MH CIT International San Antonio 2010


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Crisis Intervention Team Training for Corrections:New Dimensions & Directions

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MH CIT International San Antonio 2010

  1. 1. Crisis Intervention Team Training for Corrections:New Dimensions & DirectionsCIT International ConferenceSan Antonio, TexasJune, 2010<br />
  2. 2. United States Correctional System<br />The United States is the world leader in incarceration, with a higher proportion of its population behind bars than any other country.<br />
  3. 3. World Incarceration Rate per 100,000<br />
  4. 4. The Nation’s Federal or State Prisons or in Local Jails Held 2,424,279 Inmates on June 30, 2008 (BJS).<br />
  5. 5. In 2007<br /><ul><li>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.</li></li></ul><li>Who is under the umbrella of CJ?<br />
  6. 6. Why do these numbers matter to us?What do they have to do with understanding Crisis Intervention Team skills?<br />
  7. 7. THE MENTALLY ILL INCARCERATED<br /><ul><li>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 :
  8. 8. From June 2006-2007 more than 2 million jail admissions of the total of 13 million represented individuals with a serious mental illness.</li></li></ul><li>A 2009 American Psychiatric Association study<br /><ul><li> “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.”</li></li></ul><li>Bureau of Justice Statistics Sept 2006<br /> MENTAL ILLNESS<br /> Jail detainees had the highest rate of symptoms of a mental health disorder (60%)compared to federal or state prisoners<br /> Approximately 24% of jail inmates reported at least one symptom of a psychotic disorder<br /> SUBSTANCE ABUSE<br /> Among inmates who had a mental health problem, local jail inmates had the highest rate of dependence or abuse of alcohol or drugs (76%)<br /> Among inmates without a mental health problem 53% in local jails were dependent on or abused alcohol or drugs.<br />
  9. 9. Where are the Largest Concentrations of those with Mental Illness?<br />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)<br />
  10. 10. In Illinois, the Largest Concentration of Detainees with Mental Illness is CCDOC<br />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<br />
  11. 11. The New Asylums – Jails Have Become the Mental Hospitals of Last Resort Belcher, 1988<br />
  12. 12. The nation’s local jails are becoming the dumping ground for the mentally ill.<br /><ul><li>54% of local jail inmates report symptoms of mania
  13. 13. 30% report major depression
  14. 14. 24 % report psychotic disorders</li></li></ul><li>Cook County Jail and Criminal Court of Chicago, 54 W. Hubbard Street – (1874-1892)<br />
  15. 15. Why are the numbers important to us?<br />
  16. 16.
  17. 17. Cook County Department of Corrections – The Cook County Jail<br />Largest single site detention facility in the U.S. (over 100 acres) located in the third largest metropolitan area in the country.<br />Average daily population of ~10,000<br />Average yearly admissions of 100,000<br />Average daily intake 300-325 in the “bullpen” for distribution to the 11 Divisions<br />
  18. 18. Bureau of Justice Statistics 1999<br />
  19. 19. Dr. Linda Teplin’s Research at CCDOC<br />Found 6.1% of male detainees met diagnostic criteria for a major mental disorder on intake<br />Found 15% of females met diagnostic criteria for a major mental disorder<br />The disorder included Schizophrenia, Bipolar Disorder, and Major depression<br />More than 50% of all jail detainees have other MI diagnoses including Dysthymia, Anxiety Disorders, and Antisocial Personality Disorders<br />
  20. 20. Treatment Alternatives for a Safer Community, TASC<br />Pursuant to its statutorily defined role, TASC is the linkage case management agency for the Cook County Mental Health Court. <br />
  21. 21. The Problem<br />The Big Picture……..<br />
  22. 22. Jails Become Mental Institutions<br />Daily, ~ 200,000 people behind bars, or more than 1 in 10 inmates, suffer from:<br /> schizophrenia<br /> bipolar disorder<br /> major depression <br />70% of MI population are nonviolent offenders<br />Nearly 90% of inmates with MI have aco-occurring substance abuse problem <br />(Abram KM, Teplin LA, 1991)<br />
  23. 23. Jails Have Become the Mental Hospitals and Social Service Systems of Last Resort<br />Cermak’s Mental Health Services is the largest provider of psychiatric services in the State of Illinois.<br />
  24. 24. 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.<br />60’s – deinstitutionalization<br />70’s – increase in homeless populations<br />80’s – “War Against Drugs”<br />
  25. 25. Basic Critical CJS Problems<br />The potential public safety risk posed by the mentally ill offenders<br />The difficulties associated with housing the mentally ill in local jails<br />The inadequacy of the criminal justice process in dealing with the mentally ill defendants in all matters<br />
  26. 26. Initiation of the Cook County Mental Health Court<br />
  27. 27. System-wide Collaboration of State and County(2001-The Process Begins)<br />Cook County Criminal Justice System<br />Leadership<br />Chief Judge Timothy Evans<br />Presiding Judge Paul Biebel<br />Lead Judges – Judge Jay Crane and Judge Thomas Gainer<br />Adult Mental Health Probation Unit<br />Cook County State’s Attorney Office<br />Cook County Public Defender’s Office<br />
