1. Development and Implementation of a CIT Training Curriculum in a County Jail

2. Introductions Joan Cairns, MFT Joan Cairns, MFT Director of Jail Psychiatric Services Angelica Almeida, Ph.D. Angelica Almeida, Ph.D. Manager with Jail Psychiatric Services Michele Fisher Michele Fisher Captain and Facility Commander with San Francisco Sheriff ’ s Department

3. Learning Objectives Identify ways to collaborate with multiple agencies to develop a CIT Training Curriculum Identify ways to collaborate with multiple agencies to develop a CIT Training Curriculum Identify the steps to implement a CIT Training Curriculum (e.g., what topics should be covered) in jail setting Identify the steps to implement a CIT Training Curriculum (e.g., what topics should be covered) in jail setting Identify ways that this intervention improves treatment of incarcerated mentally ill individuals Identify ways that this intervention improves treatment of incarcerated mentally ill individuals

4. Why Develop a CIT Curriculum for a Jail Setting?

5. Federal Community Mental Health Act Signed into law in 1963 by President John F. Kennedy Signed into law in 1963 by President John F. Kennedy Community based care as an alternative to institutionalization Community based care as an alternative to institutionalization Led to “ transinstitutionalization ” and criminalization of mental illness Led to “ transinstitutionalization ” and criminalization of mental illness Rather than receiving treatment in State Hospitals, mentally ill individuals are now incarcerated Rather than receiving treatment in State Hospitals, mentally ill individuals are now incarcerated

6. Today, approximately 1.1 million people with severe mental illness are admitted to U.S. jails each year.

7. “ On any given day, between 300,000 and 400,000 people with mental illnesses are incarcerated in jails and prisons across the United States, and more than 500,000 people with mental illnesses are under correctional control in the community. ” ~ Mental Health America

8. Jails Today Rates of mental illness in jails have increased upwards of 50% over the last five years (Hirschkorn & Mitchell, 2011; Wiener, 2012) Rates of mental illness in jails have increased upwards of 50% over the last five years (Hirschkorn & Mitchell, 2011; Wiener, 2012) Forensic settings now provide significantly more mental health services to individuals than community based treatment Forensic settings now provide significantly more mental health services to individuals than community based treatment In 2012, San Francisco County provided mental health services to approximately 2.5% of the population, whereas approximately 30% of the jail population has contact with mental health staff at any given time In 2012, San Francisco County provided mental health services to approximately 2.5% of the population, whereas approximately 30% of the jail population has contact with mental health staff at any given time

9. Jails Today Most individuals (roughly 80%) are arrested for nonviolent offenses such as drug and property offenses (Baillargeon, Binswanger, Penn, Williams & Murray, 2009) Most individuals (roughly 80%) are arrested for nonviolent offenses such as drug and property offenses (Baillargeon, Binswanger, Penn, Williams & Murray, 2009) Individuals with mental illness have higher rates of recidivism (Baillargeon et al., 2009; Steadman, Redlich, Callahan, Robbins &Vesselinov, 2010) Individuals with mental illness have higher rates of recidivism (Baillargeon et al., 2009; Steadman, Redlich, Callahan, Robbins &Vesselinov, 2010) County jails see higher rates of mental illness than prisons (Hatcher, 2012) County jails see higher rates of mental illness than prisons (Hatcher, 2012) Custody staff has to be educated on mental health issues in order to create a safe environment and work alongside mental health professionals Custody staff has to be educated on mental health issues in order to create a safe environment and work alongside mental health professionals

10. Purpose of CIT in a Jail Setting Similar to officers in the community, custody staff are the first responders to crises in a jail Similar to officers in the community, custody staff are the first responders to crises in a jail Need to be “ armed ” with specialized training to address these situations Need to be “ armed ” with specialized training to address these situations Develops a collaboration between custody staff and mental health professionals Develops a collaboration between custody staff and mental health professionals

