Intermediate CIT Course Number 3841 Texas Commission on Law Enforcement Officer Standards and Educat

1
Intermediate CIT Course Number 3841 Texas
Commission on Law Enforcement Officer Standards
and Education

• Crisis Intervention Training

2
Unit Goal 1.1.

• To develop a basic understanding and respect for
  the fundamental rights of and proficiency in
  interacting with people with mental illness.

3
Top Cop Video
(View Top Cop video from Train the Trainer
course materials
4
1.1.1.

• Discuss the impetus for crisis intervention
  training and why it is so important to the law
  enforcement community.

5
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

6
Origin of the Training

• Crisis Intervention Training (CIT) was created

-Practitioner Perspective -Bureau of Justice
Assistance July 2000
7
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
8
Similar Situations Today

• 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 www.HealthyPlace.com February 21, 2004
9
Similar Situations Today

• 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
10
Similar Situations Today

• 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 womans death could have
  been avoided.

www.news8austin.com Incident occurred in 2002
11
Similar Situations Today

• 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.

Treatment Advocacy Center Washington DC
12
Headlines

• Crisis Skills Advised for Local Police
• Report Grand jury finds that most fatal
  shootings by law enforcement officers in last
  decade involved a mentally ill person

Los Angeles Times Ventura County Edition
February 27, 2002
13
Headlines

• Training urged after police shooting
• The weekend death of a mentally disabled man
  shot by a Miami-Dade police officer department
  to offer its officers more intensive training.

The Miami Herald Herald.com Posted
Thursday, October 28, 2004
14
1.1.2.

• Recognize the community mindset as it relates to
  the mentally ills relationship with law
  enforcement personnel

15
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.

16
The Problem

• Re-occurring situations in which law enforcement
  uses deadly force during encounters with
  individuals in serious mental health crisis

17
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 10/2004
18
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

19
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

20
Analysis

• 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.

21
Analysis

• 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.

Houston Police Department 2004

2004
22
Analysis

• Response to individuals in a mental health crisis
  constitutes a more refined usage of the officers
  expertise in communication.
• 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)

23
The Responses 3 Models
CIT

• Police-based specialized police response (CIT)
• Police-based specialized mental health response
• Mental-health-based specialized mental health
  response

24
1.1.3

• Illustrate the paradox of Crisis Intervention
  Training for the law enforcement officer.

25
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.

26
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. Such a
  requirement to, in effect, switch gears is
  diametrically opposed to the way officers are
  routinely expected to control conflict.

27
Police Magazine (March 2000)

• 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.

28
1.1.4.

• Explain Crisis Interventions role in Officer
  Safety

Safety
29
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, MS J Am
Acad Psychiatry Law 28338-44, 2000
30
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

31
This Training

• 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

32
This Training

• Is one more tool to add to your tool belt, one
  more skill to add to your repertoire of skills.

33
Officer Safety

• The Phoenix, Arizona Police Department reported
  that CIT training increased their officer safety
  by 70

Phoenix Police Department 2004
34
Safety

• FBI statistics state that mentally ill consumers
  are no more prone to violence than any other area
  of the population.
• HOWEVER, the variables (mental instability, high
  emotions, possible paranoia/delusions and
  substance abuse) can be very dangerous if not
  handled appropriately.

35
Safety

• 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.

36
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
  individuals compliance.

37
Law Enforcement Policy Center

• 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.

38
Law Enforcement Policy Center

• 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.

39
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 non-confrontational stance
  with the subject.

40
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

July 2004 Issue
41
CIT Programs Nationally

• Akron (OH) Delray Beach (FL)
• Ft. Wayne (IN)
• Houston (TX)
• Jackson County (MO)
• Kansas City (MO)
• Albuquerque (NM)
• Arlington (TX)
• Athens-Clarke County (GA)
• Austin (TX)

• Knoxville (TN) Minneapolis (MN)
• Montgomery County (MD)
• New London (CT)
• San Jose (CA)
• Seattle (WA)
• Lees Summit (MO)
• Lincoln (NE)
• Little Rock (AR)
• Memphis (TN)

42
Additionally, this training

• Instills confidence in the community regarding
  officers ability to handle crisis situations
• Brings law enforcement and mental health together

43
However, this training

• Is not infallible
• but is proven to be highly
  effective

44
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

45
Force

• 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

46
1.1.5.

