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Mental Health Peace Officer Course # 4001. Texas Commission on Law Enforcement Officer Standards and Education. Unit Goal: 1.0. To sensitize officer to the adversity of mental illness. 2004 U.S. Census 26.2% had a diagnosable mental disorder 6% serious mental illness 45% two or more

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Mental Health Peace Officer

Course # 4001

Texas Commission on Law Enforcement

Officer Standards and Education

unit goal 1 0 to sensitize officer to the adversity of mental illness
Unit Goal: 1.0. To sensitize officer to the adversity of mental illness.
  • 2004 U.S. Census
    • 26.2% had a diagnosable mental disorder
    • 6% serious mental illness
    • 45% two or more
    • Leading cause of disabilities in ages 15-44
factors affecting mental health situation
Factors affecting mental health situation
  • Deinstitutionalization
  • Criminalization
  • Medicalization
  • Privatization
1 1 define the term mental illness
1.1.Define the term “mental illness.”
  • Illness, disease, or condition that either substantially impacts a person’s thought, perception of reality, emotional process, or judgment, or grossly impairs a person’s behavior, as manifested by recent disturbance behavior.
1 2 list three categories of mental illness most predominately identified with disease severity
1.2. List three categories of mental illness most predominately identified with disease severity
  • Psychotic Disorder: All cases of schizophrenia
  • Mood Disorder: Severe cases of major depression and bipolar disorder
  • Anxiety Disorder: Severe cases of generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder
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Cognitive Disorders (Alzheimer’s, Substance Abuse)
  • Personality Disorders (Paranoid, anti-social)
  • Disorders first diagnosed in infancy, childhood or adolescence (Autism, Mental Retardation, Attention Deficit Hyperactivity Disorder)
1 3 define terms associated with a psychotic disorder
1.3. Define terms associated with a Psychotic Disorder
  • “A group of serious and often debilitating mental disorders...are characterized by...impaired thinking and reasoning ability, perceptual distortions, inappropriate emotional responses, inappropriate affect, regressive behavior, reduced impulse control and impaired reasoning of reality.”

(Social Work Dictionary, 2nd Edition, by Robert L. Baker)

definition of delusion
Definition of Delusion
  • False beliefs not based on factual information. A delusion implies belief in something that is contrary to fact or reality, resulting from deception, a misconception, or a mental disorder. A persistent belief maintained in spite of evidence to the contrary.
definition of hallucinations
Definition of Hallucinations:
  • Distortions in the senses where the individual experiences auditory sounds and/or visual images that are technically not there.
1 3 1 discuss schizophrenia and its relationship with psychotic disorders
1.3.1. Discuss Schizophrenia and its relationship with Psychotic Disorders
  • Schizophrenia consists of a group of psychotic disorders characterized by changes in perception.
1 4 discuss the characteristics of a mood disorders
1.4. Discuss the characteristics of a Mood Disorders
  • A mood disorder is a mental health disorder with an abnormal mood as its primary feature.
1 4 1 discuss major depressive disorder
1.4.1. Discuss Major Depressive Disorder
  • A disorder that severely affects an individuals thinking and behavior.
  • A depressed mood or loss of interest of at least two weeks duration, accompanied by symptoms such as weight loss/gain, and difficulty concentrating.
1 4 2 identify prominent characteristics of bipolar disorder
1.4.2. Identify prominent characteristics of Bipolar Disorder:
  • A brain disorder of a severe nature, that creates unusual shifts in a person’s mood, energy level, and ability to function.
symptoms of a manic phase may include
Symptoms of a Manic Phase 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.
the spectrum of bipolar disorder
The Spectrum of Bipolar Disorder:

Severe Mania

Hypomania (mild to moderate mania)

Normal/balanced mood

Mild to moderate depression

Severe depression

1 5 define anxiety disorder
1.5. Define Anxiety Disorder
  • Anxiety is a normal reaction to stress. It helps a person deal with a tense situation by helping one cope. But when anxiety becomes excessive and irrational it becomes a disorder.
anxiety disorders can include
Anxiety disorders can include:
  • Generalized Anxiety Disorder
  • Obsessive-Compulsive Disorder
  • Post traumatic Stress Disorder (PTSD)
1 5 1 define generalized anxiety disorder gad
1.5.1. Define Generalized Anxiety Disorder (GAD
  • Constant worries and fears that distract from day-to-day activities and leave a persistent feeling that something bad is about to happen.
1 5 2 describe obsessive compulsive disorder
1.5.2. Describe Obsessive-Compulsive disorder
  • Distressing, unwanted nonsensical thoughts which return despite efforts to ignore them and the ritualistic behavior utilized to control these thoughts.
obsessions are
Obsessions are:
  • Repeated, persistent, unwanted ideas, thoughts, images or impulses that you experience involuntarily and that appear to be senseless.
compulsions are
Compulsions are:
  • Repetitive behaviors that an individual feels driven or compelled to perform.
1 5 3 discuss post traumatic stress disorder ptsd
1.5.3. Discuss Post Traumatic Stress Disorder (PTSD)
  • A type of anxiety disorder that is triggered by the involvement in or witness to an extremely traumatic event.
dsmiv indicates
DSMIV indicates:

