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CRIMINALIZATION OF MENTAL ILLNESS AND THE LAW ENFORCEMENT ROLE

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CRIMINALIZATION OF MENTAL ILLNESS AND THE LAW ENFORCEMENT ROLE Risdon N. Slate, Ph.D. 2010 FBI National Academy Utah Chapter Fall Training St. George, Utah – PowerPoint PPT presentation

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Title: CRIMINALIZATION OF MENTAL ILLNESS AND THE LAW ENFORCEMENT ROLE


1
CRIMINALIZATION OF MENTAL ILLNESS AND THE LAW
ENFORCEMENT ROLE
  • Risdon N. Slate, Ph.D.
  • 2010 FBI National Academy Utah Chapter
  • Fall Training St. George, Utah

2
Free Association
  • Mentally Ill

3
Psycho
4
Jason in Friday the Thirteenth
5
Jason on Arsenio Hall Show
6
Crisis in Mandarin Chinese
7
Crises Often Drive CJ Policy
  • Crisis Intervention Team Training
  • Eugene Gregory and Alan Singletary
  • Andrew Goldstein
  • Aaron Wynn
  • Brad H.
  • Seung-Hui Cho

8
Recipe for Failure
  • Not offering adequate treatment
  • Providing no follow-up on re-entry into the
    community

9
Californias Lanterman-Petris-Short Act
  • Prompts Abramson to coin the phrase
    Criminalization of Mental Illness
  • WHY?
  • Magna Carta of the mentally ill (Abramson).

10
Each of the following cited for contributing to
the criminalization of mental illness
  • CJ Process viewed by LE as more expeditious than
    MH Process
  • Deinstitutionalization
  • Inadequate community support service
  • Lack access to intermediate long-term care

11
Deinstitutionalization
12
Patients in State Mental Hospitals
  • 20th Century
  • 21st Century
  • Beginning roughly 150,000
  • 1955 peak 559,000
  • 1960 1980 lt 100,000
  • Beginning _______
  • Estimated today _______

13
. . . The grim statistics - jails and prisons
have become the new psychiatric hospitals
14
  • Harcourt, 2006 Texas Law Review

15
  • Penrose finds as prison populations decrease
    mental hospital populations increase as prison
    populations increase mental hospital populations
    decrease.
  • Today more persons with mental illnesses in
    prisons and jails than in psychiatric hospitals.
  • Transinstitutionalization has take place

16
Factors Associated with Deinstitutionalization
Movement
  • Inhumane conditions and abuses in state
    hospitals
  • Discovery of Thorazine
  • The anti-psychiatry movement

17
2 Cases Set the Deinstitutionalization Movement
in Motion in the 1970s
  • Wyatt v. Stickney (1972)
  • OConnor v. Donaldson (1975)

18
Founders of the Anti-Psychiatry Movement
  • Michael Foucault
  • R.D. Laing
  • Thomas Szasz

19
  • Work of Szasz the anti-psychiatry movement has
    made it easier to put a person in jail than to
    secure treatment for them.

20
L. Ron Hubbard (Scientology Founder)
  • There is not one institutional psychiatrist
    alive who could not be arraigned and convicted of
    extortion, mayhem, and murder (Rissmiller
    Rissmiller).

21
Scientology
  • Religious Views
  • Prominent Members
  • Views on Formal Education
  • Views on Psychiatry

22
Community Mental Health Centers
  • JFK appropriated 3 billion in 1963 for CMHCs
  • Never allocated
  • JFK assassinated
  • Viet Nam War
  • NIMBY (Gilligan)

23
States Ways to Shift Costs for the Care of PWMI
to the Federal Government
  • Disability insurance
  • Housing assistance
  • Medicaid
  • Moving persons with mental illnesses from state
    hospitals to nursing homes
  • How Shift Costs to County Local Govt. ?

24
Managed Psychiatric or Behavioral HealthCare
  • Has actually resulted in payment of commissions
    for denial of hospital admissions
  • May result in cost shifting instead of saving
  • Limited choices, pre-certification, cut corners

25
National Alliance on Mental Illness (NAMI)
Grading the States Report
  • Average Grade for the Public Adult Mental Health
    Care Systems in the U.S. D
  • ____
  • UTAH ?

26
Medicaid vs. Medicare
27
Preferred Drug Lists/Restricted Formularies
28
Hospitals do not have to provide mental health
treatment to those unable to pay.
  • Markowitz found a predominance of private
    psychiatric hospital beds in cities to be
    significantly associated with increases in both
    arrest and crime rates, suggesting that when the
    mental health system is privatized police have
    fewer referral options to mental health treatment
    and are more likely to make an arrest.