• Identify the parameters of an officers
  qualification after receiving this training.

47
This training

• Does not make you a therapist. Understand your
  professional boundaries.

48
No CIT
(View Psychosis I video from Train the
Trainer resource material)
49
After CIT
(View Psychosis 2 video from Train the
Trainer resource material)
50
Unit Goal 2.1.

• To sensitize the student to the adversity of
  mental illness.

51
1.2.1.

• Define the term mental illness.

52
Definitions

• General Definition of Mental Illness.
• Professional Definition of Mental Illness.
• Definition of Insanity.
• Abnormal vs. Normal Behavior.

53
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

54
Basic Facts

• 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.

55
Basic Facts

• 20 - 25 of individuals may be affected by mental
  illness.
• 7.5 million children are affected by mental,
  developmental or behavioral disorders.

56
Basic Facts

• Nearly two-thirds of all people with a
  diagnosable mental disorder do not seek
  treatment.

57
Basic Facts

• With proper treatment, many people affected with
  mental illness can return to normal, productive
  lives.
• Mental illness can - and should - be treated.

Basic Facts About Mental Illness NAMI Texas
58
OCD Video
(View video newscast from Train the Trainer
materials-updated version ))
59
1.2.2.

• List four prominent categories of mental illness.

60
Categories of mental illness

• Personality Disorders
• Mood Disorders
• Psychosis
• Developmental Disorders

61
1.2.3. Personality Disorders

• Discuss Personality Disorders as they relate to
  officer contact.

62
Personality Disorders

• Many individuals who are functioning well in
  their lives may still have a personality
  disorder.
• Many with personality disorders also suffer with
  depression.
• May be seen in persons with chemical dependency
  problems.

63
Causes

• It is believed that most personality disorders
  are caused by, family history of physical or
  emotional abuse, lack of structure and
  responsibility, poor relationship with parent(s),
  and alcohol or drug abuse.

64
1.2.4.

• List the three most common personality disorders
  encountered by law enforcement officers.

65
Personality Disorders

• Paranoid
• Antisocial
• Borderline

66
Paranoid

• Interpret actions of others as threatening.
• Foresee being harmed.
• Perceive dismissiveness by others.

67
Antisocial

• Most commonly in males.
• Irresponsible antisocial behavior.
• Diagnosed after age 18.
• Trouble with authority.
• Know doing wrong, do it anyway.

68
Antisocial-possible traits

• History of truancy or runaway
• Starting fights
• Using weapons
• Physically abusing animals or people
• Lying
• Stealing or other illegal behavior

69
Borderline

• Most commonly recognized in females
• Possible traits
• -Unstable and intense personal relationships
• -Impulsiveness with relationships, spending,
  food, drugs, sex
• -Intense anger or loss of control

70
Borderline
SUICIDE

• Continued
• - Recurrent suicidal threats
• - Chronic feelings of emptiness or boredom
• - Feelings of abandonment

71
1.2.5.

• Identify prevalent behaviors associated with
  personality disorders.

72
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.

73
Behaviorscontinued

• 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.

74
1.2.6. Mood Disorders

• Discuss Mood Disorders as they relate to officer
  contact.

75
Mood Disorders

• Mental Illness demonstrated by disturbances in
  emotional reactions and feelings.
• Recognizable behaviors could include
• Lack of interest and pleasure in activities
• Extreme and rapid mood swings

76
Recognizable Behaviors continued

• Impaired judgment
• Explosive temper
• Increased spending
• Delusions

77
Causes of Mood Disorders

• Researchers believe (SAMHSA) that a complex
  imbalance in the brains chemical activity plays
  a prominent role in selectivity.
• Environmental factors can trigger or buffer
  against the onset.

78
1.2.7.

• List the two most common mood disorders
  encountered by law enforcement officers.

79
Mood Disorders

• Depression
• Bipolar Disorder

80
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.

81
Major Depression

• Unlike normal emotional experiences of sadness,
  loss, or passing mood states, major depression is
  persistent and can significantly interfere with
  an individuals thoughts, behavior, mood,
  activity, and physical health.

