Texas Laws Relating to Mental Illness

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Forensic Training Mental Illness Recognition and
Intervention Strategies
Presented by Vivian Lawrence, BA Criminal
Justice Public Policy Specialist Mental Health
Association
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Definitions
Mental illness Disease or condition that either
substantially impacts a persons thoughts,
perception of reality, emotional process,
judgement, or grossly impairs a persons
behavior, as manifested by recent disturbance
behavior.
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Definitions

• Insanity A legal term for diminished capacity
  and inability to tell right from wrong.
  Generally used by the court with regards to an
  individuals competency to stand trial.

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Professional Definition

• Diagnosis based on behaviors and thinking as
  evaluated by a psychiatrist, psychologist,
  licensed professional counselor, certified social
  worker, or other qualified professional using a
  tool known as the diagnostic standard manual of
  mental disorders fourth edition also called the
  DSM-IV.

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Definition

• Mental disorders A group of behaviors or
  symptoms known as a syndrome. Behavior which
  causes distress and disability or interference
  with usual relationships and lifestyles. The
  behavior causes pain and discomfort to the
  individual. The behavior must continue for at
  least 6 months.

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STEREOTYPES False belief about a group based on
the behavior of a few in a group.
Some of the stereotypes about persons with mental
illness include They are violent They are
paranoid They hear voices They are evil They are
unpredictable They are bizarre They have
nervous breakdowns
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Psychological Disorders Encountered By Officers

• Schizophrenia
• Mood disorders
• Bipolar disorder (manic depression
• Depressive disorders
• Anxiety disorders

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Schizophrenia

• Changes in perception
• Overly sensitive to sounds and sights,
  characterized by hallucinations
• Changes in emotions
• Impaired or distorted thinking

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Schizophrenia

• Social isolation
• Peculiar behavior
• Poor personal hygiene
• Inappropriate emotions
• Odd beliefs
• Magical thinking

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TREATMENT
Medications Used Zyprexa Risperedol Seroquel Cloz
aril Thorazine Serentil Melaril Prolixin Haldol
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Mood Disorders

• Major depressive disorder
• Bipolar disorder
• Manic
• Depressed

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Manic Symptoms

• Abnormally high, expansive or irritated mood
• Inflated self-esteem
• Decreased need for sleep
• More talkative than usual need to keep talking
• Racing thoughts, flight of ideas

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Treatment

• Medications used
• Lithium Depakote
• Tegretol Neurontin Topamax
• Lamictal

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Depressive Phase

• Prolonged feelings of sadness, hopelessness
• Feelings of guilt, worthlessness
• Difficulty concentrating or deciding
• Lack of interest
• Fatigue

• Low energy
• Change in eating or sleeping habits (more or
  less)
• Inability to enjoy usual activities
• Change in activity level

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TREATMENT
Medications Used Antidepressants Wellbutrin Remer
on Serzone Trazone Effexor Behavior Modification
Therapy
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Anxiety Disorders

• Panic disorder
• Social phobia
• Simple phobia

• Obsessive compulsive
• Post traumatic stress
• Generalized anxiety

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TREATMENT
Medications Used Anxiolytics Klonopin Tranxene Lo
razepam Buspar Vistaril Behavior Modification
Therapy
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Common Personality Disorders Encountered by Peace
Officers

• Paranoid tendency to interpret others actions
  as threatening or demeaning Expects to be used
  or harmed by others . Im being followed.
• Schizoid loners who dont feel much. No
  hallucinations.
• Schizotypal look, act and think weird.

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Personality Disorders (Cont.)

• Antisocial pattern of irresponsible and defiant
  behavior diagnosed at or around age 18 Know
  what is wrong and dont care Just plain mean
• Borderline instability of self-image, mood and
  relationships
• Histrionic excess of emotion and
  attention-seeking behaviors
• Narcissistic all about me

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Personality Disorders (Cont.)

• Avoidant very fragile
• Dependent you know this one!
• Obsessive compulsive repetitive
• Passive aggressive sulky, irritable or
  argumentative when asked to do something that
  doesnt want to do

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TREATMENT
The usual treatment for persons with Personality
Disorders is behavior modification to improve
communication and coping skills.
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Organic Mental Disorders

• Organic mental disorder symptoms include a major
  loss of contact with reality, a gross
  interference with ability to meet lifes demands.
  Person may have hallucinations, delusions,
  alteration of mood, defects in perception,
  language, memory and cognition.

