Crisis Intervention Training (CIT)
Talk to your EMS crews, see what they have done in the past, how they would like to do things, or if they have any specially trained MCOT (____________).
(Mobile crisis outreach teams)
Substance Abuse Disorders:
-"The essential feature of a substance use disorder is a cluster of mental, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems" (DSM-V, 2015). -Individuals often begin abusing substances as a form of self-medication to treat some of the symptoms previously discussed, such as depression, insomnia, or anxiety. -Prolonged abuse of any drug (alcohol, dangerous drug, controlled substance, or other substance) may cause chemical dependency or addiction. These chemicals influence consciousness, brain, and body functions. If used long enough or in large dosages, they may cause permanent damage to the central nervous system. This can create a wide range of psychological reactions that can be classified as disorders.
Possible interactions with Law Enforcement (Alzheimer's): Indecent Exposure
-A person with AD may forget social norms and have diminished impulse control. -It is common for a person with AD to leave the house without proper attire, or to undress in public.
Possible interactions with Law Enforcement (Alzheimer's): False reports & victimization
-A person with AD may lose or misplace items and call 911 to report a theft. -In some cases, reports of a burglary-in-progress or intruder, turns out to be a family member, a delivery person, a home health aide, or even a spouse.
Paranoid Personality Disorder:
-A pervasive distrust and suspiciousness of others. -Tendency to interpret the actions of others as deliberately threatening or demeaning. -Believes (without basis) that others are exploiting, harming, or deceiving him/her. -Reluctant to confide in others for fear of betrayal. -Perceives attacks on his/her character and is quick to react angrily. -May initially appear objective, rational, and unemotional but may quickly devolve into combativeness, stubbornness, and sarcasm. -Have a high need for control and autonomy, due to their lack of trust. -Tend to be rigid, critical, and cannot accept criticism.
Borderline Personality Disorder:
-A pervasive pattern of instability of interpersonal relationships, self-image, emotional expression, and poor impulse control. -May exhibit frantic efforts to avoid abandonment. A pattern of unstable relationships marked by idealizing and devaluing partners. Self-damaging impulsivity (excessive spending, promiscuous unprotected sex, substance abuse, other recklessness). -Recurrent suicidal behavior. -Poor anger control. -Emotional over-reactivity. -More frequently diagnosed in females. -It is a common misunderstanding that 'Borderline Personality Disorder' is a designation meaning someone almost experiencing another kind of mental illness. -Such as; 'borderline schizophrenia,' or a 'borderline substance abuser.' This is simply a mistake of language.
How can fractured rapport be repaired?
-Acknowledging what went wrong, and taking responsibility for one's part in the dissolution -Apologizing -Expressing sincerity -Taking corrective action
Communication considerations for someone with Intellectual Disability: Social Behavior
-Adult associating with children or early adolescents. -Ignorance of personal space. -Non-age appropriate behavior
Communication considerations for someone with Intellectual Disability: Performance Tasks that can be utilized to help determine if a ID problem exists
-Ask them to read or write a simple statement. -Give directions to their home. -Tell time. -Count to 100 by multiples of five. -Define abstract terms (such as emotions or feeling terms). -Explain how to make change from a dollar.
Cognitive disorders consist of significant cognitive decline in one or more areas:
-Attention: ability to sustain attention to a task; ability to pay attention to something despite other distractions; ability to do two things at once. -Executive function (judgment/decision making): impaired ability to plan, make decisions, hold information briefly in one's mind (a telephone number), ability to learn from mistakes. -Learning and memory: ability to repeat words or digits; ability to recall recent information; ability to apply information. -Language: ability to find the correct labels or words for an object or situation; misuse of names, verbs, or other word choices; comprehension. -Perceptual-motor: eye-hand/body coordination. -Social awareness: identification in changes in others' facial expression; emotional intelligence.
Communication considerations for someone with Intellectual Disability: Questioning methods
-Be patient for a reply. -Repeat question as needed. -Ask short, simple questions using simple language. -Speak slowly. -Ask open-ended (but uncomplicated) rather than "yes/no" questions.
Bipolar Disorder:
-Bipolar disorder is a mental illness involving cycles between extreme activity and emotional highs (mania) and depression (see above). The strongest predictors of bipolar syndrome appear to be baseline anxiety/depression which increases the risk of bipolar disorder from 2% (baseline risk due to family history) to 49% (Bernstein, 2017). -20% of adults with bipolar disorder had symptoms beginning in adolescence (Bernstein, 2017). -The lifetime prevalence rate is approximately 4% of the U.S. population will experience a bipolar episode within their lifetime (MHA, 2017). -More commonly diagnosed in women than men. -Average age of onset is approximately 25. -Suicide risk is 15 times higher than the general population. -Outcome studies show that compared with unipolar depression, bipolar disorder causes more work disability and overall poorer outcome (Bernstein, 2017). -Impulsivity is usually the reason for law enforcement interaction, which results from exhibitionism, shop-lifting, substance abuse, or other illegal activities. -People usually only seek professional assistance during the depressive phase, as the manic phase is reportedly very pleasant, energetic, and creative.
Central Nervous System (CNS) Depressants:
-CNS depressants slow down the operations of the brain and the body. -Examples of CNS depressants include alcohol, barbiturates, Clonopin, Cymbalta, Dilantin, Elavil, GHB (Gama hydroxybutryrate), Haldol, Lexapro, Paxil, Risperidal, Rohypnol, Seroquil, Serzone, Tegretol, Valium, Xanax and Zyprexa. -Some indications of depressant ingestion include: Incoordination, disorientation, sluggishness, thick or slurred speech, 'drunk' behavior, stumbling, and fumbling (MN DPS, 2017). -Methods of administration include oral ingestion and occasionally injection. -Overdose signs are shallow breathing, cold skin, dilated pupils, rapid weak pulse, or coma.
Anti-LEAPS phrases
-Calm down. -What's your problem? -You people... -Come over here. -I'm not going to tell you again... -Because these are the rules. -Because I said so.
Cannabis:
-Cannabis is the scientific name for marijuana. The active ingredient in cannabis is delta-9-tetrahydrocannabinol, or THC. -This category includes cannabinoids and synthetics like K2, Spice, Yucatan Fire, JWH, RCH, UR-114 and XLR-11. -Some indications of Cannabis ingestion include: body tremors, disoriented debris in mouth, eyelid tremors, Impaired perception of time & distance, increased appetite, marked reddening of conjunctiva, odor of burnt marijuana, possible paranoia, and relaxed inhibitions. -Methods of administration include ingestion and smoking. -There is no known overdose level for Cannabis. -CBD oil - While some companies produce CBD oil that's completely THC-free, others formulate products that contain a slight amount of THC. But often, these products only carry roughly 0.5% THC or less.
Examples of Crimes of which people with mental illness are commonly victims:
-Children with mental illness may be more vulnerable to molestation or abuse. -Their report may be less likely deemed valid or reliable by authority figures. -These victims may have greater difficulty identifying a behavior as abusive. -These victims may have difficulty identifying the perpetrator. -These victims may not have the ability to provide enough qualitative evidence (report) leading to a conviction. -Adults with a mental illness, may be easily robbed or become a victim of a con artist.
