Transcript 8.Intermediate CIT - TCOLE Course #3841 UNIT SIX

Intermediate CIT
Course TCOLE
Course # 3841
Texas Commission On Law Enforcement
AND
BCCO PCT #4 PowerPoint
UNIT SIX
Through
UNIT EIGHT
Unit Goal: 6.0
Internalize the crisis intervention
skills involved in communicating
with individuals with a mental
illness.
2
6.1 Basic Strategies for
Communicating in Crisis
Situation
1. Stay calm - breathe deeply to
become calmer
2. Be patient - avoid “crowding”
the individual, give them time to
calm down
6.1 Basic Strategies for
Communicating in Crisis Situation
Continued
3. Double-check information by
restating what you hear
4. Use the individual’s name in
talking to them
5. Give instructions or directives
one at a time, and allow time for
the person to comply
6.1 Basic Strategies for
Communicating in Crisis Situation
Continued
6. The size and age of a person with
mental illness has little to do with
whether a back-up officer should
be called
7. Remember that a person
with a mental illness may
exhibit extraordinary strength
6.1 Basic Strategies for
Communicating in Crisis Situation
Continued
8. Engagement is pivotal - keep
trying
9. Don’t underestimate the power
of hallucinations or delusions they are real from the individual’s
point of view and can be very
frightening, so try to be understanding
6.1 Basic Strategies for
Communicating in Crisis Situation
Continued
10. Never argue about a
delusion, since arguing only
solidifies the conviction - simply
accept and move on
6.1 Basic Strategies for
Communicating in Crisis Situation
Continued
11. Ask about treatment in the
past - sometimes that can help with
offering potential solutions to
the current situation
12. Remember that psychiatric
medications have side effects
that make them hard to take
6.1 Basic Strategies for
Communicating in Crisis Situation
Continued
13. Don’t express disapproval
14. Persons in mental health
crisis need more personal space watch for cues
6.2 Four Effective
Communication – Interaction
Skills
1. Safety - Your personal
safety comes first.
a. Control the surroundings.
b. Remove harmful obstacles
from the surroundings.
6.2 Four Effective Communication –
Interaction Skills – Cont’d
2. Crisis facts - The person in
distress is usually excited, alarmed,
or confused.
a. Control is very important to
persons in crisis.
b. When people feel cornered,
which translates to lack of control, they
may respond with sudden
violence.
6.2 Four Effective Communication –
Interaction Skills – Cont’d
3. Language –
a. Use the person’s name.
b. Talk quietly.
c. Speak firmly.
d. Use a calm tone of voice.
e. Avoid direct confrontation.
6.2 Four Effective Communication –
Interaction Skills – Cont’d
3. Language
–
f. Avoid labels and acronyms.
g. Limit the number of instructions,
and give them one at a time.
h. Be patient and consistent.
i. Reactions and verbal responses
may be slower than you expect.
6.2 Four Effective Communication –
Interaction Skills – Cont’d
4. Movements - Be aware of body
movements.
a. People in crisis often need more
physical space.
b. If possible, position yourself at or
below the individual’s eye level.
c. Keep all movements slow and
deliberate.
6.2.a. Nine Helpful Hints
1. Ask the person about available
support,
a. clergy,
b. family,
c. therapist,
d. doctor.
6.2.a. Nine Helpful Hints
Continued
2. Don’t be afraid to reveal your
own emotions, e.g. “Mr. Smith,
you’re making me nervous.”
3. Introduce yourself clearly
6.2.a. Nine Helpful Hints
Continued
4. You may need to re-introduce
yourself, as well.
5. Try to find ways to establish trust.
6. Keep your own emotions under
control.
6.2.a. Nine Helpful Hints
Continued
7. Allow ventilation.
8. Reassure, but be realistic, don’t
lie.
9. Listen actively.
6.3 TOP COPS
Strategies Review
7. Don’t
1. Stay calm
underestimate
2. Avoid crowding
the power of
3. Restate
hallucinations
4. Use persons
or delusions
name
8. Ask about
5. Give instructions
treatment
one at a time
history
6. Engagement is
9. Don’t express
pivotal
disapproval
20
Questions?
UNIT
SIX
DEFINE & PROCESS
Define, List & Explain 6.0: The
Process:
22
Unit Goal: 7.0
The legal process; evaluation
and techniques for appropriateness
of apprehension (arrest) and/or
detention.