29
Thats news to us Whose job is it? MOUs
30
Homelessness
31
Military
32
Daytona Beach Police Chief Michael Chitwood
  • Greyhound Therapy
  • Banishment
  • Cost-shifting

33
Surgeon Generals Report
  • The most formidable obstacle to future progress
    in the arena of mental illness and health is
  • ________

34
Violence
  • Factors linked to violence include past
    incidences of violence, substance abuse, lack of
    treatment, and non-compliance with medication.
  • Laws change for a single reason, in reaction to
    highly publicized incidences of violence. And
    it may be necessary to capitalize on the fear of
    violence (D.J. Jaffee, Treatment Advocacy
    Center)

35
  • Violence Funding for Mental Health Treatment
  • Stigma - Otto Wahl
  • One Flew Over The Cuckoos Nest
  • Negative media portrayals of persons with mental
    illnesses have reportedly contributed to roughly
    half of all citizens perceiving persons with
    mental illnesses as being more violent than
    persons without mental illnesses.
  • Famous persons with mental illnesses

36
One Flew Over the Cuckoos Nest
37
Anosognosia
  • Xavier Amador
  • Effects

38
3 Largest Inpatient Psychiatric Facilities
39
People with mental illnesses are incarcerated
longer
  • Rikers Island (NYC)
  • Average length of incarceration
  • All inmates 42 days
  • Inmates with SMI 215 days
  • Pennsylvania Prisons
  • Inmates with SMI three times more likely to serve
    maximum sentences.
  • Source www.consensusproject.org

40
Prevalence of Mental Illness
  • Ditton Study
  • James Glaze
  • Percentage of PWMI with a substance abuse disorder

41
THE LAW ENFORCEMENT RESPONSE TO PERSONS WITH
MENTAL ILLNESSES IN CRISES
42
Seth Greenberg
  • Mental illness is not a choice it is a
    medical disease.

43
VPH vs. SBC
44
CIT
  • Memphis PD

45
Gary Cordner
  • PWMI more likely to be injured by police and
    _______ times more likely to be killed by police.

46
Price
  • Police have been found to have more empathetic
    views than the general public toward pwmi in
    crises.

47
Ruiz Miller
  • Two most common misperceptions held by the police
    toward pwmi

48
Experts advise police not to resolve encounters
with pwmi in crises quickly
  • However, most police agencies do not have such
    specialized training or a formalized policy for
    such interactions.
  • Greenberg, in a study of 28 police training
    academies, found the average amount of training
    was _____hours.

49
Law Enforcement Relationship with Mental Health
Personnel
  • Fairly Negative Working Relationship
  • LE often views arrest and cj process as a more
    expedient option than referral to the mh system.
  • Mercy Bookings
  • The system that cant say no.
  • MOU

50
No Mercy
51
Mental Health Providers Refuse Treatment
  • Substance Abuse
  • History of Violence
  • Frequent Hospitalizations
  • Inability to Pay for Services

52
Police Role
  • Prefer to Be Crime Fighters over Service Providers

53
Types of Police Responses to PWMI
  • Mental Health-Based Specialized Mental Health
    Response
  • Police-Based Specialized Mental Health Response
  • Police-Based Specialized Police Response (CIT)

54
Police-Based Diversion Programs
  • Are generally pre-booking in nature.

55
Mobile Crisis Team
  • a mental health based specialized mental health
    response

56
Lamb his colleagues
  • Like joining MH LE
  • CSOs Birmingham, AL example of police-based
    mental health response.
  • CSOs do not have arrest powers

57
  • Arrest rates in police encounters with pwmi are
    lower when specialized police responses are used
    in fact, they found ____ times more likely pwmi
    to be arrested when encountering non-CIT officers
    (Steadman et al.). although one Ohio study found
    an increased arrest rate
  • Majority of Memphis PD officers perceived CIT as
    effective in reducing time spent on MH crisis
    calls (Borum et al.).

58
Reduce Police Turnaround Time Likelihood of
arrest while improving linkages to the CJ system
  • Single point of entry to the mh system
  • Streamlined intake process
  • No refusal policy

59
CIT
  • First Foremost, the goal is Officer Safety
  • Steadman estimates _____to ____CIT programs in
    U.S. (Bastardizing)
  • Reuland CIT most popular of specialized
    programs
  • Steadman et al. Memphis PD CIT (most well
    known).
  • Greenberg Memphis CIT (most often replicated).
  • Sellers et al. Memphis CIT (most effective in
    resolving mh crises).

60
CIT continued
  • Identified as the best of the 3 specialized
    responses for reducing arrest rates of pwmi
  • Reduces injuries to pwmi and police
  • Reduction in jail suicides
  • Fewer shootings of pwmi by police
  • Fewer deaths for pwmi and police
  • Increases access to mental health services
  • Officers perform general police duties when not
    responding to crises with pwmi (Reuland)
  • Inexpensive to implement

61
PWMI in Crises
  • Can typically recall their interactions with
    police.
  • Therefore, disrespect and/or abuse by police
    toward them can severely diminish their
    cooperation with police in the future.

