1. BCCO PCT #4 PowerPoint AND Intermediate CIT Course TCOLE Course # 3841 Texas Commission On Law Enforcement PARTICIPANT HANDOUT 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 ________ budgeting A. The quality and availability of mental health programs vary depending on community ________ and budgeting restraints. B. program eligibility ____________ B. Even within a community, services available depend on timing, resources, and program eligibility ____________.

4. C. mental health C. Too often, community mental health ______________ are just in short supply. D. High costs ________________ D. High costs of ________________ 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. 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 ______________ 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 arrested incarcerated stereotypical F. Like society’s stigmas and discriminations against mentally ill individuals, mental health system often __________________ 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 __________________. 2. time- consuming 2. Depending on the ___________ in your area, this may be a time- consuming process

14. 3. potential challenge 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 ____________ professionally and appropriately to the situation. 9.2 Referral Treatment Challenges – Cont’d

15. Questions UNIT NINE ?

16. 16 DEFINE & PROCESS Process: List 9.1: List 9.1: The mental health facilities in your area that can be utilized as a resource when encountering a subject/suspect you identify as having possible mental heath issues

17. 17 DEFINE & PROCESS Process: Explain 9.2 : Explain 9.2 : The possible referral/treatment challenges in your community.

18. 18 Unit Goal: 10.0 crisis communication CIT techniques apply to all areas of crisis communication.

19. 19 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.”

20. 20 crisis “Often a ________ is precipitated by a loss of some sort, or a situation that threatens normalcy or expectations. The greater the _________, the more severe the crisis will be.” 10.0 What constitutes a crisis? (Continued)

21. crisis “…the crisis is the instability and ____________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)

22. 22 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 ?

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

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

25. 10.0 Intensifying factors contribute to how a person responds to crisis: A.Negative _____________ traits A. Negative _____________ traits B. Unrealistic ________________ C. Faultysense of ______________ C. Faulty sense of ______________

26. D. ________________________ E. Poor ____________ E. Poor ____________ mechanisms due to background F. Faulty ____________ F. Faulty ____________ system 10.0 Intensifying factors contribute to how a person responds to crisis - Continued:

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

28. How can “YOU” as a Deputy Constable assist A. __________________ A. __________________ their feelings B. Avoid ________________ B. Avoid being ________________ C. ____________ realistic view of the situation C. Attempt to ____________ the individual in maintaining a realistic view of the situation

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

30. 10.1 Define Crisis Behavior and its relevance to CIT Training perceptiondecision- makingproblem solving A person suffering from a temporary ____________ in coping skills that includes perception, decision- making ability, and problem solving ability is experiencing crisis behavior.

31. Crisis behavior Crisis behavior can be different depending on individual response. ____________suffer crisis ____________ 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

32. Examples Examples of situations involving crisis: being _________ out of the house, losing a ______, being a _____ of a crime, having a __________, being involved in a _________ stop or ____________ 10.1 Define Crisis Behavior and its relevance to CIT Training – Continued

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 DEFINE & PROCESS Process: List 10.1: List 10.1: The

37. 37 DEFINE & PROCESS Process: List 10.2: List 10.2: The

38. 38 DEFINE & PROCESS Process: List 10.3: List 10.3: The

39. 39 TAKE A 10-MINUTE BREAK

40. 40 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. __________________ DEFERRED ADJUDICATION __________________

41. 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives _______ ____________ largest facility for persons with mental illness Our nation’s system of _______ and ____________ has now become the largest facility for persons with mental illness. __________ first responder crisis __________ have become the “first responder” to persons in a crisis situation

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

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

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

45. %violent While only ___ % of violent behavior is attributable to mental disorder. % mental illness An estimated ___ % of prisoners have mental illness, and ____% mental disorder ____% 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:

46. TYC ______________ medications TYC further reports that in 2002, 21% of its institutional population was on ______________ medications. mental illness disorders There has been a ____ 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:

47. Many alternatives to the “traditional” court model are being initiated, including; ______________ ______________ court ________ ________ courts, ________ ________ ________ ________ courts, domestic_____________ domestic _____________ courts, and community courts. 11.0 Jail and/or Court Deferred Adjudication Mental Health Alternatives - Continued:

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

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

50. disproportionately higher rate Persons with mental illnesses are reportedly __________________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:

51. 11.1 Concept of Mental Health Courts mental health ____________ 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 ____________ as of June 2004.

