Mental Health Peace Officer

1
Mental Health Peace Officer Course 4001
Texas Commission on Law Enforcement Officer
Standards and Education
2
Unit Goal 1.0. To sensitize officer to the
adversity of mental illness.

• 2004 U.S. Census
• 26.2 had a diagnosable mental disorder
• 6 serious mental illness
• 45 two or more
• Leading cause of disabilities in ages 15-44

3
Disorder Percentage of Population Converted to Millions Median Age of On-set
Mood Disoreder 9.5 20.9 30
Major Depressive Disorder 6.7 14.8 32
Bipolar Disorder 2.6 5.7 25
Schizophrenia 1.1 2.4 20 to early 30s
Anxiety Disorder 18.1 40 21.5
Panic Disorder 2.7 6 24
Obsessive Compulsive Disorder 1.0 2.2 19
Post Traumatic Stress Disorder 3.5 7.7 23
Autism 3.4 per 1000 children 3-10
4
Factors affecting mental health situation

• Deinstitutionalization
• Criminalization
• Medicalization
• Privatization

5
1.1.Define the term mental illness.

• Illness, disease, or condition that either
  substantially impacts a persons thought,
  perception of reality, emotional process, or
  judgment, or grossly impairs a persons behavior,
  as manifested by recent disturbance behavior.

6
1.2. List three categories of mental illness most
predominately identified with disease severity

• Psychotic Disorder All cases of schizophrenia
• Mood Disorder Severe cases of major depression
  and bipolar disorder
• Anxiety Disorder Severe cases of generalized
  anxiety disorder, obsessive-compulsive disorder,
  and post-traumatic stress disorder

7

• Cognitive Disorders (Alzheimers, Substance
  Abuse)
• Personality Disorders (Paranoid, anti-social)
• Disorders first diagnosed in infancy, childhood
  or adolescence (Autism, Mental Retardation,
  Attention Deficit Hyperactivity Disorder)

8
1.3. Define terms associated with a Psychotic
Disorder

• A group of serious and often debilitating mental
  disorders...are characterized by...impaired
  thinking and reasoning ability, perceptual
  distortions, inappropriate emotional responses,
  inappropriate affect, regressive behavior,
  reduced impulse control and impaired reasoning of
  reality.
• (Social Work Dictionary, 2nd
  Edition, by Robert L. Baker)

9
Definition of Delusion

• False beliefs not based on factual information. A
  delusion implies belief in something that is
  contrary to fact or reality, resulting from
  deception, a misconception, or a mental disorder.
  A persistent belief maintained in spite of
  evidence to the contrary.

10
Definition of Hallucinations

• Distortions in the senses where the individual
  experiences auditory sounds and/or visual images
  that are technically not there.

11
1.3.1. Discuss Schizophrenia and its relationship
with Psychotic Disorders

• Schizophrenia consists of a group of psychotic
  disorders characterized by changes in perception.

12
1.4. Discuss the characteristics of a Mood
Disorders

• A mood disorder is a mental health disorder with
  an abnormal mood as its primary feature.

13
1.4.1. Discuss Major Depressive Disorder

• A disorder that severely affects an individuals
  thinking and behavior.
• A depressed mood or loss of interest of at least
  two weeks duration, accompanied by symptoms such
  as weight loss/gain, and difficulty
  concentrating.

14
1.4.2. Identify prominent characteristics of
Bipolar Disorder

• A brain disorder of a severe nature, that creates
  unusual shifts in a persons mood, energy level,
  and ability to function.

15
Symptoms of a Manic Phase may include

• Abnormally high, expansive, 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.

16
The Spectrum of Bipolar Disorder

• Severe Mania
• Hypomania (mild to moderate mania)
• Normal/balanced mood
• Mild to moderate depression
• Severe depression

17
1.5. Define Anxiety Disorder

• Anxiety is a normal reaction to stress. It helps
  a person deal with a tense situation by helping
  one cope. But when anxiety becomes excessive and
  irrational it becomes a disorder.

18
Anxiety disorders can include

• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder
• Post traumatic Stress Disorder (PTSD)

19
1.5.1. Define Generalized Anxiety Disorder (GAD

• Constant worries and fears that distract from
  day-to-day activities and leave a persistent
  feeling that something bad is about to happen.

20
1.5.2. Describe Obsessive-Compulsive disorder

• Distressing, unwanted nonsensical thoughts which
  return despite efforts to ignore them and the
  ritualistic behavior utilized to control these
  thoughts.