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Organic Mental Disorders Two Types

• Organic - Based on a known brain pathology
  related to disease, age , drugs, accident or some
  other physical cause.
• Functional - Based on unknown causes or
  psychological factors.

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Types of Organic Mental Disorders

• Parkinsons
• Alzheimers

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Patient Rights

• All persons have certain basic legal rights,
  including people with mental illness and people
  who are in mental health facilities.

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PATIENT RIGHTS

• Questions frequently asked by Law Enforcement.
• Can a person be involuntarily admitted into
  hospital for bizarre behavior?
• How can a physician release someone taken to
  hospital on an APOWW?
• Can a person be forced to take his psychiatric
  medication?
• What are our options for persons with mental
  health that are repeat offenders?

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Patient RightsDeclaration Independence July 4,
1776

• We hold these truths to be self-evident, that
  all men are created equal, that they are endowed
  by their Creator with certain unalienable Rights,
  that among these are Life, Liberty and the
  pursuit of Happiness.--That to secure these
  rights, Governments are instituted among Men,
  deriving their just powers from the consent of
  the governed,

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Patient Rights

• Texas Department Mental Health and Mental
  Retardation Title 25 of Texas Administrative
  Code TAC
• The only time a court can order a person into
  treatment against their will is when it finds, by
  clear and convincing evidence based on recent
  acts, that the following is true

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Patient Rights

• The person is mentally ill and will probably
  seriously hurt himself or someone else because he
  recently did something to make people believe he
  would . ex. Suicide attempt, walk into heavy
  traffic or attacked someone with or without a
  weapon
• Or
• The person is mentally ill and if not treated
  suffers harm from the illness.
• And

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Patient Rights

• He has recently done something to make people
  think he probably will become so ill he can not
  care for himself. ex. Refusing to eat enough
  food to stay healthy
• And
• He is not able to make a reasonable decision
  about whether or not to be treated for his
  illness.

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Patient Rights

• Under either of the previous standards, the court
  must also find that they cannot receive the
  treatment they need in a less restrictive manner.

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Patient Rights

• Types of commitments
• Order of Protective Custody
• Temporary Commitment
• Extended Commitment
• Whether a person is admitted under any of the
  above commitments, the hospital has the right to
  discharge a person at anytime the treatment team
  determines the person no longer needs court
  ordered services

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Patient Rights

• Right to Refuse Medication
• A person has the right to refuse medication even
  if he is in a hospital for psychiatric care
  either state facility or private under an
  emergency commitment, a voluntary commitment, or
  under order of protective custody.

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Patient Rights

• When can a person be required to take medication?
• A person can be required to take medication under
  the following circumstances
• There is an emergency because his recent behavior
  shows he is likely to hurt himself or others or
• He is under 16 years of age and his guardian or
  parent consents for him or

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Patient Rights

• Medication refusal cont.
• He has been involuntarily committed under 90 day
  commitment order and judge decides he is likely
  to hurt himself or others, cannot make this
  decision for himself, and that the medication
  will help him well.

