Department of Public Safety

1. Department of Public Safety Interaction with Persons with Mental Impairments

2. Introduction Mental disorders were once thought to affect very few, but today we know the opposite is true. Many people with these conditions lead full, productive, and satisfying lives. Despite living with a diagnosis such as substance use disorder, eating disorder, depression, bipolar disorder, or schizophrenia, people go to work, vote, own homes and businesses, and contribute to their communities.

3. The History of Mental Illness • Treating public illness has long been a process of trial and error guided by public attitudes and medical theory.

4. The History of Mental Illness • 1st Revolution: Hospitalization • 2nd Revolution: Moral Management • 3rd Revolution: Society Cooperation & Interaction

5. Low point in Mental Health History • 1930’s-1950’s • Development and widespread use of somatic treatments for mental illness such as electroconvulsive therapy and psychosurgery • Treatments were based on the biological model of mental pathology that assumes mental illness is the result of a biochemical imbalance in the body and can be compared to physical diseases

6. Impact of Deinstitutionalization • Introduction of psychopharmacology (double edged sword) • Advent of psychoactive drugs convinced many that all illnesses would soon be effectively managed with medication • Movement that rapidly occurred starting in the 1960s

7. Mental Illness: Facts and Numbers (NAMI) • One in four adults-approximately 57.7 million Americans experience a mental health disorder • One in ten children live with a serious mental or emotional disorder • Fewer than one third of adults and one half of children with a diagnosed mental health disorder receive mental health services

8. Mental Illness: Facts and Numbers (NAMI) • Schizophrenia-approximately 2.4 million • Bipolar-approximately 5.7 million • Depression-approximately 14.7 million • Anxiety/PTSD-approximately 40 million • Mental health/addiction disorders-approximately 5.2 million • Twenty-four percent of state inmates and twenty-one percent of local prisoners have a history of mental health disorder.

10. Overview It is important for first responders to distinguish between the person experiencing a mental health crisis and the problem or circumstance itself. It is neither accurate nor fair to define people by their perceived conditions and we must continue to work to overcome the stigma and discrimination associated with mental illness not only in public safety but in our communities as well.

11. Overview Consider how we view other health issues, have you ever heard someone referred to as "a cancer," or "a broken leg?" Yet, we often do hear people referred to as "manic depressives" or "schizophrenics" or “crazy” This kind of derogatory labeling is disrespectful and creates a formidable barrier to successful interactions and interventions.

12. Fighting Stigma • STIGMA, DISCRIMINATION and NEGLECT prevent care and treatment from reaching people with mental illnesses. • (World Health Organization Report, October 2001).

13. Fighting Stigma • Stigma assumes many forms, both subtle and overt. It appears as prejudice and discrimination, fear, distrust, and stereotyping. • " (U.S. Surgeon General’s Report on Mental Health, 1999).

14. Introduction Responding to individuals in serious mental health crises has been historically problematic for law enforcement personnel. A lack of education and understanding of mental illness and de-escalation/crisis intervention techniques have led to the following consequences in many law enforcement agencies:

15. Consequences Litigation Injuries Low Public Confidence Incarceration of Mentally Ill Lack of Self-confidence among Police

16. Litigation • Responding to individuals in a mental health crisis has become one of the most litigious areas of law enforcement. • Consumers have been killed at a rate higher than average population. • Numerous lawsuits have been the result.

17. Injuries • Both officers and mental health consumers are injured during these types of encounters at a rate significantly higher than the average population

18. Low Public Confidence • Family members of individuals with a mental illness are afraid to call the police because they fear the police may kill their family member.

19. Incarceration of the Mentally Ill • On average, a seriously mentally ill person in the USA is three times more likely to be incarcerated than hospitalized. • The rate of reported mental illnesses in prisons is now 1.25 million compared to the estimated 283,000 in 1998 and 56.2 percent greater than mental health problems experienced by the general adult population.

20. Lack of Self-confidence among Police • Officers are not comfortable with their abilities to appropriately respond to an individual in a mental health crisis. • More education on how to deal with individuals in a mental health crisis has proven to be effective and beneficial.

21. HB93 • HB93 enables New Mexico to meet the critical training need for an intermediate level of training between the training provided in the basic training academy, and the advanced level 40-hour Crisis Intervention Training (CIT) certification course.

