Download MHPO1 - The Justice Academy

Mental Health Peace Officer
Course # 4001
Texas Commission on Law Enforcement
Officer Standards and Education
Unit Goal: 1.0. To sensitize
officer to the adversity of
mental illness.

2004 U.S. Census




26.2% had a diagnosable mental
disorder
6% serious mental illness
45% two or more
Leading cause of disabilities in
ages 15-44
Disorder
Percentage
of
Population
Converted to
Millions
Median Age of
On-set
Mood Disoreder
9.5
20.9
30
Major Depressive
Disorder
6.7
14.8
32
Bipolar Disorder
2.6
5.7
25
Schizophrenia
1.1
2.4
20 to early
30’s
Anxiety Disorder
18.1
40
21.5
Panic Disorder
2.7
6
24
Obsessive
Compulsive
Disorder
1.0
2.2
19
Post Traumatic
Stress Disorder
3.5
7.7
23
Autism
3.4 per 1000
children
3-10
Factors affecting mental
health situation


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Deinstitutionalization
Criminalization
Medicalization
Privatization
1.1.Define the term
“mental illness.”

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.
1.2. List three categories of mental
illness most predominately
identified with disease severity



Psychotic Disorder: All cases of
schizophrenia
Mood Disorder: Severe cases of major
depression and bipolar disorder
Anxiety Disorder: Severe cases of
generalized anxiety disorder,
obsessive-compulsive disorder, and
post-traumatic stress disorder



Cognitive Disorders
(Alzheimer’s, Substance Abuse)
Personality Disorders
(Paranoid, anti-social)
Disorders first diagnosed in
infancy, childhood or
adolescence (Autism, Mental
Retardation, Attention Deficit
Hyperactivity Disorder)
1.3. Define terms associated
with a Psychotic Disorder

“A group of serious and often
debilitating mental disorders...are
characterized by...impaired thinking
and reasoning ability, 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)
Definition of Delusion

False beliefs not based on factual
information. A delusion implies
belief in something that is
contrary to fact or reality,
resulting from deception, a
misconception, or a mental
disorder. A persistent belief
maintained in spite of evidence
to the contrary.
Definition of
Hallucinations:

Distortions in the senses
where the individual
experiences auditory sounds
and/or visual images that are
technically not there.
1.3.1. Discuss Schizophrenia
and its relationship with
Psychotic Disorders

Schizophrenia consists of a
group of psychotic disorders
characterized by changes in
perception.
1.4. Discuss the
characteristics of a Mood
Disorders

A mood disorder is a mental
health disorder with an
abnormal mood as its primary
feature.
1.4.1. Discuss Major
Depressive Disorder


A disorder that severely affects
an individuals thinking and
behavior.
A depressed mood or loss of
interest of at least two weeks
duration, accompanied by
symptoms such as weight
loss/gain, and difficulty
concentrating.
1.4.2. Identify prominent
characteristics of Bipolar
Disorder:

A brain disorder of a severe
nature, that creates unusual
shifts in a person’s mood,
energy level, and ability to
function.
Symptoms of a Manic
Phase may include:



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Abnormally high, expansive, or
irritated mood.
Inflated self-esteem.
Decreased need for sleep.
More talkative than usual.
Flight of ideas or feeling of
thoughts racing.
Excessive risk-taking.
The Spectrum of Bipolar Disorder:
Severe Mania
Hypomania (mild to moderate mania)
Normal/balanced mood
Mild to moderate depression
Severe depression
1.5. Define Anxiety
Disorder

Anxiety is a normal reaction
to stress. It helps a person
deal with a tense situation
by helping one cope. But when
anxiety becomes excessive
and irrational it becomes a
disorder.
Anxiety disorders can
include:



Generalized Anxiety Disorder
Obsessive-Compulsive
Disorder
Post traumatic Stress
Disorder (PTSD)
1.5.1. Define Generalized
Anxiety Disorder (GAD

Constant worries and fears
that distract from day-today activities and leave a
persistent feeling that
something bad is about to
happen.
1.5.2. Describe ObsessiveCompulsive disorder

Distressing, unwanted
nonsensical thoughts which
return despite efforts to
ignore them and the
ritualistic behavior utilized
to control these thoughts.
Obsessions are:

