Intermediate CIT Course TCOLE Course Texas Commission On

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

Unit Goal: 6. 0 Internalize the crisis intervention skills involved in communicating with individuals with a mental illness. 2

6. 1 Basic Strategies for Communicating in Crisis Situation 1. ______ - breathe deeply to become calmer 2. Be _____ - _____ avoid “crowding” the individual, give them time to calm down

6. 1 Basic Strategies for Communicating in Crisis Situation Continued 3. ____-_____ information by _____ restating what you hear 4. Use the individual’s ______ in ______ talking to them 5. Give _____ or _____ one _____ at a time, and allow time for the person to comply

6. 1 Basic Strategies for Communicating in Crisis Situation Continued 6. The _______ and _____ of a person _______ with mental illness has little to do with whether a back-up officer should be called 7. Remember that a person with a mental illness may exhibit _________________ strength

6. 1 Basic Strategies for Communicating in Crisis Situation Continued 8. _____ is _____ pivotal - keep trying 9. Don’t _______ the power of _______ hallucinations or delusions - they are real from the individual’s point of view and can be very frightening, so try to be understanding

6. 1 Basic Strategies for Communicating in Crisis Situation Continued 10. Never _______ about a _______ delusion, since arguing only solidifies the conviction - simply accept and move on

6. 1 Basic Strategies for Communicating in Crisis Situation Continued 11. Ask about _______ in the _______ past - sometimes that can help with offering potential solutions to the current situation 12. Remember that _______ medications have side effects that make them hard to take

6. 1 Basic Strategies for Communicating in Crisis Situation Continued 13. Don’t __________ disapproval 14. Persons in mental health crisis need more personal _______ - _______ watch for cues

6. 2 Four Effective Communication – Interaction Skills 1. _____ - Your personal _____ safety comes first. a. ______ the surroundings. ______ b. ________ harmful obstacles from the surroundings.

6. 2 Four Effective Communication – Interaction Skills – Cont’d 2. ____ - The person in distress is usually excited, alarmed, or confused. a. _______ is very important to _______ persons in crisis. b. When people feel _____, which _____ translates to lack of control, they may respond with sudden violence.

6. 2 Four Effective Communication – Interaction Skills – Cont’d 3. _______ – a. Use the person’s ______ b. Talk _______ c. Speak _______ d. Use a calm tone of ______ e. Avoid direct _________. Avoid _________

6. 2 Four Effective Communication – Interaction Skills – Cont’d 3. Language – f. Avoid _______. Avoid ______ and _____________ g. Limit the number of _______, Limit and give them one at a time. h. Be _______ and ______________ i. Reactions and verbal ______ Reactions may be slower than you expect.

6. 2 Four Effective Communication – Interaction Skills – Cont’d 4. _______ - Be aware of body _______ movements. a. People in crisis often need more ______ space. ______ b. If possible, _______ yourself at or below the individual’s eye level. c. Keep all ________ slow and ________ deliberate.

6. 2. a. Nine Helpful Hints 1. Ask the person about available 1. support, a. _____, _____ b. ____, ____ c. ________, ________ d. ______

6. 2. a. Nine Helpful Hints Continued 2. Don’t be _____ to reveal your _____ own emotions, e. g. “Mr. Smith, you’re making me nervous. ” 3. ________ yourself clearly ________

6. 2. a. Nine Helpful Hints Continued 4. You may need to re-____________ yourself, as well. 5. Try to find ways to establish _____ 6. Keep your own ______ under ______ control.

6. 2. a. Nine Helpful Hints Continued 7. Allow _______ 8. _____, but be realistic, don’t _____ lie. 9. ______ actively. ______

Strategies Review 1. Stay calm 2. Avoid crowding 3. Restate 4. Use persons name 5. Give instructions one at a time 6. Engagement is pivotal 7. Don’t underestimate the power of hallucinations or delusions 8. Ask about treatment history 9. Don’t express disapproval 19

DEFINE & PROCESS List & Explain 6. 1: The basic strategies that are necessary when communicating in crisis situations. Process: 20

DEFINE & PROCESS List & Explain 6. 2: Four effective communication interaction skills used when dealing with persons with a mental illness Process: 21

DEFINE & PROCESS List & Explain 6. 3: The knowledge obtained in coursework to class exercises and scenarios for role play Process: 22

