Intermediate CIT Course TCOLE Course 3841 Texas Commission

Intermediate CIT Course TCOLE Course # 3841 Texas Commission On Law Enforcement PARTICIPANT HANDOUT AND BCCO PCT #4 Power. Point UNIT NINE Through UNIT TWELVE

Unit Goal: 9. 0 Mental health referrals/resources in San Antonio & Bexar County 2

9. 0 Understanding Mental Health Referrals - Resources A. The quality and availability of A. mental health programs vary depending on community ____ and budgeting restraints. B. Even within a community, services available depend on timing, resources, and program eligibility ______

9. 0 Understanding Mental Health Referrals – Resources - Continued C. Too often, community mental health _______ are just in health short supply. D. High costs of ________________ drugs and formulary limitations also sometimes make it impossible for an indigent person to get access to needed medications.

9. 0 Understanding Mental Health Referrals – Resources - Continued E. In addition to the previously mentioned resource challenges, there is also an _______ with the willingness of mental health providers to participate in criminal justice initiated programs

9. 0 Understanding Mental Health Referrals – Resources - Continued F. Like society’s stigmas and stigmas discriminations against mentally ill discriminations individuals, mental health system often _________ against people who have been arrested or arrested incarcerated due to incarcerated stereotypical

9. 0 Understanding Mental Health Referrals – Resources - Continued F. Cont’d: concerns about criminal behavior and lack of experience working with this population.

9. 1 Local Mental Health Resources See Participant for Listing of San Antonio and Bexar County Mental Health Services

9. 1 Local Mental Health Resources San Antonio & Bexar County - Continued Center for Health Care Services Telephone 210 -261 -1000 Crisis Hotline: (210) 223 -7233 Postal address 3031 IH 10 West 78201

9. 1 Local Mental Health Resources San Antonio & Bexar County - Continued Deer Oaks Mental Health Toll-Free: 1 -866 -327 -2400 Address: 126 E. Main Plaza, Ste. 8. , San Antonio, TX 78205

9. 1 Local Mental Health Resources San Antonio & Bexar County - Continued Alamo Mental Health Group PH: (210) 614 - 8400 4242 Medical Drive, Ste 6300 San Antonio, Texas 78229

9. 1 Local Mental Health Resources San Antonio & Bexar County - Continued Mc. Cullough Center for Mental Health Services 2515 Mccullough Ave, San Antonio, TX 78212 (210) 736 -1762

9. 2 Referral Treatment Challenges 1. Once you have the individual in crisis under control, you may need to crisis take him to a facility for emergency psychiatric _________. 2. Depending on the ______ in your area, this may be a timeconsuming process consuming

9. 2 Referral Treatment Challenges – Cont’d 3. There may be a lack of services. Be aware of this potential challenge, but don’t let it detract challenge you from your goal of ______ professionally and appropriately to the situation.

Questions UNIT NINE ?

DEFINE & PROCESS List 9. 1: 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 Process: 16

DEFINE & PROCESS Explain 9. 2: The possible referral/treatment challenges in your community. Process: 17

Unit Goal: 10. 0 CIT techniques apply to all areas of crisis communication 18

10. 0 What constitutes a According to Webster… –“An unstable or crucial time or state of affairs whose outcome will make a decisive difference for better or worse. ” –“…takes people out of their comfort zones and normal coping patterns. ” 19

10. 0 What constitutes a crisis? (Continued) “Often a ____ is precipitated by a loss of some sort, or a situation that threatens normalcy or expectations. The greater the _____, the more severe the crisis will be. ” crisis 20

10. 0 What constitutes a crisis? (Continued) “…the crisis is the instability and crisis ______the event produces. A persons response to the upheaval will determine in large part, the outcome of it. ”

Discussion Questions: • Is it the event itself that is the crisis or the person’s response to the situation? • What can turn the issue into a crisis? 22

Discussion Questions: • What makes an issue, loss, tragedy or _____ seem like a crisis to one person but not to another person?

FOOD FOR THOUGHT For some persons with a mental illness, life as they know it can illness virtually stop when a crisis _____ presents itself to them. While for other people even in a crisis situation, they will continue crisis to function as ______.

10. 0 Intensifying factors contribute to how a person responds to crisis: A. Negative _______traits B. Unrealistic ________ C. Faulty sense of _______

10. 0 Intensifying factors contribute to how a person responds to crisis - Continued: D. ____________ E. Poor ____________ mechanisms due to background F. Faulty ____________ system

CLASS DISCUSSION Do you have to have a mental illness to possess the aforementioned factors? Albert Einstein

How can “YOU” as a Deputy Constable assist A. _________ their feelings _________ B. Avoid being ________ Avoid C. Attempt to ______ the ______ individual in maintaining a realistic view of the situation

How can “YOU” as a Deputy Constable assist – Continued: D. _______ available referral sources _______ E. Assist the individual in focusing on the _______ of what can be _______ changed, instead of the negative of what can’t F. Be ______-oriented and ______ guide the individual in developing a realistic plan

10. 1 Define Crisis Behavior and its relevance to CIT Training A person suffering from a temporary ______ in coping skills that includes perception, perception decisionmaking ability, and problem solving ability is solving experiencing crisis behavior.

