No Good Deed:  Improving Mental Health Crisis Response to Law Enforcement  1 st  Crisis Intervention Team International Co...
A NYS DCJS Response To: <ul><li>New York State/New York City Mental Health-Criminal Justice Panel </li></ul><ul><li>Conven...
Summit Partners
PRA Tasks <ul><li>Development of the RFA, review of applications and selection of counties to attend the Summit. </li></ul...
Participating Counties <ul><li>The seven counties selected were:  </li></ul><ul><li>Broome </li></ul><ul><li>Cattaraugus <...
County Teams <ul><li>Law enforcement  </li></ul><ul><li>NAMI </li></ul><ul><li>Mental Health/Substance Abuse </li></ul><ul...
The Problem  <ul><li>New pressures on law  </li></ul><ul><li>enforcement post </li></ul><ul><li>deinstitutionalization </l...
(1968) “Police Discretion in Emergency Apprehension of Mentally Ill Persons” <ul><li>“ Policemen confront perversion, diso...
(1987) “Psychiatrists in Blue: Police Apprehension of Mental Disorder and Dangerousness” <ul><li>“ The presence of apparen...
And Now!
And Now!
What the Summit is NOT <ul><li>“ Police Summit” </li></ul><ul><li>CIT Training </li></ul>
What the Summit IS <ul><li>Good community policing </li></ul><ul><li>Good community mental health </li></ul><ul><li>New fo...
Basic Principles <ul><li>Balance public safety and public health </li></ul><ul><li>Balance community and individual rights...
What Are We Trying to Get To? <ul><li>No one gets hurt </li></ul><ul><li>Persons with mental illness get  </li></ul><ul><l...
Who Are We Talking About? Repeated Cycles INCARCERATION ARREST Private Home Group Residence Shelter Street S.A.  Residenti...
“ Treatment-Resistant”  Clients Or “ Client-Resistant”  Services
9 Patients -2700 ER visits 3 million dollars 8 of 9 substance abuse problems 7 of 9 mental health problems Austin American...
Institutional Circuit Cost:  July 05 -- June 07  System Days Per Diem Total Cost Shelter 160 *68 10,880 Jail 96 *129 12,38...
Prevalence of Current Substance Abuse Among  Jail Detainees with Severe Mental Disorders Detainees with severe mental diso...
Trauma History  Interview Data (n=978) Percent Experiencing  Lifetime Percent Experiencing  in Last 12 Months  1 Witness o...
Increased Mortality From Medical Causes in Mental Illness   <ul><li>Increased risk of death from medical causes in schizop...
What are the Causes of Morbidity and Mortality in People with Serious Mental Illness? <ul><li>While suicide and injury acc...
% Clients by Presenting Medical Conditions California Fuse Study, 2008 # of Conditions  Alameda  Los Angeles  S’mento  San...
ED and Inpatient Visits Aggregated Across Programs (N = 598)  California FUSE Study, 2008 Pre Post Difference Visits  4,79...
 
Benefits of CIT <ul><li>What has CIT training accomplished ? </li></ul><ul><li>Memphis </li></ul><ul><ul><li>Decreased inj...
Police as Mental Health Agent <ul><li>CIT Call Profile  </li></ul><ul><li>(Las Vegas Study) </li></ul><ul><li>N=655 </li><...
Intensity of Force  N=36
CIT Study Conclusions <ul><li>Police with CIT training use force more appropriately </li></ul><ul><li>Less injury to citiz...
But…No Good Deed Goes Unpunished <ul><li>Not committable </li></ul><ul><li>Behavior problem not MI </li></ul><ul><li>Medic...
Phony Road Blocks <ul><li>Cross system information sharing </li></ul><ul><li>$ </li></ul>
What Does It Take? <ul><li>First responders handle situation well </li></ul><ul><ul><li>Dispatch </li></ul></ul><ul><ul><l...
Pre-booking Jail Diversion COMMUNITY Intercept 1 Law enforcement / Emergency services Local Law Enforcement Crisis Stabili...
Specialized Crisis Response Sites:  Basic Principles <ul><li>Identified, central drop-off for law enforcement </li></ul><u...
Pre-booking Jail Diversion COMMUNITY Intercept 1 Law enforcement / Emergency services - Transition Local Law Enforcement J...
Pre-booking Jail Diversion COMMUNITY Intercept 1 Law enforcement / Emergency services Local Law Enforcement Crisis Respone
CIT Adaptations <ul><li>Chicago/Hawaii: licensed psychologists  </li></ul><ul><li>Colorado: ICM’s </li></ul><ul><li>Albany...
<ul><li>June 25 AGENDA </li></ul><ul><li>  </li></ul><ul><li>9:30   Keynote: Setting the Stage </li></ul><ul><li>Henry J. ...
<ul><li>Agenda Day 2 </li></ul><ul><li>8:45  NYS Crisis Response Models: </li></ul><ul><li>Rensselaer County EDPRT </li></...