Unit Goal: 7. 0 The legal process; evaluation process and techniques for appropriateness of apprehension ( apprehension arrest) and/or arrest detention Legal 23

7. 1. Appropriateness of a warrantless apprehension (arrest) A. “Least restrictive alternative” is the treatment that: 1. is ______ 2. provides the consumer with the greatest possibility of _______ 24

7. 1. Appropriateness of a warrantless apprehension (arrest) – Cont’d A. “Least restrictive alternative” is the treatment that: 3. is no more __________ of __________ consumer’s physical or social liberties than is necessary to provide the consumer with the most effective treatment and to protect treatment adequately against any danger the patient poses to himself or others

7. 1. Appropriateness of a warrantless apprehension (arrest) – Cont’d B. References: 1. Reference: Texas Health and Safety Code, Sec. 571. 004 2. Reference: Texas Health and Safety Code, Sec. 574. 103

7. 2 Step-By-Step Emergency Detention Court Order A. Application for emergency detention: detention A statement that the officer has reason to believe that the risk of ______ is ______ imminent unless restrained.

7. 2 Step-By-Step Emergency Detention Court Order – Cont’d A. Application for emergency detention: detention 1. This information may be obtained from a _______ party. _______ 2. The officer does not have to _____ the behavior personally _____

7. 2 Step-By-Step Emergency Detention Court Order – Cont’d A. 3. A statement that the officer’s beliefs are derived from specific a. recent ______, ______ b. overt acts, attempts or threats that were _______ or _______ reliably reported

7. 2 Step-By-Step Emergency Detention Court Order – Cont’d A. 3. A statement that the officer’s beliefs are derived from specific d. The individuals name and ________ to the apprehended ________ person who reported observing the behavior. 1. ) List _______, _______ 2. ) ____

7. 2 Step-By-Step Emergency Detention Court Order – Cont’d A. 3. d. The individuals name and relationship to the apprehended person who reported observing the behavior. 3. ) _____, 4. ) _____, 5. ) _____, and 6. ) _____.

7. 2 Step-By-Step Emergency Detention Court Order – Cont’d B. Emergency Detention Order: Order Serves as a magistrate’s order for emergency apprehension and detention 1. Is a civil court ____ issued by ____ a magistrate

7. 2 Step-By-Step Emergency Detention Court Order – Cont’d B. Emergency Detention Order: Order Serves as a magistrate’s order for emergency apprehension and detention 2. Provides for emergency ______ and ________ for evaluation (not guaranteed admission)

7. 2 REFERENCE Reference: Texas Health and Safety Code, Sec. 573. 011

7. 3 Criteria for taking mentally challenged person into custody for their safety 1. A peace officer, without a without ______, may take a person into ______ custody if the officer believes that the person is mentally ill and that, because of that mental illness, there is a substantial risk of serious harm to the person or

7. 3 Criteria for taking mentally challenged person into custody for their safety – Continued: 1. Cont’d: or others unless the person is immediately _____; and believes there is not sufficient time to obtain a warrant.

7. 4 Assessing Justification Proper Use-Of-Force 1. Keep the situation in ________ 2. The officer may use force _______ to any other legal duty when a person is resisting arrest 3. The force must be _______

7. 4 Assessing Justification Proper Use-Of-Force – Cont’d 4. Goal is to obtain care and Goal treatment for the mentally ill treatment person Reference: Texas Penal Code, Sec. 9. 51

7. 4 Behavior intensity level indicators of an individual heading toward violence A. Agitated Behavior - trying to keep feelings inside but begin displaying such behaviors 1. ) as _____, 2. ) hand _____, 3. ) _______ pulling, etc. _______

7. 4 Behavior intensity level indicators of an individual heading toward violence – Continued: B. Disruptive Behavior - outward displays of behavior to include 1. ) ________, 2. ) ________, and 3. ) refusal to ____ with requests ____

7. 4 Behavior intensity level indicators of an individual heading toward violence – Continued: C. Destructive Behavior - begins to ____ items in the environment. ____ Physical force will probably be needed to intervene depending on circumstances

7. 4 Behavior intensity level indicators of an individual heading toward violence – Continued: D. Out of Control - individual is a danger to himself and others. The individual is out-of-control psychologically and is being psychologically threatening. Deadly force may be an option.

