Module 1 the plight of mentally ill version 2

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Dauphin County Jail Diversion Training : 

Dauphin County Jail Diversion Training Module I: The Plight of the Mentally Ill Strategic Community Care Solutions Copyright 2010 All Rights Reserved

Police Training Modules : 

Police Training Modules Module 1 The plight of the mentally ill Module 2: The need for jail diversion Module 3: What is mental illness Module 4: Experiencing mental illness Module 5: Signs of mental illness Module 6: Treatment of mental illness Module 7: Mental health medications Module 8: Other brain disorders Module 9: Co-occurring disorders Module 10: Social service system I Module 11: Social service system II Module 12: Communicating with mentally ill Module 13: Active listening Module 14: Crisis management Module 15: De-escalation Module 16: Suicide Evaluation

Slide 3: 

3 Getting arrested should not be the first step in getting mental health care, but that is what is happening everyday across this country

Slide 4: 

"The one institution that can never say no to anybody is jail and what is worse, now we have given [the mentally ill] a criminal record.“ --T. Leffler

Slide 5: 

The Intersection of Mental Illness and Criminal Justice

Background : 

Background Two hundred years ago, American jails were commonly used to house seriously mentally ill citizens. The inhumanity of that system led advocates in the 1800’s to undertake reforms in the care of the mentally ill. Modern mental hospitals run by State governments evolved in mid-20th century America with the promise of professional medical treatment and rehabilitation.

Background (cont) : 

Background (cont) There have been dramatic shifts in state psychiatric and penal populations occurring in the last 20 years. A Good Example: In the early 1970’s, Michigan’s mental institutions held about 28,000 patients, while its prisons held 8,000. Today there are less than 3,000 patients in Michigan mental hospitals, while the state’s prisons hold more than 45,000 inmates. 7

Deinstitutionalization : 

Deinstitutionalization The advent of psychotropic drugs in the 1950’s and 60’s, along with growing litigation over poor conditions and abuses in the hospitals, paved the way for states to release, or "deinstitutionalize," large numbers of patients, some of whom had been institutionalized for most of their lives. This plan held great promise for reinstating community membership with appropriate supports for released patients. Often, however, the financial burden and the search for services fell upon families.

Background (cont) : 

Background (cont) A majority of deinstitutionalized people with mental illness have anosognosia, a condition that makes them unable or unwilling to recognize their illness In the civil rights conscious state of today, advocay groups have pushed for individuals with mental illness, regardless of severity, to make their own decisions regarding their need for treatment—not surprisingly, many went off of their medication and lost touch with mental health care centers

Background (cont.) : 

Background (cont.) Without family or a means to earn money for rent, many turned to life on the streets Many of these individuals were arrested on minor charges by the police who were under social pressure to “do something” about the homeless population Approaching one third of homeless people have a psychological disorder 10

Slide 11: 

Some times I think I would get better care if I did go to jail… Well, then again, maybe not… From the research I’ve done many locations treat inmates with mental illness like dirt and think most of the are faking it…So I guess It is something I don’t every really want to find out about. --Anonymous Mental Health Consumer

Background (cont) : 

Background (cont) Since the early 1990’s, it has become common once again to find the mentally ill in jails and prisons; in fact, Prisons have become the nation's "de facto" mental health care provider Nationally, state mental hospital populations peaked at 559,000 persons, in 1955 By contrast, 70,000 individuals with severe mental illnesses are housed in public psychiatric hospitals today, 30% of whom are forensic patients referred by the courts

Scope 0f the Problem

Scope of the Problem : 

Scope of the Problem More Americans receive mental health treatment in prisons and jails than hospitals or treatment centers In fact, the country's largest psychiatric facility isn't even a hospital, it's a prison—New York City's Rikers Island, which holds an estimated 3,000 mentally ill inmates at any given time Fifty years ago, the U.S. had nearly 600,000 state hospital beds for people suffering from mental illness—today, because of federal and state funding cuts, that number has dwindled to 40,000 15

Scope of the Problem : 

Scope of the Problem According to the Federal Bureau of Justice Statistics, there are currently 1.25 million inmates with debilitating disorders ranging from schizophrenia to post-traumatic stress disorder, have been abandoned in the U.S. prison system instead of receiving treatment in hospitals 283,800 inmates are identified as having a serious mental illness—this represents 16% of the inmate populations of state and local jails 16 In a study of more than 20,000 adults entering five local jails, researchers documented serious mental illnesses in 14.5 percent of the men and 31 percent of the women, which taken together, comprises 16.9 percent of those studied—rates in excess of three to six times those found in the general population. : 

