MH CIT International San Antonio 2010

Crisis Intervention Team Training for Corrections:New Dimensions & DirectionsCIT International ConferenceSan Antonio, TexasJune, 2010

United States Correctional System
The United States is the world leader in incarceration, with a higher proportion of its population behind bars than any other country.

World Incarceration Rate per 100,000

The Nation’s Federal or State Prisons or in Local Jails Held 2,424,279 Inmates on June 30, 2008 (BJS).

In 2007
One in every 31 U.S. adults is in the corrections system, which includes jail, prison, probation and supervision, more than double the rate of a quarter century ago.

Who is under the umbrella of CJ?

Why do these numbers matter to us?What do they have to do with understanding Crisis Intervention Team skills?

THE MENTALLY ILL INCARCERATED
The size and scope of the mentally ill incarcerated was clarified in a recent report by Henry Steadman, Ph.D., Fred C. Osher, M.D., and colleagues :
From June 2006-2007 more than 2 million jail admissions of the total of 13 million represented individuals with a serious mental illness.

A 2009 American Psychiatric Association study
“found that 14.5% of male and 31.0% of female inmates recently admitted to jail have a serious mental illness, [confirming] what jail administrators already know – a substantial proportion of inmates entering jails have a serious mental illness and women have rates two times those of men.”

Bureau of Justice Statistics Sept 2006
MENTAL ILLNESS
Jail detainees had the highest rate of symptoms of a mental health disorder (60%)compared to federal or state prisoners
Approximately 24% of jail inmates reported at least one symptom of a psychotic disorder
SUBSTANCE ABUSE
Among inmates who had a mental health problem, local jail inmates had the highest rate of dependence or abuse of alcohol or drugs (76%)
Among inmates without a mental health problem 53% in local jails were dependent on or abused alcohol or drugs.

Where are the Largest Concentrations of those with Mental Illness?
The Los Angeles County Jail, the Cook County Jail (Chicago) and Riker’s Island Jail (New York City) each hold more people with mental illness on any given day than any psychiatric facility in the United States.(E. Fuller Torrey, 1999)

In Illinois, the Largest Concentration of Detainees with Mental Illness is CCDOC
Why we brought the idea to Sheriff Tom Dart and the Cook County Department of Corrections Training Institute to do Crisis Intervention Training in a jail setting

The New Asylums – Jails Have Become the Mental Hospitals of Last Resort Belcher, 1988

The nation’s local jails are becoming the dumping ground for the mentally ill.
54% of local jail inmates report symptoms of mania
30% report major depression
24 % report psychotic disorders

Cook County Jail and Criminal Court of Chicago, 54 W. Hubbard Street – (1874-1892)

Why are the numbers important to us?

Cook County Department of Corrections – The Cook County Jail
Largest single site detention facility in the U.S. (over 100 acres) located in the third largest metropolitan area in the country.
Average daily population of ~10,000
Average yearly admissions of 100,000
Average daily intake 300-325 in the “bullpen” for distribution to the 11 Divisions

Bureau of Justice Statistics 1999

Dr. Linda Teplin’s Research at CCDOC
Found 6.1% of male detainees met diagnostic criteria for a major mental disorder on intake
Found 15% of females met diagnostic criteria for a major mental disorder
The disorder included Schizophrenia, Bipolar Disorder, and Major depression
More than 50% of all jail detainees have other MI diagnoses including Dysthymia, Anxiety Disorders, and Antisocial Personality Disorders

Treatment Alternatives for a Safer Community, TASC
Pursuant to its statutorily defined role, TASC is the linkage case management agency for the Cook County Mental Health Court.

The Problem
The Big Picture……..

Jails Become Mental Institutions
Daily, ~ 200,000 people behind bars, or more than 1 in 10 inmates, suffer from:
schizophrenia
bipolar disorder
major depression
70% of MI population are nonviolent offenders
Nearly 90% of inmates with MI have aco-occurring substance abuse problem
(Abram KM, Teplin LA, 1991)

Jails Have Become the Mental Hospitals and Social Service Systems of Last Resort
Cermak’s Mental Health Services is the largest provider of psychiatric services in the State of Illinois.

The Cook County Jail is now, in effect, the largest mental hospital in Illinois. There are more people with mental illness in our state prisons than in all our public and private psychiatric institutions combined.
60’s – deinstitutionalization
70’s – increase in homeless populations
80’s – “War Against Drugs”

Basic Critical CJS Problems
The potential public safety risk posed by the mentally ill offenders
The difficulties associated with housing the mentally ill in local jails
The inadequacy of the criminal justice process in dealing with the mentally ill defendants in all matters

Initiation of the Cook County Mental Health Court

System-wide Collaboration of State and County(2001-The Process Begins)
Cook County Criminal Justice System
Leadership
Chief Judge Timothy Evans
Presiding Judge Paul Biebel
Lead Judges – Judge Jay Crane and Judge Thomas Gainer
Adult Mental Health Probation Unit
Cook County State’s Attorney Office
Cook County Public Defender’s Office