Legal
23
7.1. Appropriateness of a
warrantless apprehension
(arrest)
A. “Least restrictive
alternative” is the treatment that:
1. is available
2. provides the consumer with the
greatest possibility of improvement
24
7.1. Appropriateness of a warrantless
apprehension (arrest) – Cont’d
A. “Least restrictive alternative” is the
treatment that:
3. 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
patient poses to himself or others.
7.1. Appropriateness of a
warrantless apprehension
(arrest) – Cont’d
B. References:
1. Reference: Texas Health and
Safety Code, Sec. 571.004
2. Reference: Texas Health and
Safety Code, Sec. 574.103
7.2 Step-By-Step Emergency
Detention Court Order
A. Application for emergency
detention: A statement that the
officer has reason to believe
that the risk of harm is
imminent unless restrained.
7.2 Step-By-Step Emergency
Detention Court Order – Cont’d
A. Application for emergency
detention:
1. This information may be obtained
from a credible party.
2. The officer does not have to
witness the behavior personally.
7.2 Step-By-Step Emergency
Detention Court Order – Cont’d
A. 3. A statement that the officer’s
beliefs are derived from
specific
a. recent behavior,
b. overt acts, attempts or
threats that were observed or
reliably reported
7.2 Step-By-Step Emergency
Detention Court Order – Cont’d
A. 3. A statement that the officer’s
beliefs are derived from specific
d. The individuals name and
relationship to the apprehended
person who reported observing the
behavior.
1.) List who,
2.) what
7.2 Step-By-Step Emergency
Detention Court Order – Cont’d
A. 3. d. The individuals name and
relationship to the apprehended person who
reported observing the behavior.
3.) where,
4.) when,
5.) why, and
6.) how.
7.2 Step-By-Step Emergency
Detention Court Order – Cont’d
B. Emergency Detention Order:
Serves as a magistrate’s order
for emergency apprehension
and detention
1. Is a civil court order issued by a
magistrate
7.2 Step-By-Step Emergency
Detention Court Order – Cont’d
B. Emergency Detention Order:
Serves as a magistrate’s order for emergency
apprehension and detention
2. Provides for emergency
apprehension and transportation
for evaluation (not guaranteed
admission)
7.2 REFERENCE
Reference: Texas Health and
Safety Code, Sec. 573.011
7.3 Criteria for taking
mentally challenged person
into custody for their safety
1. A peace officer, without a
warrant, may take a person into
custody if the officer believes that
the person is mentally ill and that,
because of that mental illness, there
is a substantial risk of serious
harm to the person or
7.3 Criteria for taking mentally
challenged person into custody for
their safety – Continued:
1. Cont’d: or others unless the
person is immediately restrained;
and believes there is not
sufficient time to obtain a
warrant.
7.4 Assessing Justification
Proper Use-Of-Force
1. Keep the situation in
perspective
2. The officer may use force
comparable to any other legal duty
when a person is resisting arrest
3. The force must be reasonable
7.4 Assessing Justification
Proper Use-Of-Force – Cont’d
4. Goal is to obtain care and
treatment for the mentally ill
person
Reference: Texas Penal Code,
Sec.9.51
7.4 Behavior intensity level
indicators of an individual
heading toward violence
A. Agitated Behavior - trying to
keep feelings inside but begin
displaying such behaviors
1.) as pacing,
2.) hand wringing,
3.) hair pulling, etc.
7.4 Behavior intensity level indicators
of an individual heading toward
violence – Continued:
B. Disruptive Behavior - outward
displays of behavior to include
1.) shouting,
2.) swearing, and
3.) refusal to comply with requests
7.4 Behavior intensity level indicators
of an individual heading toward
violence – Continued:
C. Destructive Behavior - begins
to damage items in the environment.
Physical force will probably be
needed to intervene depending on
circumstances
7.4 Behavior intensity level indicators
of an individual heading toward
violence – Continued:
D. Out of Control - individual is a
danger to himself and others.
The individual is out-of-control
psychologically and is being
threatening.
Deadly force may be an option.
7.5 Officer Limitation of
Liability
A. People acting in good faith,
reasonably and without
negligence are not civilly or
criminally liable.