Types of traumatic events that can cause PTSD include:
-Combat and other military experiences -Sexual or physical assault -Learning about the violent or accidental death or injury of a loved one -Child sexual or physical abuse -Serious accidents -Natural disasters -Terrorist attacks
Jail Diversion Goals:
-Decriminalization of persons with mental illness -Increased public safety -Reduction of inappropriate incarceration of persons with mental illness -Reduce violence and victimization -Costs incurred by taxpayers when a person with mental illness is arrested, incarcerated, and/or hospitalized are decreased -Lower recidivism rates among people with mental illness
Possible interactions with Law Enforcement (Alzheimer's): Car accidents & erratic driving
-Due to confusion, diminished physical abilities, and/or memory impairment a person with AD may fail to obey street signs or traffic laws and may flee the scene. -Person with AD may drive similarly to someone under the influence, yet when an officer discerns no presence of alcohol or other substances, dementia (or AD) may be the cause.
The concept of "normalcy" is based upon what is accepted in a society or culture. "Norms" are based upon numerous variables:
-Ethnicity -Religion -Occupation -Social group -Developmental level -Education
Hallucinogens:
-Examples include Ayahuasca, DMT, LSD, peyote, psilocybin. MDMA, Molly, or Ecstasy are overlap drugs, and can cause hallucinations, but act more like stimulants in the body. -Some indications of Hallucinogen ingestion include: body tremors, dazed appearance, difficulty with speech, disoriented, hallucinations, memory loss, nausea, paranoia, perspiring, poor perception of time and distance, synesthesia, uncoordinated. -Methods of administration include ingestion, insufflation, smoking, injection, and eye drops. -There is no known threshold for hallucinogen overdose. However, for MDMA overdose the symptoms are the same as stimulant overdose.
Central Nervous System (CNS) Stimulants:
-Examples of CNS stimulants include Adderall, amphetamines, cocaine, 'crack' cocaine, ephedrine, khat, methamphetamine (crank, meth), phentermine, Sudafed, and Vyvanse. -Some indications of stimulant ingestion include: anxiety, body tremors, dry mouth, euphoria, exaggerated reflexes, excited, eyelid tremors. grinding teeth (also called bruxism), increased alertness, insomnia, irritability, redness to nasal area, restlessness, runny nose, talkative. -Methods of administration include insufflation, smoking, injection, and oral ingestion. -Overdose signs are agitation, increased body temperature, hallucinations, and seizures.
Inhalants:
-Examples of inhalants include Toluene, plastic cement, Dust off (canned air), paint, gasoline, paint thinners, hair sprays, and various anesthetic gases (like 'whip-its' or nitrous oxide). -Some indications of Inhalant ingestion include: -Bloodshot, watery eyes, confusion, disoriented, flushed face, intense headaches, lack of muscle control, noncommunicative, odor of substance, possible nausea, residue of substance, slow, thick, slurred speech. -The method of administration is inhalation. -Overdose indications are seizures and coma.
Narcotic analgesics:
-Examples of narcotic analgesics include opium, codeine, heroin, Demerol, Dilaudid, morphine, Methadone, Suboxone, Subutex, Vicodin, and Oxycontin. -Some indications of Narcotic Analgesics include: depressed reflexes, drowsiness droopy eyelids (also known as ptosis), dry mouth, euphoria, facial itching, nausea, puncture marks, slow, low, raspy speech, slowed breathing. -Methods of administration include injection, ingestion, smoking, and insufflation. -Overdose indications are slow, shallow breathing, clammy skin, seizures, and coma.
Pro-LEAPS phrases
-Excuse me sir, can I speak with you? -I am _____, what would you like me to call you? -For your safety and mine... -Could I ask you...? -Would you assist me...? -What's wrong? -What can I do to help?
External factors that can contribute to a situation escalating into a crisis include:
-Expectations the person cannot meet -Lacking a sufficient support system or being disconnected from sources of support -Substance Abuse
Determining appropriate way of transport:
-Follow departmental policy and procedure -Be aware of the distance to an approved medical facility for examination or admission Evaluate the behavior or physical condition of person: 1. Violent 2. Ambulatory-non-ambulatory 3. Comatose 5. Sedated
Tactics for gaining trust and building rapport:
-Honesty and sincerity are essential for rapport and trust. -Individuals suffering from mental health issues can be very attuned to nuances of communication (dismissiveness, ulterior motives, condescension, non-verbal cues, labeling). -Use the person's name (the name that they prefer to be called). -Be patient and try to match their conversational speed. -Maintain a calm tone of voice. -Do not minimize or discount the subject's point of view.
An officer who takes a person into custody under Emergency Detention Order - TX Health and Safety Code Section 573.002 SHALL:
-Immediately transport person to the nearest appropriate inpatient mental health facility, or -A MH facility deemed suitable by local mental health authority, if an inpatient facility is not available.
Treatment compliance is an ongoing struggle for many individuals, for reasons including:
-Lack of health insurance coverage -Expense of medications -Unpleasant side effects, including weight gain (sometimes extreme), severe constipation, sexual dysfunction, or a feeling of being dissociated, floaty, or out of sync with their body. -Many of the side effects are not permanent
What can fracture rapport?
-Making judgments -Dishonesty -Failure to follow through on one's end of an agreement -Aggression -Tone of voice (dismissive, condescending, insincere) -Exhibiting disinterest -Labeling -Patronizing/condescending
The severity of Traumatic Brain Injury ranges from:
-Mild 75% -Moderate 22% -Severe 3%
Information about drug- and alcohol-related disorders
-National Institute on Drug Abuse (NIDA) -National Institute on Alcohol Abuse and Alcoholism (NIAAA) -Substance Abuse and Mental Health Services Administration (SAMHSA)
Communication considerations for someone with Intellectual Disability: Speech/Language
-Obvious speech defects. -Limited ability to speak or comprehend at age-normative level. -Marked difficulty maintaining attention or conversation. -Difficulty describing facts in detail.
Dissociative Anesthetics:
-PCP, its analogs, ketamine, flecainide, are examples of dissociative anesthetics. -Some indications of Dissociative Anesthetics are: blank stare, confused, chemical odor, cyclic behavior, difficulty w/speech, disoriented, early HGN onset, hallucinations, incomplete verbal responses, increased pain threshold, non-communicative, perspiring, possibly violent, sensory distortions, slow or slurred speech. -Methods of administration include smoking, ingestion, injection, or eye drops. -There is no known threshold for overdose on Dissociative Anesthetics, however delusions can be so strong as to create suicidal behavior. Body temperature can become high enough to be deadly. Often the state known as 'excited delirium' is created by this type of drug, a combination of drugs, or the synergy between drugs and mental health problems.
Narcissistic Personality Disorder:
-Persistent grandiosity, need for admiration, and lack of empathy. -Exaggerates achievements, talents. -Expects to be recognized as superior. -Believes s/he is 'special' and should be treated accordingly (entitlement) -Exploits others. -Often believes oneself to have special powers or to be the chosen leader of the world or universe. -Demonstrates arrogant, haughty, or judgmental behaviors/attitudes. -More frequently diagnosed in males.