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Drugs in America
America is a psychoactive (mood -altering)
drug-oriented society. We use psychoactive drugs
to satisfy curiosity, reduce pain, influence
mood, change activity levels, reduce tension and
anxiety, decrease fatigue and boredom, improve
social interactions, temporarily escape reality,
and heighten sensation. Unfortunately, every
psychoactive substance including caffeine,
nicotine, and some prescription and OTC
medications as well as licit and illicit drugs
has the potential for abuse, because the main
effect is to produce a pleasant feeling.
From Drug abuse dependency
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DRUG CLASSIFICATIONS AND THEIR EFFECTS
STIMULANTS DEPRESSANTS SEDATIVES HALLUCINOGENS
INHALENTS MOOD ALTERING DRUGS
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STIMULANTS
AMPHETAMINE COCAINE RITALIN EFFECTS ON THE
BODY FASTER HEART RATE, RAPID BREATHING AND
INCREASED BLOOD PRESSURE, BLURRED VISION,
HEADACHE, TROUBLE SLEEPING, LOSS OF
APPETITE. HAZARDS DEPRESSION, DELUSION, PARANOIA
AND HALLUCINATION
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DEPRESSANTS
ALCOHOL HEROIN BARBITURATES CODIENE DILAUDID
OXYCODONE EFFECTS ON BODY PAIN KILLER,
EUPHORIA, DROWSINESS, RESPIRATORY DEPRESSION,
CLOUDED MENTAL FUNCTIONING. HAZARDS SLOWED
CARDIAC FUNCTIONING, SLOWED BREATHING, COMA OR
DEATH.
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SEDATIVES
GAMMA HYDROXYBUTRATE (GHB), ROHYPNOL,
BENZODIAZEPINES METHAQUALONE HYDROCODONE EFFECTS
ON THE BODY RELIEVE ANXIETY AND
INSOMNIA HAZARDS AGITATION, VIOLENT BEHAVIOR,
DEPRESS MENTAL ACTIVITY AND ALERTNESS
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INHALENTS
GASOLINE CORRECTION FLUID BUTANE
LIGHTERS PAINT THINNER FELT TIP MARKERS AEROSOL
DISPENSERS EFFECTS ON THE BODY SLIGHT
STIMULATION, LOSS OF INHIBITIONS,
INTOXICATION HAZARDS HEARING LOSS, BRAIN DAMAGE,
LIVER AND KIDNEY DAMAGE, HEART FAILURE,
SUFFOCATION, DEATH.
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HALUCINOGENS
LSD PCP PEYOTE ECTASY MARIJUANA EFFECTS
ON THE BODY INCREASED HEART RATE, MOOD SWINGS,
ANXIETY OR PANIC ATTACKS, VIOLENT BEHAVIOR,
LEARNING IMPAIRMENT HAZARDS LONG TERM BRAIN
DAMAGE, SUICIDAL OR HOMICIDAL IDEATIONS, SEIZURE,
COMA DEATH.
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OTHER MOOD ALTERING DURGS
ANABOLIC STEROID EFFECTS ON THE BODY PROMOTES THE
GROWTH OF SKELETAL MUSCEL, INCREASED LEAN BODY
MASS. HAZARD LIVER TUMORS, FLUID RETENTION, HIGH
BLOOD PRESSURE, INFERTILITY AGGRESSION, MOOD
SWINGS, VIOLENT BEHAVIOR, PARANOIA
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CLINICAL EFFECTS / SYMPTOMS
STIMULANTS SCHIZOPHRENIA HALLUCINATION
PARANOIA SLEEP DISTURBANCE HALUCINOGEN
BIPOLAR MOOD SWINGS ANXIETY
ATTACKS SEDATIVE DEPRESSION DEPRESSED MENTAL
ACTIVITY SLEEP DISTRUBANCE
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CHEMICAL CHANGES IN THE BRAIN
CURRENT RESEARCH STATES ADDICTS ARE DEFICIENT IN
ONE OF THE FOLLOWING Dopamine Gamma-aminobutyr
ic acid (GABA) Serotonin Glutamate
(GLU) Endorphins LIFE STAGES WHEN NATURAL
CHEMICAL CHANGES OCCUR Puberty Pregnancy Menopause
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Chemical Dependency or Mental IllnessHow Do I
Tell the Difference?
Chemically Dependent Person psychosis will be
extroverted. Mentally Ill Person psychosis will
be introverted.
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Medical Conditions That Mimic Mental Illness

• Brain Tumor
• Inability to concentrate
• Recall dates, perform arithmetic
• Weakness, Numbness
• Loss of Coordination
• Light sensitivity, Doubled or Blurred Vision.

• Menigititis
• Vomiting
• Neck Stiffness unable to touch chin to chest
• Dislike Bright Lights
• Drowsiness
• Confusion or may be disoriented

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Medical Conditions That Mimic Mental Illness

• Diabetes
• Shaking
• Sweating
• Blurred Vision
• Dizziness
• Confusion, poor concentration
• Fast Heart Rate
• Seizures

• Head Injury
• Muscle Weakness or stiffness
• Balance
• Gait abnormalities
• May be unable to comprehend written or spoken
  language
• Loss of emotional inflection of voice

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Thyroid Disease

• Hypothyroidism
• Thyroid gland produces too little thyroid
  hormones.
• Symptoms
• Depression
• Fatigue
• Memory difficulties

• Hyperthyroidism
• Thyroid gland produces too much thyroid hormone
• Symptoms
• Irritability
• Rapid heart rate
• Shaky hands
• Sleep disturbance
• Withdrawn behavior
• .