82
Symptoms of Major Depression

• Profoundly sad or irritable mood
• Pronounced changes in sleep, appetite, and energy
• Difficulty thinking, concentrating, and
  remembering

83
Symptoms continued

• Physical slowing or agitation
• Loss of interest in usual activities
• Feelings of hopelessness or excessive guilt
• Recurrent thoughts of death or suicide

84
Symptoms continued

• Persistent physical symptoms that do not respond
  to treatment, such as headaches, digestive
  disorders, and chronic pain.

85
Causes

• There is no one single cause of major depression.
  Psychological, biological, genetic, and
  environmental factors may all contribute to its
  development.

86
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.

87
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.

88
Manic Depression Video

• (View Manic Depression video from Train the
  Trainer (updated version) course materials)

89
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.

90
Symptoms of Mania

• Elated, happy mood or irritable, angry,
  unpleasant mood
• Increased activity or energy
• Inflated self-esteem
• Decreased need for sleep

91
Symptomscontinued

• Streaming ideas or feeling of thoughts racing
• More talkative than usual
• Excessive risk-taking
• Ambitious often grandiose plans
• Increased sexual interest and activity

92
Symptoms of Depression

• Prolonged feelings of sadness or hopelessness
• Fatigue/low energy
• Difficulty concentrating or deciding
• Lack of interest

93
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.

94
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.

95
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.

96
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.

97
1.2.8. Psychosis

• Discuss Psychosis and how it relates to officer
  contact.

98
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

99
Definition continued

• Inappropriate affect
• Regressive behavior
• Reduced impulse control and
• Impaired reasoning of reality.

Social Work Dictionary, 2nd Edition, by Robert
L. Baker
100
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.

101
1.2.9.

• Briefly illustrate a psychotic episode from a
  consumers perspective.

102
Psychosis Video

• (View 20/20 newscast from Train the Trainer
  materials)

103
Common experiences

• Hearing voices Die, die, die, Kill yourself,
  Youre no good, They are going to get you.
• Feelings of Paranoia
• Visual hallucinations
• Heightening of senses

104
1.2.10.

• Inventory the behavioral/emotional cues a person
  displays when experiencing a psychotic episode.

105
Cues

• Behavioral Cues Inappropriate dress, impulsive
  body movements, causing injury to self.
• Emotional Cues Lack of emotional response,
  inappropriate emotional reactions.

106
Class Exercise

• (Refer to Instructor
  Resource Guide)

107
1.2.11. Substance Abuse Cognitive
Disorders

• Explain how substance abuse and cognitive
  disorders relate to psychosis.

108
(No Transcript)
109
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

110
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.

111
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 effect.

112
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.

113
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
  itselfdrugs utilized to treat can lead to TD
• The neurotransmitters are blocked which over time
  may cause uncontrolled involuntary movement of
  the body and face

114
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.

115
1.2.12. Schizophrenia

• Discuss Schizophrenia as it relates to psychosis.

116
Schizophrenia

• Group of psychotic disorders characterized by
  changes in perception.
• Affects a persons ability to think clearly,
  manage his or her emotions, make decisions,
  relate to others, and distinguish fact from
  fiction.

117
Distorted thinking

• Results in
• Hallucinations
• Poor processing of information/Attention deficit
• Illogical thinking that can result in
  disorganized and rambling speech and delusions.

118
Changes in Emotion

• May overreact to situation.
• Have flat effect (Decreased emotional
  expressiveness, diminished facial expression and
  apathetic appearance).

119
Changes in Emotioncontinued

• Anhedonia Lacking pleasure or interest in
  activities that were once enjoyable.
• Withdrawn Media tends to portray as violent
  which is very rare.

120
Causes of Schizophrenia

• Like many other medical illnesses, schizophrenia
  appears to be caused by genetic vulnerability and
  environmental factors that occur during a
  persons prenatal development.

121
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.
• Higher risk of suicide. Approximately 10 of
  people with schizophrenia commit suicide.

122
1.2.13. Alzheimers

• Discuss Alzheimers disease and its involvement
  with psychosis.

123
Alzheimers 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

124
Symptoms of Alzheimers

• 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.

125
Alzheimers - Additional Facts

• Alzheimers 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.

126
1.2.14. Psychotic Episode

• Demonstrate the communicative approach an officer
  should take when confronting a person in a
  psychotic episode.

127
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

128
Continued

• Allow person to verbally ventilate
• Be aware of individuals personal space
• Introduce self
• Assure person of officers intentions to help, not
  hurt

129
1.2.15.

• Appraise personal impressions of mental illness
  after viewing the consumer presentation.