Common Symptoms of Depression may include:
-Prolonged feelings of hopelessness, helplessness, or excessive guilt. -Loss of interest in usual activities. -Difficulty concentrating or making decisions. -Low energy or fatigue. -An inability to enjoy usually pleasurable activities. -Appetite change (over or under-eating) resulting in weight loss or gain. -Changes in sleeping habits (sleeping more or less; an inability to fall asleep, or waking up early in the morning and not being able to go back to sleep).
Depressive phase may include:
-Prolonged feelings of sadness or hopelessness -Feelings of guilt and worthlessness -Difficulty concentrating or deciding -Lack of interest -Low energy -Changes in activity level -Inability to enjoy usual activities -Fatigue -May include: Abnormally high, expansive, joyful, angry, or irritated mood. Inflated self-esteem. Decreased need for sleep. More talkative than usual. Flight of ideas or feeling of thoughts racing. Excessive risk-taking.
Medication can be an essential part of an effective treatment plan and is often used to treat some of the following conditions and symptoms:
-Psychosis -Anxiety -Depression -ADHD -Impulse control -Mood swings (also known as lability)
Additional symptoms of a thought disorder:
-Reduction in emotional expressiveness. No change in emotional expression despite environment, conversation, or activity. -Nonsense speech or rambling narratives (often referred to as 'word salad.') -Confusion. -Limited ability to follow instructions. -Decreased comprehension and ability to express thoughts, intentions, or experiences. -Disheveled appearance; a person may be malodorous; may have many layers of clothes on; dressed inappropriately for the season. -Appears to be responding to stimuli not evident to the observer (listening to something the observer cannot hear; talking to someone the observer cannot see). -Poor impulse control.
Texas State Bill 1849 (Senator Whitmire)
-Sandra Bland Act -Law enforcement officers are required to learn de-escalation techniques to reduce the use of force. -"Each law enforcement agency shall make a good faith effort to divert person suffering from mental health crisis or substance abuse to proper treatment." -Establishes an easier process by which people with mental illness and/or intellectual disability can receive personal bond
Communication considerations effective in talking to someone with Alzheimer's:
-Speak clearly and concisely; resist the urge to speak loudly. -Due to potential difficulty with language comprehension, consider using 'yes' or 'no' questions. -If the person appears to have difficulty with verbal comprehension, you may try using nonverbal prompt and/or written prompts. -Be patient if the subject does not immediately follow requests or commands and/or if the subject is having difficulty communicating him/herself. The subject is likely not being intentionally resistive but is likely to be acting out of fear, confusion, and may have some delusional thought processes. -Provide reassurance of the person's safety. -Check for an identification bracelet, pendant, key chain, wallet card, or clothing number that may have the person's Safe Return ID number and emergency contact.
Communication considerations for someone with Intellectual Disability: Criminal Activity
-Subject may likely be noticeably older than others involved in offense. -Apparent the subject is a follower rather than leader of criminal activity. -May readily confess, due to lack of full understanding of the circumstances. -Behavior at the scene (remained at the scene while others ran) -May have been used as a pawn by more sophisticated offenders
Depression:
-There are two common forms of depression: one is -Major Depression Disorder, and the other is Dysthymia. -Major depressive disorder (MDD) is not just feeling sad or "blue." This is an intense level of depression that persists for at least two weeks. -Dysthymia is a mild or moderate level of depression that persists for at least two years. -Depression is one of the most common mental disorders in the U.S. (NIMH.nih.gov) -"In 2015 an estimated 16.1 million American adults had at least one major depressive episode." (NIMH, 2017) -Nearly twice as many women as men suffer major depressive episodes. -Average age of onset is mid-twenties, but depressive episodes can start much earlier. -Most people have experienced some form of depression in their lifetime or had repeated bouts with depression. -Depression is a natural reaction to trauma, loss, death, or change
Reflecting Statements:
-These are neutral responses to statements made by the subject to encourage him/her to continue talking. -Reflecting statements are intended to encourage communication. -They can be verbal, or non-verbal such as nodding, leaning in, and making eye contact. -Examples include: 'I see...' 'Tell me more about that'; 'That might be an option'; 'What other options can we consider?'
Antisocial Personality Disorder:
-This use of the term 'antisocial' is not akin to the societal use of the word to describe someone who does not want or enjoy being social. -Pervasive pattern of disregard for and violation of the rights of others, occurring since age 15. -A pattern of rule-breaking and failure to conform to social norms (infringing upon the rights of others) and/or consistently engaging in illegal behavior. -Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal gain. -Aggressiveness as indicated by repeated physical altercations (including the use of weapons) and/or a history or propensity to harm animals. -Consistent irresponsibility as indicated by failure to sustain gainful employment or honor financial obligations. -Lack of remorse. -Lack of willingness to accept accountability or consequences of his/her actions. -When considering the continuum of severity, this diagnosis could as easily apply to the gang member or the Wall Street executive. -More frequently diagnosed in males.
Post-arrest Diversion (Pretrial Diversion Programs)
-Voluntary for offenders, and provides an alternative criminal case processing. -Successful completion of the program typically results in lessening or dismissal of the charge(s).
Emergency Detention Order - TX Health and Safety Code Section 573.002
-When an officer transports someone due to mental health concerns, the officer must file a notification of detention with the receiving facility. -This serves as a magistrate's order for emergency apprehension and detention. -Is considered a civil court order issued by a magistrate. -Provides for emergency apprehension and transportation for evaluation. -An officer may take a person into custody if the officer has reason to believe and does believe (the same as a criminal affidavit). -The person is a person with mental illness AND because of that mental illness there is substantial risk of serious harm to person or others unless person is immediately restrained ("substantial risk" is demonstrated by the person's behavior, evidence of severe emotional distress and deterioration of a person's mental condition). -The officer believes there is not sufficient time to obtain a warrant. -The officer may form the belief the person meets criteria based on the report of a credible source, or on the basis of the person's conduct or circumstances under which the person is discovered.
Environmental factors often include:
-childhood history of instability -verbal/physical abuse -neglect -poor peer relationships.