22. HB93 - Three new sections were created by this legislation. Section 1 This new section requires “A minimum of forty hours of crisis management, including crisis intervention, confrontation de-escalation practicum and proper interaction with persons with mental impairments training, shall be included in the curriculum of each basic law enforcement training class.”

23. HB93 - Three new sections were created by this legislation. Section 1 This new section requires “A minimum of two hours of crisis management, including crisis intervention, confrontation de-escalation practicum and proper interaction with persons with mental impairments training, shall be included as a component of in-service law enforcement training pursuant to Section 29-7-7.1 NMSA 1978.”

24. HB93 - Three new sections were created by this legislation. Section 2 This new section requires “In-service telecommunicator training…including one hour of crisis management, including crisis intervention, confrontation de-escalation practicum and proper interaction with persons with mental impairments training, for each certified telecommunicator during each two-year period.”

25. HB93 - Three new sections were created by this legislation. Section 3 …requires “The chief law enforcement officer of a state, county or municipal law enforcement agency who was elected or appointed prior to July 1, 2011 shall complete a minimum of two hours of crisis management, including crisis intervention, confrontation de-escalation practicum and proper interaction with persons with mental impairments training, no later than July 1, 2012.”

26. Definitions As used in this section, "mental impairment" includes: a mental illness, developmental disability, posttraumatic stress disorder, dual diagnosis, autism, youth in crisis and traumatic brain injury.

27. Affected Training areas: 1. Basic Law Enforcement Training Academies 2. Officer Annual In-service Training 3. Telecommunicator Annual In-service Training 4. Chief’s & Sheriff’s In-service Training Affected Training Areas

28. 43-1-10. Emergency mental health evaluation and care. A peace officer may detain and transport a person for emergency mental health evaluation and care in the absence of a legally valid order from the court only if: (1) the person is otherwise subject to lawful arrest; (2) the peace officer has reasonable grounds to believe the person has just attempted suicide; (3) the peace officer, based upon his own observation and investigation, has reasonable grounds to believe that the person, as a result of a mental disorder, presents a likelihood of serious harm to himself or others and that immediate detention is necessary to prevent such harm. Immediately upon arrival at the evaluation facility, the peace officer shall be interviewed by the admitting physician or his designee; or (4) a licensed physician or a certified psychologist has certified that the person, as a result of a mental disorder, presents a likelihood of serious harm to himself or others and that immediate detention is necessary to prevent such harm. Such certification shall constitute authority to transport the person. Emergency Mental Health Evaluations 43-1-10 NMSA

29. Traumatic brain injury (TBI), a form of acquired brain injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. Traumatic Brain Injury

30. Autism • Time article- March 29, 2012 • Rate in 2006 was 1 in 110, today it is 1 in 88 resulting in a 25% increase • Definition continues to shift • DSM-5 will have adverse effect • Families will no longer be eligible for services

31. Autism • Fastest-growing developmental disability; 1,148% growth rate’ • 1 to 1.5 million Americans live with an autism spectrum disorder • $60 billion annual cost

32. Autism Children and adults with autism spectrum disorders are as varied in their interests, personalities, character, temperaments, and communication styles as anyone else. It's possible to have autism and have a cheerful, moody, serious, or cranky personality type.

33. Autism One person with autism might appear relatively comfortable with eye contact and another might panic when looked in the eye. It's even possible to be an affectionate touchy-feely sort of individual, with autism, or to be one that avoids even the slightest touch. Human behavior is far too complex and unpredictable to pigeon-hole anybody. No two persons behave exactly alike, with or without autism.

34. Autism There are two identifying features of autism spectrum disorders, along with a tendency to engage in atypical repetitive behaviors, that unite all persons with autism, they all have difficulty with: socialization and communication.

35. Why are they a Police Problem? Persons with an ASD are 7 times more likely to encounter the police than other individuals, because their unique communication styles and social characteristics may frighten or disturb some people. The subject with ASD will also sometimes become frightened or over-stimulated and engage in challenging or seemingly offensive behaviors. It is estimated that on 4 out 5 occasions, police will be called for an autistic subject, due to their unusual behavior, and not because of dangerous or criminal activity.

