Crisis Intervention

Front 1

What percent of adults that use health services each year?

Back 1

22%

Front 2

What percent of adults suffer from some mental illness within their lifetime?

Back 2

32%

Front 3

People with psychiatric disabilities are ___ times more likely to die in police encounters

Back 3

4 times more likely

Front 4

CIT Paradox

Back 4

You will have more control of the mentally ill person with a less authoritative approach

Front 5

Professional Definition: Mental Illness

Back 5

Mental illness is diagnosed based on behaviors and thinking as evaluated by a psychiatrist, psychologist, licensed professional counselor, licensed social worker, or other qualified professionals using a tool known as the Diagnostic and Statistical Manual of Mental Disorders

Front 6

General Definition: Mental Illness

Back 6

Illness, disease, or condition that either substantially impacts a person’s thought, perception of reality, emotional process, or judgment, or grossly impairs aperson’s behavior, as manifested by recent disturbance behavior

Front 7

Define: Insanity

Back 7

• Insanity is considered “a diminished capacity and inability to tell right from wrong.”
  
• It is generally used by the court with regard to an individual’s competency to stand trial.
  

Front 8

Abnormal vs. Normal Behavior

Back 8

A sharp dividing line between “normal” and“abnormal” behavior does not exist. Adjustment seems to follow what is called a“normal distribution,” with most people clustered around the center and therest spreading out toward the extremes

Front 9

Criteria for an involuntary emergency mental health evaluation

Back 9

• A peace officer, without warrant , may take a person into custody if the officer believes that the person is mentally ill and
• because of that mental illness, there is a substantial risk of serious harm to the person or others unless the person is immediately restrained; and
• believes there is not sufficient time to obtain a warrant

Front 10

4 Categories of Mental Illness

Back 10

1. Personality Disorders
2. Mood Disorders
3. Psychosis
4. Developmental Disorders

Front 11

3 Most common Personality Disorders

Back 11

1. Paranoid
2. Antisocial (mainly men)
3. Borderline (mainly females)

Front 12

Causes of Mood Disorders

Back 12

Researchers believethat a complex imbalance in the brain’s chemical activity plays a prominentrole in mental illness selectivity in the individual. Environmental factors canalso be a trigger or buffer against the onset

Front 13

2 Most common Mood Disorders

Back 13

1. Depression
2. Bipolar

Front 14

Bipolar Disporder

Back 14

involves mania (intense excitement) and depression

Front 15

Symptoms of mania

Back 15

elated, happy, irritable, angry, or unpleasant mood. excess energy

Front 16

Define: Psychosis

Back 16

Distortion of reality with possibly delusions and hallucinations. To the person, the hallucinations and voices are real.

Front 17

Define: Delusion

Back 17

False beliefs not based on factual information. The person may overreact to the situations or may appear to have what is called a “flat affect,” where he shows no emotion or does not seem to care about what is going on around him

Front 18

Define: Hallucinations

Back 18

Distortions in the senses, causing the individual to experience hearing or seeing something that is not there

Front 19

Symptoms of a Psychotic Episode

-Psychosis

Back 19

• inappropriate dress
• lethargic or sluggish
• impulsive or repetitive body movements
• respond to hallucinations
• causing injury to self
• strange decorations
• pictures turned over
• waste matter/trash on floors and walls

Front 20

Excited Delirium Syndrome (ExDS) signs

Back 20

• profuse sweating
• violent behavior
• bizarre behavior
• disoriented
• hallucinations
• delusional
• superhuman strength
• extreme agitation
• intense paranoia

Front 21

Define: Anhedonia

Back 21

lacking pleasure or interest in activities that were once enjoyable

Front 22

Schizophrenia Statistics

Back 22

• 2.2 million in the US
• top 10 disabilities in the world
• typically emerges in teenagers & young people
• higher risk of suicide, about 10%