Watch the video clip: The Death Of Timothy Souders by clicking the following link and selecting play on the CBS website

Psychiatric Instability Often Results in Legal Problems : 

Psychiatric Instability Often Results in Legal Problems About 20% of people with SMI who have been treated and released from a psychiatric hospital are arrested within one year of discharge—compared to 5% life time arrest rate for the general population. Usually the arrest is for minor crimes that include: Trespassing Public Intoxication Disturbing the public order Impeding the flow of traffic Drug related offenses 18

Reality Check: A Real Life Story : 

Reality Check: A Real Life Story Mike, 31, suffers from schizophrenia, bipolar disorder and depression. Since the age of 17, the Los Angeles native has been repeatedly arrested during psychosis for nuisance crimes like disturbing the peace, only to serve his time, fall off his medication and get arrested again. On three separate occasions, his hallucinations were so severe he tried to commit suicide by provoking the police to shoot him. Though he is receiving treatment, rising health care costs and declining federal help mean Mike will likely end up in jail again.

High Rates of People with Serious Mental Illness in Jail : 

High Rates of People with Serious Mental Illness in Jail Every year, about 800,000 people with severe mental illness are incarcerated in US jails More than 8% - 16% of people in US jails have a serious mental illness Women in jail have almost double the rate of serious mental illness as men 20

People with Mental Illness Do Very Poorly in the Criminal Justice System : 

People with Mental Illness Do Very Poorly in the Criminal Justice System Research shows that people with mental illness: Are more likely to be arrested—in one study, 47% vs. 26% for non-MI following police encounters Face more serious charges—are often charged with more serious crimes than others for similar behavior Receive stiffer sentences—are sentenced more severely than other people with similar crimes Often do not get treatment—a U.S. Justice department study found 60% of people with SMI in jail do not receive treatment 21

People with Mental Illness Do Very Poorly in the Criminal Justice System (cont.) : 

People with Mental Illness Do Very Poorly in the Criminal Justice System (cont.) Serve longer in jail and prison: two to five times longer in jail and average 15 months more in prison Can not make bail: often detained because they have no income and can’t make bail. Have more difficulty coping: Experience more fights, infractions, and sanctions while incarcerated, resulting in longer sentences and more jail or prison time Are more vulnerable to being exploited or manipulated by other inmates. A recent study found that people with mental illness are three times more likely to be victims of violent crime than people without Mental Illness 22

A Consumer Caution From A Mental Health Website : 

A Consumer Caution From A Mental Health Website Lets talk about what can be done to prevent the prison door from shutting on us. Now, if you’re lucky, then your “mental condition” has never lead you in doing something that requires the police to get involved. May be you’re lucky that, oh, I don’t know, that back in October of 1998 you decided to go out fooling around with a pellet gun in some semi-public area only to have a gun-ho JR police officer pull his gun and point it at your head while screaming all the time… “keep your hands where I can see them”… we make some bad choices while under the control of our mental disorder, some times, they can never be undone! This is why we must be willing to put the work into our recovery. So we can have control or at least, know when we should get more help. We can’t give up, or we might have a cell waiting for us, with a 300lb dude named Tiny as a room mate.

Slide 24: 

Implications for Inmates with Mental Illness

Implications for Inmates with Mental Illness : 

Implications for Inmates with Mental Illness Inmates tend to learn behaviors counter productive to their survival in the outside world Some of these behaviors may include: Aggressiveness Intimidation Extreme passivity Manipulative behavior Reluctance to discuss problems with authority figures 25

Implications for Inmates with MI (cont.) : 

Implications for Inmates with MI (cont.) A result of the effect of prison life on inmates is the alarmingly high rate of suicides Suicide is the leading cause of death in inmates, accounting for over half of the deaths occurring while inmates are in custody Almost all who attempt suicide have a major psychiatric disorder More than half of the victims were experiencing hallucinations at the time of the attempt 26

Implications for Society : 

Implications for Society Half of mentally ill inmates report three or more prior incarcerations—the long-term costs quickly add up The direct cost of mental health services was $69 billion in 1990; however, the estimated hidden costs of loss of productivity and long term health care costs were an additional $78.6 billion The common perception is that people with mental illness are violent—in reality, studies have shown that they commit violent acts no more often than a random sample of their peers 27

Implications for Society (cont.) : 

Implications for Society (cont.) Twenty-nine percent of jails in one survey reported holding mentally ill persons against whom no charges were ever pressed—they are jailed because no more appropriate community-based programs have the funding or space to treat them This situation has become a true civil rights issue; however, with cuts in funding for treatment in the community, it is doubtful that the situation can be reversed in the near future. 28

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