Street Encounters with Homeless 2006 – 271  2007 – 271  2008 - 150
Homeless Subjects as “Suspects” 2006 – 499  2007 – 401  2008 – 252
Calls for Service Involving Emotionally Disturbed Persons 2006  – 299 calls  2007  – 279 calls  2008  – 281 calls Westches...
Resisting Arrest Charge for Emotionally Disturbed Persons: 2006  – 6 arrest  2007  – 1 arrest  2008  – 1 arrest Westcheste...
Mental Health Outreach Contacts and Referrals 2006 –  60  2007 –  126  2008 -  225 Westchester Co., NY
Sample Action Plan Priority Area 1:  For Law Enforcement officers to be prepared to de-escalate emotionally disturbed indi...
Sample Action Plan Priority Area 2:  Develop a more coordinated response between law enforcement, mental health, and chemi...
Common Action Steps Broome Cat’gus Dutchess Erie Madison Putnam Rockl’d Task Force X X X X X X Crisis/911 Integration X X ...
PRA Recommendations <ul><li>Develop state-specific information sharing guide to guide counties on improving MH and CJ info...
<ul><li>Improved communication </li></ul><ul><li>Better 911 and Helpline integration </li></ul><ul><li>Improved integratio...
Ten Essential Elements <ul><li>Collaborative Planning and Implementation </li></ul><ul><li>Program Design </li></ul><ul><l...
CIT Officer Intervenes <ul><li>I do not even know how to began to &quot;Thank You&quot; for your class/session &quot;Impro...
Veteran’s Justice Outreach Coordinator <ul><li>Educating Community organizations </li></ul><ul><li>Facilitating MH evaluat...
Stress Factors <ul><li>Multiple deployments/stop loss </li></ul><ul><li>Unemployment/Underemployment/Financial Strife </li...
Behaviors We May See <ul><li>Risky behaviors to get the adrenaline rush </li></ul><ul><li>Speeding/Erratic driving/road ra...
Charges <ul><li>679 charges filed against 458 Veterans </li></ul><ul><li>32% arrested 2 or more times </li></ul><ul><li>27...
Driving and Charges and Risk <ul><li>43% Motor Vehicle related charges in top ten misdemeanors </li></ul><ul><li>12 % Moto...
Upcoming SlideShare
Loading in …5
×

No Good Deed: Improving Mental Health Crisis Response to Law Enforcement

2,451 views

Published on

Presented by: Dan Abreu, MS CRS LMHC
CMHS National GAINS Center

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,451
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
35
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • Cross-Systems Mapping &amp; Taking Action for Change 10/07 Trainer Note: Return to this graphic to note that people with mental illness and co-occurring substance use disorders frequently cycle in and out of the criminal justice system It is not necessary to review the content, but use this as a segue to the next slide
  • Cross-Systems Mapping &amp; Taking Action for Change 10/07 Dan you may want to insert the references for the above here in the notes; eg Skeem, 200? After Memphis CIT was implemented: injuries to individuals with mental illnesses caused by police decreased by nearly 40 percent. The rate of TACT (similar to SWAT) calls in Memphis decreased by 50 percent In 1999, the Albuquerque Police Department reported: Officers arrested, transported to jail, or protective custody fewer than 10 percent of those people with mental illnesses they contacted. Injuries were reduced to 1 percent of calls The decrease in use of SWAT was reported at 58 percent. Miami Dade CIT reports reduction in wrongful death lawsuits Las Vegas Use of Force Study (Skeem) Race: White 74%; Black; 19%; Hispanic 7% Sex: Male 61% Age: Mean = 36 With Mental Disorder: 64% Bi-polar 28% Depression: 20% Schizophrenia: 19%
  • Cross-Systems Mapping &amp; Taking Action for Change 10/07 CIT Call Profile (N=655) 295 (45%) suicide threats/attempts Suicide Plans/Methods knives 106 (36%) overdose 45 (15%) firearms 35 (12%) 98 (15%) family disturbance
  • Cross-Systems Mapping &amp; Taking Action for Change 10/07 Call Resolution 485 (74%) Hospitalization 344 (71%) Involuntary 25 (18%) Onsite resolution 6 (4%) Arrest Conclusions As event violence increased, use of force increased Use of force used in 36 incidents (6%) Use of force used in only 30 of 189 (15%) serious to extreme incidents Severity of force related to severity of threat
  • Cross-Systems Mapping &amp; Taking Action for Change 10/07 Trainer Note: This slide returns to the Sequential Intercept Model Direct people to the handout Be prepared to briefly describe each of these interventions It is not necessary to describe all of these programs in detail ; direct participants to handouts for more detailed information Trainers will have information about each community prior to the training; this can help to determine which areas need more or less discussion Emphasize the importance of cross-system collaboration Emphasize the need for triage (drop-off) centers MENTAL HEALTH DIVERSION OPTIONS: PRE-BOOKING Psychiatric Emergencies When a person experiences a mental health crisis or emergency in the community, the nature of he person’s behavior may warrant police involvement Historically, police will either arrest the person due to the behavior or transport to a hospital emergency room Police are usually required to stay with the person until a treatment disposition is made Often the person is not eligible for hospital admission and no other options are available Mobile Crisis Teams Some communities utilize mobile crisis units These programs deliver a team of mental health professionals to the person in the crisis situation or at specified satellite locations in the community These services are often limited in the capacity to manage persons who are violent or intoxicated Crisis Intervention Teams (CIT) A police-based approach developed in Memphis, TN Police officers are trained to intervene in a mental health crisis With the ability to better recognize and respond to mental health issues, law enforcement officers can avoid arresting people with mental illness, and thereby they can be diverted from involvement in the criminal justice system