2. CRIMINALIZATION OF MENTAL ILLNESS AND THE LAW ENFORCEMENT ROLE Risdon N. Slate, Ph.D. 2010 FBI National Academy Utah Chapter Fall Training – St. George, Utah

3. Free Association Mentally Ill

4. Psycho

5. Jason in Friday the Thirteenth

6. Jason on Arsenio Hall Show

7. Crisis in Mandarin Chinese

8. Crises Often Drive CJ Policy Crisis Intervention Team Training Eugene Gregory and Alan Singletary Andrew Goldstein Aaron Wynn Brad H. Seung-Hui Cho

9. Recipe for Failure Not offering adequate treatment Providing no follow-up on re-entry into the community

10. California’s Lanterman-Petris- Short Act Prompts Abramson to coin the phrase “Criminalization of Mental Illness” WHY? Magna Carta of the mentally ill (Abramson).

11. Each of the following cited for contributing to the criminalization of mental illness CJ Process viewed by LE as more expeditious than MH Process Deinstitutionalization Inadequate community support service Lack access to intermediate & long-term care

12. Deinstitutionalization

13. Patients in State Mental Hospitals 20 th Century21 st Century Beginning roughly 150,000 1955 peak = 559,000 1960 – 1980 = < 100,000 Beginning = _______ Estimated today = _______

14. ... The grim statistics - jails and prisons have become the new “psychiatric hospitals”

15. Harcourt, 2006 Texas Law Review

16. Penrose finds as prison populations decrease mental hospital populations increase; as prison populations increase mental hospital populations decrease. Today more persons with mental illnesses in prisons and jails than in psychiatric hospitals. Transinstitutionalization has take place

17. Factors Associated with Deinstitutionalization Movement Inhumane conditions and abuses in state hospitals Discovery of Thorazine The anti-psychiatry movement

18. 2 Cases Set the Deinstitutionalization Movement in Motion in the 1970s Wyatt v. Stickney (1972) O’Connor v. Donaldson (1975)

19. Founders of the Anti-Psychiatry Movement Michael Foucault R.D. Laing Thomas Szasz

20. Work of Szasz & the anti-psychiatry movement has made it easier to put a person in jail than to secure treatment for them.

21. L. Ron Hubbard (Scientology Founder) “There is not one institutional psychiatrist alive who could not be arraigned and convicted of extortion, mayhem, and murder” (Rissmiller & Rissmiller).

22. Scientology Religious Views Prominent Members Views on Formal Education Views on Psychiatry

23. Community Mental Health Centers JFK appropriated $3 billion in 1963 for CMHCs Never allocated JFK assassinated Viet Nam War NIMBY (Gilligan)

24. States’ Ways to Shift Costs for the Care of PWMI to the Federal Government Disability insurance Housing assistance Medicaid Moving persons with mental illnesses from state hospitals to nursing homes How Shift Costs to County & Local Govt. ?

25. Managed Psychiatric or Behavioral HealthCare Has actually resulted in payment of commissions for denial of hospital admissions May result in cost shifting instead of saving Limited choices, pre-certification, cut corners

26. National Alliance on Mental Illness (NAMI) Grading the States Report Average Grade for the Public Adult Mental Health Care Systems in the U.S. = D ____ UTAH= ?

27. Medicaid vs. Medicare

28. Preferred Drug Lists/Restricted Formularies

29. Hospitals do not have to provide mental health treatment to those unable to pay. Markowitz found a predominance of private psychiatric hospital beds in cities to be significantly associated with increases in both arrest and crime rates, suggesting that when the mental health system is privatized police have fewer referral options to mental health treatment and are more likely to make an arrest.

