27. Crisis Intervention Training (CIT)/Mental Health Code- 24 hrs

1. 27. Crisis Intervention Training (CIT)/Mental Health Code- 24 hrs TCLEOSE LEARNING OBJECTIVES 07/27/04

2. Objective • Unit Goal: 27.1. To develop a basic understanding and respect for the fundamental rights of and a proficiency in interacting with people with mental impairments through the use of communication techniques to de-escalate potentially volatile situations. • 27.1.1 Define mental illness. • 27.1.2 Distinguish among the different types of mental illness. • 27.1.3 Discuss psychopharmacology. • 27.1.4 Identify the process and necessary conditions to obtain a Mental Health Warrant per Texas Health and Safety Code (Mental Health Code) • 27.1.5 Identify factors to be considered in determining whether or not to request assistance. • 27.1.6 Identify factors considered in determining appropriate method of transporting patient. • 27.1.7 Explain the impetus for crisis intervention training and why the training is so important. • 27.1.8 Discuss the components of the “first three minute assessment” 27.1.9 Summarize five strategies for dealing with a person in a mental health crisis. • 27.1.10 Demonstrate the process of modeling. • 27.1.11 Explain the characteristics that contribute or interfere with communication • 27.1.12 Apply knowledge obtained in coursework to class examples and scenerios. • 27.1.13 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. • 27.1.14 Describe at least five effective communication/interaction skills used when dealing with persons with a mental illness.

3. Unit Goal: 27.1. To develop a basic understanding and respect for the fundamental rights of and a proficiency in interacting with people with mental impairments through the use of communication techniques to de-escalate potentially volatile situations

4. Opening Statement: With increasing frequency, law enforcement is being called upon to respond to individuals in serious mental health crisis. It is necessary for the law enforcement personnel to understand mental illness and the tactics and techniques that have been proven to work more effectively when responding to individuals in these situations. These tactics and techniques are different than those routinely taught to officers to control conflict. This information can help keep the officer safe, the mental health consumer safe, and greatly reduce liability on the part of the officer and the agency.

5. Mental Health Statistics: About 22.1% of the U.S. adult population uses some sort of mental health service each year. This is an understatement of the number of persons with mental health problems, as many people do not seek treatment. Some studies indicate that 32% of U.S. adults suffer from some sort of mental illness within their lifetime.

6. 27.1.1 Define mental illness

7. General definition: • “Illness, disease or condition that either substantially impacts a person’s thought, perception of reality, emotional process, judgment, or grossly impairs a person’s behavior, as manifested by recent disturbance behavior.”

8. Professional definition of Mental Illness: • Mental Illness is diagnosed based on behaviors and thinking as evaluated by a Psychiatrist, Psychologist, Licensed Professional Counselor, Licensed Social Worker, or other qualified professionals using a tool known as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, most commonly called the DSM-IV. (American Psychiatric Association, Updated, 1999)

9. Insanity (Legal Term): • Insanity is considered “a diminished capacity and inability to tell right from wrong.” This is not a psychological term. The definition varies from state to state. Generally used by the court with regards to an individual’s competency to stand trial.

10. 27.1.2 Distinguish among the different types of mental illness.

11. Abnormal and Normal Behavior: • A sharp dividing line between “normal” and “abnormal” behavior does not exist. Adjustment seems to follow what is called a normal distribution, with most people clustered around the center and the rest spreading out towards the extremes.

12. Categories of mental illness include: (1) Personality Disorder (2) Mood Disorder (3) Psychosis

13. (1) Personality Disorders

14. Many individuals who are functioning well in their lives may display characteristics of what are known as personality disorders. Individuals experiencing these disorders show personality traits that are inflexible, maladaptive or inappropriate for the situation, causing significant problems in their lives.

15. Those who have personality disorders, also usually have very little insight that they have a problem and tend to believe that the problems are caused by; other people, the “system”, or the world at large. These traits are often accompanied by some form of depression and may also be seen in those with chemical dependency problems.

16. Persons with personality disorders are not usually treated like other mental illnesses but are taught a variety of communication and coping skills, or treated for other problems such as chemical dependency or depression

17. Causes: • Although the causes for these disorders may not seem relevant for the officer dealing with these individuals, their backgrounds are significant. It is believed that most personality disorders are caused by a family history, usually beginning at a young age, of physical or emotional abuse, lack of structure and responsibility, poor relationships with one or both parents, and alcohol or drug abuse in the family.

18. The most common personality disorders encountered by peace officers are:

19. Paranoid: • Tendency to interpret the actions of others as deliberately threatening or demeaning • Expectations to be used or harmed by others • Perceives slights from other people

20. Antisocial: • Most commonly recognized in males • A pattern of irresponsible and antisocial behavior diagnosed at or after age 18 • May have one or more of the following: • History of truancy as a child or adolescent; may have run away from home • Starts fights • Use of weapons • Physical abuse of animals or other people • Deliberately destroying others’ property • Lying • Stealing • Other illegal behavior • As adults these people often have trouble with authority and are reluctant or unwilling to conform to society’s expectations of family and work • These individuals know that what they are doing is wrong, but do it anyway

21. Borderline: • Most commonly recognized in females • May have one or more of the following: • unstable and intense personal relationships • impulsiveness with relationships, spending, food, drugs, sex • intense anger or lack of control of anger • recurrent suicidal threats • chronic feelings of emptiness or boredom • feelings of abandonment

22. Treatment: • People with Personality Disorders usually will not seek treatment because they don’t think they have a problem. They may end up in the criminal justice system because their disorder may lead them to break laws and come to the attention of law enforcement. (Theft, hot-check writing, fraud etc.) They often may receive treatment for chemical dependency or depression.