Front 23

Causes of Schizophrenia

Back 23

no known causes

Front 24

Define: Clanging

Back 24

rhyming random string of words by a schitzophrenic

Front 25

Define: Neologism

Back 25

A newly created word whose meaning is unknown to others

Front 26

Alzheimer's Disease

Back 26

• Most common organic disorder of older people
• Form of Dementia and NOT considered mental illness
• Terminal Illness

Front 27

Symtoms Alzheimer's

Back 27

• Get lost easily
• memory decreases over time
• becomes easily agitated
• symptoms can be psychotic-like in nature
• symptoms of disease are progressive

Front 28

2 Most Common Developmental Disorders

Back 28

1. Autism
2. Mental Retardation

Front 29

Autism

Back 29

Appears before age 3

Characteristics:

• abnormal speech patterns
• lack of eye contact
• social isolation
• obsessive body movements
• ritualistic or habitual behavior
• resistance to change

Front 30

Autism Behaviors

Back 30

• may be verbally limited
• abnormal pitch, rate or volume when speaking
• matching, pairing, and ordering objects
• switching lights on/off
• rocking, clapping, head-banging, spinning, chin-tapping
• difficulty expressing needs, ideas or abstract concepts

Front 31

Mental Retardation

Back 31

• Manifests in persons before the age of 18
  
• significantly sub-average intellectual functioning
• deficits in adaptive behavior
• limitations in 2 or more adaptive skill areas

Front 32

Methods Questioning a Retarded Patient

Back 32

• Be patient for a reply
• repeat question as needed
• ask short, simple questions using simple language
• speak slowly
• move to a less disruptive location
• be non-threatening, but firm and persistent
• be tactful & highly aware of questioning techniques

Front 33

Suicide Statistics

Back 33

• Half of Americans experience this in their lifetime
• 4.3 million Texas had a diagnosable mental health disorder in 2002
• 1.5 times more suicides than homicides, with an average of 6 deaths each day by suicide
• 4 men to every woman
• Highest rates are the 45-54 group

Front 34

Myths about Suicide

Back 34

• People who talk about suicide wont commit suicide
• Prior unsuccessful suicide attempts mean there will never be a successful suicide
• People who commit suicide are "crazy"
• once the person begins to improve, the risk has ended

Front 35

Suicides Relationship with Mental Illness

Back 35

• 90% of suicides are relates to un-treated or under-treated mental illness
  
• 20% of bipolar die from suicide
• 15% of schizophrenia die from suicide

Front 36

Psychopharmacology

Back 36

4 categories:

1. Anti-psychotic (control hallucinations)
2. Antidepressants (control feelings of sadness, suicidal thoughts, hopelessness)
3. Mood Stabilizers (control mood swings)
4. Anti-anxiety drugs (panic attacks, phobias, PTSD)

Front 37

Psychotropic Side Effects

Back 37

• Can be uncomfortable
• Can be dehumanizing
• Are often irreversible, which may cause person to refuse to take them as directed
• Examples: muscle spasms, protruding tongue, eyes rolled back, constant leg movement, tremors, uncoordinated movements, impotence, nausea, headache, blurred vision, weight gain, fatigue, liver toxicity
  

Front 38

3 Reasons why consumers do not take medications

Back 38

1. Nasty side effects
   
2. Start feeling better
   
3. Stigma associated with mentally ill
   

Front 39

Components of "First Three Minute Assessment"

Back 39

• Elements of Evaluation
• Intellectual Functioning
• Behavioral Reactions
• Emotional Reactions

Front 40

LEAPS Concept of Interaction

Back 40

• Listen
  
• Empathize
  
• Ask
• Paraphrase
• Summarize

Front 41

The Process of Modeling

Back 41

• Learning through observation
• Things that contribute or interfere with communication (age, gender, ethnicity, affect, language, and actions)
• intervention/communication strategies (establish credibility, diffuse)