11. Curriculum Development for Enhanced Practical Interventions for Collaboration (EPIC) Training

12. Community versus Jails Important to consider the unique environment of a jail setting Important to consider the unique environment of a jail setting Note that research done in the community does not often translate to forensic settings (e.g., risk factors for suicide) Note that research done in the community does not often translate to forensic settings (e.g., risk factors for suicide)

13. Commitment to the Program Training doesn't work without buy in from all parties Training doesn't work without buy in from all parties Choosing instructors that represent all perspectives (i.e., medical, psychiatric, custody) Choosing instructors that represent all perspectives (i.e., medical, psychiatric, custody) Modeling collaboration and mutual respect Modeling collaboration and mutual respect

14. Topics for Training Introduction to Mental Illness Introduction to Mental Illness Major mental illness Major mental illness Personality Disorders Personality Disorders Cognitive Disorders Cognitive Disorders Symptoms that may be seen in custody Symptoms that may be seen in custody Interventions Interventions Behavioral Plans Behavioral Plans Collaboration between deputized staff, mental health staff, medical staff Collaboration between deputized staff, mental health staff, medical staff Psychiatric Housing Units Psychiatric Housing Units Administrative Segregation Group Administrative Segregation Group

15. Topics for Training Suicide Prevention Suicide Prevention Difference between general population and forensic setting Difference between general population and forensic setting Risk factors and warning signs of suicide risk Risk factors and warning signs of suicide risk Assessing for suicide risk Assessing for suicide risk Intervention strategies Intervention strategies Observation Housing Observation Housing Use of direct vision facilities Use of direct vision facilities Use of other inmates Use of other inmates Do not house alone Do not house alone Suicide Prevention Poster Suicide Prevention Poster Brief Training Videos in Muster Brief Training Videos in Muster

17. Topics for Training Special Populations Special Populations First arrestees and serious charges First arrestees and serious charges Veterans Veterans Transitional Age Youth Transitional Age Youth Elderly Elderly Developmental Disorders Developmental Disorders Substance Abuse Disorders and Detox Substance Abuse Disorders and Detox Symptoms Symptoms Interventions Interventions

18. Topics for Training Active Listening Active Listening Communication Strategies Communication Strategies Use of Force with Mentally Ill Use of Force with Mentally Ill Job Burnout Job Burnout Community Resources Community Resources

19. Presentations 2-3 day intensive training 2-3 day intensive training Outings to community programs Outings to community programs Tangible tools for immediate use Tangible tools for immediate use Use of scenarios, videos, role playing Use of scenarios, videos, role playing Use of recorded lectures for brief introductions to major topics Use of recorded lectures for brief introductions to major topics

20. Collaboration Team approach to difficult cases Team approach to difficult cases Vital for safety and security of facilities Vital for safety and security of facilities Working with mental health and medical staff Working with mental health and medical staff Myths held by law enforcement about mental health providers Myths held by law enforcement about mental health providers

21. Impact of CIT Curriculum Feedback from deputies Feedback from deputies Impact on jail culture and how deputized staff interacts with inmates Impact on jail culture and how deputized staff interacts with inmates Anticipated outcomes based on community model: Anticipated outcomes based on community model: Reduced violence between staff and inmates Reduced violence between staff and inmates Reduced risk of injury Reduced risk of injury Increase use of verbal de-escalation rather than hands-on interventions Increase use of verbal de-escalation rather than hands-on interventions Increased identification of individuals at risk for suicide Increased identification of individuals at risk for suicide

22. Further Information Angelica Almeida, Ph.D. Angelica Almeida, Ph.D. Angelica.almeida@sfdph.org Angelica.almeida@sfdph.org Angelica.almeida@sfdph.org 510-520-8239 510-520-8239 Joan Cairns, MFT Joan Cairns, MFT Joan.cairns.@sfdph.org Joan.cairns.@sfdph.org Joan.cairns.@sfdph.org 650-219-7275 650-219-7275

23. Questions