Psychology Mental Health in the Public Safety Domain. Dr. John Heil CIT
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1 Psychology Mental Health in the Public Safety Domain Dr. John Heil CIT
2 Goals Usable Makes sense Guides action Professional Technical language Depth of understanding
3 Public Safety Initiatives CIT- Memphis & Albuquerque CALEA
4 Memphis PD Triggering Event: An avoidable fatal shooting % of Memphis officers are CIT members 1% of calls handled by CIT lead to arrest vs. 20% national average
5 CALEA Standards- Mental Illness Guidelines for Recognition Guidelines for Intervention Procedures for accessing Resources Collaboration with Mental Health Professionals
6 A Brief History of Mental Health Treatment Asylum- seminal idea- Safety Warehousing s Community Mental Health Act of 1963 Deinstitutionalization- Reagan Era
7 Community Mental Health Act of 1963 The emergence of psychopharmacology Cost Least restrictive alternative Community Mental Health Centers as Safety Net Underfunding & Underservice
8 Deinstitutionalizat ion Problem On the Street Inability to care for self Poor support system Nature & Nurture
9 In The Jails Mental Health- Crime Overlap Impulsivity, Poor Judgment, Substance Use Mental Health Diagnosis 2/3 Boys- 3/4 Girls Depression 17% Boys- 26% Girls
10 Solution US Congress Mentally ill Offender Treatment & Crime Reduction Act of 2004 Train police and mental health professionals Pre-trial diversion Treatment for the incarcerated
11 From The Virginia Pilot Special Report: Jailing the Mentally Ill- Nov 2004 Bad for the citizens; Bad for the system; Bad for everybody Hampton Roads Jail- 23% on Psych Meds Va. Beach Jail- >10% on Psych Meds
12
13 Crisis - bed shortage- Dr. Heinhard, VA MH Commissioner Less Private beds- Insurance reimbursement Less State funded beds- Budget Responsibility shifted to communities
14 Bad for System Hampton Roads Jail- Cost: $40,000 Meds Virginia Beach- Intensive care needs (Bathing, Dressing, Eating)
15 Bad for Citizens Jail environment often worsens symptoms Isolation- as best option Waiting Place Wait for trial date Wait for mental evaluation
16 Key Concepts Police Officer as First Responder Use of Force & Use of Rapport Public Safety Triage=Police Triage + Mental Health Triage
17 First Responder Fire fighter and medical trauma Police and psychological crises
18 Intervention in the Public Domain The Street vs. the Office- Fundamental difference
19 Office: Defined & Filtered Desire/Intent/Motivation Logistics-cognitive ability, resources (car), support
20 Street: Undetermined- High danger potential
21 Use of Force & Use of Rapport Communication Styles- Compared & Contrasted Elements= Words, Voice, Body
22 Use of Force- Create a Shield- Barrier Command presence Authoritative Decisive Immediate Action-Police driven
23 Use of Force Speech: Interrogative & Imperative; High volume if needed Body language (Kinesics): Bladed, firm, Unyielding Personal Space (Proxemics( Proxemics): Distance as tactical choice
24 Use of Rapport- Remove Barriers Therapeutic Presence Supportive Accessible Patient Action-Patient driven
25 Use of Rapport Speech: Conversational: Soft Body Language: Relaxed, open Personal Space: Close
26 Common Elements Tactics Assess Triage De-fuse/De-escalate Goal Restore order (Environment- Person)
27 Public Safety Triage Public safety, Public order, Public good Citizens at large Self Perpetrator-Victim
28 Safety as Prevailing Idea Mentally ill are seldom dangerous to others Danger is most likely to self
29 Public Safety Triage Police Triage Then Mental Health Triage
30 Police Triage- 1 st Step Legal- Illegal- Dangerous- Safe Tipping Point Danger of suspect to self> Danger of others Mental Health> Legality
31 Challenge Know the difference Shift to Use of Rapport Diminished danger to public or self Back-Up present Shift back to Use of Force when needed
32 Mental Health Triage- 2 nd Step Normal- Abnormal
33 Mental Status Exam- AOCC Alert, Oriented, Conversant, Cooperative
34 AOCC Alert- conscious (or Not) Awake Responsive to environment Prototype: Substance abuse/intoxication/general Medical
35 AOCC Oriented- Reality (or Not) Aware of person, place, time Prototype 1: Schizophrenic/Bipolar-manic Prototype 2: Dementia/Alzheimer's Alcohol or Drugs- Extreme PTSD Sx- not enduring
36 Orientation Probe Who are you? What are you doing?
37 AOCC Conversant (or Not) Able to engage in back-and- forth coherent conversation Prototype: Panic Attack/Crisis (Recent trauma)
38 Conversation Probe Is there a problem? Is there something I can do to help?
39 AOCC Cooperative (or Not) Follows through on instructions, or offers a rationale for not doing so Prototype: Depressive suicide
40 Behavioral Algorithm- Actions + (Thoughts, Feelings) Means of assessment & reporting As either normal or unusual Reporting on behavior without making diagnosis
41 Actions- Deeds (& Words) Usual mode of assessment in Public Safety He/she said/did.
42 Thoughts- Disorder Confusion- Mild thought disorder (Inconsistent, repetitive, distractible) Chaotic- Serious thought disorder (Not reality based- Hallucinations, delusions)
43 Feelings- Distress Threat -- Anxiety prototype (Fearful, worrisome) Loss -- Depression prototype (Sad, Hopeless, Helpless)
44 Do Take your time Make eye contact Don t Be in a hurry to clear the call Raise voice Relaxed posture Reassure
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