Transcript UNIT EIGHT Participant Handout

Intermediate CIT
Course TCOLE Course # 3841
Texas Commission On Law Enforcement
PARTICIPANT HANDOUT
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. ______ ______ - breathe deeply to
become calmer
2. Be _________ - avoid “crowding”
the individual, give them time to
calm down
6.1 Basic Strategies for
Communicating in Crisis Situation
Continued
3. ________-_________ information by
restating what you hear
4. Use the individual’s ___________ in
talking to them
5. Give __________ or _________ one
at a time, and allow time for the
person to comply
6.1 Basic Strategies for
Communicating in Crisis Situation
Continued
6. The _______ and _____ 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 _________________ strength
6.1 Basic Strategies for
Communicating in Crisis Situation
Continued
8. __________ is pivotal - keep trying
9. Don’t _____________ 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 ______________ 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 ______________ in the
past - sometimes that can help with
offering potential solutions to
the current situation
12. Remember that ______________
medications have side effects
that make them hard to take
6.1 Basic Strategies for
Communicating in Crisis Situation
Continued
13. Don’t __________ disapproval
14. Persons in mental health
crisis need more personal _______ watch for cues
6.2 Four Effective
Communication – Interaction
Skills
1. _________ - Your personal
safety comes first.
a. ____________ the surroundings.
b. ________ harmful obstacles
from the surroundings.
6.2 Four Effective Communication –
Interaction Skills – Cont’d
2. ________ - The person in distress
is usually excited, alarmed, or
confused.
a. _____________ is very important to
persons in crisis.
b. When people feel _________, which
translates to lack of control, they may
respond with sudden violence.
6.2 Four Effective Communication –
Interaction Skills – Cont’d
3. ______________ –
a. Use the person’s ____________.
b. Talk ______________.
c. Speak ______________.
d. Use a calm tone of ___________.
e. Avoid direct __________________.
6.2 Four Effective Communication –
Interaction Skills – Cont’d
3. Language
–
f. Avoid ______ and _____________.
g. Limit the number of _____________,
and give them one at a time.
h. Be _______ and ______________.
i. Reactions and verbal ___________
may be slower than you expect.
6.2 Four Effective Communication –
Interaction Skills – Cont’d
4. _____________ - Be aware of body
movements.
a. People in crisis often need more
____________ space.
b. If possible, _____________ yourself
at or below the individual’s eye level.
c. Keep all _______________ slow and
deliberate.
6.2.a. Nine Helpful Hints
1. Ask the person about available
support,
a. _________,
b. ________,
c. _______________,
d. ____________.
6.2.a. Nine Helpful Hints
Continued
2. Don’t be __________ to reveal your
own emotions, e.g. “Mr. Smith,
you’re making me nervous.”
3. ________________ yourself clearly
6.2.a. Nine Helpful Hints
Continued
4. You may need to re-____________
yourself, as well.
5. Try to find ways to establish _____.
6. Keep your own ___________ under
control.
6.2.a. Nine Helpful Hints
Continued
7. Allow ______________.
8. _________, but be realistic, don’t
lie.
9. ____________ actively.
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
19
DEFINE & PROCESS
List & Explain 6.1: The basic strategies that are
necessary when communicating in crisis
situations.
Process:
20
DEFINE & PROCESS
List & Explain 6.2: Four effective
communication interaction skills used when
dealing with persons with a mental illness
Process:
21
DEFINE & PROCESS
List & Explain 6.3: The knowledge obtained in
coursework to class exercises and scenarios
for role play
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 ____________
2. provides the consumer with the
greatest possibility of ______________
24
7.1. Appropriateness of a warrantless
apprehension (arrest) – Cont’d
A. “Least restrictive alternative” is the
treatment that:
3. is no more ___________________ 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 ____________ 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 _____________ party.
2. The officer does not have to
__________ 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 ____________,
b. overt acts, attempts or
threats that were ______________ 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
________________ to the apprehended
person who reported observing the
behavior.
1.) List _______,
2.) ________
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.) __________,
4.) __________,
5.) __________, and
6.) __________.
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 ________ 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
____________ and ________________ 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
____________, 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 __________;
and believes there is not
sufficient time to obtain a
warrant.
7.4 Assessing Justification
Proper Use-Of-Force
1. Keep the situation in
________________
2. The officer may use force
_____________ to any other legal duty
when a person is resisting arrest
3. The force must be _____________
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 __________,
2.) hand __________,
3.) _______ 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.) ________________,
2.) ________________, and
3.) refusal to ________ with requests
7.4 Behavior intensity level indicators
of an individual heading toward
violence – Continued:
C. Destructive Behavior - begins
to ________ 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,
__________________ 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
____________ and a _______________,
as well as records of the identity,
1.) _______________,
2.) _____________, or
MEDICAL RECORDS
3.) _____________ of a patient that are
created or maintained by a
professional, is confidential.
7.5 Confidentiality –
B.EXCEPTIONS
1. _____________ 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 __________
3. To health care personnel of a jail
if it is for the __________ 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 __________
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
__________.
1. Persons with a mental illness
may, but not always, be ____________
and _______________.