30. “That’s news to us” Whose job is it? Whose job is it?MOUs

31. Homelessness

32. Military

33. Daytona Beach Police Chief Michael Chitwood Greyhound Therapy Banishment Cost-shifting

34. Surgeon General’s Report The most formidable obstacle to future progress in the arena of mental illness and health is: ________

35. Violence Factors linked to violence include: past incidences of violence, substance abuse, lack of treatment, and non-compliance with medication. “Laws change for a single reason, in reaction to highly publicized incidences of violence. …[And it] may be necessary to capitalize on the fear of violence” (D.J. Jaffee, Treatment Advocacy Center)

36. Violence & Funding for Mental Health Treatment Stigma - Otto Wahl One Flew Over The Cuckoo’s Nest Negative media portrayals of persons with mental illnesses have reportedly contributed to roughly half of all citizens perceiving persons with mental illnesses as being more violent than persons without mental illnesses. Famous persons with mental illnesses

37. One Flew Over the Cuckoo’s Nest

38. Anosognosia Xavier Amador Effects

39. 3 Largest Inpatient Psychiatric Facilities

40. People with mental illnesses are incarcerated longer Riker’s Island (NYC) Average length of incarceration All inmates = 42 days Inmates with SMI = 215 days Pennsylvania Prisons Inmates with SMI three times more likely to serve maximum sentences. Source: www.consensusproject.orgwww.consensusproject.org

41. Prevalence of Mental Illness Ditton Study James & Glaze Percentage of PWMI with a substance abuse disorder

42. THE LAW ENFORCEMENT RESPONSE TO PERSONS WITH MENTAL ILLNESSES IN CRISES

43. Seth Greenberg “Mental illness is not a … choice; it is a medical disease.”

44. VPH vs. SBC

45. CIT Memphis PD

46. Gary Cordner PWMI more likely to be injured by police and _______ times more likely to be killed by police.

47. Price Police have been found to have more empathetic views than the general public toward pwmi in crises.

48. Ruiz & Miller Two most common misperceptions held by the police toward pwmi

49. Experts advise police not to resolve encounters with pwmi in crises quickly However, most police agencies do not have such specialized training or a formalized policy for such interactions. Greenberg, in a study of 28 police training academies, found the average amount of training was _____hours.

50. Law Enforcement Relationship with Mental Health Personnel Fairly Negative Working Relationship LE often views arrest and cj process as a more expedient option than referral to the mh system. Mercy Bookings “The system that can’t say no.” MOU

51. No Mercy

52. Mental Health Providers Refuse Treatment Substance Abuse History of Violence Frequent Hospitalizations Inability to Pay for Services

53. Police Role Prefer to Be Crime Fighters over Service Providers

54. Types of Police Responses to PWMI Mental Health-Based Specialized Mental Health Response Police-Based Specialized Mental Health Response Police-Based Specialized Police Response (CIT)

55. Police-Based Diversion Programs Are generally pre-booking in nature.

56. Mobile Crisis Team = a mental health based specialized mental health response

57. Lamb & his colleagues Like joining MH & LE CSOs Birmingham, AL = example of police- based mental health response. CSOs do not have arrest powers

58. Arrest rates in police encounters with pwmi are lower when specialized police responses are used; in fact, they found ____ times more likely pwmi to be arrested when encountering non-CIT officers (Steadman et al.). [although one Ohio study found an increased arrest rate] Majority of Memphis PD officers perceived CIT as effective in reducing time spent on MH crisis calls (Borum et al.).

59. Reduce Police Turnaround Time & Likelihood of arrest while improving linkages to the CJ system Single point of entry to the mh system Streamlined intake process No refusal policy

60. CIT First & Foremost, the goal is Officer Safety Steadman estimates _____to ____CIT programs in U.S. (Bastardizing) Reuland – CIT most popular of specialized programs Steadman et al. Memphis PD CIT (most well known). Greenberg Memphis CIT (most often replicated). Sellers et al. Memphis CIT (most effective in resolving mh crises).

61. CIT continued Identified as the best of the 3 specialized responses for reducing arrest rates of pwmi Reduces injuries to pwmi and police Reduction in jail suicides Fewer shootings of pwmi by police Fewer deaths for pwmi and police Increases access to mental health services Officers perform general police duties when not responding to crises with pwmi (Reuland) Inexpensive to implement

62. PWMI in Crises Can typically recall their interactions with police. Therefore, disrespect and/or abuse by police toward them can severely diminish their cooperation with police in the future.