Dispatchers are also trained in many of these communities In some communities, mental health advocacy programs train consumers to recognize a CIT pin or medallion, so that they can be reassured that the officer has received the necessary training to be helpful to them (Steadman et al., 2000) Specialized Crisis Response Site A key aspect of crisis intervention is the availability of crisis triage centers or crisis stabilization units These are central drop-off sites, available 24 hours a day Co-location with substance abuse services at drop-off site can relieve officers of determining if the crisis is due to mental illness or substance abuse A no refusal policy allows police officers to drop off persons in crisis and return to regular patrol duties A no refusal policy means that regardless of the mental health criteria for involuntary treatment, the service uniformly accepts police referrals (Steadman et al., 2001) Community Service Officers Developed in Birmingham (AL) Community service officers assist police officers in mental health emergencies Provide crisis intervention and some follow-up Officers are civilian police employees with professional training in social work and related fields Week days, coverage is 8:00 am to 10:00 pm; Twenty-four hour coverage, weekends, holidays – a rotating schedule (Steadman et al., 2000; Reuland, 2004) System-wide Mental Assessment Response Team (SMART) Developed in Los Angeles, California Combined police/mental health provider secondary co-response Provides a mental health evaluation unit and 24 hour hotline available to officers (Reuland and Cheney, 2005)
  • Cross-Systems Mapping &amp; Taking Action for Change 10/07 Essential Elements of a Specialized Response: (Consensus Project) Call Taker and Dispatcher Protocols On-Scene Assessment of Signs and Symptoms of Mental Illness, and Subsequent Disposition On-Scene Stabilization and De-Escalation Transportation and Custodial Transfer Specialized Crisis Response Sites/Treatment Supports and Services Specialized Training Organizational Support Confidentiality and Information Exchange Collaborative Planning and Implementation Programs Evaluation and Sustainability
  • Cross-Systems Mapping &amp; Taking Action for Change 10/07 Trainer Note: This slide returns to the Sequential Intercept Model Direct people to the handout Be prepared to briefly describe each of these interventions It is not necessary to describe all of these programs in detail ; direct participants to handouts for more detailed information Trainers will have information about each community prior to the training; this can help to determine which areas need more or less discussion Emphasize the importance of cross-system collaboration Emphasize the need for triage (drop-off) centers MENTAL HEALTH DIVERSION OPTIONS: PRE-BOOKING Psychiatric Emergencies When a person experiences a mental health crisis or emergency in the community, the nature of he person’s behavior may warrant police involvement Historically, police will either arrest the person due to the behavior or transport to a hospital emergency room Police are usually required to stay with the person until a treatment disposition is made Often the person is not eligible for hospital admission and no other options are available Mobile Crisis Teams Some communities utilize mobile crisis units These programs deliver a team of mental health professionals to the person in the crisis situation or at specified satellite locations in the community These services are often limited in the capacity to manage persons who are violent or intoxicated Crisis Intervention Teams (CIT) A police-based approach developed in Memphis, TN Police officers are trained to intervene in a mental health crisis With the ability to better recognize and respond to mental health issues, law enforcement officers can avoid arresting people with mental illness, and thereby they can be diverted from involvement in the criminal justice system Dispatchers are also trained in many of these communities In some communities, mental health advocacy programs train consumers to recognize a CIT pin or medallion, so that they can be reassured that the officer has received the necessary training to be helpful to them (Steadman et al., 2000) Specialized Crisis Response Site A key aspect of crisis intervention is the availability of crisis triage centers or crisis stabilization units These are central drop-off sites, available 24 hours a day Co-location with substance abuse services at drop-off site can relieve officers of determining if the crisis is due to mental illness or substance abuse A no refusal policy allows police officers to drop off persons in crisis and return to regular patrol duties A no refusal policy means that regardless of the mental health criteria for involuntary treatment, the service uniformly accepts police referrals (Steadman et al., 2001) Community Service Officers Developed in Birmingham (AL) Community service officers assist police officers in mental health emergencies Provide crisis intervention and some follow-up Officers are civilian police employees with professional training in social work and related fields Week days, coverage is 8:00 am to 10:00 pm; Twenty-four hour coverage, weekends, holidays – a rotating schedule (Steadman et al., 2000; Reuland, 2004) System-wide Mental Assessment Response Team (SMART) Developed in Los Angeles, California Combined police/mental health provider secondary co-response Provides a mental health evaluation unit and 24 hour hotline available to officers (Reuland and Cheney, 2005)
