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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 TAKE A 15-MINUTE BREAK COURSE & INSTRUCTOR EVALUATION Form • Please complete a course and instructor evaluation form. • If you rate 2 or below you must justify on reverse side. • Constructive Criticism helps all, being negative helps no one. • Exam • Graduation THANK YOU & STAY SAFE