23. (2) Mood Disorders

24. Depression: • Depression is a disorder common among many people. • 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. • Major depression is not just a bad mood or feeling “blue” but a disorder that affects thinking and behavior not caused by any other physical or mental disorder. • A major depressive syndrome is defined as a depressed mood or loss of interest, of at least two weeks duration accompanied by associated symptoms such as weight loss/gain and difficulty concentrating. Five or more symptoms are generally present during the same two-week period and are represented by a change from previous functioning. Depressed mood or loss of interest must also be included.

25. Other symptoms of depression may include: • Prolonged feelings of hopelessness or excessive guilt • Loss of interest in usual activities • Difficulty concentrating or making decisions • Low energy/fatigue • Changes in activity level • An inability to enjoy usual activities • Changes in eating habits leading to weight gain or loss • 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.

26. Depression and suicide: • The single most common factor in suicidal behavior or death by suicide is that the individual is experiencing depression.

27. Suicide prevention: • Listen, empathize, ask, paraphrase and summarize (“L-E-A-P-S”) • Reference: Houston Police Department “Crisis Intervention Team 40-Hour Curriculum Student Manual Year 2000”

28. Accessing the Levels of Danger: • Symptoms? • Nature of current stressor? • Method and degree? • Prior attempt? • Acute vs. chronic? • Medical status? • Chance for rescue? • Social resources?

29. Danger to self • Intent (actions/words) • Gross neglect for personal safety • Specific plan (action/words) • Plans/means available

30. Danger to others: • Intent (actions/words) • Specific person identified • Agitated, angry, explosive • Irrational, impulsive, reckless (intent/actual)

31. Myths about suicide: • MYTH: People who talk about suicide won’t commit suicide. • MYTH: People who commit suicide are “crazy”. • MYTH: Once the person begins to improve, the risk has ended. • MYTH: Prior unsuccessful suicide means there will never be a successful suicide • Note to the instructor: Use the video “Community Encounters: Attempted Suicide”

32. Treatment for Depression: • A number of non-addictive medications are used in treating depression, if needed. It is recommended that persons taking medications for depression not use alcohol. Alcohol can interact with the medications and increase alcohol’s effects or create problems in reaction time and judgment. • Many people self medicate their depression with alcohol or other non-prescribed drugs which may give them temporary relief but tends to only increase the depressive symptoms.

33. Bipolar Disorder: • An illness involving mania (an intense enthusiasm) and depression.

34. Mania 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.

35. An individual may quickly swing from the manic phase to the depressed stage. • An individual cannot maintain the level of activity normally associated with mania for a long period of time.

36. (3) Psychosis:

37. An illness involving a distortion of reality that may be accompanied by delusions and/or hallucinations most commonly seen in persons with Schizophrenia, Bipolar Disorder, Severe Depression or Drug Induced Disorders.

38. Definition of Delusion: • False beliefs not based on factual information. The person may overreact to the situations or may appear to have what is called a “flat affect” where he shows no emotion or does not seem to care about what is going on around him. (Examples: Social isolation, inappropriate emotions, odd beliefs and magical thinking)

39. Definition of Hallucinations: • Distortions in the senses where the individual experiences hearing or seeing something that is not there. There is poor processing of information and illogical thinking that can result in disorganized and rambling speech and/or delusions.

40. Definition of Mood Disorders: • Another type of mental illness demonstrated by disturbances in one’s emotional reactions and feelings. The primary symptom is the extremes of mood. Depression is the most common of the two extremes.

41. Behavioral cues of persons with a psychosis: • Inappropriate or bizarre dress • Body movements are lethargic or sluggish • Impulsive or repetitious body movements • Responding to hallucinations • Causing injury to self • Home environment: strange decorations (aluminum on windows), pictures turned over, waste matter/trash on floors and walls. • Unusual attachment to childish objects or toys

42. Emotional cues of persons with a psychosis: • Lack of emotional response • Extreme or inappropriate sadness • Inappropriate emotional reactions

43. Substance and cognitive disorders (drug related disorders included) - symptoms include: • A major loss of contact with reality • A gross interference with the ability to meet life’s demands • May have possible delusions and hallucinations • Alteration of mood • Defects in perception, language, memory and cognition

44. Substance Abuse Disorder: • Prolonged abuse of any drug (alcohol, prescription medications or “street drugs”) will cause chemical dependency or addiction. This has an effect on consciousness and if used long enough or in large dosages may cause permanent damage to the central nervous system. This may cause a wide range of psychological reactions that can be classified as disorders.

45. Alzheimer’s Disease: • The most common Organic Mental Disorder of older people is Alzheimer’s disease. An individual experiencing this disease may get lost easily, have poor memory, and become easily agitated. It is estimated that 2 to 3 million Americans are afflicted with Alzheimer’s and over 11,000 die each year. • Gerwo, Josh R. Psychology: An Introduction. (3rd ed.) Harper-Collins Publishers

46. Psychological Disorders:

47. Schizophrenia: • Consists of a group of psychotic disorders characterized by changes in perception. Causes an over sensitivity to sounds and visions characterized by hallucination and/or impaired distorted thinking.

48. Distorted thinking results in: • Poor processing of information • Illogical thinking that can result in disorganized and rambling speech, and/or delusions.

49. Changes in Emotion: • May overreact to situations • Have “flat affect” • It is not defined as a “split-personality” or “Psychosis”.

50. Developmental Disorders