52. 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

53. 1. 1. In ____ year after being ________, those in the group were arrested a total of 713 times 2. mental health no new ____________ 2. One year after completing the mental health court program, 199 of the group (54%) had no new ____________ 11.1 Concept of Mental Health Courts – Cont’d

54. 3. % 3. For that same period, there were only 178 arrests for the entire group - a ___ % reduction at a time when there was no longer court oversight 4. dropped % 4. Probation violations dropped by ___ % 11.1 Concept of Mental Health Courts – Cont’d

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

56. Eighteen months after introducing a mental health court, Oklahoma County officials assert that the county ____________ 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

57. 11.2 State of Texas Jail Diversion Ideal

58. 11.2.A, Elements of the Texas Jail Diversion Ideal A. A. __________ and ____________ of law enforcement personnel and the courts B. B. The ____________ and utilization of crisis intervention teams (CIT)

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

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

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

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

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

64. 11.3 Two Approaches to Jail Diversion 1. ____-________ 1. ____-________ __________ occurs at first contact with law enforcement, prior to any formal charges. a. crisis a. Most communities that use this system have ___________ training for their officers and a 24-hour crisis center with a no-refusal policy

65. 1. ____ -___________ 1. ____ -___________ 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

66. 2. ______-____________diversion 2. ______-____________ diversion is the most used program. a. a. This process is to identify and __________ consumers after they have been booked. b. b. A plan is then created to implement upon ______________. 11.3 Two Approaches to Jail Diversion – Continued

67. 11.4 Facts associated with Jail Diversion Concept A. mental illness committing a non-violent offense A. Nationally, nearly ________ of the inmates in prison with a mental illness were incarcerated for committing a non-violent offense

68. 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:

69. C. mental illness % police contacts C. Calls for police service in which mental illness is a factor make up between ___ % and _____ % of all police contacts, and continue to pose significant operational problems for the police. 11.4 Facts associated with Jail Diversion Concept – Continued:

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

71. 11.5 Benefits of Jail Diversion 1. _________________ 1. _________________ of persons with mental illness 2. 2. The ____________ of over representation of people with mental illness in the criminal justice system is addressed

72. 3. Reduced 3. Reduced ______________ 4. Increased 4. Increased public ____________ 5. Reduction 5. Reduction of inappropriate _________________ of persons with mental illness 11.5 Benefits of Jail Diversion – Continued

73. 6. Length 6. Length of stay in jails shortened in lieu of increased access to ______________ 7. Violence 7. Violence and _____________ is reduced 11.5 Benefits of Jail Diversion – Continued

74. 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

75. A. A. The complex issue of __________________ is in need of a formidable solution. B. reality B. This reality has multiple causes and requires ____________-_______ participation to create and implement a uniform standard. 11.5 Benefits of Jail Diversion – Continued

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

77. Questions UNIT ELEVEN ?

78. 78 DEFINE & PROCESS Process: Explain 11.0: Explain 11.0: The jail/court related alternatives and referrals for persons with a mental illness

79. 79 DEFINE & PROCESS Process: Explain 11.1: Explain 11.1: The concept of mental health courts

80. 80 DEFINE & PROCESS Process: Explain 11.2: Explain 11.2: The the State of Texas Jail Diversion Ideal

81. 81 DEFINE & PROCESS Process: List & Explain 11.3: List & Explain 11.3: The two approaches to jail diversion

82. 82 DEFINE & PROCESS Process: List & Explain 11.4: List & Explain 11.4: The two facts associated with the jail diversion concept

83. 83 DEFINE & PROCESS Process: List & Explain 11.5: List & Explain 11.5: The the benefits of jail diversion

84. 12.0 Evaluation of Success

85. 12.1 Components for Evaluating Success 1. 1. Reduction of criminal __________ 2. 2. Improved ____________ between law enforcement and mental health professionals 3. 3. Reduced percentage of _________ to hospital in crisis

86. 4. 4. Reduced percentage of consumers needing emergency ______________ care 5. 5. Reduced rates of officer ___________ 12.1 Components for Evaluating Success – Continued: Reduction Improved Reduced

87. Questions UNIT TWELVE ?

88. 88 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.”

89. 89

90. Questions?

91. 91 DEFINE & PROCESS Process: List & Explain 12.0: List & Explain 12.0: The your understanding and value of evaluation in demonstrating success

92. 92 DEFINE & PROCESS Process: Explain 12.1: Explain 12.1: The key points

93. 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

94. TAKE A 10-MINUTE BREAK

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

96. UPCOMING TRAINING Current TRAINING Schedule of Courses offered by Bexar County Constable’s Office PCT#4 96 Bexar County Constable’s Office PCT#4 TRAINING SCHEDULE 2014

97. 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

98. Quiet….Test in Progress

99. 99

100. Exam Graduation THANK YOU & STAY SAFE STAY SAFE

101. End of Day TWO… “STAY VIGILANT…..STAY SAFE…..”