21
Obsessions are

• Repeated, persistent, unwanted ideas, thoughts,
  images or impulses that you experience
  involuntarily and that appear to be senseless.

22
Compulsions are

• Repetitive behaviors that an individual feels
  driven or compelled to perform.

23
1.5.3. Discuss Post Traumatic Stress Disorder
(PTSD)

• A type of anxiety disorder that is triggered by
  the involvement in or witness to an extremely
  traumatic event.

24
DSMIV indicates

• The essential features of PTSD include
• Experiencing, witnessing, or confrontation with
  an event or events that involve actual or
  threatened death or serious injury, or a threat
  to the physical integrity of self or others

25
1.5.4. Apply knowledge gained to a discussion of
at-risk occupations

• ...persons in emergency service fields are a
  population highly prone to suffering from PTSD,
  as a direct result of their work.
• ...involved in traumatic events through direct or
  indirect involvement on a daily basis.
• PTSD affects both men and women.
• ...not only with front-line personnel but
  tele-communicators, dispatchers and support
  staff.

26
1.6. Discuss the term Cognitive Disorder

• Cognition refers to that operation of the mind
  process by which we become aware of objects of
  thought and perception, including all aspects of
  perceiving, thinking, and remembering.

27
The two most common cognitive disorders include

• Alzheimers Disease
• Substance Abuse Disorders

28
1.6.1. Discuss the most commonly addressed
organic brain disorder

• The most common Organic Brain Disorder in persons
  over the age of 65 is Alzheimers disease.
• Alzheimers is one of several disorders that
  cause a gradual loss of brain cells.
• The cause of all demensia is abnormal loss of
  brain tissue.

29
. Demensia is characterized by loss of memory
PLUS one or more of the following

• Aphasia
• Apraxia
• Agnosia
• Loss of higher executive functioning

30
1.6.2. Discuss the relevance of addressing
substance abuse disorders in the topic of mental
illness

• Prolonged abuse of any drug can cause chemical
  dependency or addiction.
• If these substances are used for extended periods
  of time/large dosages, they may also cause
  permanent damage to the central nervous system.
• This damage can cause a wide range of
  psychological reactions that are classified as
  disorders.

31
Co-occurring Disorders

• The co-occurrence of mental health disorders and
  substance abuse disorders, which would include
  alcohol and/or drug dependence or abuse.

32
1.7. Define the term Personality Disorder

• American Psychiatric Association (APA) defines as
  "an enduring pattern of inner experience and
  behavior that deviates markedly from the
  expectations of the culture of the individual who
  exhibits it".

33
1.7.1. Discuss examples of Paranoid Personality
Disorder

• An on-going unfounded distrust and suspiciousness
  of people.

34
1.7.2. Discuss relevant characteristics of
Antisocial Personality Disorder

• Behavior that is manipulative.
• Often victimizes and violates the rights of
  others.
• Fail to conform to societal norms
• Often have a history of juvenile conduct disorder
  and criminal activities prompted by reckless,
  impulsive and violent behaviors.
• This disorder is also most common in men.

35
1.8. List the most common mental disorders that
are first diagnosed prior to the age of eighteen

• Developmental disorders of Autism Spectrum
  Disorder (ASD),
• Mental Retardation, and
• Attention Deficit Hyperactivity Disorder (ADHD).

36
The Developmental Disabilities Assistance and
Bill of Rights Act of 1990 defines a
developmental disability as

• a severe, chronic disability of a person five
  years of age or older.
• Such a disability is attributable to a mental or
  physical impairment or combination of the two.
• Is manifested before a person reached the age of
  twenty-two.
• May continue indefinitely.
• 
  continued...

37

• Substantial limitation of three or more specified
  life activities.
• Reflects the persons need for lifelong or
  extended care, treatment, or other services which
  are planned and coordinated according to that
  persons needs.
• Infants and young children (newborn to age 5)
  with developmental disabilities have
  substantially delayed development or specific
  congenital or acquired conditions

38
1.8.1. Discuss Autism Spectrum Disorder (ASD)

• Brain developmental disorder that impairs social
  interaction and communication causing restricted
  and repetitive behavior, all starting before the
  age of three.

39
1.8.2. Define Mental Retardation

• A range of substantial limitations in mental
  functioning manifested in persons before the age
  of 18, creating a pattern of slow learning during
  childhood and significantly below normal global
  intellectual functioning as an adult.