The essential features of PTSD include:

“Experiencing, witnessing, or confrontation with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of self or others”

1 5 4 apply knowledge gained to a discussion of at risk occupations
1.5.4. Apply knowledge gained to a discussion of at-risk occupations
  • ...persons in emergency service fields are a population highly prone to suffering from PTSD, as a direct result of their work.
  • ...involved in traumatic events through direct or indirect involvement on a daily basis.
  • PTSD affects both men and women.
  • ...not only with “front-line” personnel but tele-communicators, dispatchers and support staff.
1 6 discuss the term cognitive disorder
1.6. Discuss the term Cognitive Disorder
  • Cognition refers to that operation of the mind process by which we become aware of objects of thought and perception, including all aspects of perceiving, thinking, and remembering.
the two most common cognitive disorders include
The two most common cognitive disorders include:
  • Alzheimer’s Disease
  • Substance Abuse Disorders
1 6 1 discuss the most commonly addressed organic brain disorder
1.6.1. Discuss the most commonly addressed organic brain disorder
  • The most common Organic Brain Disorder in persons over the age of 65 is Alzheimer’s disease.
  • Alzheimer’s is one of several disorders that cause a gradual loss of brain cells.
  • The cause of all demensia is abnormal loss of brain tissue.
demensia is characterized by loss of memory plus one or more of the following
. Demensia is characterized by loss of memory PLUS one or more of the following:
  • Aphasia
  • Apraxia
  • Agnosia
  • Loss of higher executive functioning
1 6 2 discuss the relevance of addressing substance abuse disorders in the topic of mental illness
1.6.2. Discuss the relevance of addressing substance abuse disorders in the topic of mental illness
  • Prolonged abuse of any drug can cause chemical dependency or addiction.
  • If these substances are used for extended periods of time/large dosages, they may also cause permanent damage to the central nervous system.
  • This damage can cause a wide range of psychological reactions that are classified as disorders.
co occurring disorders
Co-occurring Disorders
  • The co-occurrence of mental health disorders and substance abuse disorders, which would include alcohol and/or drug dependence or abuse.
1 7 define the term personality disorder
1.7. Define the term Personality Disorder
  • American Psychiatric Association (APA) defines as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it".
1 7 1 discuss examples of paranoid personality disorder
1.7.1. Discuss examples of Paranoid Personality Disorder
  • An on-going unfounded distrust and suspiciousness of people.
1 7 2 discuss relevant characteristics of antisocial personality disorder
1.7.2. Discuss relevant characteristics of Antisocial Personality Disorder
  • Behavior that is manipulative.
  • Often victimizes and violates the rights of others.
  • Fail to conform to societal norms
  • Often have a history of juvenile conduct disorder and criminal activities prompted by reckless, impulsive and violent behaviors.
  • This disorder is also most common in men.
1 8 list the most common mental disorders that are first diagnosed prior to the age of eighteen
1.8. List the most common mental disorders that are first diagnosed prior to the age of eighteen
  • Developmental disorders of Autism Spectrum Disorder (ASD),
  • Mental Retardation, and
  • Attention Deficit Hyperactivity Disorder (ADHD).
slide36
The Developmental Disabilities Assistance and Bill of Rights Act of 1990 defines a developmental disability as:
  • a severe, chronic disability of a person five years of age or older.
  • Such a disability is attributable to a mental or physical impairment or combination of the two.
  • Is manifested before a person reached the age of twenty-two.
  • May continue indefinitely.

continued...

