Chapter Twelve

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© 2013 by Pearson Higher Education, Inc Upper Saddle River, New Jersey 07458 • All Rights Reserved Crisis Intervention William Harmening Roosevelt University Harmening, Crisis Intervention: The Criminal Justice Response to Chaos, Mayhem, and Disaster Chapter 12 THE CRISIS OF MENTAL ILLNESS

Transcript of Chapter Twelve

Page 1: Chapter Twelve

© 2013 by Pearson Higher Education, IncUpper Saddle River, New Jersey 07458 • All Rights Reserved

Crisis InterventionWilliam Harmening

Roosevelt University

Harmening, Crisis Intervention: The Criminal Justice Response to Chaos, Mayhem, and Disaster

Chapter 12THE CRISIS OF MENTAL ILLNESS

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© 2013 by Pearson Higher Education, IncUpper Saddle River, New Jersey 07458 • All Rights Reserved

12.1

12.2

12.3

12.4

To describe the problem of mental illness in the context of the criminal justice mission.

To summarize the traditional police and corrections response to mental illness.

To list and define some of the more common types of mental illness faced by crisis responders.

To summarize the accepted best practices for responding to mentally ill offenders, victims, suspects,

and inmates.

CHAPTER OBJECTIVES

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To describe the problem of mental illness in the context of the criminal justice mission.

Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes

12.1

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12.1 The Problem of Mental Illness

OVERVIEW

Handling cases involving the mentally ill can be dangerous, both for the police and the mentally ill individuals with whom they come in contact.

During the period 1997-2006 there were 1058 officers assaulted in America, and 13 feloniously killed while responding to calls involving mentally ill people.

Many, if not most people suffering a mental illness will react negatively to the police, and this reaction tends to cause the police to resort to their training and take a defensive posture, many times resorting to the use of force to de-escalate the situation.

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12.1 The Problem of Mental Illness

OVERVIEW

• In the first nine months of 2006, the LAPD had 46,129 contacts with people suspected of being mentally ill. Of those, 709 had attempted suicide and 4,686 were taken into custody for an involuntary commitment and psychiatric evaluation.

• The Lincoln, Nebraska Police Dept. reported that in 2002 it handled over 1,500 cases involving mentally ill persons, and that it has spent more time on these cases than on burglaries, felony assaults, or traffic accidents involving injuries.

• In 2000, officers in Florida transported more than 40,000 people for an involuntary 72-hour psychiatric evaluation. This number exceeded burglaries (26,087) and aggravated assaults (39,120) handled during the same year.

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To summarize the traditional police and corrections response to mental illness.

Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes

12.2

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12.2 The Police Response

THE POLICE RESPONSE

Traditionally, the police have had two major problems effecting their response to cases involving the mentally ill:

• A lack of training on how to effectively respond to, contain, and de-escalate such a crisis without the need for heightened or deadly force.

• The perception among police officers that mentally ill people are always more violent than non-mentally people, a perception that is not necessarily supported by available research.

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12.2 The Police Response

THE POLICE RESPONSE

The problems with police training and perceptions come together to cause an officer to immediately enter a situation in a more heightened state of readiness and with an expectation that some level of force will be necessary. The combination of these two reactions only increases the potential for a violent outcome if a confrontation occurs.

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To list and define some of the more common types of mental illness faced by crisis responders.

Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes

12.3

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12.3 Types of Mental Illness

Thought Disorders

Characterized by a person’s disordered thinking and a disconnect from reality. Most common type is schizophrenia.

• Paranoid Schizophrenia These individuals can be extremely dangerous. Typically fixated on the false belief that someone is out to get them, or that they are being persecuted in some manner.

• Disorganized Schizophrenia Typically incoherent. Disorganized speech and behavior are almost always present. Delusions and hallucinations are common. There is typically no consistent theme to their thinking.

• Catatonic Schizophrenia Typically withdrawn and unresponsive. They may show very little movement, and may curl up in a fetal position. They pose essentially no danger to responders.

• Residual Schizophrenia The after effects of a schizophrenic episode. Individuals typically experience depression anda loss of interest in life. Their ability to communicate is greatly diminished.

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12.3 Types of Mental Illness

Thought Disorders

According to the Diagnostic and Statistical Manual of the APA (DSM-IV-TR), in order to be diagnosed with schizophrenia, a person must demonstrate at least two of the following:

• DelusionsDelusions of control, Nihilistic delusions, Delusional jealousy, Delusion of guilt or sin, Delusion of mind being read, Delusion of reference, Erotomania, Grandiose delusion, Persecutory delusion, Religious delusion, Somatic delusion

• HallucinationsAuditory or visual/ positive or negative

• Disorganized Speech

• Grossly disorganized or catatonic behavior

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12.3 Types of Mental Illness

Mood Disorders

Symptoms include extremes in how the person feels, either extreme agitation, excitement, or depression.