Front 42

Not actively Listening

Back 42

• Arguing
  
• Criticizing
  
• Jumping to conclusions
  
• Pacifying
  
• derailing the conversation
• moralizing
• Name-Calling

Front 43

3 Levels of Active Listening

Back 43

1. Listening to words
   
2. Listen to Whole Messages (content, feelings, reason)
   
3. Reflecting the Whole Message (paraphrase)
   

Front 44

Barriers to Active Communication

Back 44

• Arguing
• Criticizing
• Jumping to Conclusions
• Pacifying
• Derailing
• Moralizing
• Name-Calling
• Ordering

Front 45

Techniques of Active Listening

Back 45

• Repeating
• Re-Wording
• Paraphrasing
• Reflection of feeling
• Minimal Encouragers

Front 46

Basic Strategies

Back 46

• Stay calm and patient, breathe
• use the person's name
• give instructions one at a time
• avoid crowding: give them time & watch for cues
• engagement is key: keep trying
• restate to double check info
• don't argue about the hallucinations
• don't express disapproval

Front 47

Basic Strategies When Communicating with the Mentally Ill

Back 47

• Stay Calm
• Be Patient
• Double-check info you are hearing
• Use their name
• Give instructions one at a time
• Remember they can exhibit extraordinary strength
• Engagement is pivotal
• Don't underestimate the power of hallucinations or delusions

Front 48

4 Effective Communication Skills

Back 48

1. Safety
2. Crisis Facts
3. Language
4. Movements

Front 49

Process in evaluating the appropriateness of a warrant-less apprehension

Back 49

“Least restrictivealternative” is the treatment that:

• is available
  
• provides the consumer with the greatest possibility of improvement
• is no more restrictive of consumer’s physical or social liberties than is necessary to provide the consumer with the most effective treatment and to protect adequately against any danger the patient poses to himself or others.

Front 50

Assistance Request Factors

Back 50

• Size and age ofa person with mental illness has very little to do with whether a back-upofficer should be called
• Like any otherperson under stress, a person with a mental illness may exhibit extraordinarystrength. Persons with a mental illness may, but not always, be unpredictableand irrational. Behavior is very individualized.
• Requestassistance as needed. Backup may be needed for the safety of the officer, theindividual, or others
• Contact thelocal Mental Health Mental Retardation (MHMR) Center for assistance, education,and referrals to appropriate resources.
  

Front 51

What constitutes a Crisis?

Back 51

• “… an unstable or crucial time or state of affairs whose outcome will make a decisive difference for better or worse”
• “….takes people out of their comfort zones and normal coping patterns.”
• “Often a crisis is precipitated by a loss of some sort, or a situation that threatens normalcy or expectations. The greater the threat, the more severe the crisis will be.”
• “….the crisis is the instability and threat the event produces. A person’s response to the upheaval will determine, in large part, the outcome of it.”
  

Front 52

Define Crisis Behavior

Back 52

A person suffering from a temporary breakdown incoping skills that includes perception, decision-making ability, and problemsolving ability is experiencing crisis behavior

Front 53

List Benefits of Jail Diversion

Back 53

• Decriminalization of persons with mental illness
• The problem of overrepresentation of people with mental illness in the criminal justice system is addressed
• Reduced hospitalization
• Increased public safety
• Reduction of inappropriate incarceration of persons with mental illness
• Length of stay in jails shortened in lieu of increased access to treatment
• Violence and victimization is reduced
• Costs incurred by taxpayers when a person with mental illness is arrested, incarcerated, and/or hospitalized are addressed
  

Front 54

Jail Diversion Concept Facts

Back 54

• Nationally, nearly half of the inmates in prison with a mental illness were incarcerated for committing a non-violent offense
• Some 150,000 former patients of TDMHMR now find themselves caught up in the criminal justice system, mainly because there is no other place for them
• Calls for police service in which mental illness is a factor make up between 7% and 10% of all police contacts, and continue to pose significant operational problems for the police
• National analyses have demonstrated that diverted clients had significantly lower criminal justice costs than non-diverted clients
  

Front 55

2 Approaches to Jail Diversion

Back 55

1. Pre-Booking
2. Post-Booking