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Substantial limitation of three or more specified life activities.
  • Reflects the person’s need for lifelong or extended care, treatment, or other services which are planned and coordinated according to that person’s needs.
  • Infants and young children (newborn to age 5) with developmental disabilities have substantially delayed development or specific congenital or acquired conditions
1 8 1 discuss autism spectrum disorder asd
1.8.1. Discuss Autism Spectrum Disorder (ASD)
  • Brain developmental disorder that impairs social interaction and communication; causing restricted and repetitive behavior, all starting before the age of three.
1 8 2 define mental retardation
1.8.2. Define Mental Retardation
  • A range of substantial limitations in mental functioning manifested in persons before the age of 18, creating a pattern of slow learning during childhood and significantly below normal global intellectual functioning as an adult.
1 8 3 explain the primary differences that exist between a mental illness and mental retardation
1.8.3. Explain the primary differences that exist between a Mental Illness and Mental Retardation
  • 3% of the American population is considered to posses a mental retardation (sub-average score of 69 or less on Wechler Intelligence Scale or Stanford Binet IQ test).
  • While…22.1% of the American population is diagnosed with a mental illness.
1 8 4 describe prevalent factors of attention deficit hyperactivity disorder adhd
1.8.4. Describe prevalent factors of Attention Deficit Hyperactivity Disorder (ADHD)
  • A medical condition characterized by difficulties with inattention or hyperactivity and impulsivity.
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2.0. Discuss psychopharmacology as it relates to medications prescribed and prominent side effects in persons with a mental illness.
2 1 name four categories of medications utilized in controlling the symptoms of mental illness
2.1. Name four categories of medications utilized in controlling the symptoms of mental Illness.
  • Anti-psychotic
  • Antidepressants
  • Mood stabilizers (Hallucinogenic)
  • Anti-anxiety drugs
2 2 list side effects that can be associated with utilizing psychotherapeutic medications
2.2. List side effects that can be associated with utilizing psychotherapeutic medications:
  • muscle spasms, protruding tongue, eyes rolled back, constant leg movement, tremors, uncoordinated movements, impotence, nausea, headache, blurred vision, weight gain, fatigue, liver toxicity
side effects can be
Side effects can be
  • uncomfortable
  • dehumanizing
  • and are often irreversible, which may cause person to refuse to take them as directed
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2.3. Define Tardive Dyskinsia (TD) and its relationship to the utilization of psychotherapeutic medications
  • Some of these side effects are permanent, even after the medications have been stopped; the medications have a tendency to produce neurological damage.
2 1 3 list common reasons for a consumer deviating from their prescribed medication schedule
2.1.3. List common reasons for a consumer deviating from their prescribed medication schedule
  • Side effects
  • The stigma associated with being mentally ill, i.e., they don’t want people to know they have a mental illness
  • They start feeling better and think they no longer need the medications
3 0 discuss signs and symptoms of suicide
3.0. Discuss signs and symptoms of suicide
  • Average of 6 deaths each day by suicide in Texas
  • 121 more people committed suicide in 2001 than in 2000. This is a six percent increase in one year. The gender breakdown was reported at 1,772 males vs. 442 females (i.e., about 4 men for each woman)
  • Highest rates of suicide are in the 45-54 age group (15.2 per 100,000), with the second being the 75-year-and-older age group (18 per 100,000)
  • 90% of suicides are reportedly related to untreated or under-treated mental illness with the most common being depression.
  • Nearly 20% of people diagnosed with bipolar disorder and 15% diagnosed with schizophrenia die from suicide.
3 1 explain the process of evaluating suicidal risk
3.1. Explain the process of evaluating suicidal risk
  • An individual considering suicide may try to reach out to you in a direct or indirect manner.
  • There is no positive means of identifying immediate risk of suicide however; most warning signs especially in combination indicate that the individual is experiencing some sort of emotional stress.
suicidal intervention strategies
Suicidal intervention strategies
  • The three “I’s”:
  • Contracts:
3 1 1 evaluate the risk of suicide by the law enforcement officer
3.1.1. Evaluate the risk of suicide by the Law Enforcement Officer
  • Occupational conditions.
  • More prone to the risk of divorce, alcoholism, emotional/physical problems and Post Traumatic Stress Disorder (PTSD).
  • Innate nature of the police culture.
4 0 explain crisis behavior and its relevance to cit training
4.0. Explain Crisis Behavior and its relevance to CIT Training
  • You interact with people who are angry, emotional, injured, frightened, or traumatized. Some of these people welcome your presence, while others resent it.
4 1 discuss the cycle of crisis behavior
4.1. Discuss the cycle of crisis behavior

Definition of Crisis Behavior:

  • A person suffering from a temporary breakdown in coping skills that includes perception, decision-making, and problem solving abilities
  • Different depending on individual response.
  • Anyone can suffer from a crisis and its effects can vary with time, place, and person
crisis escalation cycle
Crisis Escalation Cycle:
  • As an individual enters into a crisis situation their response enters into fairly predictable stages. If acutely psychotic, responding to internal stimuli, or intoxicated, these stages will vary and may become even more erratic.
crisis cycle
Crisis Cycle:
  • Onset
  • Escalation and Anger
  • Out of control behavior
4 2 discuss officer interactions with persons who have a mental illness
4.2. Discuss officer interactions with persons who have a mental illness
  • Stay calm
  • Be patient
  • Double-check information
  • Use the individual’s name
  • Give instructions or directives one at a time

continued...