7. 5 Officer Limitation of Liability A. People acting in good faith, A. _________ and without negligence are not civilly or criminally liable. B. Reference: Texas Health and Safety Code, Sec. 571. 019(a)

7. 5 Confidentiality A. Communication between a Communication ______ and a ________, ______ as well as records of the identity, 1. ) ________, 2. ) _______, or MEDICAL RECORDS 3. ) _______ of a patient that are created or maintained by a professional, is confidential.

7. 5 Confidentiality – B. EXCEPTIONS 1. _______ to medical or law 1. enforcement personnel a. ) if there is a probability of imminent physical injury by the patient or b. ) others, or b. ) c. ) there is a probability of immediate mental or d. ) emotional injury to the patient

7. 5 Confidentiality – B. EXCEPTIONS - Cont’d: B. include: 2. When the patient _____ 3. To health care personnel of a jail if it is for the _____ purpose of _____ providing health care

7. 5 Confidentiality – B. EXCEPTIONS - Cont’d: B. include: include 4. “ 4. Memorandum of Understanding” MOU (refer to the definition section of the IRG) C. Reference: Texas Health and Safety Code, Sec. 611. 002, 611. 004

7. 6 Assistance (Back Up) during approach A. Size and age of a person with mental illness has very little to do with whether a back-up officer should be _____

7. 6 Assistance (Back Up) during approach – Cont’d B. Like any other person under stress, a person with a mental stress illness may exhibit extraordinary _____. 1. Persons with a mental illness may, but not always, be ____________ and ________.

7. 6 Assistance (Back Up) during approach – Cont’d B. Like any other person under stress, a person with a mental illness may exhibit extraordinary ______. 2. ______ is very individualized.

7. 6 Assistance (Back Up) during approach – Cont’d C. Request ______ as needed. Back-up may be needed for the Back-up SAFETY of the officer, the SAFETY individual, or others. D. Contact the local Mental Health Mental Retardation (MHMR) Center for assistance, education, and referrals to appropriate resources

OFFICER SAFETY TIP Food for thought: “It is not the size of the dog in the fight, it is the size of the fight in the dog that will make a difference” difference in and with your SAFETY

7. 7 Bexar County Constable’s Office PCT#4 Bexar County Constable Office PCT#4 policies and procedures and/or Standard Operating Procedures will be followed. Review policy for our office or refer participant to appropriate resources.

4 # T PC . 7. 8. Appropriate method of transporting mentally ill consumer CT 4 P E L TAB S N O C 54

7. 8 Determining appropriate method of transport A. Follow Bexar County Constable A. PCT#4 policy and procedure or SOP B. Be aware of the ________ to an approved medical facility for examination or admission

7. 8 Determining appropriate method of transport – Cont’d: C. Evaluate the behavior or Evaluate behavior physical condition of person: 1. _____ 2. _____ 3. _______-non-ambulatory 4. _____

DEFINE & PROCESS List & Explain 7. 1: The process in evaluating the appropriateness of a warrantless apprehension. Process: 57

DEFINE & PROCESS List & Explain 7. 2: The step by step process for obtaining an emergency detention order Process: 58

DEFINE & PROCESS List & Explain 7. 3: The criteria an officer must meet in order to take a person with a mental illness who has committed no crime into custody involuntarily for emergency mental health evaluation Process: 59

DEFINE & PROCESS List & Explain 7. 4: The Propose justifications in assessing proper use of force option Process: 60

DEFINE & PROCESS List & Explain 7. 5: Officer’s limitation of liability Process: 61

DEFINE & PROCESS List & Explain 7. 6: The factors to be considered in determining whether assistance should be requested during approach Process: 62

DEFINE & PROCESS List & Explain 7. 7: Agency SOP in requesting assistance Process: 63

DEFINE & PROCESS List & Explain 7. 8: The factors considered in determining appropriate method of transporting consumer. Process: 64

Unit Goal: 8. 0 The world of the mentally ill through legal and societal concerns and perspectives. 65

8. 1 homeless mentally ill A. On any given night approximately 600, 000 Americans are _____, and more than 2 million people are homeless throughout the year. 1. According to conservative estimates, ____- _______ of people _______ who are homeless have a serious mental illness,

8. 1 homeless mentally ill person – Continued A. 2. more than ____- _____ also have _____ a substance abuse disorder. (NCH Fact Sheet #5)

8. 1 homeless mentally ill person – Continued B. Vast increases in homelessness seem to have occurred in the 1980 s when ______and ______ options for lower incomes became an issue. 1. Today however, a new wave of homeless mentally ill persons has emerged due to;

8. 1 homeless mentally ill person – Continued 1. a. combined with denial of services due to ____ cuts, and premature discharge due to managed care. 1. b. Homeless persons with mental disorders remain homeless longer due to ______ from family and friends

8. 1 homeless mentally ill person – Continued 1. c. _____ to employment or 1. d. low ______ status, 1. e. poor physical _____ and 1. f. more contact with the ____ system.

