1. BCCO PCT #4 PowerPoint AND Intermediate CIT Course TCOLE Course # 3841 Texas Commission On Law Enforcement UNIT NINE Through UNIT TWELVE

2. 2 Unit Goal: 9.0 Mental health referrals/resources in San Antonio & Bexar County

3. 9.0 Understanding Mental Health Referrals - Resources A. mental health community mindset budgeting A. The quality and availability of mental health programs vary depending on community mindset and budgeting restraints. B. program eligibility criteria B. Even within a community, services available depend on timing, resources, and program eligibility criteria.

4. C. mental healthresources C. Too often, community mental health resources are just in short supply. D. High costs prescription D. High costs of prescription drugs and formulary limitations also sometimes make it impossible for an indigent person to get access to needed medications. 9.0 Understanding Mental Health Referrals – Resources - Continued

5. E. impasse willingness of mental health providers to participate in criminal justice initiated programs E. In addition to the previously mentioned resource challenges, there is also an impasse with the willingness of mental health providers to participate in criminal justice initiated programs 9.0 Understanding Mental Health Referrals – Resources - Continued

6. F. stigmas discriminations discriminates arrested incarcerated stereotypical F. Like society’s stigmas and discriminations against mentally ill individuals, mental health system often discriminates against people who have been arrested or incarcerated due to stereotypical 9.0 Understanding Mental Health Referrals – Resources - Continued

7. F. Cont’d : F. Cont’d : concerns about criminal behavior and lack of experience working with this population. 9.0 Understanding Mental Health Referrals – Resources - Continued

8. 9.1 Local Mental Health Resources See Participant for Listing of San Antonio and Bexar County Mental Health Services

9. Center for Health Care Services Telephone 210-261-1000 Crisis Hotline: (210) 223-7233 Postal address 3031 IH 10 West 78201 9.1 Local Mental Health Resources San Antonio & Bexar County - Continued

10. Deer Oaks Mental Health Toll-Free: 1-866-327-2400 Address: 126 E. Main Plaza, Ste. 8., San Antonio, TX 78205 9.1 Local Mental Health Resources San Antonio & Bexar County - Continued

11. Alamo Mental Health Group PH: (210) 614 - 8400 4242 Medical Drive, Ste 6300 San Antonio, Texas 78229 9.1 Local Mental Health Resources San Antonio & Bexar County - Continued

12. McCullough Center for Mental Health Services 2515 Mccullough Ave, San Antonio, TX 78212 (210) 736-1762 9.1 Local Mental Health Resources San Antonio & Bexar County - Continued

13. 9.2 Referral Treatment Challenges 1. crisis emergency 1. Once you have the individual in crisis under control, you may need to take him to a facility for emergency psychiatric evaluation. 2. resources time- consuming 2. Depending on the resources in your area, this may be a time- consuming process

14. 3. potential challenge responding professionally 3. There may be a lack of services. Be aware of this potential challenge, but don’t let it detract you from your goal of responding professionally and appropriately to the situation. 9.2 Referral Treatment Challenges – Cont’d

15. Questions UNIT NINE ?

16. 16 Unit Goal: 10.0 crisis communication CIT techniques apply to all areas of crisis communication.

17. 17 10.0 What constitutes a According to Webster… crucial time –“An unstable or crucial time or state of affairs whose outcome will make a decisive difference for better or worse.” comfort zones –“…takes people out of their comfort zones and normal coping patterns.”

18. 18 crisis threat crisis “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.” 10.0 What constitutes a crisis? (Continued)

19. crisis “…the crisis is the instability and threat the event produces. A persons response to the upheaval will determine in large part, the outcome of it.” 10.0 What constitutes a crisis? (Continued)

20. 20 Discussion Questions: crisisIs it the event itself that is the crisis or the person’s response to the situation? What can turn the issue into a crisis ?

21. What makes an issue, loss, tragedy or stress seem like a crisis to one person but not to another person?What makes an issue, loss, tragedy or stress seem like a crisis to one person but not to another person? Discussion Questions:

22. FOOD FOR THOUGHT mental illness crisis situation For some persons with a mental illness, life as they know it can virtually stop when a crisis situation presents itself to them. crisis normal While for other people even in a crisis situation, they will continue to function as normal.