Mental and Health Issues Affecting Clients
Schizophrenia – 8
Schizoaffective Disorder – 10
Bipolar Disorder – 24
Major Depression – 2
Psychotic Disorder NOS – 3
Substance Abuse Disorders – 49
Mood Disorder NOS - 2
Post-traumatic Stress Syndrome – 1
HIV+ – 2
Hepatitis C – 2
Herpes Virus – 1
Cancer - 2

What we learned about our participants:
The program participants have:
Much more extensive criminal backgrounds(compared to a 9 year review of Cook County drug court participants)
Much more extensive psychiatric histories (including major Axis II Personality Disorders)
Most identified individuals have long-standing mental health and addiction/dependency issues

Current Charges
Possession of a controlled substance (PCS) – 20
Retail theft – 15
Theft – 3
Burglary - 8
Residential Burglary - 1
Manufacture/Delivery – 1
Forgery – 1
Prostitution - 1

Types of Facilities Currently in Use
Residential treatment facility – 5
Psychosocial rehabilitation (PSR) day program – 15
Nursing home – 6
Inpatient psychiatric unit – 1
Receiving CST Services - 11
Employed – 3
Recovery/halfway house/ACT house – 18
Individual housing - 16
Enrolled in educational program – 2
Outpatient Substance Abuse Services – 11
Suboxone Therapy - 5

Program Impact
Decreased criminal activity
Decreased hospitalizations
Decreased incarceration
Decreased county cost expenditures
Improved quality of life

Crisis Intervention Team Training
From the Street to the Jail

Initially
Class representation included:
Cook County Sheriffs Police
Department of Correction Officers
Juvenile “Boot Camp”
Court Services
Woman’s Justice

We found
Centralized: Training all Departments and Divisions together
Vs
Decentralized: Training similar Divisions together

Emergency Response Team
ERT is a specialized team of heavily armored, trained individuals responding in force to gain compliance from a resisting detainee where physical takedown and extraction is used to gain compliance and control.

Crisis Intervention Team
CIT uses de-escalation techniques by a single trained staff individual with support by other officers to insure safety and gain the trust and compliance of the detainee in crisis without the use of force

Crisis Intervention Team
CIT is first, foremost and always a safetyprogram for correctional staff
Tacticalresponse is alwaysan option
CIT training offers an option in a situation
CIT training arms law enforcement and corrections with additional tools for 21st century situations

Components
Continuum, Continuity
Corrections
Collaboration
Curriculum
Courts
Challenges

Continuum-It Doesn’t Stop at the Jail Door
Mental Illness
Substance abuse, Co-occurring Disorders, Addiction
Intellectual Disability
Elderly & Medical Issues
Prison Rape Elimination Act-Sexual Harassment, Intimidation, Abuse, Violence & Rape
Suicide-Recognition & Prevention

Corrections-Transitioning
Law Enforcement-Serve & Protect the public-20% of emergency 911 calls for service in Chicago include a mental health component
Corrections-Safety & Security of Detainees –among the 11 divisions, detainees with MI range from 1.5% to 85%

What Correction Officers Say
Interviews were conducted anonymously in the past with officers and revealed that mental health training did not adequately prepare them for real-life situations they face daily on the job
Improving training in skills and mental health issues enable staff to better identify signs of stress in detainees & improve effectiveness in prevention of violence and self-harm

Contribution from Correction Officers
Prevention of violence and self harm requires observation, intervention and communication skills
When staff detect detainee agitated behavior and respond calmly, nonviolently and communicate in a positive manner, there is a high likelihood of a safe outcome

Collaboration
Correction Administration and Training Division
Interaction of line Correction Officers, Supervisors and Mental Health Services
Family Panels
Community Services

Curriculum
Eliminate Juvenile Block
From involuntary petition to General Orders & protection of constitutional rights
Role Playing

Courts
Awareness of Corrections of specialty therapeutic courts:
Domestic Violence
Drug
Mental Health
Veterans
Prostitution

ConsiderAll Truth Passes through three stages:
First, it is ridiculed
Second, it is violently opposed
Thirdly, it is accepted as being self-evident
Arthur Schopenhauer

Challenges
Current correctional barriers-lack of General Orders, creation of CIT response as option to ERT when appropriate
Inertia-institutional change
Stigma & stereotypical beliefs-”mentals”
Effective treatment & preparation for release-transitioning 93.7% of the prison population who will eventually be released back into the community

New Directions
Advanced Veterans CIT training

New Directions
Advanced Juvenile Training

New Directions
Elders at Risk
Faith Based Community-clergy
Probation and Parole Officers
College and University Security Agencies
Veterans Administration Hospital Law Enforcement
Expand partnering of peer to peer groups with Law Enforcement-Veterans, Disability advocacy organizations

Acknowledgements
Cook County Sheriffs Training Institute, Dr. Carl Alaimo
Urban Institute
Cook County Mental Health Court, Mr. Albert J. Pizza

Questions

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