130
Consumer Presentation
(View Jack Callahan video from Train the
Trainer course materials)
131
1.2.16. Developmental Disorders

• List the two most common developmental disorders
  that relate to officer contact.

132
Developmental Disorders

• Two most common
• Autism
• Mental Retardation

133
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.

134
AutismCommunication 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

Communication
135
AutismOther 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

136
Autism Video

• (View Autism video from Train the Trainer
  (updated version) course materials))

137
Mental Retardation

• Refers to a range of substantial limitations in
  mental functioning manifested in persons before
  the age of 18.

138
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

139
Degrees of Mental Retardation

• Moderate IQ 54-40
• Severe IQ 39-25
• Profound IQ Below 25

140
Methods for Questioning

• Be patient for a reply
• Repeat question as needed
• Ask short, simple questions using simple language
• Speak slowly

141
Methodscontinued

• Move to a less disruptive location to assist with
  focusing
• Be non-threatening, but firm and persistent
• Be highly aware of questioning techniques

142
Areas to Consider to Assist in Identification

• Criminal Activity
• Educational History
• Physical Appearance
• Speech/Language
• Social Behavior
• Performance Tasks

143
Strategies for IdentificationCriminal Activity

• Noticeably older than others involved in offense
• Follower
• Ready to Confess
• Remained at scene while others ran

144
Strategies for IdentificationEducational History

• Below usual grade level
• ID states mental impairments
• Check MHMR records

145
Strategies for IdentificationPhysical Appearance

• Inappropriately dressed for season
• Unusual physical structure
• Awkwardness of movement/poor motor skills
• Difficulty writing

146
Strategies for IdentificationSpeech/Language

• Obvious speech defects
• Limited response or understanding
• Inattentiveness
• Difficulty describing facts in detail

147
Strategies for IdentificationSocial Behavior

• Adult associating with children or adolescents
• Eager to please
• Non-age appropriate behavior
• Easily influenced by others

148
Strategies of IdentificationPerformance 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

149
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.specialoly
  mpics .org)

150
1.2.17. Developmental Disorders

• Discuss Developmental Disorders as they relate to
  officer contact.

151
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.

152
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.

153
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.

154
1.2.18.

• Identify behaviors associated with Developmental
  Disorders as they relate to officer contact.

155
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

156
Behaviorscontinued

• 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

157
Unit Goal 1.3.

• To develop a knowledge base concerning suicide
  and the evaluation of danger levels.

158
1.3.1 Suicide

• Verbalize commonly stated myths about suicide

159
Myths

• People who talk about suicide wont 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.

160
Fact

• There is no typical suicide victim. It happens
  to young and old, rich and poor.
• 
  

American Association of Suicidology
161
1.3.2.

• Discuss suicide and its relationship with mental
  illness.

162
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

163
Continued

• Nearly 20 of people diagnosed with bipolar
  disorder die from suicide
• Nearly 15 of people diagnosed with Schizophrenia
  die from suicide

164
1.3.3.

• Explain the phrase suicide by cop.

165
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

166
Continued

• One studyfound 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 policeprovoking law
  enforcement officers into shooting them.
  
  
• 
  

Treatment Advocacy Center

February 2005
167
1.3.4.

• Record questions that will assist in evaluating
  an individuals current level of suicidal danger.

168
Evaluating Level of Suicidal Danger

• Symptoms?
• Nature of current stressor?
• Method and degree?
• Prior attempt?

169
Levels of dangercontinued

• Acute vs. chronic?
• Medical status?
• Chance of rescue?
• Social resources?

170
Danger to Self

• Intent (actions/words)
• Gross neglect for personal safety
• Specific plan (action/words)
• Plans/means available

171
Danger to Others

• Intent (actions/words)
• Specific person identified
• Agitated, angry, explosive
• Irrational, impulsive, reckless (intent/actual)

172
Statistics
173
Statistics
174
Suicide Video 1
(View 1 Depression, Suicide video from Train
the Trainer course materials)
175
Suicide Video 2
(View 2 Depression, suicide video from Train
the Trainer course materials)
176
Unit Goal 1.4.

• Discuss Psychopharmacology as it relates to
  medications prescribed and prominent side effects
  in persons with a mental illness.

177
1.4.1.

• Name four categories of medications utilized in
  controlling the symptoms of mental illness.