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The size and age of a person with mental illness has little to do with whether a back-up officer should be called
  • Engagement is pivotal - keep trying
  • Don’t underestimate the power of hallucinations or delusions
  • Never argue about a delusion
  • Ask about treatment in the past
  • Do not take a judgmental stance.
  • Don’t express disapproval
  • Persons in mental health crisis need more personal space
4 3 explain how to utilize observation as a tool for evaluative purposes
4.3. Explain how to utilize observation as a tool for evaluative purposes
  • Consciousness
  • Activity
  • Speech
  • Thinking
  • Affect and Mood
  • Memory
  • Orientation
  • Perception
  • Physical symptoms
4 3 1 discuss additional ways to obtain useful information for evaluative purposes
4.3.1. Discuss additional ways to obtain useful information for evaluative purposes
  • In addition to your personal observations, it is important to obtain information from witnesses and family members and friends.
six step model of crisis intervention
Six step model of Crisis Intervention
  • Defining the problem
  • Ensuring client safety
  • Providing support
  • Examine alternatives
  • Making Plans
  • Obtaining commitment
slide66
4.4. Demonstrate how Crisis Intervention Techniques can be utilized in domestic disturbance situations.
4 5 discuss emerging trends in crisis intervention techniques
4.5. Discuss emerging trends in Crisis Intervention techniques
  • Has evolved into a major human service sub-specialty
  • Has become widely apparent that a reactive approach to crisis intervention is not enough; proactive and preventive models need to be developed and implemented
slide69
Unit Goal: 5.0. To explore the world of the mentally ill through a discussion of legal and societal concerns and perspectives.
5 1 discuss the mentally ill person in the situation of being homeless
5.1. Discuss the mentally ill person in the situation of being homeless.
  • On any given night approximately 600,000 Americans are homeless
  • More than 2 million people are homeless throughout the year
  • One-third of the people who are homeless have a serious mental illness
  • One-half also have a substance abuse disorder.
5 2 discuss the mentally ill individual as a victim of crime
5.2. Discuss the mentally ill individual as a victim of crime.
  • “People with mental illness are more likely to be victims than perpetrators of violence”

National Institute of Justice, 1996

statistics
Statistics:
  • 4-13% of mentally ill consumers are perpetrators of crime
  • Mentally Ill consumers are 140 times more likely to be victim of theft
  • 3 million Mentally Ill consumers are estimated to be victimized each year
  • In a year, more than one-quarter of mentally ill consumers say they are victimized
5 3 evaluate the stigma and societal discrimination that exists toward persons who are mentally ill
5.3. Evaluate the stigma and societal discrimination that exists toward persons who are mentally ill.

Stigma is a mark of disgrace or shame. It is made up of various components, including:

  • Labeling someone with a condition
  • Stereotyping people with that condition
  • Creating a division (i.e., a superior “us” and a denigrated “them”)
  • Discriminating against someone on the basis of their label
slide74
5.3.1. Discuss the Americans with Disabilities Act as it relates to individuals diagnosed with a mental illness
  • “The Americans with Disabilities Act (ADA) entitles people with disabilities to the same service and protections that police departments provide to anyone else. They may not be excluded or segregated from services, denied services, or otherwise provided with lesser services or protection than are provided to others.”
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6.0. Develop an increased understanding of the legal process; evaluation and techniques for appropriateness of apprehension per Texas Health and Safety Code (Mental Health Code.)