Repeated, persistent,
unwanted ideas, thoughts,
images or impulses that you
experience involuntarily and
that appear to be senseless.
Compulsions are:

Repetitive behaviors that an
individual feels driven or
compelled to perform.
1.5.3. Discuss Post
Traumatic Stress Disorder
(PTSD)

A type of anxiety disorder
that is triggered by the
involvement in or witness to
an extremely traumatic
event.
DSMIV indicates:
The essential features of PTSD
include:
“Experiencing, witnessing, or
confrontation with an event
or events that involve actual
or threatened death or
serious injury, or a threat to
the physical integrity of self
or others”
1.5.4. Apply knowledge
gained to a discussion of
at-risk occupations


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...persons in emergency service fields
are a population highly prone to
suffering from PTSD, as a direct result
of their work.
...involved in traumatic events through
direct or indirect involvement on a
daily basis.
PTSD affects both men and women.
...not only with “front-line” personnel
but tele-communicators, dispatchers
and support staff.
1.6. Discuss the term
Cognitive Disorder

Cognition refers to that
operation of the mind
process by which we become
aware of objects of thought
and perception, including all
aspects of perceiving,
thinking, and remembering.
The two most common
cognitive disorders
include:


Alzheimer’s Disease
Substance Abuse Disorders
1.6.1. Discuss the most
commonly addressed
organic brain disorder



The most common Organic Brain
Disorder in persons over the age
of 65 is Alzheimer’s disease.
Alzheimer’s is one of several
disorders that cause a gradual
loss of brain cells.
The cause of all demensia is
abnormal loss of brain tissue.
. Demensia is
characterized by loss of
memory PLUS one or more
of the following:




Aphasia
Apraxia
Agnosia
Loss of higher executive
functioning
1.6.2. Discuss the relevance
of addressing substance
abuse disorders in the topic
of mental illness



Prolonged abuse of any drug can cause
chemical dependency or addiction.
If these substances are used for
extended periods of time/large
dosages, they may also cause
permanent damage to the central
nervous system.
This damage can cause a wide range of
psychological reactions that are
classified as disorders.
Co-occurring Disorders

The co-occurrence of mental
health disorders and
substance abuse disorders,
which would include alcohol
and/or drug dependence or
abuse.
1.7. Define the term
Personality Disorder

American Psychiatric
Association (APA) defines as
"an enduring pattern of inner
experience and behavior that
deviates markedly from the
expectations of the culture
of the individual who
exhibits it".
1.7.1. Discuss examples of
Paranoid Personality
Disorder

An on-going unfounded
distrust and suspiciousness
of people.
1.7.2. Discuss relevant
characteristics of
Antisocial Personality
Disorder


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Behavior that is manipulative.
Often victimizes and violates the
rights of others.
Fail to conform to societal norms
Often have a history of juvenile
conduct disorder and criminal
activities prompted by reckless,
impulsive and violent behaviors.
This disorder is also most common in
men.
1.8. List the most common
mental disorders that are
first diagnosed prior to the
age of eighteen



Developmental disorders of
Autism Spectrum Disorder (ASD),
Mental Retardation, and
Attention Deficit Hyperactivity
Disorder (ADHD).
The Developmental Disabilities
Assistance and Bill of Rights
Act of 1990 defines a
developmental disability as:


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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.
Is manifested before a person reached
the age of twenty-two.
May continue indefinitely.
continued...

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Substantial limitation of three or
more specified life activities.
Reflects the person’s need for lifelong
or extended care, treatment, or other
services which are planned and
coordinated according to that person’s
needs.
Infants and young children (newborn to
age 5) with developmental disabilities
have substantially delayed
development or specific congenital or
acquired conditions
1.8.1. Discuss Autism
Spectrum Disorder (ASD)

Brain developmental
disorder that impairs social
interaction and
communication; causing
restricted and repetitive
behavior, all starting before
the age of three.
1.8.2. Define Mental
Retardation

A range of substantial
limitations in mental
functioning manifested in
persons before the age of 18,
creating a pattern of slow
learning during childhood and
significantly below normal
global intellectual functioning
as an adult.
1.8.3. Explain the primary
differences that exist
between a Mental Illness
and Mental Retardation