Intellectual Disability limitations may include deficits in:
-communication -self-care -home living -personal safety -academic functioning -occupational abilities
Types of events might result in a person feeling as though he/she is in a crisis- situation:
-death of a loved one -death of a pet -getting locked out of the house/car -layoff or termination from work -financial difficulty -divorce, separation, or child custody -legal difficulties
Examples of mental illness include
-depression -anxiety -schizophrenia -bipolar disorder -borderline personality disorder -eating disorders -addictive behaviors
The primary goal of CITs involves calming persons with mental illness who are in crisis and referring them to mental health care services, rather than incarcerating them. This goal...includes:
-lessening injuries to officers -alleviating harm to the person in crisis -promoting decriminalization of individuals with mental illness -reducing the stigma associated with mental disorders -using a team approach when responding to crises
CIT has been shown to positively impact:
-officer perceptions -decrease the need for higher levels of police intervention -re-direct those in crisis from the criminal justice to the health care system
Personality disorders that may be most frequently encountered by peace officers include:
-paranoid personality disorder -antisocial personality disorder -borderline personality disorder -narcissistic personality disorder
Although individuals with mental illness comprise fewer than 4 in every 100 adults in America, individuals with mental illness generate no less than _____ calls for police service
1 in 10
Approximately _____ adults in the U.S. (9.8 million, or 4%) experience a serious mental illness in a given year that substantially interferes with or limits one or more major life activities
1 in 25
Estimated _____ individuals transported to hospital emergency rooms in psychiatric crisis are taken there by police
1 in 3
The 5 Universal Truths of Human Interaction as described by Dr. Thompson are:
1. ALL cultures want to be treated with Dignity and Respect. 2. ALL people would rather be asked than told what to do. 3. ALL people want to know why they are asked or told to do something. 4. ALL people would rather have options than threats. 5. ALL people want a second chance to make matters right.
Two reasons to APWAW (Arrest person without a warrant):
1. Evidence of mental illness 2. Substantial risk behaviors
Initial Three-Point Assessment
1. Level of comprehension -Does the person understand what you're saying? -Can the person follow instructions? -Is person able to answer basic questions related to orientation (i.e. person, place, time)? -When person speaks do their comments make sense related to the circumstances? -How is the person speaking (quickly, slowly, slurred, mumbled)? 2. Behavior -How is the person practicing basic self-care (Disheveled, dressed appropriately for season)? -Is the person caring for hygiene (bathing)? -When was the last time the person ate or drank anything? -How is the person's physical coordination? -Compliant or non-compliant? If non-compliant could it be due to mental health issues? 3. Emotion -What is the prevailing emotional state? (anger, sadness, euphoria, anxious) -Is the emotional state appropriate to the context of the situation? -Does the person exhibit quickly fluctuating emotional expressions? (laughing to crying) -Is person exhibiting extreme or baseless suspiciousness or paranoia? -Is person's facial expression and body language consistent with their stated mood?
Consider this three-phase process:
1. Safety - of the public, the subject, and the police 2. Stability - attempt to stabilize the person through verbal and non-verbal de-escalation skills 3. Problem solving - Try to get the person into a rational frame of mind (lessen emotional reactivity). Increases the likelihood of future compliance and resolution
Traumatic Brain Injury Impact on Daily Life: It has been estimated there are upwards of _______ ER visits among civilians in the U.S. each year due to head injuries.
1.7 million -Of those treated approximately 275,000 are hospitalized and 52,000 die (CDC, NIH, DoD, & VA Leadership Panel, June 2013). -The presentation (symptoms) vary by person and severity of TBI; areas of attention, executive function, learning and memory, language, eye-hand coordination, and social awareness are all subject to effect.
People with severe mental illnesses are over __ times more likely to be victims of violent crime than the general population.
10
"risk of being killed when approached or stopped by law enforcement in the community is ____ higher for individuals with untreated serious mental illness than for other civilians"
16 times
Intellectual Disability: is detectible in infancy or early childhood, and by definition, must be diagnosed by the age of ___
18
Deinstitutionalization began in ____
1955
Nearly _____ of all people with a diagnosable mental illness do not seek treatment
2/3 21.4% of youth age 13-18 experience a severe mental disorder, and approximately 13% of children age 8-15.
Degrees of Intellectual Disability: Severe Intellectual Disability IQ
20-50
Between 1980 and 1995, the total number of individuals incarcerated in American jails and prisons increased _____, despite the fact that the population only grew by 16%
216%
Depending on the age group in question, and how homelessness is defined, the consensus estimate as of 2014 was that, at minimum, _____ of the American homeless were seriously mentally ill at any given point in time.
25% 140,000 individuals
Due to the major cuts to public mental health services in 2003, "law enforcement calls about people in psychiatric crisis jumped from fewer to 11,000 in 2003, to more than ____ in 2012" (DePrang, 2014), thereby eradicating the expected monetary savings from making the initial mental health budget cuts.
27,000
About ___ of US adults suffer for a severe form of mental illness according a report for the Treatment Advocacy Center
3%
Only _____ of violent acts can be attributed to individuals living with a serious mental illness.
3% - 5%
Most people with mental illness are not violent and only ____ of violent acts can be attributed to individuals living with a serious mental illness
3%-5% The vast majority of people with mental health problems are no more likely to be violent than anyone else
Mental health courts have grown from 4 in 1997 to over ___ in 2017. "Offenders who are arrested and complete the mental health court program have a much lower recidivism rate than their peers: 20 percent versus 72 percent."
300 -Majority of mental health court participants have a serious mental illness in addition to a co-occurring substance abuse disorder. -Referrals to mental health courts typically come from defense attorneys, judges, jail staff, or family members.
_________ service members have dealt with PTSD across 19 years of combat
300,000 - 500,000
The Department of Defense reported in 2011 that _____ military service members were diagnosed with Traumatic Brain Injury
33,149 -The rate of TBI among military members increased significantly among the Operation Iraqi -Freedom/Operation Enduring Freedom military service members due to the frequency of explosion-related exposures
Degrees of Intellectual Disability: Moderate Intellectual Disability IQ
35-50
Compared to imprisonment, treating a mentally ill person in a mental hospital is at least ___ times as expensive, on a month-by-month basis
4 Mental health treatment can prevent future incarcerations, making it the more long-term cost-effective option
Approximately _______ people in prison [nationwide] would likely have been in mental hospitals in the past
40,000 to 72,000
In 2015, there were an estimated _____ adults aged 18 or older in the United States with mental illness within the past year.
43.4 million -This number represented 17.9% of all U.S. adults, or 1 out of every 5 people -These mental illnesses ranged from mild to severe.
__________ of the homeless had any mental illness. More would be labeled homeless if these were annual counts rather than point-in-time counts
45% 250,000 individuals
________ states have CIT programs.
46 of the 50 Arkansas, Alabama, West Virginia, and Rhode Island are the only states that do not have CIT programs.
Degrees of Intellectual Disability: Mild Intellectual Disability IQ
50-69
In January 2015, the most extensive survey ever undertaken found ______ people were homeless on a given night in the United States
564,708
______ with Alzheimer's will wander," either on foot in via car, and "if not found within 24 hours, up to half of those who wander risk serious injury or death
6 out of 10 people The 22, Aging and Disability Resource Centers (ADRCs) statewide, run by the Texas Health and Human Services Commission can be excellent resources for officers who come across an elderly adult who may need assistance.
