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National Drug Court Institute Drug Court Training DRUG COURTS Trauma Informed Police Responses PRESENTED BY: VANESSA PRICE, INSPECTOR, RETIRED Collaboration of: Cary Heck, Ph.D. Steve Hanson Charles Armhein, PsyD Vanessa Price NDCI: A Professional Services Division of NADCP Presentation Objectives • Identify the types of Axis 1 Disorders and how to effectively communicate with those having a disorder • Define and list the symptoms and behaviors associated with Personality Disorder • Identify the types of trauma and associated behaviors 2 The Drug Court Model • Collaborative approach to treating substance abusing offenders in the community • Program Participants receive: – Frequent drug and alcohol testing – Intensive supervision by local or state probation agencies – Appropriate levels of treatment for substance abuse disorders – Regular contact with the supervising judge 3 The Ten Key Components 1. Justice and Treatment Integration 2. Non-adversarial Approach 3. Early Identification 4. Continuum of services 5. Drug Testing 6. Coordinated Strategy 7. Judicial Supervision 8. Monitoring and Evaluation 9. Interdisciplinary Education 10. Forging Partnerships 4 Behavior Pathways • Rewarding behaviors can become routine • “Subconscious” control of the behavior • Difficult to extinguish behaviors because people are not always aware when they are initiated • Resistant to change 5 Introduction Part I Disorders • Mental illness: Axis • Personality: Axis II Part II Trauma • Related Disorders • Traumatic Events 6 Mental Illness in Jails • 2 million annual bookings nationwide • 16 % males suffer • 31% female suffer 7 Axis I Disorders • Axis I disorders are like a medical illness, an illness that impairs behavioral functioning in some way: • • • • Florid Episodic Dysfunction Disruption 8 Axis I Disorders When it’s the personality that’s disordered • • Not about an illness but about difficulties of someone’s personality, what they are like as a person, and how they handle stress. Some personality disorders can be a challenge for law enforcement, such as people prone to interpersonal conflicts. 9 Broad Categories • Thinking • Mood 10 What is Psychosis? Psychosis is when thinking is severely impaired, either how thoughts are put together or the content of one’s thoughts. Most common in schizophrenia and schizoaffective disorder. Three main symptoms: • • • Delusions Hallucinations Impaired thinking processes 11 Delusions • Paranoid - the person believes that there are people who are trying to hurt him or her, “someone is out to get me.” They may even report this to the police. • Grandiose - “I own four states and two countries,” superhuman abilities, related to famous people, believes to have great wealth (but can’t get access), etc. 12 Hallucinations False perceptual experience through one of the senses. • Auditory (voices) • Visual 13 Disorganized Thinking Problem in organizing thoughts, may be hard for the person to communicate or make himself understood. 14 Disorganized Behavior • Poor hygiene • Inappropriate clothing • Silence – non responsive to questions 15 The Psychotic Disorders • Schizophrenia – a chronic illness, but it can occur in episodes and have remissions. Usually overall functioning is lower than before onset of the illness. Marked by hallucinations, delusions, and/or thought disorder. • Schizoaffective disorder –Rather the person has episodes of both psychotic symptoms and mood symptoms that are not connected. 16 Mood disorders Major Depressive Disorder • • • • • Psychological pain Fatigue Loss of energy Poor concentration Poor memory 17 Bipolar • Once called manic• • • • • • depression Manic episodes Feeling exceptionally Irritable and aggressive. Grandiose delusions. High level of energy Paranoid. 18 Major Depressive Major depressive disorder with psychotic features – the person is so depressed that the depression leads to psychotic symptoms. 19 Anxiety Disorders Sense of being… •Danger • Worry •Fear •Threatened 20 Anxiety Disorders • Obsessive compulsive disorder • Generalized anxiety disorder • Panic disorder 21 Impulse Control Disorder •Outbursts •Aggressive feelings, •Poor frustration tolerance 22 The Approach: Talking to People 23 Talking to People Caveat: Follow your training and department policies to assure safety at the scene, safety, as you already know, is the priority. This module will build on your knowledge of mental illness and trauma to help you add skills, but this material does not replace previous training nor department policy guidance. 24 Talking to People That being said, engagement is the key… Engagement is not only good for the person you are responding to, it is also a good risk reduction strategy when it is appropriate. 25 People with Psychosis • Do not reason instead, emphasize with emotions: Feelings first: “It sounds like you feel...” • Don’t try to talk them out of unusual ideas “What you’re telling me is…” “Given all that you told me it must be very difficult to…” 26 People with Psychosis •Give them your full attention. •“I’m sorry I have to interrupt but I need to take care of this quickly.” Add I’m sorry about that you were telling me about … before I had to interrupt. •Maintain calm and open body language. •Silences are okay. 27 People with Psychosis • If asked do you believe the delusion just simply say, “I want to hear more about what you’re having to deal with, can you help me understand…?” • Ask him or her: “I want to check if I’m getting this right, is this it…? ? 28 People who are Agitated De-escalation: Communication that calms someone • One person takes lead communicating • Take your time • Speak slowly and calmly • An attitude of trying to help, vs. threats or arguing 29 People who are Agitated • • • • Eye contact – neither too much or too little Maintain safe distance Sit with person if seated, perhaps at side But…, avoid unrealistic statements or promises. 30 Talking to People -- Agitation • Show empathy • Acknowledge a grievance • Use open ended questions • Emphasize the person’s point of view, not yours • “Tell me what happened” and “What can I do to help?” • “I want to help but it’s hard for me to understand when you’re shouting.” 31 Personality Disorders The major ones with high relevance for law enforcement include: • Narcissistic • Borderline • Antisocial 32 Narcissistic • • • • • • Grandiose Self-centered Entitled Arrogant Needs admiration Lacks empathy 33 Borderline • Highly emotional and agitated • Poor coping with negative feelings • Needy and dependent on others • Impulsive behavior • Suicidal thinking or attempts • History of childhood trauma (sexual abuse) 34 Other Personality Disorders • Schizotypal • Schizoid • Antisocial 35 Post-Traumatic Stress Disorder Caused by exposure to, or witnessing, an event that threatened death or serious injury, along with a sense of fear, horror, or helplessness. 36 Trauma • Events that are beyond expectable experience and overwhelm the person’s psychological resources. • Think of the war veteran where the family said he was never the same after he returned. 37 Types Trauma • Recent traumatic event • Chronic PTSD • Delayed PTSD • Chronic abuse, in childhood or later 38 Dissociation Cutting off awareness and connection to memory, thoughts, and feelings. 39 Always on the edge • Memories and thoughts remain unbearably intense • Thoughts are intrusive and cannot be stopped • Nightmares are frequent • People react as if they are back at the traumatic scene 40 Following a Traumatic Event Person may be: • Confused • Numbed • Calm • Severely distressed. 41 Trauma Speaking quickly Matter of fact tone 42