3% of the American population is
considered to posses a mental
retardation (sub-average score of 69
or less on Wechler Intelligence Scale
or Stanford Binet IQ test).
While…22.1% of the American
population is diagnosed with a mental
illness.
Mental Illness
Mental
Retardation
Unrelated to
intelligence
Below average
intellectual
functioning
Develops at any
point in life
Occurs prior to
the age of 18
No cure but
medications can
help
Permanent
intellectual
impairment
Behavior less
predictable
Behavior
consistent to
functional level
1.8.4. Describe prevalent
factors of Attention Deficit
Hyperactivity Disorder
(ADHD)

A medical condition
characterized by difficulties
with inattention or
hyperactivity and
impulsivity.

Questions and Discussion
2.0. Discuss
psychopharmacology as
it relates to medications
prescribed and
prominent side effects in
persons with a mental
illness.
2.1. Name four categories of
medications utilized in
controlling the symptoms
of mental Illness.




Anti-psychotic
Antidepressants
Mood stabilizers
(Hallucinogenic)
Anti-anxiety drugs
2.2. List side effects that
can be associated with
utilizing psychotherapeutic
medications:

muscle spasms, protruding
tongue, eyes rolled back,
constant leg movement, tremors,
uncoordinated movements,
impotence, nausea, headache,
blurred vision, weight gain,
fatigue, liver toxicity
Side effects can be



uncomfortable
dehumanizing
and are often irreversible,
which may cause person to
refuse to take them as
directed
2.3. Define Tardive
Dyskinsia (TD) and its
relationship to the
utilization of
psychotherapeutic
medications

Some of these side effects are
permanent, even after the
medications have been stopped;
the medications have a tendency
to produce neurological damage.
2.1.3. List common reasons
for a consumer deviating
from their prescribed
medication schedule



Side effects
The stigma associated with being
mentally ill, i.e., they don’t want
people to know they have a
mental illness
They start feeling better and
think they no longer need the
medications

Questions and Discussion
3.0. Discuss signs and
symptoms of suicide

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Average of 6 deaths each day by suicide in
Texas
121 more people committed suicide in 2001 than
in 2000. This is a six percent increase in one
year. The gender breakdown was reported at
1,772 males vs. 442 females (i.e., about 4 men
for each woman)
Highest rates of suicide are in the 45-54 age
group (15.2 per 100,000), with the second being
the 75-year-and-older age group (18 per
100,000)
90% of suicides are reportedly related to
untreated or under-treated mental illness
with the most common being depression.
Nearly 20% of people diagnosed with bipolar
disorder and 15% diagnosed with schizophrenia
die from suicide.
3.1. Explain the process of
evaluating suicidal risk


An individual considering suicide
may try to reach out to you in a
direct or indirect manner.
There is no positive means of
identifying immediate risk of
suicide however; most warning
signs especially in combination
indicate that the individual is
experiencing some sort of
emotional stress.
Suicidal intervention
strategies


The three “I’s”:
Contracts:
3.1.1. Evaluate the risk of
suicide by the Law
Enforcement Officer

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Occupational conditions.
More prone to the risk of
divorce, alcoholism,
emotional/physical problems
and Post Traumatic Stress
Disorder (PTSD).
Innate nature of the police
culture.

Questions and Discussion
4.0. Explain Crisis Behavior and
its relevance to CIT Training

You interact with people who
are angry, emotional,
injured, frightened, or
traumatized. Some of these
people welcome your
presence, while others resent
it.
4.1. Discuss the cycle of
crisis behavior
Definition of Crisis Behavior:
 A person suffering from a
temporary breakdown in coping
skills that includes perception,
decision-making, and problem
solving abilities
 Different depending on
individual response.
 Anyone can suffer from a crisis
and its effects can vary with
time, place, and person
Crisis Escalation Cycle:

As an individual enters into a
crisis situation their
response enters into fairly
predictable stages. If
acutely psychotic,
responding to internal
stimuli, or intoxicated, these
stages will vary and may
become even more erratic.
Crisis Cycle:



Onset
Escalation and Anger
Out of control behavior
4.1.1. List examples, for
officer response, at each
level of escalation
Person
Officer
Level 4: Violence
Level 3:
Hostility
Level 2: Anger
Level 1: Anxiety
Calm
Anger/Fear
Fear
Anxiety
Empathy
Supportive
4.2. Discuss officer
interactions with persons
who have a mental illness

