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Recognizing and Managing the Special Needs Inmate

Presented by:Presented by:

Lori Harriman, Treatment SupervisorLori Harriman, Treatment Supervisor

Mary Baker, Training ManagerMary Baker, Training Manager

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Overview

• Special Needs Inmates (SNI)

• Importance of Identifying & Managing SNI

• Areas Affected by, and Indicative of, SN

• Common Special Needs Conditions

• Stability to Crisis

• Steps for Managing SNI

• Mental Health Referrals

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Objectives

Define Special Needs Inmates (SNI) List the 5 Reasons for Identifying &

Managing SNI List the 7 Common SN Conditions List the 5 General Areas Affected

by/Indicative of Special Needs List Warning Signs for Potential Violence List the 4 Steps for Managing SNI in Crisis List the Steps to Making both Non-

Emergency and Emergency MH Referrals

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Offenders who require special management due to a congenital or acquired condition affecting their well-being and functioning.

Special Needs Inmates Defined…

Categories

Psychological/Mental IllnessPsychological/Mental Illness

IntellectualIntellectual

Physical/BiologicalPhysical/Biological

OtherOther

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Five Reasons for Identifying Five Reasons for Identifying and Managing SNIand Managing SNI

LL - Law - LawOO - Operations - OperationsRR - Rehabilitation - RehabilitationRR - Re-Entry - Re-Entry SS - Safety - Safety

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General Areas Affected by or Indicative of Special Needs

T - ThinkingA - AppearanceB - BehaviorsF – FunctioningM - Mood

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1. Psychosis

2. Depression

3. Mania

4. Anxiety

5. Personality Types

6. Sensorial Disabilities

7. Cognitive/Intellectual Disabilities

Seven Common ConditionsSeven Common Conditions

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Psychosis

Two major components:

»Delusions

»Hallucinations

Psychosis is a state in which a person is disconnected from reality.

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Psychosis, cont’d.

Delusions are fixed, false beliefs

Paranoid Delusions

Delusions of Grandeur

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Psychosis, cont’d.

Hallucinations are sensory experiences with no basis in reality.

• Auditory (hear)

• Visual (see)

• Tactile (touch)

• Gustatory (taste)

• Olfactory (smell)

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Psychotic Episode

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Signs of Psychosis

Disorganized or irrational thoughts Talking to internal stimuli Dulled/heightened emotional expression Disorganized speech Withdrawal Poor personal hygiene Shifting eye contact Bizarre behaviors

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Person with Psychosis

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Insomnia or excessive sleeping Decreased or increased appetite Irritability/anxiety Lack of energy, initiative, motivation Feelings of hopelessness, helplessness and/or

worthlessness Reduced ability to think, concentrate or make

decisions Loss of interest or pleasure in all or almost all

activities

Depressionis a state in which feelings of sadness, loss, anger, or frustration interfere with everyday life for > 2 weeks.

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Depression

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A significantly elevated mood/heightened state of being.A significantly elevated mood/heightened state of being.

Racing thoughts Little or no sleep Rapid, loud speech Highly energized,creative, confident Lack of judgment/impulsivity Heightened distractibility/irritability

Mania

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Mania

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Anxiety DisordersA chronic condition characterized by an

excessive and persistent sense of apprehension, stress, and worry.

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Emotional Symptoms of AnxietyEmotional Symptoms of Anxiety

Anxiety is more than just a feeling. As a product of the body’s fight-or-flight response, anxiety involves a wide range of physical symptoms. Common physical symptoms of anxiety include:

•Pounding heart •Sweating •Stomach upset or dizziness •Frequent urination or diarrhea •Shortness of breath

•Tremors and twitches •Muscle tension •Headaches •Fatigue •Insomnia

Physical Symptoms of AnxietyPhysical Symptoms of Anxiety

Feelings of apprehension or dread

Trouble concentrating

Feeling tense and jumpy

Anticipating the worst

Irritability / Restlessness

Feeling like your mind’s gone blank

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Types of Anxiety

•Generalized Anxiety Disorder

•Phobias

•Social Anxiety Disorder

•Obsessive-Compulsive Disorder

•PTSD

•Adjustment Disorder

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Emotional Symptoms of Anxiety

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Post Traumatic Stress Disorder

Irritability / outbursts of anger Exaggerated startle response(jumpiness) Hyper-vigilance Reactive to triggers Shaking, sweating, cowering, etc. Sleep disturbances (nightmares)

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Person withPerson with

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Personality Personality Types…Types…

Anti-Social Personality

Paranoid Personality

Borderline Personality

are characterized by chronic, inappropriate and are characterized by chronic, inappropriate and maladaptive interactions and behaviorsmaladaptive interactions and behaviors

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Anti-Social Personality

Disregard for other people’s rights & property or for rules, regulations, and boundaries as manifested by:

Repeated lying Impulsiveness Aggressiveness/Irritability Lack of remorse Cleverness Deceit and manipulation

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Paranoid Personality

is characterized by a chronic & pervasive distrust and suspicion of others, i.e. a belief that they are being lied to, deceived, or exploited or that friends, family, and romantic partners are untrustworthy and unfaithful,

ANDis manifested by:• Outburst of anger in response to perceived deception• Looking for hidden meanings in gestures &

conversations

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Borderline Personality

Unstable and intense relationships Impulsive behaviors that are potentially

self-damaging Self-injurious and/or suicidal behaviors Unstable emotions Intense anger or difficulty controlling anger Feelings of emptiness

is characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior

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Sensorially DisabledSensorially Disabled

An inmate that has any long-lasting An inmate that has any long-lasting conditions such as blindness, deafness, or conditions such as blindness, deafness, or

a severe vision or hearing impairmenta severe vision or hearing impairment

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Cognitive/Intellectual FactorsAreas of Deficit:• Memory • Motivation/Energy• Attentiveness/Concentration• Adaptability• Social Skills• Impulse/Self Control• Following Direction• Information Processing• Judgment (Naïveté)• Planning & Problem Solving• ADL’s• Speech and/or Language (written or spoken)• Mood/Coping Stability• Knowledge/Education

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the co-existence of attentional problems and hyperactivity

AD/HD

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Traumatic Brain Injury (TBI)

Occurs when an external force traumatically injures the brain. TBI can cause a host of, behavioral, cognitive, emotional, and physical effects including seizures, paralysis, poor coordination, weakness, headaches, and sensory problems.