10. 1 Define Crisis Behavior and its relevance to CIT Training – Continued Crisis behavior can be different depending on individual response. ______ can suffer from a ______ suffer crisis and its effects can vary with time, place, and person.

10. 1 Define Crisis Behavior and its relevance to CIT Training – Continued Examples of situations involving Examples crisis: being _____ out of the house, losing a ______, being a _____ of a crime, having a _____, being involved in a _____ stop or ______

10. 2 Tactics & Techniques in Domestic Disturbances

10. 3 Crisis Intervention Techniques can be utilized in domestic disturbance situations TRAFFIC STOP

Questions UNIT TEN ?

DEFINE & PROCESS List 10. 1: The Process: 36

DEFINE & PROCESS List 10. 2: The Process: 37

DEFINE & PROCESS List 10. 3: The Process: 38

TAKE A 10 -MINUTE BREAK 39

Unit Goal: 11. 0 Jail and/or Court deference alternatives and referrals for persons with a mental illness. __________________ DEFERRED ADJUDICATION 40

11. 0 Jail and/or Court Deferred Adjudication Mental Health Alternatives Our nation’s system of _______ and ____________ has now become the ______ largest facility for persons with mental illness. _____ have become the “ first _____ responder” to persons in a crisis responder crisis situation

11. 0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued: Judges, law enforcement personnel, and mental health experts struggle with trying to find a ______________ to the increasing numbers passing through the legal system.

11. 0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued: The Mental Health Association of Texas states that “deinstitutionalization without adequate community supports (such as supported housing and employment) contributes to an ________of people with ________ mental illness in prisons. ”

11. 0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued: There is an overrepresentation of people in our prison system

11. 0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued: While only ___% of violent behavior violent is attributable to mental disorder. An estimated ___% of prisoners have mental illness, and ____% of the young people under the ____% Texas Youth Commission have a mental disorder.

11. 0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued: TYC further reports that in 2002, 21% TYC of its institutional population was on ______________ medications. There has been a ____ in the number of persons with mental illness or co-occurring disorders who are appearing before the court system.

11. 0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued: Many alternatives to the “traditional” court model are being initiated, including; _______ court _______ courts, ________ courts, domestic _______ courts, _______ and community courts.

11. 0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued: Programs such as the Jail Diversion Program are also being Program implemented in many states, including Texas (see HB 2292). These courts/programs have been implemented to address the underlying _____ that brought the _____ consumer to court in the first place

11. 0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued: Bexar County now has a “______” with a Judge (Honorable Wayne Christianson) currently adjudicating Veterans charged with The aim is to link ______ and mental health consumers to community-based services.

11. 0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued: Persons with mental illnesses are reportedly _________at a disproportionately higher rate than other individuals (Lamb and Weinberger, 1998). Over 11 million adults are booked each year into U. S. jails (Steadman et al. , 1999).

11. 1 Concept of Mental Health Courts According to a collaborative survey conducted by NAMI, the GAINS Center, and the Council on State Governments, at least 94 communities across the U. S. have established mental health ______as of June 2004. ______

11. 1 Concept of Mental Health Courts – Cont’d Portland state researcher Heidi Hendricks followed 368 people who were diverted to the Clark County Mental Health Court from the traditional court system. Her results are as follows:

11. 1 Concept of Mental Health Courts – Cont’d 1. In ____ year after being ____, those in the group were arrested a total of 713 times 2. One year after completing the mental health court program, 199 of the group (54%) had no new ______

11. 1 Concept of Mental Health Courts – Cont’d 3. For that same period, there were only 178 arrests for the entire group - a ___% reduction at a time when there was no longer court oversight 4. Probation violations dropped by ___%

11. 1 Concept of Mental Health Courts – Cont’d 5. The percentage of those in the group with three or more arrests dropped from ____ % to __% (an dropped 88% decline)

11. 1 Concept of Mental Health Courts – Cont’d Eighteen months after introducing a mental health court, Oklahoma County officials assert that the county ______ as much as $15, 000 per year by putting an offender in treatment instead of jail.

11. 2 State of Texas Jail Diversion Ideal

11. 2. A, Elements of the Texas Jail Diversion Ideal A. _____ and ______ of A. law enforcement personnel and the courts B. The ______ and utilization of crisis intervention teams (CIT)

11. 2. A, Elements of the Texas Jail Diversion Ideal – Cont’d: C. Development of _______ location for mental health assessment without arrest for arrest individuals with non-violent criminal conduct criminal D. Development of holding ____ providing structured treatment in lieu of arrest

11. 2. A, Elements of the Texas Jail Diversion Ideal – Cont’d: E. Development of _______ services F. Development of timely and effective _______ process G. Development of required community support

11. 2. A, Elements of the Texas Jail Diversion Ideal – Cont’d: H. Development of an identified method for addressing ______ and needed support services

11. 2. A, Elements of the Texas Jail Diversion Ideal – Cont’d: H. B. 2292 states that “the 1. department shall require each local mental health authority to incorporate __________ strategies 2. into the authority’s _______ management practices