23. 10.0 Intensifying factors contribute to how a person responds to crisis: A.Negativepersonality traits A. Negative personality traits B. Unrealisticexpectations B. Unrealistic expectations C. Faultysense of identity C. Faulty sense of identity

24. D. Disconnectedness E. Poorcoping E. Poor coping mechanisms due to background F. Faulty belief F. Faulty belief system 10.0 Intensifying factors contribute to how a person responds to crisis - Continued:

25. CLASS DISCUSSION Do you have to have a mental illness to possess the aforementioned factors? Albert Einstein

26. How can “YOU” as a Deputy Constable assist A. Acknowledge A. Acknowledge their feelings B. Avoidjudgmental B. Avoid being judgmental C. assist realistic view of the situation C. Attempt to assist the individual in maintaining a realistic view of the situation

28. D. Investigate D. Investigate available referral sources E. positive E. Assist the individual in focusing on the positive of what can be changed, instead of the negative of what can’t F. solution F. Be solution -oriented and guide the individual in developing a realistic plan How can “YOU” as a Deputy Constable assist – Continued:

29. 10.1 Define Crisis Behavior and its relevance to CIT Training breakdown perceptiondecision- makingproblem solving A person suffering from a temporary breakdown in coping skills that includes perception, decision- making ability, and problem solving ability is experiencing crisis behavior.

30. Crisis behavior Crisis behavior can be different depending on individual response. Anyonesuffercrisis Anyone can suffer from a crisis and its effects can vary with time, place, and person. 10.1 Define Crisis Behavior and its relevance to CIT Training – Continued

31. Examples Examples of situations involving crisis: being locked out of the house, losing a job, being a victim of a crime, having a divorce, being involved in a traffic stop or accident 10.1 Define Crisis Behavior and its relevance to CIT Training – Continued

32. 10.2 Crisis Intervention Techniques in domestic disturbance situations

33. 10.2 Tactics & Techniques in Domestic Disturbances

34. 10.3 Crisis Intervention Techniques can be utilized in domestic disturbance situations TRAFFIC STOP

35. Questions UNIT TEN ?

36. 36 TAKE A 10-MINUTE BREAK

37. 37 Unit Goal: 11.0 Jail and/or Court deference alternatives and referrals for persons with a mental illness Jail and/or Court deference alternatives and referrals for persons with a mental illness. JUSTICE SYSTEM MENTAL HEALTH DEFERRED ADJUDICATION

38. 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives jails prisons largest facility for persons with mental illness Our nation’s system of jails and prisons has now become the largest facility for persons with mental illness. Police first responder crisis Police have become the “first responder” to persons in a crisis situation

39. solution Judges, law enforcement personnel, and mental health experts struggle with trying to find a solution to the increasing numbers passing through the legal system. 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued:

40. increase mental illness The Mental Health Association of Texas states that “deinstitutionalization without adequate community supports (such as supported housing and employment) contributes to an increase of people with mental illness in prisons.” 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued:

41. There is an overrepresentation of people in our prison system 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued:

42. 3%violent While only 3% of violent behavior is attributable to mental disorder. 16% mental illness An estimated 16% of prisoners have mental illness, and 50% mental disorder 50% of the young people under the Texas Youth Commission have a mental disorder. 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued:

43. TYC psychotropicmedications TYC further reports that in 2002, 21% of its institutional population was on psychotropic medications. rise mental illness disorders There has been a rise in the number of persons with mental illness or co-occurring disorders who are appearing before the court system. 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued:

44. Many alternatives to the “traditional” court model are being initiated, including; Veteran Veteran court drug drug courts, mental health mental health courts, domesticviolence domestic violence courts, and community courts. 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued:

45. Jail Diversion Program Programs such as the Jail Diversion Program are also being implemented in many states, including Texas (see HB 2292). issues These courts/programs have been implemented to address the underlying issues that brought the consumer to court in the first place 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued:

46. Veteran’s Court Bexar County now has a “ Veteran’s Court ” with a Judge (Honorable Wayne Christianson) currently adjudicating Veterans charged with veterans mental health The aim is to link veterans and mental health consumers to community-based services. 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued:

47. arrested disproportionately higher rate Persons with mental illnesses are reportedly arrested at a disproportionately higher rate than other individuals (Lamb and Weinberger, 1998). Over 11 million adults are booked each year into U.S. jails (Steadman et al., 1999). 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued:

48. 11.1 Concept of Mental Health Courts mental health courts According to a collaborative survey conducted by NAMI, the GAINS Center, and the Council on State Governments, at least 94 communities across the U.S. have established mental health courts as of June 2004.