B. Reference: Texas Health and
Safety Code, Sec. 571.019(a)
7.5 Confidentiality
A. Communication between a
patient and a professional,
as well as records of the identity,
1.) diagnosis,
2.) evaluation, or
MEDICAL RECORDS
3.) treatment of a patient that are
created or maintained by a
professional, is confidential.
7.5 Confidentiality –
B.EXCEPTIONS
1. Disclosure to medical or law
enforcement personnel
a.) if there is a probability of
imminent physical injury by the
patient or
b.) others, or
c.) there is a probability of
immediate mental or
d.) emotional injury to the patient
7.5 Confidentiality –
B. EXCEPTIONS - Cont’d:
B. include:
2. When the patient consents
3. To health care personnel of a jail
if it is for the sole purpose of
providing health care
7.5 Confidentiality –
B. EXCEPTIONS - Cont’d:
B. include:
4.“Memorandum of Understanding”
MOU (refer to the definition section
of the IRG)
C. Reference: Texas Health and
Safety Code, Sec. 611.002, 611.004
7.6 Assistance (Back Up)
during approach
A. Size and age of a person with
mental illness has very little to do
with whether a back-up officer
should be called
7.6 Assistance (Back Up)
during approach – Cont’d
B. Like any other person under
stress, a person with a mental
illness may exhibit extraordinary
strength.
1. Persons with a mental illness
may, but not always, be
unpredictable and irrational.
7.6 Assistance (Back Up)
during approach – Cont’d
B. Like any other person under stress,
a person with a mental illness may
exhibit extraordinary strength.
2. Behavior is very individualized.
7.6 Assistance (Back Up)
during approach – Cont’d
C. Request assistance as needed.
Back-up may be needed for the
SAFETY of the officer, the
individual, or others.
D. Contact the local Mental Health
Mental Retardation (MHMR) Center
for assistance, education, and
referrals to appropriate resources
OFFICER SAFETY TIP
Food for thought: “It is
not the size of the dog in
the fight, it is the size of
the fight in the dog that
will make a difference” in
and with your SAFETY
7.7 Bexar County
Constable’s Office PCT#4
Bexar County Constable
Office PCT#4 policies and
procedures and/or Standard
Operating Procedures will be
followed.
Review policy for our office or
refer participant to appropriate
resources.
.
7.8. Appropriate method
of transporting mentally
ill consumer
54
7.8 Determining appropriate
method of transport
A. Follow Bexar County Constable
PCT#4 policy and procedure or SOP
B. Be aware of the distance to an
approved medical facility for
examination or admission
7.8 Determining appropriate
method of transport – Cont’d:
C. Evaluate the behavior or
physical condition of person:
1. Violent
2. Comatose
3. Ambulatory-non-ambulatory
4. Sedated
Questions?
UNIT
SEVEN
DEFINE & PROCESS
Define, List & Explain 7.0: The
Process:
58
TAKE A 15-MINUTE BREAK
Unit Goal: 8.0
The world of the mentally ill
through legal and societal concerns
and perspectives.
60
8.1 homeless mentally ill
A. On any given night approximately
600,000 Americans are homeless,
and more than 2 million people are
homeless throughout the year.
1. According to conservative
estimates, one-third of people who
are homeless have a serious
mental illness,
8.1 homeless mentally ill
person – Continued
A. 2. more than one-half also have
a substance abuse disorder.
(NCH Fact Sheet #5)
8.1 homeless mentally ill
person – Continued
B. Vast increases in homelessness
seem to have occurred in the 1980s
when incomes and housing options
for lower incomes became an issue.
1. Today however, a new wave of
homeless mentally ill persons
has emerged due to;
8.1 homeless mentally ill
person – Continued
1.a. combined with denial of services
due to funding cuts, and premature
discharge due to managed care.
1.b. Homeless persons with mental
disorders remain homeless longer
due to isolation from family and
friends
8.1 homeless mentally ill
person – Continued
1.c. barriers to employment or
1.d. low income status,
1.e. poor physical health and
1.f. more contact with the
legal system.
8.2 Mentally ill individual
as a victim of crime
“People with mental illness are
more likely to be
victims than
perpetrators
of violence”
* National Institute of Justice, 1996
8.2 Mentally ill individual
as a victim of crime –Cont’d
Why then is … thirteen times
more research compiled
concerning the mentally ill as
perpetrators of violent acts
rather than as victims of
violent acts?