6 1 discuss the process in evaluating the appropriateness of a warrant less apprehension
6.1. Discuss the process in evaluating the appropriateness of a warrant less apprehension.
  • “Least restrictive alternative” is the process that:
  • Is available
  • Provides the consumer with the greatest possibility of improvement
  • Is no more restrictive of consumer’s physical or social liberties than is necessary
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6.1.2. Describe the step by step process of Apprehension by a Police Officer without a warrant to include emergency apprehension.
slide81
Texas Health and Safety Code, Sec.573.001
  • Texas Health and safety Code, Sec .573.002
  • Texas health and safety Code, Sec.573.011
  • Texas health and safety Code, Sec.573.012
  • Texas health and safety Code, Sec.573.021
  • Texas health and safety Code, Sec.573.022
  • Texas health and safety Code, Sec.573.023
slide82

6.1.3. Discuss the Orders

of Protective Custody

process

  • Texas health and safety Code, Sec.574.021
  • Texas health and safety Code, Sec.574.022
  • Texas health and safety Code, Sec.574.023
slide83
6.1.4. Research departmental policies in requesting assistance and transport of a consumer before and after apprehension
6 1 5 propose justifications in assessing proper use of force option
6.1.5. Propose justifications in assessing proper use of force option.
  • Keep the situation in perspective
  • The officer may use force comparable to any other legal duty when a person is resisting arrest
  • The force must be reasonable
  • Goal is to obtain care and treatment for the mentally ill person
6 2 explain an officer s limitation of liability
6.2. Explain an officer’s limitation of liability.
  • People acting in good faith, reasonably and without negligence are not civilly or criminally liable.
slide86
6.3. Discuss Confidentiality as it relates to the topic of Mental Health and Law Enforcement involvement
  • Communication between a patient and a professional, as well as records of the identity, diagnosis, evaluation, or treatment of a patient that is created or maintained by a professional
unit goal 7 0 gain an understanding of mental health referrals resources in the student s community
Unit Goal: 7.0. Gain an understanding of mental health referrals/resources in the student’s community.
7 1 investigate possible referral treatment challenges in your community
7.1. Investigate possible referral/treatment challenges in your community.
  • Lack of available services
  • Willingness of mental health providers
  • Quality and availability of mental health programs
  • High costs of prescription drugs and formulary limitations
slide90
7.2. Discuss the players and strategies needed to coordinate a quality community mental health program
  • Who else in your community could share in these responsibilities?
7 2 1 define a partnership and its relevance in community and law enforcement collaboration
7.2.1. Define a partnership and its relevance in community and law enforcement collaboration

Definition of a partnership

  • An arrangement between two or more parties who have agreed to work cooperatively toward shared objectives in which there is: shared authority and respect, joint investment of resources, shared liability or risk taking, and ideally, mutual benefits
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Definition of collaboration:
  • A system that integrates the resources and delivery of appropriate Mental Health care services through processes or techniques used by different entities in order to control or influence: the quality, accessibility, utilization, costs and prices, or outcomes of social services provided to a defined population.
slide94
“The criminal justice and mental health worlds are very different. We come from different traditions, we speak different languages, and to some degree have different values, expectations, and goals. Furthermore, few of us expected or desired to work in both the criminal justice and mental health worlds, and few of us have been trained or educated to understand the other world.”
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7.3. 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.

7 4 discuss the state of texas jail diversion ideal
7.4. Discuss the State of Texas Jail Diversion Ideal
  • Education and training of law enforcement personnel and the courts
  • The development and utilization of crisis intervention teams (CIT)
  • Development of a centralized location for mental health assessment, without, arrest for individuals with non-violent criminal conduct
  • Development of holding facilities providing structured treatment in lieu of arrest
  • Development of linking and referral services
  • Development of timely and effective screening process
  • Development of required community support
  • Development of an identified method for addressing housing and needed support services
8 0 unit goal understanding program evaluation in demonstrating measuring success
8.0. Unit Goal: Understanding program evaluation in demonstrating/measuring success.
  • Measuring program effectiveness can assist in determining how successful your program responses are to your area.
  • It will also evaluate any changes or adaptations/modifications that might be appropriate.
  • Look at trends for the total agency.
three types of useful data
Three types of useful data
  • Quantitative data
  • Quantity Data
  • Process Data
in conclusion
In conclusion:
  • It is important to dispel commonly held misconceptions about people who have mental illnesses. This training has been based on the following working assumptions:
slide103
Mental illness is not a crime.
  • Most people with mental illnesses are fully functioning community members.
  • There is no correlation between mental illness and a persons participation in crime.
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Involvement in infractions (traffic violations, loitering, disorderly conduct) may be a manifestation of a persons mental illness or failure to receive treatment for the illness, rather than a result of intentional wrongdoing.
slide105
Some people with mental illnesses may be more vulnerable to crime, abuse or injury than the general population.
  • Mental illness is a continuum- highly functional to highly debilitating.