Florida implemented a specific pre-arrest diversion program in 2013 wherein 80% of diverted offenders completed the 90-day program, only ___ of whom were re-arrested
6%
____ Americans deal with diagnoses of PTSD in any given year
7.7 million
Degrees of Intellectual Disability: Borderline Intellectual Functioning IQ
70-79
A 2014 analysis of six American studies of victimization among homeless individuals with serious mental illness reported lifetime rates of victimization from ____
74% to 87% This means that people with mental illness had a 74-87% chance of being victimized in their lifetime
Study of the Houston Police Department's officer involved shootings and found that those officers responding to calls designated as CIT-related calls were ____ less likely to use their guns then when they responded to other types of calls
82%
People believed post 9/11 Veterans are ___ more likely to suffer from mental illness
83%
Dementia is not a normal part of the aging process, but, up to half of all people over the age of ___ are affected by some form of dementia
85 Dementia can be cause by a number of different health conditions, including vascular disease, brain damage, stroke, as well as other conditions
Degrees of Intellectual Disability: Average IQ
90-109
Washington Post investigative reporters undertook a large research endeavor in an attempt to better classify and identify police use of force. Their findings indicated ____ fatal officer-involved shootings in 2015
990
Autism Spectrum Disorder:
A condition that an individual may have had since birth or childhood which has prevented them from full social or vocational independence in adulthood, and which continues throughout their lifespan
Language:
Ability to find the correct labels or words for an object or situation; misuse of names, verbs, or other word choices; comprehension
A mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your _________
Ability to function
Learning and memory:
Ability to repeat words or digits; ability to recall recent information; ability to apply information
Attention:
Ability to sustain attention to a task; ability to pay attention to something despite other distractions; ability to do two things at once
You statements are statements that begin with You; You is often interpreted as ___ by the listener.
Accusatory -You statements imply the listener is personally responsible for the issue at hand, and creates defensiveness in the listener. -Example: 'You are not listening'.
Tactical Transparency refers to explaining an ____ before initiating it, so the person with whom you are interacting knows what to expect.
Action -This tactic may be particularly useful in crisis situations, particularly for individuals suffering from PTSD, Autism Spectrum Disorders, or who are otherwise highly reactive and may tend to interpret events or behaviors as threatening.
Autism Spectrum Disorder: When interviewing, be patient, calm, and detached, which tends to help prevent ______ in questioning process.
Agitation
Insanity
An unsoundness of mind or lack of the ability to understand that prevents one from having the mental capacity required by law to enter into a particular relationship, status, or transaction or that releases one from criminal or civil responsibility
______ can experience mental illness, regardless of age, gender, race, education level, or socioeconomic level.
Anyone
Subchapter A
Apprehension by a peace officer or transportation for emergency detention by a guardian
_________ are most common, followed by visual hallucinations.
Auditory hallucinations A person may experience more than one auditory hallucination at a time.
Officers in contact with ___________ will notice certain behaviors such as fear of touch, repetitive behavior (such as rocking, striking themselves, or noises), insistence on routine, extreme anxiousness in new situations, and a tendency to become confused easily.
Autism Spectrum Disorder
Aggressive and hostile
Behaviors that communicate a distance from or even a danger to another individual (blading, hand on grip of pistol)
Friendly and helpful
Behaviors that convey safety, respect, and a desire to help. Can be conveyed verbally, and nonverbally (through neutral body language, and pleasant facial expression)
Degrees of Intellectual Disability: Profound Intellectual Disability IQ
Below 20
_________ are things that could not occur in real life (aliens removed all the person's organs and they continue to function without any internal organs).
Bizarre delusions
Researchers believe that a complex imbalance in the _________ plays a prominent role in mental illness selectivity in the individual.
Brain's chemical activity -Environmental factors can also be a trigger or buffer against the onset. -Mood disorders also have a genetic component, meaning that they tend to run in families
__________ accelerate the heart rate and elevate the blood pressure and 'speed-up,' or over-stimulate, the body.
CNS stimulants
The primary goal of CITs involves ________ with mental illness who are in crisis and referring them to mental health care service, rather than incarcerating them.
Calming persons
Individuals with mental illness are traditionally not ___________. Law enforcement is highly scrutinized by the public and private sectors when force is utilized in these cases, even when provocation is evident.
Career criminals
Traumatic Brain Injury Causation:
Caused by impact to the head, or other mechanisms of rapid movement or displacement of the brain within the skull, as can happen with blast injuries"
Implementing effective strategies can help keep the officer safe, keep the public safe, and greatly reduce _______
Civil liability
Autism Spectrum Disorder: Some people on the Autism spectrum cannot communicate verbally, or use only a ___________.
Cluster of words
Research conducted over the last decade has shown that the most successful models of treatment for people with ______ provide integrated mental health and substance abuse services
Co-occurring disorders Substance abuse treatment is a critical element in a comprehensive system of care.
____________ include Alzheimer's Disease and other forms of dementia, as well as Traumatic Brain Injury (TBI).
Cognitive disorders
Medication is not always necessary, and that decision should be made _______ with the affected person and his/her support system
Collaboratively This may include a physician, therapist, psychologist, social worker, family advocate, and sometimes a psychiatrist.
Research has indicated Crisis Intervention Training improves officer __________ towards individuals with mental illness
Comfortability, knowledge, and attitudes
The quality and availability of mental health treatment options vary by location, and often depend on ____________________
Community priorities and budgeting constraints.
Medication non-compliance is a ______ problem for law enforcement because abrupt medication cessation is a primary cause of crisis incidents.
Continuous
Hallucinations can make it very difficult for someone to focus on a ____________________________ to what is being said
Conversation, hear, understand, or respond
Many people, especially those in ______, feel that medications squash creativity, artistry, and remove the drive to create.
Creative fields
The term 'insanity' is not a psychological term, but is a legal term used as a defense to avoid __________ for certain acts.
Criminal consequences
Much of the increased rates of incarceration are due to deinstitutionalization, so those with mental illness are routed through the ___________, rather than through the mental health system
Criminal justice system
Generally, the underlying element behind mental illness-related behavior is usually not ___________
Criminal or malicious
Intellectual Disability: This is a fixed mental condition that, unlike many mental illnesses, cannot be "_____"
Cured
In some cases, when the police arrive, the subject is holding an implement that may be perceived as potentially harmful and results in a _______ encounter
Deadly force
For individuals with access to medications, they often _______ the medications for a variety of reasons, including:
Decline or discontinue -Many people, especially those in creative fields, feel that medications squash creativity, artistry, and remove the drive to create. -Just as with other medications, psychiatric medications can be lethal if one mixes medications, mixes with alcohol (or other drugs) is allergic, or takes too much. -It is common for individuals suffering from mental illness to discontinue medications because they start to feel better and believe that they no longer need them. -Medication non-compliance is a continuous problem for law enforcement because abrupt medication cessation is a primary cause of crisis incidents.
It is a ______ of mental functioning involving thinking, memory, and reasoning.
Degeneration Dementia severity can range from mild (some impairment in day to day living) to severe (completely reliant upon others for basic needs)
The ____ of rapport can often determine the course of the interaction (positive or negative)
Degree
_____________ is a term that has been used to describe the policy of relocating people experiencing severe mental illness out of residential mental health facilities and the subsequent closure of many of those facilities.
Deinstitutionalization This process did not provide a substitute so that individuals with mental health concerns could receive needed medication, stabilization, or therapy to assist them in living successfully in the community
____ can be drug induced, medication induced, or due to a medical condition
Delirium -Develops over a short period (hours or days) -Attentional deficits (reduced ability to direct, focus, sustain, or shift attention) -Memory deficit. -Disorientation. -Often creates an inability to comprehend speech, or follow instructions.