(see the Archives of General Psychiatry,
August 2005)
8.2 Mentally ill Statistics:
A. 4-13% are perpetrators of
crime
B. They are 140 times more likely to
be victim of theft
C. 3 million are estimated to be
victimized each year
8.2 Mentally ill Statistics
Continued:
D. In a year, more than one-quarter
of mentally ill persons say they
are victimized
E. There is an 11-times-higher risk
for them than for the general
population
8.2 Mentally ill individual
as a victim of crime –Cont’d
The public tends to be surprised by
these findings, due to the
stereotype that people with a
mental illness are dangerous.
Violence among this population is
caused by many of the same factors
that produce violence in the rest of
us.
8.2 Mentally ill individual
as a victim of crime –Cont’d
People become violent when they
feel threatened,
when they feel out of control, or
with the excessive usage of mindaltering substances.
“We don’t think about their
vulnerability to victimization.”
- Alison McCook, Reuters Health
8.2 Mentally ill individual
as a victim of crime –Cont’d
People with mental illness are
more vulnerable to crime than
others.
They often live in poor communities,
areas with higher crime rates.
8.2 Mentally ill individual
as a victim of crime –Cont’d
They can be unable to make safe
decisions, such as avoiding an
empty, dark street.
- North Western University
8.2 Mentally ill individual
as a victim of crime –Cont’d
The effect of crime is also more
destabilizing with a person with
mental illness.
Dr. Linda A. Teplin
8.2 Tips for responding to
a victim's needs:
Victim’s Need to Feel Safe –
people feel helpless,
vulnerable and
afraid by the trauma of their
victimization.
8.2 Tips for responding to
a victim's needs – Cont’d:
B. As a law enforcement
officer, you are usually the first to
approach the victim –
how the officer responds to the
victim is very important
8.2 Tips for responding to
a victim's needs – Cont’d:
C. Victim’s Need to Express His/her
Emotions - victims need to air their
emotions and tell their story after
the trauma of a crime, and they
need to have their feelings
accepted and their story heard nonjudgmentally
8.2 Tips for responding to
a victim's needs – Cont’d:
D Victim’s Need to Know What
Comes Next - the officer can help
relieve some of the anxiety by
telling victims what to expect in the
aftermath of the crime, which will
help prepare them for the upcoming
investigation process
8.2 Mentally ill Crime
Victims
A. Children with mental illness
may be molested or abused.
B. They are often unable to identify
the suspect.
8.2 Mentally ill Crime Victims –
Cont’d
C. Adults with a mental illness
may be easily robbed or become a
victim of a con artist.
D. A person with a mental illness
has the same chance of being
victimized as the general public,
but they reportedly have less chance
of a successful prosecution.
8.2 Mentally ill Crime Victims –
Cont’d
E. Mentally retarded victims of
crime will need special consideration
upon approach
F. This population may not even
know they have been victimized,
due to their naiveté and lack of ability
to discriminate between good and
bad social situations
8.2 Mentally ill Crime Victims –
Cont’d
G. Mentally retarded victims
are also easily fooled and become
easily vulnerable.
H. These victims, just as with
mentally ill victims, will need to be
treated with extreme patience and
respect.
8.3 Societal & Stigma
Discrimination towards
Mentally ill
A. Stigma is a mark of disgrace or
shame. It is made up of various
components, including:
1. Labeling someone with a
condition
2. Stereotyping people with that
condition
8.3 Societal & Stigma
Discrimination towards
Mentally ill – Continued
A. Stigma :
3. Creating a division (i.e., a
superior “us” and a denigrated
“them” )
4. Discriminating against
someone on the basis of their label
8.3 Societal & Stigma
Discrimination towards
Mentally ill - Continued
B. Stigmas encourage inaccurate
perceptions.
1. The term
mental illness
in itself alludes to
false information
8.3 Societal & Stigma
Discrimination towards
Mentally ill – Continued
B. Stigmas encourage inaccurate
perceptions.
2.“Mental” suggests an
illegitimate medical condition that
is “all in your head,” and therefore a
sign of weakness.
8.3 Societal & Stigma
Discrimination towards
Mentally ill – Continued
B. Stigmas encourage inaccurate
perceptions.
3. The term “mental” suggests a
separation from a physical
illness, when in fact they are
entwined
8.3 Societal & Stigma
Discrimination towards Mentally
ill – Continued
B. Stigmas encourage inaccurate
perceptions.