178
Categories of drugs

• Anti-psychotic
• Thorazine, Mellaril, Haldol
• Controls hallucinations
• Ex Schizophrenia

179
Categoriescontinued

• Antidepressants
• Elavil, Prozac, Zoloft
• Control feelings of sadness, hopelessness,
  suicidal thoughts
• Ex depression

180
Categoriescontinued

• Mood Stabilizers
• Tegratol, Lithium, Depakote
• Control mood swings
• Ex bipolar disorder

181
Categoriescontinued

• Anti-anxiety drugs
• Xanax, Valium, Buspar
• Feeling of powerlessness, extreme apprehension,
  panic
• Ex Phobias, Post Traumatic Stress Disorder

182
1.4.2.

• List possible side effects with the use of
  psychotropic medications.

183
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

184
Side effects can be

• Uncomfortable
• Dehumanizing
• Often irreversible

185
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

186
1.4.3.

• Discuss old vs. new medications.
  

VS.
187
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

188
1.4.4.

• Recognize three primary reasons why consumers do
  not take their medications as prescribed.

189
Why medications are not taken

• Side effects
• Sigma
• Start feeling better
• Continuous problem for law enforcementthe above
  deviations are the primary cause of crisis
  concerns.

190
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?
• Is the treatment worse than the illness?

191
Unit Goal 1.5.

• To orient students to a variety of advanced modes
  of communication.

192
1.5.1.

• List the components of the first three minute
  assessment.

3 minutes
193
First Three Minute Assessment Four Components

• Elements of Evaluation
• Intellectual Functioning
• Behavioral Reactions
• Emotional Reactions

194
Elements of Evaluation

• Appearance and Behavior
• Stream of Talk
• Thought Content
• Perceptual Abnormalities

• Affect-prevailing emotional tone
• Concentration
• Cognitive-intellectual functions

195
Intellectual Functioning

• Clear/Alert vs. Foggy/Confused
• Difficulty in Understanding
• Stream of Mental Activity
• Over Productive
• Delusions/Hallucinations

196
Behavioral Reactions

• Attitude
• Controlled Behavior
• Coordination/Gait
• Distrusting/Withdrawn/Isolates Self
• Shy/Meek/Introverted

197
Emotional Reactions

• Low/Depressed/Sad
• Volatile/Emotional swings
• Helpful/Motivated/Caring
• Suspicious
• Irritable/Annoyed/Angry
• Bitter
• Bullying

198
1.5.2.

• Summarize the usage of the L.E.A.P.S. concept of
  interaction.

199
L.E.A.P.S.

• L isten
• E mpathize
• A sk
• P araphrase
• S ummarize

200
1.5.3.

• Demonstrate the process of modeling.

201
Process of Modeling

• Learning through observation
• Communication/Contribute or Interfere
• Intervention/Communication strategies

202
1.5.4.

• Discuss the characteristics that contribute to a
  positive communication experience.

203
Characteristics to Positive Communication

• Introductions
• Opening Statements
• Reflecting Statements
• Methods for Gaining Trust
• Communication to Defuse

Communication
204
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.

205
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

206
Continuedexamples

• 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.
• I would like to work with you to find solutions
  to your problem.

207
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

208
Methods for Gaining Trust

• Honesty/Sincerity
• Follow Through
• Validation of Positive Actions
• Forewarn

209
Examples

• Im 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 when you
  ride in the police car.

210
Communication to Defuse

• Show understanding/empathy
• Use modeling
• Reassure
• Allow ventilation

211
1.5.5.

• List barriers to active communication.

212
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.

213
Lack of Active Listening

• Arguing
• Criticizing
• Jumping to Conclusions
• Pacifying

• Derailing
• Moralizing
• Name-Calling
• Ordering

214
1.5.6.

• Discuss three levels of active listening.

215
Three Levels of Active Listening

• Listening to Words
• Listening to Whole Messages
• Reflecting the Whole Message

216
1.5.7.

• Briefly explain the techniques repeating,
  paraphrasing, and reflection of feelings as they
  relate to active listening.

217
Techniques to Active Listening

• Repeating
• Paraphrasing
• Reflection of Feelings

218
Repeating

• Simply restate what the person has said in his
  words
• This helps ensure you heard what you think you
  heard
• If possibleuse less provocative language to
  defuse a situation
• Blowing someone away vs.
• Harming
  someone

219
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
  money right now.

