Development and Implementation of a CIT Training Curriculum in a County Jail

1. Development and Implementation of a CIT Training Curriculum in a County Jail

2. Introductions • Joan Cairns, MFT Director of Jail Psychiatric Services • Angelica Almeida, Ph.D. Manager with Jail Psychiatric Services • Michele Fisher Captain and Facility Commander with San Francisco Sheriff’s Department

3. Learning Objectives • Identify ways to collaborate with multiple agencies to develop a CIT Training Curriculum • Identify the steps to implement a CIT Training Curriculum (e.g., what topics should be covered) in jail setting • Identify ways that this intervention improves treatment of incarcerated mentally ill individuals

4. Why Develop a CIT Curriculum for a Jail Setting?

5. Federal Community Mental Health Act • Signed into law in 1963 by President John F. Kennedy • Community based care as an alternative to institutionalization • Led to “transinstitutionalization” and criminalization of mental illness • Rather than receiving treatment in State Hospitals, mentally ill individuals are now incarcerated

6. Today, approximately 1.1 million people with severe mental illness are admitted to U.S. jails each year.

7. “On any given day, between 300,000 and 400,000 people with mental illnesses are incarcerated in jails and prisons across the United States, and more than 500,000 people with mental illnesses are under correctional control in the community.” ~ Mental Health America

8. Jails Today • Rates of mental illness in jails have increased upwards of 50% over the last five years (Hirschkorn & Mitchell, 2011; Wiener, 2012) • Forensic settings now provide significantly more mental health services to individuals than community based treatment • In 2012, San Francisco County provided mental health services to approximately 2.5% of the population, whereas approximately 30% of the jail population has contact with mental health staff at any given time

9. Jails Today • Most individuals (roughly 80%) are arrested for nonviolent offenses such as drug and property offenses (Baillargeon, Binswanger, Penn, Williams & Murray, 2009) • Individuals with mental illness have higher rates of recidivism (Baillargeon et al., 2009; Steadman, Redlich, Callahan, Robbins &Vesselinov, 2010) • County jails see higher rates of mental illness than prisons (Hatcher, 2012) • Custody staff has to be educated on mental health issues in order to create a safe environment and work alongside mental health professionals

10. Purpose of CIT in a Jail Setting • Similar to officers in the community, custody staff are the first responders to crises in a jail • Need to be “armed” with specialized training to address these situations • Develops a collaboration between custody staff and mental health professionals

11. Curriculum Development for Enhanced Practical Interventions for Collaboration (EPIC) Training

12. Community versus Jails • Important to consider the unique environment of a jail setting • Note that research done in the community does not often translate to forensic settings (e.g., risk factors for suicide)

13. Commitment to the Program • Training doesn't work without buy in from all parties • Choosing instructors that represent all perspectives (i.e., medical, psychiatric, custody) • Modeling collaboration and mutual respect

14. Topics for Training • Introduction to Mental Illness • Major mental illness • Personality Disorders • Cognitive Disorders • Symptoms that may be seen in custody • Interventions • Behavioral Plans • Collaboration between deputized staff, mental health staff, medical staff • Psychiatric Housing Units • Administrative Segregation Group

15. Topics for Training • Suicide Prevention • Difference between general population and forensic setting • Risk factors and warning signs of suicide risk • Assessing for suicide risk • Intervention strategies • Observation Housing • Use of direct vision facilities • Use of other inmates • Do not house alone • Suicide Prevention Poster • Brief Training Videos in Muster

17. Topics for Training • Special Populations • First arrestees and serious charges • Veterans • Transitional Age Youth • Elderly • Developmental Disorders • Substance Abuse Disorders and Detox • Symptoms • Interventions

18. Topics for Training • Active Listening • Communication Strategies • Use of Force with Mentally Ill • Job Burnout • Community Resources

19. Presentations • 2-3 day intensive training • Outings to community programs • Tangible tools for immediate use • Use of scenarios, videos, role playing • Use of recorded lectures for brief introductions to major topics

20. Collaboration • Team approach to difficult cases • Vital for safety and security of facilities • Working with mental health and medical staff • Myths held by law enforcement about mental health providers

21. Impact of CIT Curriculum • Feedback from deputies • Impact on jail culture and how deputized staff interacts with inmates • Anticipated outcomes based on community model: • Reduced violence between staff and inmates • Reduced risk of injury • Increase use of verbal de-escalation rather than hands-on interventions • Increased identification of individuals at risk for suicide

22. Further Information • Angelica Almeida, Ph.D. • Angelica.almeida@sfdph.org • 510-520-8239 • Joan Cairns, MFT • Joan.cairns.@sfdph.org • 650-219-7275

23. Questions