40
1.8.3. Explain the primary differences that exist
between a Mental Illness and Mental Retardation

• 3 of the American population is considered to
  posses a mental retardation (sub-average score of
  69 or less on Wechler Intelligence Scale or
  Stanford Binet IQ test).
• While22.1 of the American population is
  diagnosed with a mental illness.

41
Mental Illness Mental Retardation
Unrelated to intelligence Below average intellectual functioning
Develops at any point in life Occurs prior to the age of 18
No cure but medications can help Permanent intellectual impairment
Behavior less predictable Behavior consistent to functional level
42
1.8.4. Describe prevalent factors of Attention
Deficit Hyperactivity Disorder (ADHD)

• A medical condition characterized by difficulties
  with inattention or hyperactivity and
  impulsivity.

43

• Questions and Discussion

44
2.0. Discuss psychopharmacology as it relates to
medications prescribed and prominent side effects
in persons with a mental illness.
45
2.1. Name four categories of medications utilized
in controlling the symptoms of mental Illness.

• Anti-psychotic
• Antidepressants
• Mood stabilizers (Hallucinogenic)
• Anti-anxiety drugs

46
2.2. List side effects that can be associated
with utilizing psychotherapeutic medications

• muscle spasms, protruding tongue, eyes rolled
  back, constant leg movement, tremors,
  uncoordinated movements, impotence, nausea,
  headache, blurred vision, weight gain, fatigue,
  liver toxicity

47
Side effects can be

• uncomfortable
• dehumanizing
• and are often irreversible, which may cause
  person to refuse to take them as directed

48
2.3. Define Tardive Dyskinsia (TD) and its
relationship to the utilization of
psychotherapeutic medications

• Some of these side effects are permanent, even
  after the medications have been stopped the
  medications have a tendency to produce
  neurological damage.

49
2.1.3. List common reasons for a consumer
deviating from their prescribed medication
schedule

• Side effects
• The stigma associated with being mentally ill,
  i.e., they dont want people to know they have a
  mental illness
• They start feeling better and think they no
  longer need the medications

50

• Questions and Discussion

51
3.0. Discuss signs and symptoms of suicide

• Average of 6 deaths each day by suicide in Texas
• 121 more people committed suicide in 2001 than in
  2000. This is a six percent increase in one year.
  The gender breakdown was reported at 1,772 males
  vs. 442 females (i.e., about 4 men for each
  woman)
• Highest rates of suicide are in the 45-54 age
  group (15.2 per 100,000), with the second being
  the 75-year-and-older age group (18 per 100,000)
• 90 of suicides are reportedly related to
  untreated or under-treated mental illness with
  the most common being depression.
• Nearly 20 of people diagnosed with bipolar
  disorder and 15 diagnosed with schizophrenia die
  from suicide.

52
3.1. Explain the process of evaluating suicidal
risk

• An individual considering suicide may try to
  reach out to you in a direct or indirect manner.
• There is no positive means of identifying
  immediate risk of suicide however most warning
  signs especially in combination indicate that the
  individual is experiencing some sort of emotional
  stress.

53
Suicidal intervention strategies

• The three Is
• Contracts

54
3.1.1. Evaluate the risk of suicide by the Law
Enforcement Officer

• Occupational conditions.
• More prone to the risk of divorce, alcoholism,
  emotional/physical problems and Post Traumatic
  Stress Disorder (PTSD).
• Innate nature of the police culture.

55

• Questions and Discussion

56
4.0. Explain Crisis Behavior and its relevance to
CIT Training

• You interact with people who are angry,
  emotional, injured, frightened, or traumatized.
  Some of these people welcome your presence, while
  others resent it.

57
4.1. Discuss the cycle of crisis behavior

• Definition of Crisis Behavior
• A person suffering from a temporary breakdown in
  coping skills that includes perception,
  decision-making, and problem solving abilities
• Different depending on individual response.
• Anyone can suffer from a crisis and its effects
  can vary with time, place, and person

58
Crisis Escalation Cycle

• As an individual enters into a crisis situation
  their response enters into fairly predictable
  stages. If acutely psychotic, responding to
  internal stimuli, or intoxicated, these stages
  will vary and may become even more erratic.