  28. 28. Mental and Health Issues Affecting Clients<br />Schizophrenia – 8<br />Schizoaffective Disorder – 10<br />Bipolar Disorder – 24<br />Major Depression – 2<br />Psychotic Disorder NOS – 3<br />Substance Abuse Disorders – 49<br />Mood Disorder NOS - 2<br />Post-traumatic Stress Syndrome – 1<br />HIV+ – 2<br />Hepatitis C – 2<br />Herpes Virus – 1<br />Cancer - 2<br />
  29. 29. What we learned about our participants:<br />The program participants have:<br />Much more extensive criminal backgrounds(compared to a 9 year review of Cook County drug court participants)<br />Much more extensive psychiatric histories (including major Axis II Personality Disorders)<br />Most identified individuals have long-standing mental health and addiction/dependency issues<br />
  30. 30. Current Charges<br />Possession of a controlled substance (PCS) – 20<br />Retail theft – 15<br />Theft – 3<br />Burglary - 8<br />Residential Burglary - 1<br />Manufacture/Delivery – 1<br />Forgery – 1<br />Prostitution - 1<br />
  31. 31. Types of Facilities Currently in Use<br />Residential treatment facility – 5<br />Psychosocial rehabilitation (PSR) day program – 15<br />Nursing home – 6<br />Inpatient psychiatric unit – 1<br />Receiving CST Services - 11<br />Employed – 3<br />Recovery/halfway house/ACT house – 18<br />Individual housing - 16<br />Enrolled in educational program – 2<br />Outpatient Substance Abuse Services – 11<br />Suboxone Therapy - 5<br />
  32. 32. Program Impact<br />Decreased criminal activity<br />Decreased hospitalizations<br />Decreased incarceration <br />Decreased county cost expenditures<br />Improved quality of life<br />
  33. 33. Crisis Intervention Team Training<br />From the Street to the Jail<br />
  34. 34. Initially<br />Class representation included:<br /><ul><li>Cook County Sheriffs Police
  35. 35. Department of Correction Officers
  36. 36. Juvenile “Boot Camp”
  37. 37. Court Services
  38. 38. Woman’s Justice</li></li></ul><li>We found<br />Centralized: Training all Departments and Divisions together<br />Vs<br />Decentralized: Training similar Divisions together<br />
  39. 39. Emergency Response Team<br />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.<br />
  40. 40. Crisis Intervention Team<br />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 <br />
  41. 41. Crisis Intervention Team<br />CIT is first, foremost and always a safetyprogram for correctional staff<br />Tacticalresponse is alwaysan option<br />CIT training offers an option in a situation<br />CIT training arms law enforcement and corrections with additional tools for 21st century situations<br />
  42. 42. Components<br />Continuum, Continuity<br />Corrections<br />Collaboration<br />Curriculum<br />Courts<br />Challenges<br />
  43. 43. Continuum-It Doesn’t Stop at the Jail Door<br />Mental Illness<br />Substance abuse, Co-occurring Disorders, Addiction<br />Intellectual Disability<br />Elderly & Medical Issues<br />Prison Rape Elimination Act-Sexual Harassment, Intimidation, Abuse, Violence & Rape<br />Suicide-Recognition & Prevention<br />
  44. 44. Corrections-Transitioning<br />Law Enforcement-Serve & Protect the public-20% of emergency 911 calls for service in Chicago include a mental health component<br />Corrections-Safety & Security of Detainees –among the 11 divisions, detainees with MI range from 1.5% to 85%<br />
  45. 45. What Correction Officers Say<br /><ul><li>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</li></ul>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 <br />
  46. 46. Contribution from Correction Officers<br /><ul><li>Prevention of violence and self harm requires observation, intervention and communication skills
  47. 47. 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</li></li></ul><li>Collaboration<br />Correction Administration and Training Division<br />Interaction of line Correction Officers, Supervisors and Mental Health Services<br />Family Panels<br />Community Services<br />
  48. 48. Curriculum<br />Eliminate Juvenile Block<br />From involuntary petition to General Orders & protection of constitutional rights<br />Role Playing<br />
  49. 49. Courts<br />Awareness of Corrections of specialty therapeutic courts:<br />Domestic Violence<br />Drug <br />Mental Health<br />Veterans<br />Prostitution<br />
  50. 50. ConsiderAll Truth Passes through three stages:<br /><ul><li>First, it is ridiculed</li></ul>Second, it is violently opposed<br />Thirdly, it is accepted as being self-evident <br /> Arthur Schopenhauer<br />
  51. 51. Challenges<br />Current correctional barriers-lack of General Orders, creation of CIT response as option to ERT when appropriate<br />Inertia-institutional change<br />Stigma & stereotypical beliefs-”mentals”<br />Effective treatment & preparation for release-transitioning 93.7% of the prison population who will eventually be released back into the community<br />
  52. 52. New Directions<br />Advanced Veterans CIT training<br />
  53. 53. New Directions<br />Advanced Juvenile Training<br />
  54. 54. New Directions<br />Elders at Risk<br />Faith Based Community-clergy<br />Probation and Parole Officers<br />College and University Security Agencies<br />Veterans Administration Hospital Law Enforcement<br />Expand partnering of peer to peer groups with Law Enforcement-Veterans, Disability advocacy organizations<br />
  55. 55. Acknowledgements<br />Cook County Sheriffs Training Institute, Dr. Carl Alaimo<br />Urban Institute<br />Cook County Mental Health Court, Mr. Albert J. Pizza<br />
  56. 56. Questions<br />