62
Typical CIT Training Components
  • Signs Symptoms of Mental Illness
  • Types of Psychotropic Medications
  • De-escalation Techniques
  • Interaction with Consumers of MH Services (IOOV)
  • Memphis PD CIT training includes 8 Hrs. of
    interaction with consumers of MH Services
    (Cochran selectivity in choosing participants
    Borum Thompson ___to ___ of sworn force).

63
Stephen R. Covey, author of the Seven Habits of
Highly Effective People,
  • Seek first to understand, then to be understood.

64
Ten Commandments of De-Escalation
  • The Art of De-Escalation http//www.neoucom.edu/CJ
    CCOE/cit.html
  •  It is the wise officer who can, at times,
    conceal his or her combat-ready status.
  • 1) Your safety comes first
  • 2) Keep therapeutic spacing
  • 3) Speak in tones that fit the situation
  • 4) When appropriate use non-threatening posture
  • 5) Personalize the conversation (i.e. use first
    names)
  • 6) Ask how you can help
  • 7) Dont be afraid to set firm yet calm limits
  • 8) Never validate hallucinations
  • 9) Dont internalize peoples negative comments
  • 10) Never forget schizophrenia, bipolar disorder,
    and major depression are organic and genetic
    disorders. The person did nothing to inherit
    them. So, there by the grace of God, go I.

65
Comptom, Michael. T. Kotwicki, Raymond J.
(2007) Responding to individuals with mental
illnesses. Sudbury, Massachusetts Jones and
Bartlett Publishers.  
  • Law enforcement responses to emotional people in
    volatile situations cannot rely on convincing
    people by making a rational proposal to think
    differently. Rather, negotiators need to create
    a stable and respectful environment within which
    emotional individuals can take solace and rest.
    Arguing with a paranoid or aggressive person is
    futile. 

66
Tips From Fred Frese, Ph.D.
  • Remain as calm and respectful as possible.
  • Talk to others.
  • Separate the persons present and talk with them
    individually to determine why one is saying that
    the other has a mental illness.
  • Whether seeing a psychiatrist?
  • Case manager?
  • Ever in a mental health facility?
  • Whether person is taking or has been prescribed
    medication?
  • Ask if the person has any strange or unusual
    beliefs?
  • Psychiatric treatment, medications, beliefs and
    history.

67
  • At some point, the negotiator may want to ask
    what the person is hearing or seeing in doing
    so, remember to be respectful of what the person
    is experiencing.
  • Heightened Sensitivity
  • Persons with schizophrenia typically exhibit a
    heightened sensitivity to stimuli in their
    environment. Person may be easily startled by
    sudden noises, or being overly reactive to sudden
    changes in lighting or quick movements by persons
    or objects in his or her surroundings.
  • Thus, when an officer first encounters a person
    with mental illness, the environment should be
    altered to reduce stimulation. Turn down radios,
    and flashing lights and sirens should be
    minimized.

68
Full Metal Jacket
69
Rain Man
70
Training Video
71
Most People Who Are Mentally Ill Are Not Violent
72
Thought and/or Mood Disorders
  • Psychosis a general term for a state of mind in
    which thinking becomes irrational and/or
    disturbed. It refers primarily to delusions and
    hallucinations.  
  • Hallucination
  • Delusion

73
Command Hallucinations
74
Tony Rolons interaction with Arnold
  • Who was in the attic?
  • Delusion or Hallucination?

75
Patricia Deegan
  • Hearing Disturbing Voices

76
HIPAA
77
Medical Security Program
78
Sam Cochran
  • Specialized Training VS. Services

79
Treatment
  • Cuts drug use in half
  • Reduces crime by 80
  • Reduces arrests by 64
  • Linda Rosenberg,
  • President CEO
  • National Council for Community Behavioral
    Healthcare

80
Opportunity - Annual Costs Per Person Linda
Rosenberg
81
Lord Kelvin
  • When you can measure what you are speaking about,
    and express it in numbers, then you know
    something about it but when you cannot measure
    it, when you cannot express it in numbers, your
    knowledge is of a meager and unsatisfactory kind.

82
Cost Savings
83
Californias AB 2034 Program
84
2007 RAND STUDY Ridgely et al.
  • Allegheny County, PA
  • Total Cost Savings of
  • 9,584.00
  • per participant
  • for a
  • ½ Million Dollar Savings
  • Over 2 Years

85
COLLABORATION (MOUs)
  • Mental Health Courts
  • Intensive Case Management
  • Assertive Community Treatment
  • Re-entry
  • Establishing Best Practices
  • Influencing Policy

86
Crisis in Mandarin Chinese
87
  • A wise man should consider that health is the
    greatest of human blessings, and learn how by his
    own thought to derive benefit from his
    illnesses. -- Hippocrates
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