  • Trainer Note: This slide returns to the Sequential Intercept Model Direct people to the handout Be prepared to briefly describe each of these interventions It is not necessary to describe all of these programs in detail ; direct participants to handouts for more detailed information Trainers will have information about each community prior to the training; this can help to determine which areas need more or less discussion Emphasize the importance of cross-system collaboration Emphasize the need for triage (drop-off) centers MENTAL HEALTH DIVERSION OPTIONS: PRE-BOOKING Psychiatric Emergencies When a person experiences a mental health crisis or emergency in the community, the nature of he person’s behavior may warrant police involvement Historically, police will either arrest the person due to the behavior or transport to a hospital emergency room Police are usually required to stay with the person until a treatment disposition is made Often the person is not eligible for hospital admission and no other options are available Mobile Crisis Teams Some communities utilize mobile crisis units These programs deliver a team of mental health professionals to the person in the crisis situation or at specified satellite locations in the community These services are often limited in the capacity to manage persons who are violent or intoxicated Crisis Intervention Teams (CIT) A police-based approach developed in Memphis, TN Police officers are trained to intervene in a mental health crisis With the ability to better recognize and respond to mental health issues, law enforcement officers can avoid arresting people with mental illness, and thereby they can be diverted from involvement in the criminal justice system Dispatchers are also trained in many of these communities In some communities, mental health advocacy programs train consumers to recognize a CIT pin or medallion, so that they can be reassured that the officer has received the necessary training to be helpful to them (Steadman et al., 2000) Specialized Crisis Response Site A key aspect of crisis intervention is the availability of crisis triage centers or crisis stabilization units These are central drop-off sites, available 24 hours a day Co-location with substance abuse services at drop-off site can relieve officers of determining if the crisis is due to mental illness or substance abuse A no refusal policy allows police officers to drop off persons in crisis and return to regular patrol duties A no refusal policy means that regardless of the mental health criteria for involuntary treatment, the service uniformly accepts police referrals (Steadman et al., 2001) Community Service Officers Developed in Birmingham (AL) Community service officers assist police officers in mental health emergencies Provide crisis intervention and some follow-up Officers are civilian police employees with professional training in social work and related fields Week days, coverage is 8:00 am to 10:00 pm; Twenty-four hour coverage, weekends, holidays – a rotating schedule (Steadman et al., 2000; Reuland, 2004) System-wide Mental Assessment Response Team (SMART) Developed in Los Angeles, California Combined police/mental health provider secondary co-response Provides a mental health evaluation unit and 24 hour hotline available to officers (Reuland and Cheney, 2005)
  • No Good Deed: Improving Mental Health Crisis Response to Law Enforcement

    1. 1. No Good Deed: Improving Mental Health Crisis Response to Law Enforcement 1 st Crisis Intervention Team International Conference June 2, 2010 San Antonio Dan Abreu, MS CRS LMHC CMHS National GAINS Center
    2. 2. A NYS DCJS Response To: <ul><li>New York State/New York City Mental Health-Criminal Justice Panel </li></ul><ul><li>Convened in the wake of several recent, highly publicized violent incidents involving individuals with mental illnesses, officials in New York State (NYS) and New York City (NYC) convened a panel to examine these cases, consider opinions of experts and recommend actions to improve services and promote the safety of all New Yorkers </li></ul>
    3. 3. Summit Partners
    4. 4. PRA Tasks <ul><li>Development of the RFA, review of applications and selection of counties to attend the Summit. </li></ul><ul><li>Pre-conference preparation provided through phone conference calls with each county’s stakeholder teams </li></ul><ul><li>Law Enforcement/Mental Health Summit held on June 20, 2009 </li></ul><ul><li>Post summit technical assistance and follow-up calls with county stakeholder teams </li></ul>
    5. 5. Participating Counties <ul><li>The seven counties selected were: </li></ul><ul><li>Broome </li></ul><ul><li>Cattaraugus </li></ul><ul><li>Dutchess </li></ul><ul><li>Erie </li></ul><ul><li>Madison </li></ul><ul><li>Putnam </li></ul><ul><li>Rockland </li></ul>
    6. 6. County Teams <ul><li>Law enforcement </li></ul><ul><li>NAMI </li></ul><ul><li>Mental Health/Substance Abuse </li></ul><ul><li>Peers </li></ul><ul><li>District Attorney’s Office </li></ul><ul><li>Public Defender’s Office </li></ul><ul><li>Probation </li></ul><ul><li>Crisis Responders/ER Staff </li></ul><ul><li>Jail Administrators </li></ul>
    7. 7. The Problem <ul><li>New pressures on law </li></ul><ul><li>enforcement post </li></ul><ul><li>deinstitutionalization </li></ul><ul><li>NO </li></ul>
    8. 8. (1968) “Police Discretion in Emergency Apprehension of Mentally Ill Persons” <ul><li>“ Policemen confront perversion, disorientation, misery, irresoluteness, and incompetence much more often than any other social agent.” </li></ul><ul><li>“ Though policemen readily acknowledge that dealing with mentally ill persons is an integral part of their work, they hold that it is not a proper task for them.” </li></ul><ul><li>“ Officers complain that taking someone to the psychiatric service of the hospital is a tedious, cumbersome, and uncertain procedure.” </li></ul>
    9. 9. (1987) “Psychiatrists in Blue: Police Apprehension of Mental Disorder and Dangerousness” <ul><li>“ The presence of apparent mental disorder adds further complexity to the discretionary work of line officers, as they come to assume a quasi-psychiatric functions, rendering judgments about the level of pathology being manifested by their subjects, and about optimal strategies for exercising medicolegal control over such persons.” </li></ul>
    10. 10. And Now!
