MENTAL HEALTH MENTAL HEALTH CONFERENCECONFERENCE

Bringing Calm to ChaosBringing Calm to Chaos

Stephen Lucente, Ph.D.Stephen Lucente, Ph.D.Correctional Behavioral HealthCorrectional Behavioral Health

Durham, NCDurham, NC

WELCOME

WHAT DOES A TRAINING ON WHAT DOES A TRAINING ON WORKING WITH MENTAL WORKING WITH MENTAL

ILLNESS HAVE TO DO WITH ILLNESS HAVE TO DO WITH WORKING IN JAILS?????WORKING IN JAILS?????

An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year

(Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.)

The estimated percentage of inmates with mental health disorders within the incarcerated population:

Males: 56%

Females: 73%

James, D.J. & Glaze, L.E. (2006). Mental Health Problems of Prison and Jail Inmates. Retrieved July 26, 2007, from http://www.ojp.usdoj.gov/bjs/pubs/pdf/mhppji.htm

SERIOUS MENTAL ILLNESS

1 in 17 Americans (6%) live with a serious mental illness

Several studies conclude that between 15 and 20 percent of the jail and prison population qualify as having serious mental illness.

NORTH CAROLINANORTH CAROLINA

Approximately 14.6% of the NC Approximately 14.6% of the NC prison population meet the prison population meet the criteria for Serious Mental criteria for Serious Mental

IllnessIllness

Inmate population is Inmate population is 40,37940,379

The number of inmates who are estimated to meet the criteria for SMI in North Carolina is….

5,8955,895

A very brief explanation of how we got here……

If you want to understand today, you have to search yesterday.  ~Pearl Buck

Let’s Go Back In TIMELet’s Go Back In TIME

Early 1800’sEarly 1800’s

Dorthea DixDorthea Dix

1880 Census of mentally ill 1880 Census of mentally ill personspersons

• Most comprehensive report up to this time

• identified 40,942 “insane persons” in “hospitals and asylums for the insane.”

• 397 “insane persons” in jails and prisons

1930 Survey1930 Survey

• Studied over 10,000 arrestees

• Only 1.5 % were “insane” at the time of the arrest.

1955 1955

• Population: 165,000,000

• Number of State Psychiatric Beds: 559,000

Deinstitualization

Effects of Deinstitutionalization

• In 1955 there were 340 public psychiatric beds per 100,000 people.

• In 2005 there were 17 public psychiatric beds per 100,000 people.

• 95 percent reduction

North Carolina Effects

• In 1955 there were 232 psychiatric beds available per 100,000 people

• In 2005 there were 17 psychiatric beds available per 100,000 people

Minimum Requirements

• A consensus of experts polled for this report suggests that 50 public psychiatric beds per 100,000 population is a minimum number.

• In North Carolina this would mean that we would need a total of 4,297 beds (or 2,836 beds then we have in total)

19391939

• Lionel Penrose, British psychiatrist and mathematician, wrote paper on relationship between number of state psychiatric beds and that of prisons

• Stated that they were inversely related: as one decreases, the other increases

Prevalence of Mental Illness Prevalence of Mental Illness in Correctionsin Corrections

Individuals displaying symptoms characteristic of mental illness were found to have a 67% higher probability of being arrested than individuals not displaying such symptoms

(Teplin 1984, 2000)

Prevalence of Mental Illness Prevalence of Mental Illness in Correctionsin Corrections

A 2014 study “The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey” stated the following:

•35,000 public-hospital patients Vs.

•356,000 mentally ill inmates

2014 Study

“There is probably no state where mental health services have deteriorated as much as they have in North Carolina over the last decade.”

North Carolina

• 3 psychiatric facilities

• Largest is Central Regional Hospital with 398 beds

• Mecklenburg County Jail (1,904) and Wake County Jail (1,568) both have as many mentally ill individuals as does the state hospitals.

Average Number of Infractions Average Number of Infractions by Inmates in North Carolina by Inmates in North Carolina

Time Served

0-4 Months

5-8 Months

9-24Months

25 or more Months

Overall

PrisonerwithMentalHealthProblems

2.1 2.7 4.5 11.8 6.5

PrisonerWith NOMentalHealthProblems

1.7 2.2 3.3 6.8 3.4

Crisis Intervention TeamCrisis Intervention Team

C I TC I TCRISIS INTERVENTION TEAM: CRISIS INTERVENTION TEAM: A Frontline Response to Working A Frontline Response to Working with Mental Illness in Correctionswith Mental Illness in Corrections

What Is Crisis Intervention Team? What Is Crisis Intervention Team? (CIT)(CIT)

• Effective crisis response for “first responders”

• Began as a Patrol based; pre-booking diversion

• Specialized training for law enforcement officers and correction officers for handling mental health crises

• Built on a foundation of volunteer officers

What Is Crisis Intervention Team? What Is Crisis Intervention Team? (CIT)(CIT)

• Officers have individual responsibility and overall accountability for the crisis situation

• It is a PROGRAM with partnerships to the treatment system and with consumers and consumer advocates

• A change in culture - attitudes and behaviors

• A “Best Practice”

What’s the Field Saying about CIT?What’s the Field Saying about CIT?

http://www.youtube.com/watch?v=37Li1Z4D_To

Who Is CIT For?Who Is CIT For?

• Persons with a mental illness

• Including, those with co-occurring substance use disorders

• Those “in crisis”

Core Elements of CITCore Elements of CIT

• Partnerships with mental health and advocates• Defined Policies and Procedures• Identified CIT Coordinator• Special selection of officers• 24 hours of training• Connection to mental health services• Data collection and evaluation of program• On-going in-service training• Recognition program

Why Become CIT Trained?Why Become CIT Trained?

• Ability to respond quickly• Decrease officer injury• Decrease inmate or probationer injury• Increased officer confidence in their skill• Increase chance for consumer to

connect to mental health system• Reduce liability• Partnerships=Solutions

CIT Training: Learning CIT Training: Learning ObjectivesObjectives

• Explain the signs and symptoms about serious mental illnesses

• Describe the difference and similarities between the three main types of serious mental illness

• Explain key parts of the brain and their connection to the development of mental illness.

CIT Training: Learning CIT Training: Learning ObjectivesObjectives

• Learn new effective ways for managing stress and improve on self-care

• Describe crisis intervention skills that are effective for people with mental illnesses in crisis

• Practice new de-escalation skills

SPECIAL NEEDS DESERVE SPECIAL NEEDS DESERVE SPECIAL CARESPECIAL CARE

C I T