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Medical Conditions That Mimic Mental Illness

• Other Medical Conditions
• Pneumonia
• High Blood Pressure
• Epilepsy
• Adverse Reactions to Medications
• Severe Infections/High Fever

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Intervention Strategies

• Stay calm, breathe deeply
• Be patient and give the person time to calm down
• Maintain as much eye contact as possible while
  understanding that some cultures and disorders
  make eye contact uncomfortable
• If possible, provide a quiet place (car or room)
  free of noise and distractions

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Strategies (Cont.)

• Listen
• Take notes
• Be aware not only of verbal but also non-verbal
  communications
• Avoid asking why?
• Ask open-ended questions

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Strategies (Cont.)

• Use individuals first name
• Allow the person to use your first name
• Double check for understanding
• Give instructions one at a time and allow extra
  time for compliance
• Avoid stigmatizing words

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Calling for Back-up

• Safety
• Officer
• Individual
• Public
• Telecares mobile crisis team
• 866-260-8000

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Voluntary Diversions

• Person must be willing to get help
• Cannot give a choice of arrest or voluntary
  evaluation or treatment
• If person requests transport to a specific
  facility, then do so

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Involuntary Diversion

• Warrantless detention
• Apprehension by peace officer without a warrant
• Texas health and safety code, section 573.001
• Warranted detention
• Magistrate order for emergency admission and
  detention
• Texas health and safety code, section 573.011

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Transporting the Person With Mental Illness

• Officer should follow department policy and
  procedure distance to approved medical facility
  for examination or admission behavior or
  physical condition of person (violent, comatose,
  ambulatory, non-ambulatory, sedated)

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Who can help?

• Imminent Danger
• Mental health crisis

• Call 911
• Telecare Mobile Crisis Team
• 866-260-8000
• Dallas County Mental Health Constables
• 214-653-7121

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SUICIDE IN CORRECTIONAL FACILITIES
Data from American Association of Suicidology
Correctional Suicide Prevention n by Ronald L.
Bonner, Psy,D.
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11 LEADING CAUSES of DEATH in the U.S.A. 2000

• Rank Cause of Death Deaths
• 1. Disease of heart 710,760
• 2. Malignant neoplasms 553,091
• 3. Cerebrovascular disease 167,661
• 4. Chronic lower respiratory 122,009
• 5. Accidents 97,900
• 6. Diabetes mellitus 69,301
• 7. Influenza pneumonia 65,313
• 8. Alzheimers disease 49,558
• 9. Nephritis, nephrosis 37,251
• 10. Septicemia 31,224
• 11. Suicide 29,350
• Homicide is 14th

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SIGNS AND SYMPTOMS

• Talking about suicide
• Statements about hopelessness or worthlessness
• Preoccupation with death
• Loss of interest in things one cares about.

• Suddenly calmer
• Visiting or calling people one cares about
• Making arrangements
• Setting ones affairs in order
• Giving things away

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RISK FACTORS FOR JAIL POPULATION
PAST HISTORY SUICIDE ATTEMPTS, FAMILY SUICIDE
HISTORY, INTOXICATION, DEPRESSED MOOD,
HOPELESSNESS, SUICIDE IDEATION, INTERPERSONAL
LOSS, NATURE OF OFFENSE.
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PROFILE OF JAIL SUICIDE VICTIM
YOUNG, WHITE, SINGLE, FIRST TIME , NON VIOLENT
OFFENDERS, INTOXICATED, SUBSTANCE ABUSE HISTORY,
HANGING BY BED CLOTHING, ISOLATED JAIL HOUSING
AND DEATH WITHIN 24 HOURS OF ARREST.
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PROFILE OF PRISON SUICIDE VICTIM
SIGNIFICANT MENTAL ILLNESS, HISTORY OF SUICIDE
ATTEMPTS, OLDER AGE, LENGTHY SENTENCES,
INSTITUTIONAL PROBLEMS INVOLVING PROTECTIVE
CUSTODY AND IMMIGRATION STATUS,
SEGREGATED/ISOLATED HOUSING.
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U.S.A. SUICIDE 2000 OFFICIAL FINAL DATA
NUMBER PER
DAY RATE of Death Nation 29,350
80.2 10.7
1.2 Males 23,618 64.5
17.5 2.0
Females 5,723 15.7
4.1 0.5
Whites 26,475 72.3
11.7 1.3 Non
whites 2,875 7.9
5.9 0.9
Blacks 1,962 5.4
5.6 0.7
Elderly (65 ) 5,306 14.5
15.3 0.3
Young (15-24) 3,994
10.9 10.4 12.8 Rates
per 100,000 in population Source CDC/NCHS,
National Vital Statistics System
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HOW TO HELP SUICIDAL PERSON