11. 2. A, Elements of the Texas Jail Diversion Ideal – Cont’d: H. B. 2292 states that 3. managing adults with schizophrenia and bi-polar disorder to _____ the involvement of those clients with the criminal justice system. ”

11. 3 Two Approaches to Jail Diversion 1. ____-_____ occurs ____-____ at first contact with law enforcement, prior to any formal charges. a. Most communities that use this system have ______ training for their officers and a 24 -hour crisis center with a no-refusal policy

11. 3 Two Approaches to Jail Diversion – Continued 1. ____-______ diversion occurs at first contact with law enforcement, prior to any formal charges – continued: b. The Crisis Intervention Team process is an example of this approach.

11. 3 Two Approaches to Jail Diversion – Continued 2. ______-____________ diversion is diversion the most used program. a. This process is to identify and _____ consumers after they have been booked. b. A plan is then created to implement upon _______.

11. 4 Facts associated with Jail Diversion Concept A. Nationally, nearly ____ of the A. inmates in prison with a mental illness were incarcerated for committing a non-violent offense

11. 4 Facts associated with Jail Diversion Concept – Continued: B. Some 150, 000 former patients of TDMHMR now find themselves caught up in the criminal justice system, mainly because there is no other place for them.

11. 4 Facts associated with Jail Diversion Concept – Continued: C. Calls for police service in which mental illness is a factor make up between ___% and _____% of all police contacts, and continue to pose significant operational problems for the police.

11. 4 Facts associated with Jail Diversion Concept – Continued: D. National analyses have demonstrated that _______ had significantly lower criminal justice costs than non-diverted clients

11. 5 Benefits of Jail Diversion 1. _________ of persons with _________ mental illness 2. The ______ of over representation of people with mental illness in the criminal justice system is addressed

11. 5 Benefits of Jail Diversion – Continued 3. Reduced _______ Reduced 4. Increased public ______ Increased 5. Reduction of inappropriate Reduction _________ of persons with mental illness

11. 5 Benefits of Jail Diversion – Continued 6. Length of stay in jails shortened Length in lieu of increased access to _______ 7. Violence and _______ is Violence reduced

11. 5 Benefits of Jail Diversion – Continued 8. Costs incurred by taxpayers when a person with mental illness is arrested, incarcerated, and/or hospitalized are addressed

11. 5 Benefits of Jail Diversion – Continued A. The complex issue of A. _________ is in need of a formidable solution. B. This reality has multiple causes reality and requires ______-_______ participation to create and implement a uniform standard.

11. 5 Benefits of Jail Diversion – Continued C. Collaboration among all Collaboration involved parties is necessary to successfully achieve the process of ______ persons with mental illness from unnecessary arrest and arrest confinement to appropriate treatment confinement resources.

Questions UNIT ELEVEN ?

DEFINE & PROCESS Explain 11. 0: The jail/court related alternatives and referrals for persons with a mental illness Process: 78

DEFINE & PROCESS Explain 11. 1: The concept of mental health courts Process: 79

DEFINE & PROCESS Explain 11. 2: The the State of Texas Jail Diversion Ideal Process: 80

DEFINE & PROCESS List & Explain 11. 3: The two approaches to jail diversion Process: 81

DEFINE & PROCESS List & Explain 11. 4: The two facts associated with the jail diversion concept Process: 82

DEFINE & PROCESS List & Explain 11. 5: The the benefits of jail diversion Process: 83

12. 0 Evaluation of Success

12. 1 Components for Evaluating Success 1. Reduction of criminal _____ 2. Improved ______ between law enforcement and mental health professionals 3. Reduced percentage of _____ to hospital in crisis

12. 1 Components for Evaluating Success – Continued: 4. Reduced percentage of consumers needing emergency _______ care 5. Reduced rates of officer ______ Reduction Improved Reduced

Questions UNIT TWELVE ?

H. B. 2292 states: “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. ” system 88

89

Questions?

DEFINE & PROCESS List & Explain 12. 0: The your understanding and value of evaluation in demonstrating success Process: 91

DEFINE & PROCESS Explain 12. 1: The key points Process: 92

SOURCES All Course Sources and/or Resources are listed in your Participant Handout Crisis Intervention TRAINING (CIT) Course # 3841 Bexar County Constable Office PCT#4

TAKE A 10 -MINUTE BREAK

“Knowledge is “POWER” Stay informed, stay SAFE, stay Vigilant & stay Alive”

UPCOMING TRAINING Bexar County Constable’s Office PCT#4 TRAINING SCHEDULE 2014 Current TRAINING Schedule of Courses offered by Bexar County Constable’s Office PCT#4 96

COURSE & INSTRUCTOR EVALUATION Form • Please complete a course and instructor evaluation form. • If you rate 2 or below you must justify on reverse side. • Constructive Criticism helps all, being negative helps no one.

Quiet…. Test in Progress

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• Exam • Graduation THANK YOU & STAY SAFE

End of Day TWO… “STAY VIGILANT…. . STAY SAFE…. . ”