36. More often Victims Persons with autism are also more likely to be victimized than other persons. Because of their impaired ability to communicate and socially interact, they may be more likely to be victims of institutional abuse in group homes, treatment facilities, nursing homes, schools, hospitals, and residential facilities. Children and adults with autism are often bullied, due to their unique social characteristics.

37. PTSD is a real illness. PTSD can initiate after experiencing a dangerous event, such as war, a hurricane, or bad accident. You do not have to be physically hurt to get PTSD. It is possible to arise after you see other people, such as a friend or family member, get hurt. Post-Traumatic Stress Disorder (PTSD)

38. Symptoms must last more than one month to be considered PTSD. In order to find out if one has PTSD, they should talk to their doctor or health care provider. Post-Traumatic Stress Disorder (PTSD)

39. The term dual diagnosis is used to describe the comorbid condition of a person considered to be suffering from a mental illness and a substance abuse problem. The concept can be used broadly such as: depression and alcoholism, or can be restricted to specify severe mental illness (e.g. psychosis, schizophrenia ) and substance misuse disorder (e.g. cannabis abuse), or a person who has a milder mental illness and a drug dependency, such as panic disorder or generalized anxiety disorder and is dependent on opioids. Dual Diagnosis

40. Dual Diagnosis • According to reports published in the Journal of the American Medical Association (JAMA): • Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse • Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness

41. Dual Diagnosis • Violence is more prevalent among the dually diagnosed • Domestic violence and suicide attempts are more common • Sexual abuse is also more of a problem

42. Developmental disabilities are a diverse group of severe chronic conditions that are due to mental and/or physical impairments. The term is used most commonly to refer to disabilities affecting daily functioning in three or more of the following areas: Capacity for independent living Economic self sufficiency Learning Mobility Receptive and expressive language, Self-care, Self-direction Developmental Disabilities

43. Classifications of Impairment Developmental disabilities are usually classified as severe, profound, moderateormild, as assessed by the individual's need for supports, which may be life-long. Generally, persons in the mildcategory may be able to live independently and participate in life-long employment. Moderate category persons will, most often, need varying levels of support from their families or from community agencies. The profound and severe category persons are more likely to have very high levels of dependence with many requiring intensive supports as their mastery of activities of daily living (ADLs) is generally quite limited or non-existent. Developmental Disabilities

44. The term first appeared in U.S. law in 1970, when Congress used the term to describe the population of individuals who had historically been placed in state institutions, in its effort to improve conditions in these dehumanizing facilities (P.L. 91-517, "The Developmental Disabilities Services and Facilities Construction Act of 1970"). The law has since been amended many times, and now calls for the full community inclusion and self-determination of people with developmental disabilities (P.L. 106-402). Currently, United States Code title 42, Chapter 144 defines individuals as having a developmental disability or delay if they possess the following: Mental retardation Cerebral palsy Autism spectrum disorders Various genetic and chromosomal disorders such as Down syndrome Fragile X syndrome, Fetal Alcohol Spectrum Disorders Developmental Disabilities and the Law

45. Building blocks to de-escalation: Patience Empathy Professionalism Compassion Building Blocks to de-escalation

46. "Most people with mental illness are not violent, but for their own safety and the safety of others officers should be aware that some people with mental illness who are agitated and possibly deluded or paranoid may act erratically, sometimes violently. If the person is acting erratically, but not directly threatening any other person or him- or herself, such an individual should be given time to calm down. Patience

47. Empathy means to accurately and sensitively understand the other person's experience, feelings, and concerns. The empathetic officer will accurately sense the person's feelings as if they were his or her own without becoming lost in the other person's concerns. Empathy

48. If the officer can effectively show empathetic understanding, then he or she will be setting up the conditions whereby the crisis situation may be defused, calmed, and contained. Empathy

49. Officers who practice and use, (over and over again) the techniques of empathetic understanding, will become more proficient and more successful as time goes on. Empathetic responding is a skill that will make officers more successful not only in police work but also in one's daily living. Empathy

50. 1. Non Crisis Encounter: Typical subject encounters involve individuals who able to think without impairment, control their actions, and able to respond to commands. Two Encounter Types