Psychosis is an illness involving a distortion of reality that may be accompanied by _____________
Delusions and/or hallucinations. The individual may have sensory experiences that are not real (see or hear things that others cannot see or hear) or may believe things that have no factual basis (that s/he is Jesus Christ)
_______ is a name for a group of symptoms caused by disorders that affect the brain
Dementia Although memory loss is a common sign of dementia, memory loss alone does not mean someone has dementia
Depression and suicide: The single most common factor in suicidal behavior or death by suicide is that the individual is experiencing ___________
Depression
Two common mood disorders likely to be encountered by law enforcement officers are __________ Disorder
Depression and Bi-Polar
Homeless individuals are also at greater risk for infectious diseases and have higher rates of chronic medical conditions such as ____________
Diabetes and heart disease
Mental illness is diagnosed based on behaviors and thinking as evaluated by a psychologist, licensed professional counselor, licensed social worker, or other qualified professionals most commonly using a tool known as the ______________
Diagnostic and Statistical Manual of Mental Disorders
Stigma is a mark of ________. It is made up of various components, including:
Disgrace or shame -Labeling someone with a condition -Stereotyping people with that condition -Creating a division (a superior 'us' and a denigrated 'them') -Discriminating against someone on the basis of a label
____________ include drugs that inhibit pain by cutting off or dissociating the brain's perception of the pain.
Dissociative anesthetics
Hallucinations
Distortions in sensory input, causing the individual to experience hearing, seeing, feeling, or smelling something that is not apparent to others.
The 43.4 million with mental illness does not include substance use disorders, such as _______ disorders
Drug- or alcohol-related
Possible interactions with Law Enforcement (Alzheimer's): Shoplifting
Due to memory impairment, a person with AD may forget to pay for items.
Bipolar Disorder:
Each phase of mood lasts at least four days. People usually only seek professional assistance during the depressive phase, as the manic phase is reportedly very pleasant, energetic, and creative.
Chapter 573
Emergency Detention
A personality disorder is an _________ of thinking, feeling, and behaving that is relatively stable (inflexible) over time, and that deviates markedly from the person's culture
Enduring pattern This deviation in thinking and behaving may affect one's perceptions of themselves and others; emotional reactions; the ability to maintain healthy interpersonal relationships; and/or ability to manage impulses
Due to individual, ___________ factors, any one person might react to or perceive a crisis situation differently from another person.
Environmental, cultural, and circumstantial This might be especially true for an individual suffering from a mental illness due to the possibility of disrupted emotions or thought distortions.
Autism Spectrum Disorder: Illustrative materials, repetition (clarification) of previous statements, praise, encouragement, and attentive listening will assist in the __________
Exchange process.
Perceptual-motor:
Eye-hand/body coordination
These stigmas perpetuate a negative stereotype of people with mental illness that fuels______ and reinforces distorted perceptions, leading to further stigma.
Fear and mistrust
It is common for individuals suffering from mental illness to discontinue medications because they start to _______ and believe that they no longer need them
Feel better
Delusion
Fixed false beliefs that are maintained despite overwhelming evidence to the contrary.
If speaking with a subject who is exhibiting mental health concerns, you may inquire as to whether the person is receiving mental health treatment and if they have the contact information for their provider, or if there is a _________ member they would like you to call.
Friend or a family
_________ cause the user to perceive things differently than they appear to others.
Hallucinogens
________ of prescription drugs and lack of health care also sometimes make it impossible for an indigent, homeless, unstable, or disorganized person to get access to needed medications.
High costs
__________ rooms are an option. Visit your local hospital. Talk to the charge nurse, or ER doctor and see how they handle mental health emergencies.
Hospital emergency
Social awareness:
Identification in changes in others' facial expression; emotional intelligence
Bath Salts are frequently analogs of other drugs, or some mix of solvents and chemicals. Behavior is hard to predict, as is overdose. This may also be a cause of the __________
Idiopathic excited delirium Some of the substances known to have been sold as bath salts are: alpha PVP, ethylone, MDPV, methoxelamine, methylone, and pentylone
A common anecdote about Autism spectrum disorders is:
If you've met one person with Autism, you've met one person with Autism. The manifestations of the disorder are so widely varied that it is difficult to draw any sweeping characterizations.
__________ is also a primary concern for individuals with a mental illness. These substances can have an adverse effect when used in combination with prescribed medications, and/or when used to self-medicate.
Illegal drug and alcohol usage In addition, combining drugs or alcohol with medications may result inconsistent medication absorption, dangerous chemical combinations, and a lack of medical monitoring.
Executive function (judgment/decision making):
Impaired ability to plan, make decisions, hold information briefly in one's mind (a telephone number), ability to learn from mistakes
Others may suffer from persistent mental illness, which is indicated by long durations of _______.
Impairment
Some individuals suffer from serious mental illness, which means severe __________ in one or more major life activities
Impairment and limits -financial -occupational -social
There is also an _____ with the willingness of mental health providers to participate in criminal justice initiated programs
Impasse Just like society's stigmas and discriminations against mentally ill individuals, the mental health system often discriminates against people who have been arrested or incarcerated.
Origin of Training and Community Awareness: The program was conceived in Memphis TN., after police shot a 26-year-old man with mental illness.
In September 1987, White Memphis police officers answered a 911 call. A young African American man with a history of mental illness was cutting himself with a knife and threatening suicide. Police officers are trained to respond with deadly force when they perceive their lives are in danger. At the outset of the incident, it appeared that the only life in danger was the young man's, from self-inflicted wounds. As they were trained to do at the time, officers at the scene confronted the man and demanded he drop his weapon. At this, he became more upset and ran at the officers who, in fear for their own safety, opened fire and killed him....Although the welfare of both officers and the mentally ill in situations of confrontation had been a concern for some time, this death, with its racial overtones, was the catalyst that resulted in the creation of CIT a year later
Deinstitutionalization and lack of community mental health resources resulted in _______ instead of treatment
Incarceration
__________ include a wide variety of breathable substances that produce mind-altering results and effects.
Inhalants
A person in crisis may be more prone to acting ______ (self-preservation) rather than with logical thought.
Instinctually Non-compliance may be the result of a combination of these factors rather than an intentional act of defiance.
An inability to read or write is illiteracy, in and of itself, does not indicate _________
Intellectual Disability
Intellectual Disability: This disability includes deficits in ___________ functioning (failure to meet developmental and socio-cultural standards for intellectual and personal independence standards)
Intellectual and adaptive
Autism is often indicated by an inability to have typical ____________, including conversations, emotional recognition, sharing and understanding of thoughts, feelings, or social courtesies.
Interpersonal exchanges -May avoid eye contact. -May not answer questions, or may respond with something unrelated. -May repeat (echo) words said to him/her without providing a response to question or statement. -Volume of speech may not be appropriate to circumstance (may speak very loudly or softly). -A person with Autism may have difficulty understanding or comprehending the natural give-and-take (rhythms) of verbal exchange. They may also have difficulty expressing self in a manner that is comprehensible to the officer.