59
Crisis Cycle

• Onset
• Escalation and Anger
• Out of control behavior

60
4.1.1. List examples, for officer response, at
each level of escalation
Person Officer

Level 4 Violence Anger/Fear
Level 3 Hostility Fear
Level 2 Anger Anxiety
Level 1 Anxiety Empathy
Calm Supportive
61
4.2. Discuss officer interactions with persons
who have a mental illness

• Stay calm
• Be patient
• Double-check information
• Use the individuals name
• Give instructions or directives one at a time
• 
  continued...

62

• The size and age of a person with mental illness
  has little to do with whether a back-up officer
  should be called
• Engagement is pivotal - keep trying
• Dont underestimate the power of hallucinations
  or delusions
• Never argue about a delusion
• Ask about treatment in the past
• Do not take a judgmental stance.
• Dont express disapproval
• Persons in mental health crisis need more
  personal space

63
4.3. Explain how to utilize observation as a tool
for evaluative purposes

• Consciousness
• Activity
• Speech
• Thinking
• Affect and Mood
• Memory
• Orientation
• Perception
• Physical symptoms

64
4.3.1. Discuss additional ways to obtain useful
information for evaluative purposes

• In addition to your personal observations, it is
  important to obtain information from witnesses
  and family members and friends.

65
Six step model of Crisis Intervention

• Defining the problem
• Ensuring client safety
• Providing support
• Examine alternatives
• Making Plans
• Obtaining commitment

66
4.4. Demonstrate how Crisis Intervention
Techniques can be utilized in domestic
disturbance situations.
67
4.5. Discuss emerging trends in Crisis
Intervention techniques

• Has evolved into a major human service
  sub-specialty
• Has become widely apparent that a reactive
  approach to crisis intervention is not enough
  proactive and preventive models need to be
  developed and implemented

68

• Questions and Discussion

69
Unit Goal 5.0. To explore the world of the
mentally ill through a discussion of legal and
societal concerns and perspectives.
70
5.1. Discuss the mentally ill person in the
situation of being homeless.

• On any given night approximately 600,000
  Americans are homeless
• More than 2 million people are homeless
  throughout the year
• One-third of the people who are homeless have a
  serious mental illness
• One-half also have a substance abuse disorder.

71
5.2. Discuss the mentally ill individual as a
victim of crime.

• People with mental illness are more likely to be
  victims than perpetrators of violence
• National Institute of Justice, 1996

72
Statistics

• 4-13 of mentally ill consumers are perpetrators
  of crime
• Mentally Ill consumers are 140 times more likely
  to be victim of theft
• 3 million Mentally Ill consumers are estimated to
  be victimized each year
• In a year, more than one-quarter of mentally ill
  consumers say they are victimized

73
5.3. Evaluate the stigma and societal
discrimination that exists toward persons who are
mentally ill.

• Stigma is a mark of disgrace or shame. It is made
  up of various components, including
• Labeling someone with a condition
• Stereotyping people with that condition
• Creating a division (i.e., a superior us and a
  denigrated them)
• Discriminating against someone on the basis of
  their label

74
5.3.1. Discuss the Americans with Disabilities
Act as it relates to individuals diagnosed with a
mental illness

• The Americans with Disabilities Act (ADA)
  entitles people with disabilities to the same
  service and protections that police departments
  provide to anyone else. They may not be excluded
  or segregated from services, denied services, or
  otherwise provided with lesser services or
  protection than are provided to others.

75
5.4. Discuss legal and societal concerns from a
mental health consumers vantage point.
76
5.5. Participate in a discussion of the family
member perspective on mental illness.
77

• Questions and Discussion

78
6.0. Develop an increased understanding of the
legal process evaluation and techniques for
appropriateness of apprehension per Texas Health
and Safety Code (Mental Health Code.)
79
6.1. Discuss the process in evaluating the
appropriateness of a warrant less apprehension.

• Least restrictive alternative is the process
  that
• Is available
• Provides the consumer with the greatest
  possibility of improvement
• Is no more restrictive of consumers physical or
  social liberties than is necessary

80
6.1.2. Describe the step by step process of
Apprehension by a Police Officer without a
warrant to include emergency apprehension.
81

• Texas Health and Safety Code, Sec.573.001
• Texas Health and safety Code, Sec .573.002
• Texas health and safety Code, Sec.573.011
• Texas health and safety Code, Sec.573.012
• Texas health and safety Code, Sec.573.021
• Texas health and safety Code, Sec.573.022
• Texas health and safety Code, Sec.573.023

82

6.1.3. Discuss the Orders of Protective Custody
process

• Texas health and safety Code, Sec.574.021
• Texas health and safety Code, Sec.574.022
• Texas health and safety Code, Sec.574.023

83
6.1.4. Research departmental policies in
requesting assistance and transport of a consumer
before and after apprehension
84
6.1.5. Propose justifications in assessing proper
use of force option.