    11. 11. And Now!
    12. 12. What the Summit is NOT <ul><li>“ Police Summit” </li></ul><ul><li>CIT Training </li></ul>
    13. 13. What the Summit IS <ul><li>Good community policing </li></ul><ul><li>Good community mental health </li></ul><ul><li>New forms of partnership </li></ul>
    14. 14. Basic Principles <ul><li>Balance public safety and public health </li></ul><ul><li>Balance community and individual rights </li></ul><ul><li>Play to the strengths of each system </li></ul><ul><li>Minimize penetration into the Criminal Justice System </li></ul>
    15. 15. What Are We Trying to Get To? <ul><li>No one gets hurt </li></ul><ul><li>Persons with mental illness get </li></ul><ul><li>an effective response </li></ul><ul><li>Community more at peace </li></ul><ul><li>More effective expenditure of </li></ul><ul><li>taxpayers money </li></ul>
    16. 16. Who Are We Talking About? Repeated Cycles INCARCERATION ARREST Private Home Group Residence Shelter Street S.A. Residential Treatment Mental Health Inpatient COMMUNITY
    17. 17. “ Treatment-Resistant” Clients Or “ Client-Resistant” Services
    18. 18. 9 Patients -2700 ER visits 3 million dollars 8 of 9 substance abuse problems 7 of 9 mental health problems Austin American Statesman, 2009
    19. 19. Institutional Circuit Cost: July 05 -- June 07 System Days Per Diem Total Cost Shelter 160 *68 10,880 Jail 96 *129 12,384 Detox 8 **1,000 8,000 Prison 408 *79 32,232 Hospital Inpatient 15 *657 9,855 Parole 60 **7 420 Unaccounted 43 - - Total 730 $73,771 Annualized Cost $36,886
    20. 20. Prevalence of Current Substance Abuse Among Jail Detainees with Severe Mental Disorders Detainees with severe mental disorder plus either alcohol or drug abuse/dependence = 72% = 72% Adapted from: Abram, K.M. and Teplin, L.A. “Co-Occurring Disorders Among Mentally Ill Jail Detainees: Implications for Public Policy.” American Psychologist , 46(10):1036-1045, 1991 and Teplin, L.A. “Personal Communication.” Males Females Disorder Alcohol Abuse/ Dependence Drug Abuse/ Dependence Alcohol Abuse/ Dependence Drug Abuse/ Dependence Schizophrenia 59% 42% 56% 60% Major Depression 56% 26% 37% 57% Mania 33% 24% 39% 64% Any Severe Disorder 58% 33% 40% 60%
    21. 21. Trauma History Interview Data (n=978) Percent Experiencing Lifetime Percent Experiencing in Last 12 Months 1 Witness of Violence 65.4% 31.7%  Sexual Abuse 55.2% 31.7% Physical Abuse   90.2% 65.2%  Any Trauma 94.0% 64.7% Any Abuse 92.9% 61.1% 1 – For Those Respondents Experiencing Trauma in Lifetime
    22. 22. Increased Mortality From Medical Causes in Mental Illness <ul><li>Increased risk of death from medical causes in schizophrenia and 20% (10-15 yrs) shorter lifespan1 </li></ul><ul><li>Bipolar and unipolar affective disorders also associated with higher SMRs from medical causes 2 </li></ul><ul><ul><li>1.9 males/2.1 females in bipolar disorder </li></ul></ul><ul><ul><li>1.5 males/1.6 females in unipolar disorder </li></ul></ul><ul><li>Cardiovascular mortality in schizophrenia increased from 1976-1995, with greatest increase in SMRs in men from 1991-1995 3 </li></ul><ul><li>SMR = standardized mortality ratio (observed/expected deaths). </li></ul><ul><li>Harris et al. Br J Psychiatry . 1998;173:11 . Newman SC, Bland RC. Can J Psych. 1991;36:239-245. </li></ul><ul><li>2. Osby et al. Arch Gen Psychiatry . 2001;58:844-850. </li></ul><ul><li>3. Osby et al. BMJ . 2000;321:483-484. </li></ul>
    23. 23. What are the Causes of Morbidity and Mortality in People with Serious Mental Illness? <ul><li>While suicide and injury account for about 30-40% of excess mortality, about 60% of premature deaths in persons with schizophrenia are due to “natural causes” </li></ul><ul><ul><li>Cardiovascular disease </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Respiratory diseases </li></ul></ul><ul><ul><li>Infectious diseases </li></ul></ul>
    24. 24. % Clients by Presenting Medical Conditions California Fuse Study, 2008 # of Conditions Alameda Los Angeles S’mento Santa Cruz Tulare Total One Condition 13% 50% 32% 15% 46% 32% Two Conditions 34% 27% 34% 34% 29% 32% Three Conditions 34% 19% 31% 28% 19% 26% Four or Five Conditions 18% 3% 2% 22% 6% 10%