Only about 4% of ____________ in the United States can be attributed to mental illness...yet nearly 40% of news stories about mental illness connect it to violent behavior that harms other people
Interpersonal violence
It is important to remember that it is rare to see someone ______ from the ingestion of just one type of drug, dangerous drug, or other substance.
Intoxicated Especially as it pertains to prescription medications and psychotropic drugs, there is very often a mix of substances influencing the symptoms and physical manifestations that are visible.
Substantial risk
Is demonstrated by the person's behavior, evidence of severe emotional distress and deterioration of a person's mental condition
In 2016, the Texas Department of Housing and Community Affairs (TDHCA) indicated that homeless persons with mental illness remain homeless longer due to _____ from family and friends
Isolation
_______ affects the same opioid brain receptors as morphine, appears to have properties that expose users to the risks of addiction, abuse, and dependence
Kratom -In Thailand, it is a controlled substance and is a commonly abused illegal drug. -In the U.S., kratom is listed as a "drug of concern" by the DEA. -May be mixed with a caffeinated beverage, or codeine-containing cough syrup, perhaps most often to create the drink called 4×100. This drink is said to have effects similar to alcohol intoxication
Some people refuse treatment for fear of being '______.'
Labeled The stigma can lead to isolation due to shame and embarrassment.
People with personality disorders may become involved in the criminal justice system because their way of thinking and perceiving their environment and others may lead them to_______
Lawbreaking behaviors Individuals with personality disorders often also exhibit some form of mood, depression, or anxiety concerns, and frequently substance abuse.
________ is associated with factors including ability to maintain employment and thus earn sufficient income, quality of social relationships, ability to engage in leisure activities, and level of acquired disability
Life satisfaction
The 80/20 rule
Listen for 80% of the time and talk for 20%
The crisis may have been precipitated by a __________ and may result in the person feeling confused, alarmed, overwhelmed, desperate, hopeless, helpless, enraged, or terrified.
Loss or a challenging situation
Mental hospital beds per capita in the U.S. are ____ than they have been since 1850
Lower
A type of court that combines judicial supervision with community mental health treatment and support services in an effort to reduce criminal recidivism; improve quality of life of people with mental illnesses and increase their participation in effective treatment; and to reduce court-and corrections-related costs.
Mental Health Court -These courts include substance-abuse courts, and Veterans courts (which take into account a Veteran's military history, PTSD, and other considerations) -All incentives and sanctions are based upon the individuals' specific charges, history, and needs.
Texas Penal Code, Section 8.01, Insanity Is an affirmative defense to prosecution that, at the time of the conduct charged, the actor, as a result of severe ___________, did not know that his conduct was wrong
Mental disease or defect The term 'mental disease or defect' does not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct.
Title 7
Mental health and intellectual disability
Post Traumatic Stress Disorder
Mental health condition that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.
_________ are more common than cancer, diabetes, heart disease or AIDS.
Mental illnesses
_______ prisoners comprise a large fraction of the jail and prison population
Mentally ill Over the last half-century, mental hospital capacity has dwindled, while prison and jail capacity has vastly expanded
The severity of Traumatic Brain Injury is often delineated between __________
Mild, moderate, and severe -Mild TBI accounts for 75% of TBIs. -Moderate TBI accounts for approximately 22% of TBIs and is characterized by identifiable persistent deficits (in the above mentioned cognitive domains) that a person will experience the remainder of his/her life. -Severe TBI accounts for approximately 3% of TBIs, and is usually associated with other bodily injury and requires intensive medical intervention. -Mild TBI is most common among the civilian population whereas moderate TBI is more prevalent among the military population.
It is speculated the rate of Traumatic Brain Injury among _______ is higher but is underreported and under identified
Military personnel
The term "psychotropic medication" refers to any medication capable of affecting the _________
Mind, emotions, and behavior.
________ are demonstrated by disturbances in emotional reactions and feelings.
Mood disorders In other words, one's emotional experience (mood) is inconsistent with his/her circumstances. Examples of mood disorders include depressive disorders and bipolar disorders.
Traumatic Brain Injury is the leading cause of death in adults under age 45 (__________) and is the second leading cause of death adults over 65
Motor vehicle accidents
__________ relieve pain, induce euphoria, and create mood changes in the user.
Narcotic analgesics
_______ damage can occur if an individual has had to take a form of medication in high doses for many years.
Neurological
__________ are events that could occur in real life (phone tapped by the FBI, people are out to get me).
Non-bizarre delusions
People in crisis may not be able to understand your statements or commands, but can often read your _____ cues and sense your level of concern, empathy, investment, and genuineness
Non-verbal
Crisis Intervention Training is foremost about _______. This training is intended to assist officers in being able to recognize the signs and symptoms of mental illness and to respond:
Officer safety -effectively -appropriately -professionally
Individuals are often discouraged and/or unable to persist in finding the best treatment options for their condition and circumstances, since there is no "_______" treatment.
One size fits all
Officers' attitudes about the impact of CIT on improving ____________ and the preparedness of officers to handle calls involving persons with mental illness are positively associated with officers' confidence in their abilities or with officers' perceptions of overall departmental effectiveness.
Overall safety, accessibility of services, officer skills and techniques
Police Executive Research Forum
PERF
Meaning and implications of a crisis: A _________ of pain, distress, or disordered function" or an "emotionally significant event or radical change of status in a person's life
Paroxysmal attack
If you are able to contact the provider, keep in mind that provider is limited information they can provide to you, due to ________
Patient confidentiality. However, you can provide information to the provider and ask how the provider recommends you proceed (hospital, clinic, questions to ask).
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))
The severity of each condition varies from ______ (mild, moderate, and severe). Those symptoms and their severity can change; occasionally being acute, and then receding.
Person to person Some individuals experience 'chronic' or long-term conditions, while others experience more "acute" or immediate symptoms
__________ often become evident in adolescence or early adulthood. It is believed that most personality disorders are caused by a combination of environmental and genetic factors.
Personality disorders
___________ can also induce a psychotic state. Potential conditions include: organic brain disorders (brain injury or infections to the brain) and drug or alcohol withdrawal.
Physical circumstances
Manic Phase may include:
Poor insight into one's disorder or behaviors and poor judgment accompany mania. Therefore, the person's financial accounts or important relationships may be in such disarray as to lead to adverse outcomes, including loss of important friends and family support or connections, serious financial setbacks, job losses, legal problems, and homelessness
__________ - Diverting someone from the criminal justice system (no arrest or charges made), and guiding them toward a different form of intervention:
Pre-arrest Diversion -Mental health treatment facility -Hospital - This may be a good option for a first-time, low level offender who would only be further hampered by having an arrest record.
Traumatic Brain Injury can occur from _____ to a blast, blunt force trauma, and penetrating injuries.