• Keep the situation in perspective
• The officer may use force comparable to any other
  legal duty when a person is resisting arrest
• The force must be reasonable
• Goal is to obtain care and treatment for the
  mentally ill person

85
6.2. Explain an officers limitation of liability.

• People acting in good faith, reasonably and
  without negligence are not civilly or criminally
  liable.

86
6.3. Discuss Confidentiality as it relates to the
topic of Mental Health and Law Enforcement
involvement

• Communication between a patient and a
  professional, as well as records of the identity,
  diagnosis, evaluation, or treatment of a patient
  that is created or maintained by a professional

87

• Questions and Discussion

88
Unit Goal 7.0. Gain an understanding of mental
health referrals/resources in the students
community.
89
7.1. Investigate possible referral/treatment
challenges in your community.

• Lack of available services
• Willingness of mental health providers
• Quality and availability of mental health
  programs
• High costs of prescription drugs and formulary
  limitations

90
7.2. Discuss the players and strategies needed to
coordinate a quality community mental health
program

• Who else in your community could share in these
  responsibilities?

91
Framework of Responsibilities
Criminal Justice Mental Health Community Family Advocacy Social Services
Rehabilita-tion Prevention Cross training Crime Management Treatment Rehabilita-tion Prevention Cross training Disease management Rehabilia- tion Housing Income Support Job training Care Rehabilita -tion Housing Income Support Representa -tion Protection Cross training Rehabilita -tion Housing Income Support Job training Cross training
92
7.2.1. Define a partnership and its relevance in
community and law enforcement collaboration

• Definition of a partnership
• An arrangement between two or more parties who
  have agreed to work cooperatively toward shared
  objectives in which there is shared authority
  and respect, joint investment of resources,
  shared liability or risk taking, and ideally,
  mutual benefits

93

• Definition of collaboration
• A system that integrates the resources and
  delivery of appropriate Mental Health care
  services through processes or techniques used by
  different entities in order to control or
  influence the quality, accessibility,
  utilization, costs and prices, or outcomes of
  social services provided to a defined population.

94

• The criminal justice and mental health worlds
  are very different. We come from different
  traditions, we speak different languages, and to
  some degree have different values, expectations,
  and goals. Furthermore, few of us expected or
  desired to work in both the criminal justice and
  mental health worlds, and few of us have been
  trained or educated to understand the other
  world.

95
7.3. List the mental health facilities in your
area that can be utilized as a resource when
encountering a subject/suspect you identify as
having possible mental heath issues.
96
7.4. Discuss the State of Texas Jail Diversion
Ideal

• Education and training of law enforcement
  personnel and the courts
• The development and utilization of crisis
  intervention teams (CIT)
• Development of a centralized location for mental
  health assessment, without, arrest for
  individuals with non-violent criminal conduct
• Development of holding facilities providing
  structured treatment in lieu of arrest
• Development of linking and referral services
• Development of timely and effective screening
  process
• Development of required community support
• Development of an identified method for
  addressing housing and needed support services

97
There are two types of jail diversion

• Pre-booking
• Post-booking

98

• Questions and Discussion

99
8.0. Unit Goal Understanding program evaluation
in demonstrating/measuring success.

• Measuring program effectiveness can assist in
  determining how successful your program responses
  are to your area.
• It will also evaluate any changes or
  adaptations/modifications that might be
  appropriate.
• Look at trends for the total agency.

100
Three types of useful data

• Quantitative data
• Quantity Data
• Process Data

101

• Questions and Discussion

102
In conclusion

• It is important to dispel commonly held
  misconceptions about people who have mental
  illnesses. This training has been based on the
  following working assumptions

103

• Mental illness is not a crime.
• Most people with mental illnesses are fully
  functioning community members.
• There is no correlation between mental illness
  and a persons participation in crime.

104

• Involvement in infractions (traffic violations,
  loitering, disorderly conduct) may be a
  manifestation of a persons mental illness or
  failure to receive treatment for the illness,
  rather than a result of intentional wrongdoing.

105

• Some people with mental illnesses may be more
  vulnerable to crime, abuse or injury than the
  general population.
• Mental illness is a continuum- highly functional
  to highly debilitating.

106

• END