49. Portland state researcher Heidi Hendricks followed 368 people who were diverted to the Clark County Mental Health Court from the traditional court system. Her results are as follows: 11.1 Concept of Mental Health Courts – Cont’d

50. 1. onediverted 1. In one year after being diverted, those in the group were arrested a total of 713 times 2. mental health no new arrests 2. One year after completing the mental health court program, 199 of the group (54%) had no new arrests 11.1 Concept of Mental Health Courts – Cont’d

51. 3. 75% 3. For that same period, there were only 178 arrests for the entire group - a 75% reduction at a time when there was no longer court oversight 4. dropped 62% 4. Probation violations dropped by 62% 11.1 Concept of Mental Health Courts – Cont’d

52. 5. dropped 26% 3% 5. The percentage of those in the group with three or more arrests dropped from 26% to 3% (an 88% decline) 11.1 Concept of Mental Health Courts – Cont’d

53. saved Eighteen months after introducing a mental health court, Oklahoma County officials assert that the county saved as much as $15,000 per year by putting an offender in treatment instead of jail. 11.1 Concept of Mental Health Courts – Cont’d

54. 11.2 State of Texas Jail Diversion Ideal

55. 11.2.A, Elements of the Texas Jail Diversion Ideal A.Educationtraining A. Education and training of law enforcement personnel and the courts B. development B. The development and utilization of crisis intervention teams (CIT)

56. C. centralized mental health assessment arrest non-violent criminal C. Development of centralized location for mental health assessment without arrest for individuals with non-violent criminal conduct D. facilities arrest D. Development of holding facilities providing structured treatment in lieu of arrest 11.2.A, Elements of the Texas Jail Diversion Ideal – Cont’d:

57. E. linking E. Development of linking services F. screening F. Development of timely and effective screening process G. community support G. Development of required community support 11.2.A, Elements of the Texas Jail Diversion Ideal – Cont’d:

58. H. housing H. Development of an identified method for addressing housing and needed support services 11.2.A, Elements of the Texas Jail Diversion Ideal – Cont’d:

59. H.B. 2292 H.B. 2292 states that “the 1. jail diversion strategies 1. department shall require each local mental health authority to incorporate jail diversion strategies 2. disease 2. into the authority’s disease management practices 11.2.A, Elements of the Texas Jail Diversion Ideal – Cont’d:

60. H.B. 2292 H.B. 2292 states that 3. reduce criminal justice system 3. managing adults with schizophrenia and bi-polar disorder to reduce the involvement of those clients with the criminal justice system.” 11.2.A, Elements of the Texas Jail Diversion Ideal – Cont’d:

61. 11.3 Two Approaches to Jail Diversion 1. Pre-bookingdiversion 1. Pre-booking diversion occurs at first contact with law enforcement, prior to any formal charges. a. specialized crisis a. Most communities that use this system have specialized training for their officers and a 24-hour crisis center with a no-refusal policy

62. 1. Pre-booking 1. Pre-booking diversion occurs at first contact with law enforcement, prior to any formal charges – continued: b. Crisis Intervention Team b. The Crisis Intervention Team process is an example of this approach. 11.3 Two Approaches to Jail Diversion – Continued

63. 2. Post-bookingdiversion 2. Post-booking diversion is the most used program. a. divert a. This process is to identify and divert consumers after they have been booked. b. release b. A plan is then created to implement upon release. 11.3 Two Approaches to Jail Diversion – Continued

64. 11.4 Facts associated with Jail Diversion Concept A.half mental illness committing a non-violent offense A. Nationally, nearly half of the inmates in prison with a mental illness were incarcerated for committing a non-violent offense

65. B. criminal justice there is no other place for them B. 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. 11.4 Facts associated with Jail Diversion Concept – Continued:

66. C. mental illness 7%10%police contacts C. 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. 11.4 Facts associated with Jail Diversion Concept – Continued:

67. D. significantly lower criminal justice costs D. National analyses have demonstrated that diverted clients had significantly lower criminal justice costs than non-diverted clients 11.4 Facts associated with Jail Diversion Concept – Continued:

68. 11.5 Benefits of Jail Diversion 1. Decriminalization 1. Decriminalization of persons with mental illness 2. problem 2. The problem of over representation of people with mental illness in the criminal justice system is addressed

69. 3. Reducedhospitalization 3. Reduced hospitalization 4. Increasedsafety 4. Increased public safety 5. Reduction incarceration 5. Reduction of inappropriate incarceration of persons with mental illness 11.5 Benefits of Jail Diversion – Continued

70. 6. Length treatment 6. Length of stay in jails shortened in lieu of increased access to treatment 7. Violencevictimization 7. Violence and victimization is reduced 11.5 Benefits of Jail Diversion – Continued

71. 8. Costs 8. Costs incurred by taxpayers when a person with mental illness is arrested, incarcerated, and/or hospitalized are addressed 11.5 Benefits of Jail Diversion – Continued

72. A. criminalization A. The complex issue of criminalization is in need of a formidable solution. B. reality communitywide B. This reality has multiple causes and requires community - wide participation to create and implement a uniform standard. 11.5 Benefits of Jail Diversion – Continued

73. C. Collaboration divertingmental illness arrest confinement C. Collaboration among all involved parties is necessary to successfully achieve the process of diverting persons with mental illness from unnecessary arrest and confinement to appropriate treatment resources. 11.5 Benefits of Jail Diversion – Continued