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Understanding TBI

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From Stability to CrisisFrom Stability to Crisis

What are the What are the

warning signs?warning signs?

= Crisis= CrisisStressStress CopingCoping++

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Warnings SignsWarnings Signs

Ignores you completelyIgnores you completely Excitability – ‘Amped’Excitability – ‘Amped’ Aggravated movementsAggravated movements Stops all movementStops all movement Acts intoxicated/Out of controlActs intoxicated/Out of control Pre-Attack body positioningPre-Attack body positioning Verbal posturing/threatsVerbal posturing/threats Emotional meltdownEmotional meltdown

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Attend

Communicate

Evaluate

Respond & Refer

Four Steps for Intervening with an Inmate in Crisis

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Four Steps for Intervening with an Inmate in Crisis, cont’d.

Engage Make eye contact Minimize distractions Be present & genuine

Attend

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Engage by Asking Questions Self-harm, suicidality, harm to others

Listen Understand

RespondRespond Reflect, validate, cReflect, validate, clarify (content, (content,

feeling, meaning, intent)feeling, meaning, intent)

Four Steps for Intervening with an Inmate in Crisis, cont’d.

Communicate

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RiskNeedPerson in Environment (TABFM)

Four Steps for Intervening with an Inmate in Crisis, cont’d.

Evaluate

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EmergencyEmergencyCode Blue Code Blue Risk ManagementRisk ManagementEmergency ReferralEmergency Referral

Non-EmergencyNon-EmergencyDe-escalateDe-escalateNon-Emergency ReferralNon-Emergency ReferralRefer to Counselor/CCW, Supervisor, etc.Refer to Counselor/CCW, Supervisor, etc.

Four Steps for Intervening with an Inmate in Crisis, cont’d.

Respond & ReferRespond & Refer

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Mental Health Referrals(Hampden County)

NON-EMERGENCY

Non-Emergency Referral Form TABFM

FMHS will respond within 10 days

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Mental Health ReferralsMental Health Referrals(Hampden County)

EMERGENCY

When an inmate is at risk of imminent self harm/suicide:•Call ESU at ext. 2328

•FMHS will respond within 1 hr., daily 9a-4p

•Maintain safety until Special Ops arrives•FMHS staff will evaluate & provide recommendations

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Mental Health ReferralMental Health Referral(Hampshire County)

A. The inmate fills out a request and it is sent to Medical. Medical will decide on a referral to forensics.  If the inmate is in obvious need, the shift supervisor will contact ServiceNet (if no one is on shift to provide the assistance).

B. The clinician from ServiceNet or Franklin/Hampshire County Emergency Services will provide care & services for inmates referred for mental and/or emotional illness and intellectual disabilities. 

C. The ServiceNet or Franklin/Hampshire County Emergency Services will provide prompt emergency response to inmates referred for psychosis and/or suicidal disorders.

D. The ServiceNet or Franklin/Hampshire County Emergency Services shall in cooperation with the HSU or the Deputy Superintendent provide appropriate action for Special Needs Inmates in regards to housing assignments, program assignments, disciplinary measures, and transfers in and out of facility. 

E. Coverage from the ServiceNet is Monday-Friday 9:00am–5:00pm & from the Franklin/Hampshire County Emergency Services Monday- Friday 5:00pm – 9:00am (weekends, holidays, & after hours if necessary).

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Mental Health ReferralMental Health Referral(Hampshire County)

Inmates referred for mental health treatment receive a comprehensive evaluation by a licensed mental health professional within 14 days of the referral request date and includes at least the following: 

• Review of mental health screening and appraisal data. 

• Direct observations of behavior.  • Collection and review of additional data from

individual diagnostic interviews and tests assessing personality, intellect, and coping abilities. 

• Compilation of the individual's mental health history. 

• Development of an overall treatment/management plan with appropriate referral to include transfer to mental health facility for inmates whose psychiatric needs exceed the treatment capability of the facility. 

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Emergency Stabilization UnitEmergency Stabilization Unit((ESU)ESU)

A 7 bed mental health inpatient A 7 bed mental health inpatient program for men housed in C Towerprogram for men housed in C Tower

Designed to give short-term intensive Designed to give short-term intensive psychiatric evaluation and treatmentpsychiatric evaluation and treatment

Referrals are made directly to the ESUReferrals are made directly to the ESUAdmissions are between the hours of Admissions are between the hours of

9am and 5pm on regular working days.9am and 5pm on regular working days.

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Emergency Stabilization UnitEmergency Stabilization Unit((ESU)Criteria for AdmissionESU)Criteria for Admission

Inmate is considered to be a danger to self Inmate is considered to be a danger to self or others.or others.

Inmate is functioning so poorly he cannot Inmate is functioning so poorly he cannot take care of his daily needs.take care of his daily needs.

Inmate presents with an unclear diagnosis Inmate presents with an unclear diagnosis and a period of observation is required.and a period of observation is required.

Inmate who is acutely psychotic or suffers Inmate who is acutely psychotic or suffers from a serious affective disorderfrom a serious affective disorder..

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Practice ReferralPractice Referral