Depression

-Depressed most of the day, and almost everyday-Diminished interest in almost all activities-Significant weight change-Insomnia-Feelings of worthlessness-Recurrent thoughts of death-Inability to think rationally

People who are severely depressed can be dangerous if they are having thoughts of suicide. They may force the police to use deadly force against them…”suicide by cop.”

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12.3 Types of Mental Illness

Mood Disorders

Symptoms include extremes in how the person feels, either extreme agitation, excitement, or depression.

Bipolar Disorder

A second type of mood disorder, and one that can be extremely dangerous for those who confront people suffering from this disorder, is bipolar disorder, also called manic-depressive disorder.

People diagnosed with this disorder will experience periods of elevated mood, energy, and cognition (mania), as well as periods of depression. Typically the two extremes are separated by periods of relatively normal functioning, and psychotic-like features, such as delusions and hallucinations, are sometimes experienced at the extremes.

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12.3 Types of Mental Illness

Anxiety Disorders

These disorders are marked by abnormal amounts of fear, worry, or uneasiness. At their extreme, these disorders can include physical symptoms such as chest pains and shortness of breath. A person suffering from a severe anxiety disorder may be entirely unable to function normally without some type of therapeutic intervention, to include medication.

If they are in the midst of an anxiety episode, whichmany of them are during a personal crisis, then they have the capacity to behave in unpredictable and erratic ways, and can be dangerous.

- Generalized anxiety disorder- Panic disorder- Obsessive-compulsive disorder- Post-traumatic stress disorder (PTSD)- Separation anxiety

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To summarize the accepted best practices for responding to mentally ill offenders, victims, suspects, and inmates.

Learning ObjectivesAfter this lecture, you should be able to complete the following Learning Outcomes

12.4

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12.4 Best Practices

The Memphis Model (CIT)

Developed in 1988 to reduce violent encounters between mentally ill individuals and the police.

Included the formation of a specially trained crisis intervention team (CIT) to respond to cases involving mentally ill individuals. Team members received training from mental health professionals and family advocates.

Goals of the program:

• To de-escalate a situation involving a mentally ill individual without the use of force.

• To avoid arrest where possible, and divert the individual to needed services.

• To work in partnership with community mental health centers and drug-alcohol treatment centers.

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12.4 Best Practices

The Memphis Model (CIT)

Benefits that have been seen in Memphis…

-Crisis response is immediate-Arrests and use of force have decreased-Underserved consumers are identified and provided services-Patient violence in the ER has decreased-Officers are better trained in de-escalation techniques-Officer injuries have decreased-Officer appreciation in the community has increased-Less “victimless” crime arrests-Decrease in health care liability in jail-Cost savings

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12.4 Best Practices

De-escalation Techniques• ENGAGEMENT

- Non-threatening approach- Be cognizant of the person’s boundaries- Identify self in a calm and professional voice- A simple purpose statement, “I’m only here to help you.”

• ESTABLISH RAPPORT

- Ask their name- Look for a point of connection (i.e., tattoos, sports logo, military, etc.)- Establish trust through honest disclosure

• ACTIVE LISTENING

- Minimal encouragements- Paraphrasing- Emotion-labeling- Open-ended questions- “I” messages- Effective pauses

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12.4 Best Practices

Community Resources

It is important that all officers have a knowledge of the available resources within their communities. They may include…

- Primary care facilities- Counseling centers- Support groups- Advocacy groups- Faith-based providers- Shelters

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© 2013 by Pearson Higher Education, IncUpper Saddle River, New Jersey 07458 • All Rights Reserved

Every year mentally ill individuals are killed while interacting with police, and every year police officers are killed during those interactions. It is a volatile situation that requires an understanding on the part of the police of the various types

of mental illness.

The traditional police response to mentally ill individuals has been problematic. Officers receive very little training in this

area, and are quick to resort to the appropriate level of force in a given situation regardless of the person’s mental

condition.

Programs such as the “Memphis Model” have been established to provide a specialized response to cases

involving the mentally ill. Essentially all police jurisdictions now have access to a crisis intervention team (“CIT”) with

officers trained for this purpose. The benefits have included less injuries, cost savings, and an increase in public

awareness of the problem of mental illness.

CHAPTER SUMMARY

12.1

12.2

12.4

There are many types of mental illness officers should be aware of. Most can be classified as either thought disorders,

mood disorders, or anxiety disorders.12.3

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© 2013 by Pearson Higher Education, IncUpper Saddle River, New Jersey 07458 • All Rights Reserved

DISCUSSION QUESTIONS

1. Discuss the concept of personal responsibility, and whether you believe the mentally ill should still be held accountable for their crimes?

2. Do some basic Internet research, and then discuss the differences between the verdicts of “guilty but mentally ill” and “not guilty by reason of insanity.”

3. Do you believe the criminal justice system should recognize a difference between a mentally ill person who is psychologically impaired and an intoxicated person who is chemically impaired? Assuming both commit the same crime, and both are unable to understand the implications of their actions, should they be treated differently?