    25. 25. ED and Inpatient Visits Aggregated Across Programs (N = 598) California FUSE Study, 2008 Pre Post Difference Visits 4,799 3,380 1,419 30% decrease* ED Charges $8,531,971 $7,066,670 $1,465,301 17% decrease* Inpatient Admissions 959 822 137 14% decrease* Cumulative Inpatient Days 4,299 4,200 99 2% decrease Inpatient Admission Charges $35,799,433 $33,081,671 $2,717,762 8% decrease
    26. 27. Benefits of CIT <ul><li>What has CIT training accomplished ? </li></ul><ul><li>Memphis </li></ul><ul><ul><li>Decreased injuries 40% </li></ul></ul><ul><ul><li>Reduced TACT (like SWAT) 50% </li></ul></ul><ul><li>Albuquerque </li></ul><ul><ul><li>Fewer than 10% SMI arrested </li></ul></ul><ul><ul><li>Injuries reduced to !% calls </li></ul></ul><ul><ul><li>Decrease SWAT by 58% </li></ul></ul><ul><li>Miami Dade </li></ul><ul><ul><li>Reduction in wrongful death suits </li></ul></ul><ul><li>Las Vegas </li></ul><ul><ul><li>More appropriate use of force </li></ul></ul><ul><ul><li>Reduced injuries to citizens and police </li></ul></ul>
    27. 28. Police as Mental Health Agent <ul><li>CIT Call Profile </li></ul><ul><li>(Las Vegas Study) </li></ul><ul><li>N=655 </li></ul><ul><li>45% suicide threat/attempt </li></ul><ul><li>15% family disturbance </li></ul><ul><li>64% serious mental illness </li></ul><ul><li>04% result in arrest </li></ul>(Skeem, et. al. 2006)
    28. 29. Intensity of Force N=36
    29. 30. CIT Study Conclusions <ul><li>Police with CIT training use force more appropriately </li></ul><ul><li>Less injury to citizens </li></ul><ul><li>Less injury to officers </li></ul>
    30. 31. But…No Good Deed Goes Unpunished <ul><li>Not committable </li></ul><ul><li>Behavior problem not MI </li></ul><ul><li>Medical not psychiatric </li></ul><ul><li>Substance abuse not MI </li></ul><ul><li>Needs detox before MH admission </li></ul><ul><li>Needs medical clearance </li></ul><ul><li>No insurance coverage </li></ul><ul><li>Appropriate but no beds available </li></ul>
    31. 32. Phony Road Blocks <ul><li>Cross system information sharing </li></ul><ul><li>$ </li></ul>
    32. 33. What Does It Take? <ul><li>First responders handle situation well </li></ul><ul><ul><li>Dispatch </li></ul></ul><ul><ul><li>Officers </li></ul></ul><ul><li>Appropriate treatment options </li></ul><ul><li>available in a timely fashion </li></ul><ul><ul><li>Crisis </li></ul></ul><ul><ul><li>Post-crisis </li></ul></ul>
    33. 34. Pre-booking Jail Diversion COMMUNITY Intercept 1 Law enforcement / Emergency services Local Law Enforcement Crisis Stabilization Units
    34. 35. Specialized Crisis Response Sites: Basic Principles <ul><li>Identified, central drop-off for law enforcement </li></ul><ul><li>“ Police-friendly” policies and procedures </li></ul><ul><li>Streamlined intake </li></ul><ul><li>“ No refusal” policy </li></ul><ul><li>Legal foundations to support work </li></ul><ul><li>Innovative and extensive cross-training </li></ul><ul><li>Linkages to community services </li></ul><ul><ul><li>Even for those who do not meet criteria for inpatient commitment </li></ul></ul>Steadman, et al, 2001
    35. 36. Pre-booking Jail Diversion COMMUNITY Intercept 1 Law enforcement / Emergency services - Transition Local Law Enforcement Jail Releases Other Crisis Stabilization Units Service Linkage : ICM/ACT EBP’s Peer Bridging Medical f/u Trauma Specific Services Jail linkage Other Assistance: Medication Access Benefits Housing Information Sharing
    36. 37. Pre-booking Jail Diversion COMMUNITY Intercept 1 Law enforcement / Emergency services Local Law Enforcement Crisis Respone
    37. 38. CIT Adaptations <ul><li>Chicago/Hawaii: licensed psychologists </li></ul><ul><li>Colorado: ICM’s </li></ul><ul><li>Albany, NY: Mobile Crisis Response to ER </li></ul><ul><li>Use of peers in training and on calls and in ER’s/Crisis Services </li></ul><ul><li>Training Jail CO’s </li></ul>