4. Studies reported at
MayoClinic.com show that there is in
fact a physical change in the
brain associated with mental
illness, suggesting that a biological
basis exists.
8.3 Societal & Stigma
Discrimination towards Mentally
ill – Continued
C. It is also a common stereotype
that persons with a mental
illness are dangerous and
unpredictable,
although statistics do
not substantiate this
idea (concept)
8.3 Societal & Stigma
Discrimination towards Mentally
ill – Continued
C. 1. It continues to be believed that
they are somehow less competent,
that they are not able
to work, and that they
need to be
institutionalized to
“get better.”
8.3 Societal & Stigma Discrimination
towards Mentally ill – Continued
D. These stigmas perpetuate a
negative portrayal of people with
mental illness that
1.) fuels fear and
2.) mistrust and
3.) reinforces distorted
perceptions, leading to further
stigma
8.3 Societal & Stigma
Discrimination towards Mentally
ill – Continued
D. 1. It can lead to devastating
consequences. Some people
refuse treatment for fear of
being “labeled.”
D.2. The stigma can lead to social
distancing due to shame and
embarrassment
8.3 Societal & Stigma
Discrimination towards Mentally
ill – Continued
D.3. Discrimination in the
workplace reportedly continues,
even with the American with
Disabilities Act in place.
D.4. Victims may lose jobs through
the stress of coworker gossip and
lack of promotion.
8.3 Societal & Stigma
Discrimination towards Mentally
ill – Continued
D.5. The stigma even extends to
the medical community, where
health insurance coverage is
more limited for mental
illnesses than for physical
illnesses.
8.3 Societal & Stigma
Discrimination towards Mentally
ill – Continued
E. Dispelling prominent myths
regarding mental illness can
reduce undeserved stigma.
8.3 Societal & Stigma Discrimination
towards Mentally ill – Continued
F. Consider the following:
Myth: Mental illness does not affect
the average person.
Reality: No one is immune to
mental illness. More hospital beds are
filled by individuals with mental
illness than those with cancer,
heart, and lung disease combined.
8.3 Societal & Stigma Discrimination
towards Mentally ill – Continued
F. Consider the following:
Myth: Mental illness is an indication
of a weakness of character.
Reality: A combination of factors
contributes to mental illness, including
malfunction of neurotransmitters,
heredity, stress, and recreational drug
usage.
8.3 Societal & Stigma Discrimination
towards Mentally ill – Continued
F. Consider the following:
Myth: A person with a mental
illness is also mentally
retarded.
Reality: There are some persons
with a dual diagnosis, but the
conditions are fundamentally
different.
8.3 Societal & Stigma Discrimination
towards Mentally ill – Continued
F. Consider the following:
Myth: If you have a mental
illness, you are “crazy” all the time.
Reality: Mental illness is often
temporary. People suffering from
even the most severe mental illness
are in touch with reality as often as
they are actively psychotic.
8.3 Societal & Stigma Discrimination
towards Mentally ill – Continued
F. Consider the following:
Myth: If people with other
disabilities can cope on their own,
people with mental illness should
be able to do so as well.
Reality: Most people who have a
disabling illness need help to return
to normal functioning.
8.3 Societal & Stigma Discrimination
towards Mentally ill – Continued
F. Consider the following:
Reality: fills this role for a physical
illness just as therapeutic
rehabilitation is needed for mental
illness.
8.3 Societal & Stigma Discrimination
towards Mentally ill – Continued
F. Consider the following:
Myth: Most people who struggle
with mental illness live on the
streets or are in mental
hospitals.
Reality: About two-thirds of
Americans who have a mental
illness live in community settings.
8.4 Legal & Social
Concerns Mental Health
Consumer’s
Guest Speaker: a mental health consumer
to speak to the officers about their
experiences with the legal and mental
health systems. The goal of this section is
to sensitize the officer to the lives, feelings,
and thoughts of a person with a mental
illness and their perspective on
communication with law enforcement.
8.5 Family member
perspective on mental
illness.
Guest Speaker: family member
perspective on mental illness.
Questions?
UNIT
EIGHT
DEFINE & PROCESS
Define, List & Explain 8.0: The
Process:
106
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”
TAKE A 15-MINUTE BREAK