74. Questions UNIT ELEVEN ?

75. 12.0 Evaluation of Success

76. 12.1 Components for Evaluating Success 1. recidivism 1. Reduction of criminal recidivism 2. relationship 2. Improved relationship between law enforcement and mental health professionals 3. referrals 3. Reduced percentage of referrals to hospital in crisis

77. 4. 4. Reduced percentage of consumers needing emergency psychiatric care 5. injury 5. Reduced rates of officer injury 12.1 Components for Evaluating Success – Continued: Reduction Improved Reduced

78. Questions UNIT TWELVE ?

79. 79 H.B. 2292 states: require each local mental health authority to incorporate jail diversion strategies criminal justice system “The department shall require each local mental health authority to incorporate jail diversion strategies into the authority’s disease management practices for managing adults with schizophrenia and bi-polar disorder to reduce the involvement of those clients with the criminal justice system.”

80. 80

81. Questions?

82. 82 DEFINE & PROCESS Process: Define 7.0: Define 7.0: Explain the key points – elements for Human Trafficking Investigation

83. SOURCES All Course Sources and/or Resources are listed in your Participant Handout Bexar County Constable Office PCT#4 Crisis Intervention TRAINING (CIT) Course # 3841

84. TAKE A 10-MINUTE BREAK

85. “Knowledge is “POWER” Stay informed, stay SAFE, stay Vigilant & stay Alive”

86. UPCOMING TRAINING Current TRAINING Schedule of Courses offered by Bexar County Constable’s Office PCT#4 Racial Profiling Course – TCOLE Course #3256 (8-hrs) 8-hrs on Saturday October 4 th, 2014 from 10:30 am to 7:30 pm. Racial Profiling Course – TCOLE Course #3256 (8-hrs) on Friday October 10, 2014 from 8:00 am to 5:00 pm Eye Witness Evidence Course – TCOLE Course # 3286 (4-hrs) Saturday October 11, 2014 from 10:30 am to 2:30 pm Eye Witness Evidence Course – TCOLE Course # 3286 (4-hrs) Sunday October 12 th, 2014 from 11:00 am to 3:00 pm. Eye Witness Evidence Course – TCOLE Course # 3286 (4-hrs) Friday October 17 th, 2014 from 1:00 pm to 5:00 pm. 86 Bexar County Constable’s Office PCT#4 TRAINING SCHEDULE 2014

87. 87 Advanced TCOLE Instructor Course – TCOLE #1017 (40hrs), Day One Saturday November 1 st,2014 from 11:00 am to 6:00 pm (Deputy Chief George D. Little and Deputy Constable Roland Berg) Day Two Advanced TCOLE Instructor Course – TCOLE #1017, Day Two Sunday November 2 nd,2014 from 11:00 am to 6:00 pm (Deputy Chief George D. Little and Deputy Constable Roland Berg) Day Three Advanced TCOLE Instructor Course – TCOLE #1017, Day Three Friday November 7 th,2014 from 9:00 am to 6:00 pm (Deputy Chief George D. Little and Deputy Constable Roland Berg ) Lesson Presentation preparation time. Instructors available Day Four Advanced TCOLE Instructor Course – TCOLE #1017, Day Four Saturday November 8 th,2014 from 11:00 am to 6:00 pm (Deputy Chief George D. Little and Deputy Constable Roland Berg)

88. 88 Day Five Advanced TCOLE Instructor Course – TCOLE #1017, Day Five & Grad Sunday November 9 th, 2014 from 11:00 am to 6:00 pm – Presentations, Final Test & Graduation (Deputy Chief G. D. Little and Dep. Constable R. Berg ) HIV-AIDS & Viral Hepatitis in Criminal Justice Profession Course – TCOLE # 3804 (8-hrs) 8-hrs on Saturday November 15 th, 2014 from 10:00 am to 6:00 pm. HIV-AIDS & Viral Hepatitis in Criminal Justice Profession Course – TCOLE # 3804 (8-hrs) 4-hrs on Thursday December 4th, 2014 from 1:00 am to 5:00 pm HIV-AIDS & Viral Hepatitis in Criminal Justice Profession Course – TCOLE # 3804 (8-hrs) 4-hrs on Friday December5th, 2014 from 1:00 am to 5:00 pm KNOWLEDGE IS POWER

89. Please complete a course and instructor evaluation form. If you rate 2 or below you must justify on reverse side. Constructive CriticismConstructive Criticism helps all, being negative helps no one. COURSE & INSTRUCTOR EVALUATION Form

90. Quiet….Test in Progress

91. 91

92. Exam Graduation THANK YOU & STAY SAFE STAY SAFE

93. End of Day TWO…