Proximity
Just as with other medications, _________ medications can be lethal if one mixes medications, mixes with alcohol (or other drugs) is allergic, or takes too much
Psychiatric
At any given time, there are more people with untreated severe ___________ living on America's streets than are receiving care in hospitals
Psychiatric illnesses
_________ can be present with other diagnoses, such as substance intoxication, bipolar disorder, and even major depressive disorder.
Psychosis
Thought disorder can include _________ spectrum diagnosis.
Psychosis or a schizophrenia
Episodes of ___________ may lead to homelessness and homelessness itself can worsen chronic medal (or mental health) conditions...
Psychosis or major depression
Severe mental illnesses account for at least a _____ of all fatalities involving law enforcement.
Quarter
The spectrum of Autism severity:
Ranges from severe (sometimes non-verbal, highly reactive to change, surprise, strangers; with co-occurring intellectual disability) to mild (able to function, maintain employment, and live independently while also creating and maintaining reciprocal relationships).
The traumatic incident that most often results in PTSD is ______
Rape
A friendly, harmonious relationship; especially: a relationship characterized by agreement, mutual understanding, or empathy that makes communication possible or easy
Rapport "communion or fellowship
There are _______ situations in which law enforcement uses unnecessary, excessive or deadly force during encounters with individuals in mental health crisis.
Re-occurring
Psychosis: To the affected person, these hallucinations and delusions are ______.
Real Active MRI scans show that the neural pathways that are engaged when one hears a voice speaking to them, are the same neural pathways that are activated during an auditory hallucination.
Myth: Mental illness is an indication of weakness or character flaws, and people can snap out of it if they try hard enough.
Reality: A combination of factors contribute to mental illness, including genetic predispositions, trauma, a history of abuse, medical illness, brain chemistry, and recreational drug use.
Myth: Most people who struggle with mental illness are homeless, live in group homes or are in mental hospitals.
Reality: About two-thirds of Americans who have a mental illness live in the community and lead productive lives.
Myth: I can't do anything for a person with a mental health problem
Reality: Everyone can make a difference for someone with mental health concerns. "Only 44% of adults with diagnosable mental health problems and less than 20% of children and adolescents receive needed treatment" (U.S. DHHS, 2017). It may be life changing to help someone access mental health services.
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 treatment to return to optimal functioning. Physician oversight and physical therapy fills this role for a physical illness, just as therapeutic intervention is needed for those experiencing mental illness.
Myth: Mental illness does not affect the average person.
Reality: No one is immune from mental illness. "43.7 Million Americans struggle with mental health conditions annually" (MHA, 2017). The impact of stigma is tragic because mental health challenges are actually very common. However, there are good treatments available
Myth: If you have a mental illness, you are 'crazy' all the time.
Reality: Some mental illnesses are temporary. Many can be actively managed with medication and behavior modification, so that the illness is virtually undetectable. People suffering from even the most severe mental illness are in touch with reality as often as they are actively psychotic.
Myth: A person with a mental illness is also intellectually challenged.
Reality: There are some persons with a dual diagnosis, but the conditions are fundamentally different. Many people with mental health diagnoses are extremely intelligent, creative, and innovative.
CIT's impact on community relations __________ as well as increase public trust and confidence in law enforcement among people suffering from mental illness, their families, and the community at large.
Reduce complaints, financial liability, and lawsuits
A person on the Autism spectrum may display restricted, ____________ of behavior, interests, or activities.
Repetitive patterns -May be fixated on a word, topic, object, sound. -Difficult to redirect attention and concentration away from object -Person may become distraught if object of attention is removed or withheld. -Individual may exhibit repetitive motor movements, such as rocking, hand
I statements are statements that begin with "I"; "I" statements, in contrast, do not imply blame; "I" statements give the speaker ______ for their portion of the interaction, helps to build rapport, and eases communication.
Responsibility
The purpose of tactical transparency is to provide the subject with a clearer interpretation of your behavior as a police officer, and to convey your mutual interest in assuring the _____ of everyone involved.
Safety This method is utilized only when it is safe to do so, when there is adequate support (backup, medical personnel), and when there is no indication of impending violence. In this instance, as in all others, officer safety is paramount
Scientists believe many different genes may increase the risk of ________, but that no single gene causes the disorder by itself.
Schizophrenia
Scientists also think that interactions between genes and aspects of the individual's environment are necessary for ________ to develop. Environmental factors may include:
Schizophrenia -Exposure to viruses -pre-natal nutrition -problems during birth -psychosocial factors
Stigmas encourage inaccurate perceptions. 'Mental' suggests an illegitimate medical condition that is 'all in your head,' and therefore a _______
Sign of weakness The term 'mental' suggests a separation from a physical illness, when in fact they are entwined
Mental health conditions often occur _______; for example, individuals often suffer from substance abuse issues in addition to other mental health conditions.
Simultaneously
A sharp dividing line between 'normal' and 'abnormal' behavior does not exist and is often based upon _____ for specific societies, cultures, and subcultures.
Social norms If practiced in the other culture or society, those practices may be deemed 'abnormal.'
There are also episodes of mental illness that are situational in nature and may be due to __________
Stress, grief, or substance abuse The duration and severity of these episodes is often based upon a number of factors including coping skills, social support, treatment, and substance use
Co-occurring Mental Illness and Substance Abuse Disorder: _____ are defined by category and familiar types in the category
Substances
Medication can help the person attain a degree of _____ that enables him/her to engage more fully in therapy and learning how to manage the condition through coping skills and self-care
Symptom relief
___________ are less frequent, but happen, sometimes resulting in self injury.
Tactile hallucinations
Subtitle C
Texas Mental Health Code
Senate Bill 1849 (Whitmire, 2017)
The department shall require each local mental health authority to incorporate jail diversion strategies into the authority's disease management practices for managing adults with schizophrenia and bi-polar disorder to reduce the involvement of those clients with the criminal justice system
Possible interactions with Law Enforcement (Alzheimer's): Homicide
The presence of a weapon may lead to unexpected danger, as a person with AD may believe his/her loved one is an intruder.
Ambiguous
These behaviors are open to interpretation and can have a wide range of meanings to individuals in crisis. Often if the posture is not overtly friendly, it is interpreted as dangerous.
A mental illness is a condition that impacts a person's _________ and may affect his or her ability to relate to others and function on a daily basis.
Thinking, feeling or mood
Even within a community, available services depend on _____________ eligibility criteria.
Timing, resources, and program Too often, community mental health resources are just in short supply.
Atypical motor movements of Autism may be evident, such as walking on ________.
Tiptoes or unusual gait -Can be impulsive and potentially aggressive, without provocation. -Differences typically become noticeable by age 3.
CIT may have a ________ on officers' attitudes by increasing exposure to and familiarity with mental illness
Transformative effect
Autism Spectrum Disorder: Avoid physical contact or limiting personal space, which may result in an unintended __________ situation.
Use of force
Persons with serious mental illness were 4 times more likely to be a _____ of violent crime than the general population
Victim
Serious mental illness had been _____ of crime at a rate 11 times higher than the general population
Victim
Involuntary Commitment:
Warrantless Apprehension, also called a Police Officer Emergency Commitment or Detention