    38. 39. <ul><li>June 25 AGENDA </li></ul><ul><li>  </li></ul><ul><li>9:30 Keynote: Setting the Stage </li></ul><ul><li>Henry J. Steadman, President, PRA </li></ul><ul><li>10:00 What Exactly Is “CIT”? </li></ul><ul><li>Lt. Jeffry Murphy, CIT Coordinator, Chicago Police Department </li></ul><ul><li>10:30 Break Out 1: Identifying Local Strengths and Gaps </li></ul><ul><ul><ul><ul><ul><li>Report Out 1 </li></ul></ul></ul></ul></ul><ul><li>12:00 Lunch: Movie: Legacy of the Harp </li></ul><ul><li>Documentary about consumers with justice histories and their participation in and graduation from a Forensic Peer Specialist Training Program </li></ul><ul><li>1:00 Consumer Experience and Responses to Crises </li></ul><ul><li>Isaac Brown, Training Coordinator, MHEP Inc. </li></ul><ul><li>Steve Miccio, Executive Director, PEOPLe Inc. </li></ul><ul><li>1:40 Crisis Stabilization: The Forgotten Component </li></ul><ul><li>Leon Evans, Executive Director, Center for Health Care Services, San Antonio, Texas </li></ul><ul><li>Break Out 2: Priority Responses   </li></ul><ul><li>3:15 Report Out 2 </li></ul><ul><li>3:45 Veterans Issues – An Emerging CJ/MH Response </li></ul><ul><li>George Basher, Health Systems Specialist, VA Healthcare Network Upstate New York </li></ul>
    39. 40. <ul><li>Agenda Day 2 </li></ul><ul><li>8:45 NYS Crisis Response Models: </li></ul><ul><li>Rensselaer County EDPRT </li></ul><ul><li>Albany CART Teams </li></ul><ul><li>Westchester County EDPRT </li></ul><ul><li>10:15 Break Out 3: Action Planning </li></ul><ul><li>11:00 Report Out 3 </li></ul><ul><li>11:30 Next Steps including Technical Assistance and Follow-up </li></ul><ul><li> </li></ul>Break Out 3: Action Planning 11:00 Report Out 3 11:30 Next Steps including Technical Assistance and Follow-up - Julie Pasquini, Director Office of Public Safety, DCJS - Richard Miraglia, Associate Commissioner, Forensic Services - Henry J. Steadman, President, PRA
    40. 41. Street Encounters with Homeless 2006 – 271 2007 – 271 2008 - 150
    41. 42. Homeless Subjects as “Suspects” 2006 – 499 2007 – 401 2008 – 252
    42. 43. Calls for Service Involving Emotionally Disturbed Persons 2006 – 299 calls 2007 – 279 calls 2008 – 281 calls Westchester Co. NY
    43. 44. Resisting Arrest Charge for Emotionally Disturbed Persons: 2006 – 6 arrest 2007 – 1 arrest 2008 – 1 arrest Westchester Co. NY
    44. 45. Mental Health Outreach Contacts and Referrals 2006 – 60 2007 – 126 2008 - 225 Westchester Co., NY
    45. 46. Sample Action Plan Priority Area 1: For Law Enforcement officers to be prepared to de-escalate emotionally disturbed individuals and determine most appropriate course of action for individual to safely get needs met . Objective Action Step Who When 1 Training for law enforcement, including jail, road patrol officers and dispatch (alternative referrals). <ul><li>Christy and Mary attend the recruit and in-service train the trainer and begin training officers by February </li></ul><ul><li>Have officers trained in CIT in </li></ul><ul><li>Training for dispatch </li></ul><ul><li>Involve ER Counselors in training with law enforcement. </li></ul>Christa H. Sheriff’s Office and Mary O., DCS Jerri R., OGH Fall 2009
    46. 47. Sample Action Plan Priority Area 2: Develop a more coordinated response between law enforcement, mental health, and chemical dependency. Objective Action Step Who When 1 Increase cross-system communication between mental health, law enforcement, and chemical dependency <ul><li>Form a Forensic Task Force for partners to meet on a regular basis to plan for ED individual that recycle through our systems </li></ul><ul><li>Develop an electronic system for ongoing communication between agency staff when significant events occur in between meetings </li></ul>Dawn M., Christa H. Sheriff’s Office July 2009 September 2009
    47. 48. Common Action Steps Broome Cat’gus Dutchess Erie Madison Putnam Rockl’d Task Force X X X X X X Crisis/911 Integration X X 911 database X Data analysis X X LE/ER Imp. X X X X Increase ER Response X X X X Info sharing X X X X X Xsystem train X X X X X LE training X X X X X Consumers X X X X High users X X Veterans X X Jails X
    48. 49. PRA Recommendations <ul><li>Develop state-specific information sharing guide to guide counties on improving MH and CJ information sharing </li></ul><ul><li>Develop a training matrix specifying type of training offered, target participants, sponsoring agency. Distinguish Police CIT Training from generic Police Mental Health Training. </li></ul>