220
Reflection of Feelings

• Express awareness of other persons feelings
• Example
• You sound depressed.

221
Additional Techniques

• Re-wording
• Use this to verify shared meaning of word or
  phrase
• Redefine the situation to create the option you
  want
• Dont be afraid to say
• I dont know what you mean

222
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

223
1.5.8.

• Verbally illustrate examples of You vs. I
  statements.

224
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

225
Unit Goal 1.6.

• To internalize the crisis intervention skills
  involved in communicating with individuals with a
  mental illness.

226
1.6.1.

• List the basic strategies that are necessary when
  communicating in crisis situations.

227
Strategies

• Stay calm
• Avoid crowding
• Restate
• Use persons name
• Give instructions one at a time
• Engagement is pivotal

• Dont underestimate the power of hallucinations
  or delusions
• Ask about treatment history
• Dont express disapproval

228
1.6.2.

• Describe at least four effective
  communication/interaction skills used when
  dealing with persons with a mental illness.

229
Communication/Interaction Skills

• Safety
• Crisis Facts
• Language
• Movements

230
Safety

• Your personal safety comes first
• Control the surroundings
• Remove harmful obstacles from the surroundings

231
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 respond with violence

232
Language
Sally
Mike
Joe
Tom

• Use persons name frequently
• Avoid direct confrontation, labels and acronyms
• Limit number of instructions

• Be patient and consistent
• Be aware of slower reaction time responses may
  be given slower than you expect

233
Movements

• Be aware of body movements
• People in crisis often need more personal space
• Keep movements slow and deliberate

234
1.6.3.

• Apply knowledge obtained in coursework to class
  exercises and scenarios for role play.

235
Unit Goal 1.7.

• Develop an increased understanding of the legal
  process evaluation and techniques for
  appropriateness of apprehension.

236
1.7.1.

• List the process in evaluating the
  appropriateness of a warrentless apprehension.

237
Least Restrictive Alternative

• The treatment that
• Provides the consumer with the greatest
  possibility of improvement

238
Continued

• The treatment that
• Is no more restrictive of consumers 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.

239
1.7.2.

• Describe the step by step process for obtaining
  an emergency detention order.

240
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 officers beliefs are
  derived from specific recent behavior, overt
  acts, attempts or threats that were observed or
  reliably reported.

241
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

242
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

243
1.7.3.

• 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.

244
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 obtain a
  warrant

245
1.7.4.

• Propose justification in assessing proper use of
  force options.

246
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

247
Continued

• Changes in behavior intensity level are
  indicators of possible violent behavior
• Agitated Behavior
• Disruptive Behavior
• Destructive Behavior
• Out of Control

248
1.7.5.

• Explain an officers limitation of liability.

249
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)

250
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

251
Exceptions to confidentiality rule

• Medical or law enforcement per incident
• Patient consent
• Health care personnel at Jail facility
• Memorandum of Understanding

252
1.7.6.

• Identify factors to be considered in determining
  whether assistance should be requested during an
  approach.

253
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

254
1.7.7.

• Research departmental policies in requesting
  assistance.

255
1.7.8.

• Identify factors considered in determining
  appropriate method of transporting consumer.

256
Method of Transport

• Follow departmental policy
• Be aware of distances to nearest facilities
• Evaluate behavior or physical condition

257
Unit Goal 1.8.

• To explore the world of the mentally ill through
  discussion of legal and societal concerns and
  perspectives.

258
1.8.1.

• Discuss the mentally ill person in a situation of
  being homeless.

259
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

260
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.

261
1.8.2.

• Discuss the mentally ill individual as a victim
  of crime.

262
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 isThirteen times more research compiled
  concerning the mentally ill as perpetrators of
  violent acts rather than victims of violent acts?

263
Victimscontinued

• 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

264
Victims

• We dont 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

265
Responding to Victim Needs

• Victims need to feel safe
• Victim's need to express his/her emotions
• Victims need to know what comes next

266
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

267
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 patience and
  respect

268
1.8.3.

• Evaluate the stigma and societal concerns from a
  mental health consumers vantage point.

269
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

270
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 illness
  are dangerous, less competent, not able to work
  and need institutionalized to get better.

271
Factscontinued

• Stigmas 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

272
Myths That Support Sigmas

• 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

273
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