8. 2 Mentally ill individual as a victim of crime “People with mental illness are more likely to be _____________ perpetrators perpetrators of violence” violence * National Institute of Justice, 1996

8. 2 Mentally ill individual as a victim of crime –Cont’d Why then is … thirteen times more research compiled concerning the mentally ill as _________ of violent acts rather than as ________of violent acts? (see the Archives of General Psychiatry, August 2005)

8. 2 Mentally ill Statistics: A. 4 -13% are _______ of crime B. They are 140 times more likely to be victim of ____ C. 3 million are estimated to be _______ each year

8. 2 Mentally ill Statistics Continued: D. In a year, more than one-quarter of mentally ill persons say they are victimized E. There is an ____-times-higher risk for them than for the general population

8. 2 Mentally ill individual as a victim of crime –Cont’d The public tends to be surprised by these findings, due to the ___________ that people with a mental illness are dangerous Violence among this population is Violence caused by many of the same factors that produce violence in the rest of us.

8. 2 Mentally ill individual as a victim of crime –Cont’d People become _____ when they People _____ feel threatened, when they _______ out of control, or _______ with the excessive ________ of ________ mind-altering substances. “We don’t think about their vulnerability to victimization. ” - Alison Mc. Cook, Reuters Health

8. 2 Mentally ill individual as a victim of crime –Cont’d People with mental illness are People more _____ to crime than others. _____ They often live in poor communities, They poor areas with higher crime rates.

8. 2 Mentally ill individual as a victim of crime –Cont’d They can be unable to make safe ______, such as avoiding an ______ empty, dark street. - North Western University

8. 2 Mentally ill individual as a victim of crime –Cont’d The effect of crime is also more crime _________ with a person with mental illness Dr. Linda A. Teplin

8. 2 Tips for responding to a victim's needs: Victim’s Need to Feel _____ – _____ people feel _____, people ________________ and ________ by the trauma of their ______ victimization.

8. 2 Tips for responding to a victim's needs – Cont’d: B. As a law enforcement officer, you are usually the first to _______ the victim – victim how the officer responds to the victim is victim very important

8. 2 Tips for responding to a victim's needs – Cont’d: C. Victim’s Need to Express His/her ______ - victims need to air their ______ emotions and tell their story after the of a crime, trauma and they need to have their feelings accepted and their story heard nonjudgmentally

8. 2 Tips for responding to a victim's needs – Cont’d: D _________ Need to Know What Comes Next - the officer can help relieve some of the anxiety by telling victims what to expect in the aftermath of the crime, which will crime help prepare them for the upcoming investigation process

8. 2 Mentally ill Crime Victims A. _____ with mental illness _____ may be molested or abused. B. They are often unable to identify the suspect.

8. 2 Mentally ill Crime Victims – Cont’d C. _____ with a mental illness may _____ be easily robbed or become a victim of a con artist. D. A person with a mental illness has the same chance of being _______ as the general public, _______ but they reportedly have less chance of a successful prosecution.

8. 2 Mentally ill Crime Victims – Cont’d E. Mentally retarded victims of crime will need ________ consideration upon approach F. This _____ may not even know _____ they have been victimized, due to their naiveté and lack of ability to discriminate between good and bad social situations

8. 2 Mentally ill Crime Victims – Cont’d G. Mentally retarded victims are also easily ____ and become easily vulnerable H. These victims, just as with mentally ill victims, will need to be ____ with extreme patience and ____ respect.