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Stay calm
Be patient
Double-check information
Use the individual’s name
Give instructions or
directives one at a time
continued...
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The size and age of a person with
mental illness has little to do with
whether a back-up officer should be
called
Engagement is pivotal - keep trying
Don’t underestimate the power of
hallucinations or delusions
Never argue about a delusion
Ask about treatment in the past
Do not take a judgmental stance.
Don’t express disapproval
Persons in mental health crisis need
more personal space
4.3. Explain how to utilize
observation as a tool for
evaluative purposes

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Consciousness
Activity
Speech
Thinking
Affect and Mood
Memory
Orientation
Perception
Physical symptoms
4.3.1. Discuss additional
ways to obtain useful
information for evaluative
purposes

In addition to your personal
observations, it is important
to obtain information from
witnesses and family
members and friends.
Six step model of Crisis
Intervention




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Defining the problem
Ensuring client safety
Providing support
Examine alternatives
Making Plans
Obtaining commitment
4.4. Demonstrate how
Crisis Intervention
Techniques can be
utilized in domestic
disturbance situations.
4.5. Discuss emerging trends
in Crisis Intervention
techniques


Has evolved into a major human
service sub-specialty
Has become widely apparent
that a reactive approach to
crisis intervention is not
enough; proactive and
preventive models need to be
developed and implemented

Questions and Discussion
Unit Goal: 5.0. To explore
the world of the mentally
ill through a discussion of
legal and societal concerns
and perspectives.
5.1. Discuss the mentally ill
person in the situation of
being homeless.

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On any given night approximately
600,000 Americans are homeless
More than 2 million people are
homeless throughout the year
One-third of the people who are
homeless have a serious mental
illness
One-half also have a substance
abuse disorder.
5.2. Discuss the mentally ill
individual as a victim of
crime.

“People with mental illness
are more likely to be
victims than perpetrators of
violence”
National Institute of Justice, 1996
Statistics:

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4-13% of mentally ill consumers
are perpetrators of crime
Mentally Ill consumers are 140
times more likely to be victim of
theft
3 million Mentally Ill consumers
are estimated to be victimized
each year
In a year, more than one-quarter
of mentally ill consumers say
they are victimized
5.3. Evaluate the stigma and
societal discrimination
that exists toward persons
who are mentally ill.
Stigma is a mark of disgrace or shame. It
is made up of various components,
including:
 Labeling someone with a condition
 Stereotyping people with that
condition
 Creating a division (i.e., a superior
“us” and a denigrated “them”)
 Discriminating against someone on the
basis of their label
5.3.1. Discuss the Americans
with Disabilities Act as it
relates to individuals
diagnosed with a mental
illness

“The Americans with Disabilities Act
(ADA) entitles people with disabilities
to the same service and protections
that police departments provide to
anyone else. They may not be excluded
or segregated from services, denied
services, or otherwise provided with
lesser services or protection than are
provided to others.”
5.4. Discuss legal and
societal concerns from a
mental health consumer’s
vantage point.
5.5. Participate in a
discussion of the family
member perspective on
mental illness.

Questions and Discussion
6.0. Develop an increased
understanding of the
legal process; evaluation
and techniques for
appropriateness of
apprehension per Texas
Health and Safety Code
(Mental Health Code.)
6.1. Discuss the process in
evaluating the
appropriateness of a
warrant less apprehension.

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“Least restrictive alternative” is the
process that:
Is available
Provides the consumer with the
greatest possibility of improvement
Is no more restrictive of consumer’s
physical or social liberties than is
necessary
6.1.2. Describe the step by
step process of
Apprehension by a Police
Officer without a warrant
to include emergency
apprehension.
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


Texas Health and Safety Code,
Sec.573.001
Texas Health and safety Code, Sec
.573.002
Texas health and safety Code,
Sec.573.011
Texas health and safety Code,
Sec.573.012
Texas health and safety Code,
Sec.573.021
Texas health and safety Code,
Sec.573.022
Texas health and safety Code,
Sec.573.023
6.1.3. Discuss the Orders
of Protective Custody
process



Texas health and safety Code,
Sec.574.021
Texas health and safety Code,
Sec.574.022
Texas health and safety Code,
Sec.574.023
6.1.4. Research
departmental policies in
requesting assistance
and transport of a
consumer before and
after apprehension
6.1.5. Propose justifications
in assessing proper use of
force option.