    49. 50. <ul><li>Improved communication </li></ul><ul><li>Better 911 and Helpline integration </li></ul><ul><li>Improved integration of Village and State Police </li></ul><ul><li>One of the best conferences ever </li></ul><ul><li>Breakouts well planned and efficient </li></ul><ul><li>Communication piece was key. We would leave person with ER staff without sufficient information and in some case 13 hours later the person would be seen and crisis would appear resolved. The ER staff wasn’t aware that the SWAT team was at the person’s house the night before. </li></ul>Summit Evaluation
    50. 51. Ten Essential Elements <ul><li>Collaborative Planning and Implementation </li></ul><ul><li>Program Design </li></ul><ul><li>Specialized Training </li></ul><ul><li>Call-Taker and Dispatcher Protocols </li></ul><ul><li>Stabilization, Observation, and Disposition </li></ul><ul><li>Transportation and Custodial Transfer </li></ul><ul><li>Information Exchange and Confidentiality </li></ul><ul><li>Treatment, Supports, and Services </li></ul><ul><li>Organizational Support </li></ul><ul><li>Program Evaluation and Sustainability </li></ul>
    51. 52. CIT Officer Intervenes <ul><li>I do not even know how to began to &quot;Thank You&quot; for your class/session &quot;Improving Police Encounters with Returning Veterans&quot; at the CIT Conference in Atlanta.  I have been home just over a week and was already confronted by a Marine OIF with PTSD. !  </li></ul><ul><li>Your video helped me interpret reckless driving and anger as possible PTSD symptoms ...It saved us from having to go hands on because I was able to reach out with the verbal skills I learned in your class and this situation did not escalate.  </li></ul><ul><li>In fact, because of that same video and that scenario where the VET had the handgun, I was able to ask the right question &quot;do you have any weapons?&quot;.  He looked me straight in the eye and began to weep and asked me to take the weapon for safekeeping until he felt he was ready to have it back.  What a heart wrenching sight to have this honorable Marine hand over his weapon to me.    </li></ul><ul><li>I gave him and his wife the Veteran Suicide phone number that I put in my contacts during your class/session.    On Monday, I will contact the VA in my area and have them follow-up.  THANK YOU with all my heart. </li></ul>
    52. 53. Veteran’s Justice Outreach Coordinator <ul><li>Educating Community organizations </li></ul><ul><li>Facilitating MH evaluations of veterans charged with nonviolent crimes </li></ul><ul><li>Work to provide courts with a plan of community based alternatives to incarceration </li></ul><ul><li>Collaborate with HCRV Specialists in care for veterans recently discharged from prisons/jails </li></ul>
    53. 54. Stress Factors <ul><li>Multiple deployments/stop loss </li></ul><ul><li>Unemployment/Underemployment/Financial Strife </li></ul><ul><li>(had “important” job in the military and was “respected.” At home, work may not be as significant – this can be frustrating) </li></ul><ul><li>Relationship/Marital Conflict </li></ul>
    54. 55. Behaviors We May See <ul><li>Risky behaviors to get the adrenaline rush </li></ul><ul><li>Speeding/Erratic driving/road rage (drive down middle of road/avoidance of objects on side of road, swerving under bridges, driving over curbs.) </li></ul><ul><li>In traffic jam, may panic, feel “ambushed” if stuck in traffic. </li></ul><ul><li>Alcohol abuse/DV/child abuse </li></ul><ul><li>Addiction (various – work, alcohol, drugs, sex, food, adrenaline) </li></ul>
    55. 56. Charges <ul><li>679 charges filed against 458 Veterans </li></ul><ul><li>32% arrested 2 or more times </li></ul><ul><li>27% felony charges </li></ul><ul><li>19% DWI </li></ul><ul><li>10% Assault </li></ul><ul><li>22% of felony charges included a weapon </li></ul>Travis County Jail Survey, 2008
    56. 57. Driving and Charges and Risk <ul><li>43% Motor Vehicle related charges in top ten misdemeanors </li></ul><ul><li>12 % Motor Vehicle related charges in top ten felonies </li></ul><ul><li>34% overall rate </li></ul>Travis County Jail Survey, 2008

    ×