• LISTEN DONT LECTURE. What the person really
  needs in this crisis period is someone who will
  listen to what is being said. Try to understand
  from their viewpoint.
• ACCEPT WHAT IS SAID AND TREAT IT SERIOULSY. Do
  not judge. Do not offer platitudes.
• ASK DIRECTLY IF THE INDIVIDUAL IS THINKING OF
  SUICIDE. If the person has not been thinking of
  suicide, he or she will tell you. If the person
  has been thinking of it your asking allows the
  opportunity to bring it out in the open.
  Isolation and the feeling that there is no one to
  talk to compounds suicidal ideation. YOU WILL
  NOT CAUSE SOMEONE TO COMMMIT SUICIDE BY ASKING
  THEM IF THEY ARE SUICIDAL.

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HOW TO HELP SUICIDAL PERSON cont.

• TALK OPENLY AND FREELY AND TRY TO DETERMINE
  WHETHER THE PERSON HAS A PLAN FOR SUICIDE. The
  more detailed the plan the greater the risk.
• TRY TO FOCUS THE PROBLEM. Point out that
  depression causes people to see only the negative
  in their lives and to be temporarily unable to
  see the positive. Elicit from the persons past
  and present positive aspects which are being
  ignored.
• HELP THE PERSON TO INCRESASE HIS/HER PERCEPTION
  OF ALTERNATIVES TO SUICIDE. Look at what the
  person hopes to accomplish by suicide and
  generate alternatives ways to reaching the same
  goals. Help determine what needs to be done or
  changed.

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HOW TO HELP SUICIDAL PERSON cont.

• HELP THE PERSON RECALL HOW THEY USED TO COPE.
  Get the person to talk about a past problem and
  how it was resolved. What coping skills did he
  or she use.
• DO NOT BE MISLED BY PERSONS COMMENT THAT HE OR
  SHE IS PAST THE EMOTIONAL CRISIS. The person
  might feel initial relief after talking of
  suicide, but the same thinking could recur later.
• ACT RESPECTFULLY. Do arrange with the person to
  be back in contact within a few hours. Offer
  yourself as a caring and concerned listener until
  professional assistance has been obtained.

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HOW TO HELP A SUICIDAL PERSON cont.

• DO NOT AVOID ASKING FOR ASSISTANCE AND
  CONSULTATON. Call upon whomever is needed,
  depending upon the severity of the case. DO NOT
  TRY TO HANDLE EVERYTHING ALONE. Seek out
  referrals from hotlines.

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ACA NCCHC RESPONSE TO INMATE SUICIDE
In response to research and increased litigation
involving jail and prison suicides, several
suicide prevention standards have been developed
to help guide correctional systems and meet
acceptable standards of care. The standards of
care developed by the American Correctional
Association and the National Commission on
Correctional Health Care have been the basis for
several programs implemented by correctional
institutions across the country. New York
Correctional Facilities began a program which
resulted in an annual decrease of suicide
completions by one third (177 per 100,000 before
program in 1984. 54 per 100,000 in 1997)
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COMMON COMPONENTS OF SUICIDE PREVENTION PROGRAM
Suicide risk screening and assessment mental
health referrals, interpersonal communication and
humanistic attitude suicide risk levels
corresponding monitoring, and watch procedures
emergency medical procedures and staff
training. Such programs are essential defense
in liability causes whereby suicide prevention
procedures are formalized and implemented by well
trained staff.