
• Increasing numbers of mentally ill
consumers are passing through the legal
system
• The largest facility for persons with a
mental illness has become our nations
jails and prisons
355
Problem
• Deinstitutionalization without adequate
community support
• Over representation of mentally ill in our
prison system
356
Statistics Show…
• Only 3% of violent behavior is attributable
to a mental disorder, however,
• 16% of prisoners have a mental illness
• 50% of youth in the Texas Youth
Commission (TYC) have a mental disorder
• In 2002 TYC reported that 21% of its
institutional population was on
psychotropics
• Persons with a mental illness are arrested
357
Solutions/Alternatives to Jail
•
•
•
•
•
Drug Courts
Mental Health Courts
Domestic Violence Courts
Community Courts
Jail Diversion Programs
358
And…
• These courts/programs are being
implemented to address the underlying
issues of the consumers criminal justice
involvement
• The aim is to link consumers with
community based services
359
11.1.
• Discuss the concept of mental health
courts.
360
Mental Health Courts
• A collaborative survey conducted by
NAMI, the GAINS center and COSG’s
report at least 94 communities across the
United States have established mental
health courts as of June 2004.
361
Research results
• One year after completing a mental health court
program, 54% had no new arrests
• Probation violations dropped by 62%
• Three or more arrests dropped form 26% to 3% (an 88%
decline) Clark County Mental Health Court
• Eighteen months after introducing a mental health court,
the county saved $15,000 per year by putting offenders
in treatment instead of jail
Oklahoma County Officials
362
11.2.
• Describe the State of Texas Jail Diversion
Ideal.
363
H.B. 2292 states:
• “The department shall require each local
mental health authority to incorporate jail
diversion strategies into the authority’s
disease management practices for
managing adults with schizophrenia and
bi-polar disorder to reduce the involvement
of those clients with the criminal justice
system.”
364
Implementation
• Education and training of law enforcement
personnel and the courts
• The development and utilization of Crisis
Intervention Teams (CIT)
• Development of centralized location for
mental health assessment without arrest
for individuals with non-violent criminal
365
Continued…
• Development of holding facility providing
structured treatment in lieu of arrest
• Development of Linking Services
• Development of timely and effective
screening process
366
Continued…
• Development of required community
support
• Development of an identified method for
addressing housing and needed support
services
367
11.3.
• List two approaches to Jail Diversion.
368
Two Approaches
• Pre-booking Diversion
• Post-booking Diversion
369
11.4.
• List two facts associated with the jail
diversion concept.
370
Facts
• Nationally, nearly half of the inmates in
prisons with a mental illness were
incarcerated for committing a non-violent
offense
• Over 150,000 former patients of TDMHMR
now find themselves caught in the
Criminal Justice System
371
Facts…continued
• Calls for police service where mental
illness is a factor make up 7 to 10% of all
police contact
• National analyses show that a diverted
subject had significantly lower criminal
justice costs than the non-diverted subject
372
11.5.
• List benefits of Jail Diversion.
373
Benefits
• Decriminalization
• Overrepresentation is
addressed
• Reduced hospitalization
• Reduction of inappropriate
incarceration
• Length of jail stay shortened
• Violence and victimization
reduced
• Increased public safety
• Costs to taxpayers reduced
374
Unit Goal: 12.0
• Understanding of evaluation in
demonstrating success.
375
12.1.
• List four components utilized in evaluating
success rates.
376
Evaluating Success
• Criminal recidivism reduced
• Relationship between Law Enforcement
and Mental Health Professionals improved
• Reduced % of crisis referrals to hospitals
377
Continued…
• Less % of consumers needing emergency
psychiatric care
• Officer injury rate reduced
• Consumer and community safety
increased
378
379
For Instructors Use
Note: Attached are additional slides for
facilitators inclusion as needed.
380
BREAK
381
BREAK
382
QUESTIONS?
383
End of Day One…
384
385
386
Quiet….Test in Progress
387
TEST
388
This Is A Test
389
•
•
Scenario
390
Role Play
391
392
393
Group Interaction
394
395
FORWARD
Questions?
DEFINE & PROCESS
Define 7.0: Explain the key points – elements
for Human Trafficking Investigation
Process:
399
SOURCES
All Course
Sources
and/or
Resources
are listed
in your
Participant
Handout
Crisis Intervention
TRAINING (CIT)
Course # 3841
Bexar County Constable Office PCT#4
“Knowledge is
“POWER” Stay
informed, stay
SAFE, stay
Vigilant & stay
Alive”
UPCOMING TRAINING
Bexar County Constable’s Office PCT#4
TRAINING SCHEDULE
2014
Current TRAINING Schedule of Courses
offered by
Bexar County Constable’s Office
PCT#4
Racial Profiling Course – TCOLE Course
#3256 (8-hrs) 8-hrs on Saturday October 4th,
2014 from 10:30 am to 7:30 pm.
Racial Profiling Course – TCOLE Course
#3256 (8-hrs) on Friday October 10, 2014
from 8:00 am to 5:00 pm
402
Advanced TCOLE Instructor Course – TCOLE #1017
(40hrs), Day One Saturday November 1st ,2014 from 11:00
am to 6:00 pm (Deputy Chief George D. Little and Deputy
Constable Roland Berg)
Advanced TCOLE Instructor Course – TCOLE #1017, Day
Two Sunday November 2nd ,2014 from 11:00 am to 6:00
pm (Deputy Chief George D. Little and Deputy Constable
Roland Berg)
Advanced TCOLE Instructor Course – TCOLE #1017, Day
Three Friday November 7th ,2014 from 9:00 am to 6:00 pm
(Deputy Chief George D. Little and Deputy Constable Roland
Berg ) Lesson Presentation preparation time. Instructors
available
Advanced TCOLE Instructor Course – TCOLE #1017, Day
Four Saturday November 8th,2014 from 11:00 am to 6:00
pm (Deputy Chief George D. Little and Deputy Constable
403
Roland Berg)
Advanced TCOLE Instructor Course – TCOLE #1017, Day
Five & Grad Sunday November 9th, 2014 from 11:00 am to
6:00 pm – Presentations, Final Test & Graduation (Deputy
Chief G. D. Little and Dep. Constable R. Berg )
HIV-AIDS & Viral Hepatitis in Criminal Justice Profession
Course – TCOLE # 3804 (8-hrs) 8-hrs on Saturday November
15th, 2014 from 10:00 am to 6:00 pm.
HIV-AIDS & Viral Hepatitis in Criminal Justice Profession
Course – TCOLE # 3804 (8-hrs) 4-hrs on Thursday December
4th, 2014 from 1:00 am to 5:00 pm
HIV-AIDS & Viral Hepatitis in Criminal Justice Profession
Course – TCOLE # 3804 (8-hrs) 4-hrs on Friday December5th,
2014 from 1:00 am to 5:00 pm
KNOWLEDGE IS POWER
404
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