63. Typical CIT Training Components Signs & Symptoms of Mental Illness Types of Psychotropic Medications De-escalation Techniques Interaction with Consumers of MH Services (IOOV) Memphis PD CIT training includes 8 Hrs. of interaction with consumers of MH Services (Cochran selectivity in choosing participants; Borum & Thompson ___to ___% of sworn force).

64. Stephen R. Covey, author of the Seven Habits of Highly Effective People, “Seek first to understand, then to be understood.”

65. Ten Commandments’ of De-Escalation: The Art of De-Escalation http://www.neoucom.edu/CJCCOE/cit.htmlhttp://www.neoucom.edu/CJCCOE/cit.html “It is the wise officer who can, at times, conceal his or her combat-ready status.” 1) Your safety comes first 2) Keep therapeutic spacing 3) Speak in tones that fit the situation 4) When appropriate use non-threatening posture 5) Personalize the conversation (i.e. use first names) 6) Ask how you can help 7) Don’t be afraid to set firm yet calm limits 8) Never validate hallucinations 9) Don’t internalize people’s negative comments 10) Never forget schizophrenia, bipolar disorder, and major depression are organic and genetic disorders. The person did nothing to inherit them. So, there by the grace of God, go I.

66. Comptom, Michael. T. & Kotwicki, Raymond J. (2007) “Responding to individuals with mental illnesses. Sudbury, Massachusetts: Jones and Bartlett Publishers. Comptom, Michael. T. & Kotwicki, Raymond J. (2007) “Responding to individuals with mental illnesses. Sudbury, Massachusetts: Jones and Bartlett Publishers. Law enforcement responses to emotional people in volatile situations cannot rely on convincing people by making a rational proposal to think differently. Rather, negotiators need to create a stable and respectful environment within which emotional individuals can take solace and rest. Arguing with a paranoid or aggressive person is futile.

67. Tips From Fred Frese, Ph.D. Remain as calm and respectful as possible. Talk to others. Separate the persons present and talk with them individually to determine why one is saying that the other has a mental illness. Whether seeing a psychiatrist? Case manager? Ever in a mental health facility? Whether person is taking or has been prescribed medication? Ask if the person has any strange or unusual beliefs? Psychiatric treatment, medications, beliefs and history.

68. At some point, the negotiator may want to ask what the person is hearing or seeing; in doing so, remember to be respectful of what the person is experiencing. Heightened Sensitivity Persons with schizophrenia typically exhibit a heightened sensitivity to stimuli in their environment. Person may be easily startled by sudden noises, or being overly reactive to sudden changes in lighting or quick movements by persons or objects in his or her surroundings. Thus, when an officer first encounters a person with mental illness, the environment should be altered to reduce stimulation. Turn down radios, and flashing lights and sirens should be minimized.

69. Full Metal Jacket

70. Rain Man

71. Training Video

72. Most People Who Are Mentally Ill Are Not Violent

73. Thought and/or Mood Disorders Psychosis = a general term for a state of mind in which thinking becomes irrational and/or disturbed. It refers primarily to delusions and hallucinations. Hallucination Delusion

74. Command Hallucinations

75. Tony Rolon’s interaction with “Arnold” Who was in the attic? Delusion or Hallucination?

76. Patricia Deegan Hearing Disturbing Voices

77. HIPAA

78. Medical Security Program

79. Sam Cochran Specialized Training VS. Services

80. Treatment Cuts drug use in half Reduces crime by 80% Reduces arrests by 64% Linda Rosenberg, President & CEO National Council for Community Behavioral Healthcare

81. Opportunity - Annual Costs Per Person – Linda Rosenberg

82. Lord Kelvin When you can measure what you are speaking about, and express it in numbers, then you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind.”

83. Cost Savings

84. California’s AB 2034 Program

85. 2007 RAND STUDY Ridgely et al. Allegheny County, PA Total Cost Savings of $9,584.00 per participant for a ½ Million Dollar Savings Over 2 Years

86. COLLABORATION (MOUs) Mental Health Courts Intensive Case Management Assertive Community Treatment Re-entry Establishing Best Practices Influencing Policy

87. Crisis in Mandarin Chinese

88. “A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses.” -- Hippocrates