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

Keep the situation in perspective
The officer may use force
comparable to any other legal
duty when a person is resisting
arrest
The force must be reasonable
Goal is to obtain care and
treatment for the mentally ill
person
6.2. Explain an officer’s
limitation of liability.

People acting in good faith,
reasonably and without
negligence are not civilly or
criminally liable.
6.3. Discuss Confidentiality
as it relates to the topic of
Mental Health and Law
Enforcement involvement

Communication between a
patient and a professional,
as well as records of the
identity, diagnosis,
evaluation, or treatment of a
patient that is created or
maintained by a professional

Questions and Discussion
Unit Goal: 7.0. Gain an
understanding of mental
health
referrals/resources in
the student’s community.
7.1. Investigate possible
referral/treatment
challenges in your
community.

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Lack of available services
Willingness of mental health
providers
Quality and availability of
mental health programs
High costs of prescription drugs
and formulary limitations
7.2. Discuss the players and
strategies needed to
coordinate a quality
community mental health
program

Who else in your community
could share in these
responsibilities?
Framework of
Responsibilities
Criminal
Justice
Mental
Health
Community
Family
Advocacy
Social
Services
Rehabilitation
Treatment
Rehabilitation
Rehabiliation
Care
Rehabilita
-tion
Representa
-tion
Rehabilita
-tion
Protection
Housing
Cross
training
Income
Support
Prevention
Housing
Prevention
Cross
training
Crime
Management
Cross
training
Housing
Income
Support
Job training
Disease
management
Income
Support
Job
training
Cross
training
7.2.1. Define a partnership
and its relevance in
community and law
enforcement collaboration
Definition of a partnership
 An arrangement between two or
more parties who have agreed to
work cooperatively toward
shared objectives in which there
is: shared authority and respect,
joint investment of resources,
shared liability or risk taking,
and ideally, mutual benefits
Definition of collaboration:
 A system that integrates the
resources and delivery of
appropriate Mental Health care
services through processes or
techniques used by different
entities in order to control or
influence: the quality,
accessibility, utilization, costs
and prices, or outcomes of social
services provided to a defined
population.

“The criminal justice and mental
health worlds are very different. We
come from different traditions, we
speak different languages, and to
some degree have different values,
expectations, and goals. Furthermore,
few of us expected or desired to work
in both the criminal justice and
mental health worlds, and few of us
have been trained or educated to
understand the other world.”
7.3. 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 heath issues.
7.4. Discuss the State of
Texas Jail Diversion Ideal

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Education and training of law enforcement
personnel and the courts
The development and utilization of crisis
intervention teams (CIT)
Development of a centralized location for
mental health assessment, without, arrest for
individuals with non-violent criminal conduct
Development of holding facilities providing
structured treatment in lieu of arrest
Development of linking and referral services
Development of timely and effective screening
process
Development of required community support
Development of an identified method for
addressing housing and needed support
services
There are two types of
jail diversion


Pre-booking
Post-booking

Questions and Discussion
8.0. Unit Goal:
Understanding program
evaluation in
demonstrating/measuring
success.



Measuring program effectiveness can
assist in determining how successful
your program responses are to your
area.
It will also evaluate any changes or
adaptations/modifications that might
be appropriate.
Look at trends for the total agency.
Three types of useful
data



Quantitative data
Quantity Data
Process Data

Questions and Discussion
In conclusion:

It is important to dispel
commonly held
misconceptions about people
who have mental illnesses.
This training has been based
on the following working
assumptions:



Mental illness is not a
crime.
Most people with mental
illnesses are fully
functioning community
members.
There is no correlation
between mental illness and
a persons participation in
crime.

Involvement in infractions
(traffic violations,
loitering, disorderly
conduct) may be a
manifestation of a persons
mental illness or failure to
receive treatment for the
illness, rather than a result
of intentional wrongdoing.


Some people with mental
illnesses may be more
vulnerable to crime, abuse
or injury than the general
population.
Mental illness is a
continuum- highly functional
to highly debilitating.

END