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 ___________.
2. ___________ is very individualized.
7.6 Assistance (Back Up)
during approach – Cont’d
C. Request ____________ 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 ________________
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. __________
2. __________
3. ______________-non-ambulatory
4. __________
DEFINE & PROCESS
List & Explain 7.1: The process in evaluating
the appropriateness of a warrantless
apprehension.
Process:
57
DEFINE & PROCESS
List & Explain 7.2: The step by step process for
obtaining an emergency detention order.
Process:
58
DEFINE & PROCESS
List & Explain 7.3: 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
Process:
59
DEFINE & PROCESS
List & Explain 7.4: The Propose justifications in
assessing proper use of force option
Process:
60
DEFINE & PROCESS
List & Explain 7.5: Officer’s limitation of
liability
Process:
61
DEFINE & PROCESS
List & Explain 7.6: The factors to be considered
in determining whether assistance should be
requested during approach
Process:
62
DEFINE & PROCESS
List & Explain 7.7: Agency SOP in requesting
assistance
Process:
63
DEFINE & PROCESS
List & Explain 7.8: The factors considered in
determining appropriate method of
transporting consumer.
Process:
64
Unit Goal: 8.0
The world of the mentally ill
through legal and societal concerns
and perspectives.
65
8.1 homeless mentally ill
A. On any given night approximately
600,000 Americans are __________,
and more than 2 million people are
homeless throughout the year.
1. According to conservative
estimates, ____- _______ of people
who are homeless have a serious
mental illness,
8.1 homeless mentally ill
person – Continued
A. 2. more than ____- _____ 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 ____________and ____________
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 ________ cuts, and premature
discharge due to managed care.
1.b. Homeless persons with mental
disorders remain homeless longer
due to ____________ from family and
friends
8.1 homeless mentally ill
person – Continued
1.c. __________ to employment or
1.d. low ______ status,
1.e. poor physical __________ and
1.f. more contact with the
________ system.
8.2 Mentally ill individual
as a victim of crime
“People with mental illness are
more likely to be
_____________
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
_________________ of violent acts
rather than as _______________of
violent acts?
(see the Archives of General Psychiatry,
August 2005)
8.2 Mentally ill Statistics:
A. 4-13% are _____________ of crime
B. They are 140 times more likely to
be victim of ________
C. 3 million are estimated to be
______________ 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 ____-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 ___________
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 _________ when they
feel threatened,
when they _______ out of control, or
with the excessive _______________ of
mind-altering 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 __________ 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
____________, 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
_________________ 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 _________ –
people feel _________,
________________ and
____________ 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
______________ 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
___________ - 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 _________ 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. __________ 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. _____ 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
______________ 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 ________ consideration
upon approach
F. This _________ 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 ________ and become
easily vulnerable.
H. These victims, just as with
mentally ill victims, will need to be
________ with extreme patience and
respect.
8.3 Societal & Stigma
Discrimination towards
Mentally ill
A. ________ is a mark of disgrace or
shame. It is made up of various
components, including:
1. ________ someone with a condition
2. ________________ people with that
condition
8.3 Societal & Stigma
Discrimination towards
Mentally ill – Continued
A. Stigma :
3. Creating a ______________ (i.e., a
superior “us” and a denigrated
“them” )
4. Discriminating against
someone on the basis of their ______
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
___________________ 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
______________ 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. ______________ 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 ___________
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.) __________ fear and
2.) mistrust and
3.) _________________ 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 “____________.”
D.2. The stigma can lead to social
_______________ due to shame and
embarrassment
8.3 Societal & Stigma
Discrimination towards Mentally
ill – Continued
D.3. Discrimination in the
_____________ reportedly continues,
even with the American with
Disabilities Act in place.
D.4. Victims may lose jobs through
the stress of coworker ________ and
lack of promotion.
8.3 Societal & Stigma
Discrimination towards Mentally
ill – Continued
D.5. The stigma even extends to
the ____________ 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. ___________ 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 _______ 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 ____________ of character.
Reality: A combination of _________
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 _______ ____________, 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 “______” 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 _________
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 __________________
rehabilitation is needed for mental
illness.
8.3 Societal & Stigma Discrimination
towards Mentally ill – Continued
F. Consider the following:
Myth: Most people who ___________
with mental illness live on the
streets or are in mental
hospitals.
Reality: About ____-_________ of
Americans who have a mental
illness live in community settings.
8.4 Legal & Social
Concerns Mental Health
Consumer’s VIDEO
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.
VIDEO.
Questions?
DEFINE & PROCESS
List & Explain 8.1: The mentally ill person in
the situation of being homeless
Process:
111
DEFINE & PROCESS
List & Explain 8.2: The mentally ill individual as
a victim of crime
Process:
112
DEFINE & PROCESS
List & Explain 8.3: The stigma and societal
discrimination that exists toward persons who
are mentally ill.
Process:
113
DEFINE & PROCESS
List & Explain 8.4: The legal and societal
concerns from a mental health consumer’s
vantage point.
Process:
114
DEFINE & PROCESS
List & Explain 8.5: The family member
perspective on mental illness.
Process:
115
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