8. 3 Societal & Stigma Discrimination towards Mentally ill A. disgrace or disgrace A. ____ is a mark of ____ shame. It is made up of various shame components, including: 1. ____ someone with a condition ____ 2. ________ people with that ________ condition

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued A. Stigma : 3. Creating a _______ (i. e. , a _______ superior “us” and a denigrated “them” ) 4. Discriminating against Discriminating someone on the basis of their ______

8. 3 Societal & Stigma Discrimination towards Mentally ill - Continued B. Stigmas encourage inaccurate perceptions 1. The term mental illness in itself alludes to alludes false information

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued B. Stigmas encourage inaccurate perceptions. 2. “ 2. Mental” suggests an Mental ___________________ medical condition that is “all in your head, ” head and therefore a sign of weakness

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued B. Stigmas encourage inaccurate perceptions. 3. The term “mental” suggests a mental _______ from a physical _______ illness, when in fact they are entwined

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued B. Stigmas encourage inaccurate perceptions. 4. _______ reported at _______ Mayo. Clinic. com show that there is in fact a physical change in the brain associated with mental illness, suggesting that a biological basis exists.

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued C. It is also a common ______ that persons with a mental illness are dangerous and unpredictable, although statistics do not substantiate this idea (concept)

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued C. 1. It continues to be believed that they are somehow less competent, that they are not able to work, and that they work need to be institutionalized to “get better. ” better

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued D. These stigmas perpetuate a negative portrayal of people with mental illness that 1. ) _____ fear and 2. ) mistrust and 3. ) _________ distorted perceptions, leading to further stigma

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued D. 1. It can lead to devastating consequences. Some people refuse treatment for fear of being “______. ” ______ D. 2. The stigma can lead to social ________ due to shame and ________ embarrassment

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued D. 3. Discrimination in the Discrimination _______ reportedly continues, _______ even with the American with Disabilities Act in place. D. 4. Victims may lose jobs through the stress of coworker ____ and ____ lack of promotion.

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued D. 5. The stigma even extends to stigma the ______ community, where ______ health insurance coverage is more limited for mental illnesses than for physical illnesses.

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued E. ______ prominent myths regarding mental illness can reduce undeserved stigma

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued F. Consider the following: following Myth: Mental illness does not affect Myth: the average person. Reality: No one is _______ to mental _______ illness. More hospital beds are filled by individuals with mental illness than those with cancer, cancer heart, and heart lung disease combined. lung

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued F. Consider the following: following Myth: Mental illness is an indication Myth: of a ______ of character. ______ Reality: A combination of _________ contributes to mental illness, including malfunction of neurotransmitters, heredity, stress, and recreational drug usage.

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued F. Consider the following: following Myth: A Myth: person with a mental illness is also mentally retarded. Reality: There are some persons with a ____________, but the ______ conditions are fundamentally different.

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued F. Consider the following: following Myth: If you have a mental Myth: illness, you are “______” all the time. ______ Reality: Mental illness is often temporary. People suffering from even the most severe mental illness are in touch with reality as often as they are actively psychotic

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued F. Consider the following: following Myth: If people with other _____ Myth: _____ 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 help to return to normal functioning

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued F. Consider the following: following Reality: fills this role for a physical illness just as _________ rehabilitation is needed for mental illness.

8. 3 Societal & Stigma Discrimination towards Mentally ill – Continued F. Consider the following: following Myth: Most people who ______ Myth: ______ with mental illness live on the streets or are in mental hospitals. Reality: About _________ of _____ Americans who have a mental illness live in community settings

8. 4 Legal & Social Concerns Mental Health Consumer’s VIDEO Guest Speaker: a mental health consumer to speak to the officers about their experiences with the legal and mental health systems. The goal of this section is to sensitize the officer to the lives, feelings, and thoughts of a person with a mental illness and their perspective on communication with law enforcement.

8. 5 Family member perspective on mental illness. VIDEO

Questions?

DEFINE & PROCESS List & Explain 8. 1: The mentally ill person in the situation of being homeless Process: 111

DEFINE & PROCESS List & Explain 8. 2: The mentally ill individual as a victim of crime Process: 112

DEFINE & PROCESS List & Explain 8. 3: The stigma and societal discrimination that exists toward persons who are mentally ill. Process: 113

DEFINE & PROCESS List & Explain 8. 4: The legal and societal concerns from a mental health consumer’s vantage point. Process: 114

DEFINE & PROCESS List & Explain 8. 5: The family member perspective on mental illness. Process: 115

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

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

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