Criminal Justice & Mental Illness: Principles and Application, A New Beginning

1. Criminal Justice & Mental Illness: Principles and Application, A New Beginning NAMI Indiana Indiana University Purdue University

2. Pam McConey, M.A.E. Mike Kempf, Ret. Alan Schmetzer, M.D. Joe Vanable, Ph.D. Joan Lafuze, Ph.D. Christine Jewell, B.S. Kellie Meyer, M.A. Your Speakers:

3. How this project began

4. Three Largest Psychiatric Institutions • LA County Jail • Cook County Jail in Chicago • Rikers Island in NY

5. Indiana’s largest Psychiatric facility Wabash Valley Correctional Facility

6. Developing Rapport

7. The Impact of the Family Perspective

8. Our Developmental Approach • Defining Mental Illness • Decisions about Categories • Decisions about Treatments • Emphasizing the role of our target audience

9. The Process • We spent time as a development team, discussing what was needed and both what we wanted to present and how. • We did pilot test runs, using ourselves as the “audience.” • We refined and re-wrote – even doing some minor re-writes as we learned more about Department of Corrections (D.O.C.) personnel’s responses to our programs.

10. Defining Mental illness • We wanted: • Clarity • Impact • To accomplish this, we worked carefully on: • Wording • Small words rather than large whenever possible • Use of definitions when big, unfamiliar words were needed • Examples – from popular movies

11. Conscious Decisions on Categories • Use of only the diagnoses to which D.O.C. staff were likely to be exposed, for example: • Antisocial Personality Disorder • Alcohol Dependence • Depression • Schizophrenia • Use of both current “diagnostic” names and more common terms – for example, when “Bipolar Disorder” was discussed, the older term, “Manic Depressive” was also given.

12. Keys to “Treatment” Presentation • Discuss mainly treatments available within D.O.C. • Knowledge of D.O.C. formulary • And D.O.C. utilization of mental health professionals’ time • When other treatments are mentioned, such as Electro-convulsive Therapy, work vigorously to dispel myths.

13. Emphasis on How Staff Are Important • Discussion of how, as front line people “in the trenches,” they are really the eyes and ears of the treating professionals. • The staff truly know “the population.” • They can identify those who need evaluation.

14. Suggesting Alternatives • Helping the staff members feel empowered. • Letting them know that we do not expect them to be diagnosticians. • Giving them options about what to do in typical but difficult situations.

15. Letting the Audience Participate • The role play activities were opportunities to: • Have fun. • Laugh about how things could be handled poorly. • Practice responses that were more likely to succeed. • Break up talks that – let’s face it – could be boring!

16. Flexibility • We have a program that can be modified for special needs. • For example, concentrating on suicide in a facility dealing with two recent such episodes. • This is very useful for our different D.O.C. facilities and their leaders at different times.

17. Teamwork • The importance of all team members cannot be over-emphasized: • Family members • Consumers • Educators • Psychiatrists • A NAMI-Indiana Administrator • And a Theater Major! • All had a lot to offer for each module.

18. The importance of the knowing the Biological Basis of Mental Illness

19. The Role of the Nervous System & Synapses • Most of our behavior is controlled by neurons in the brain • Ten billion neurons • Many different regions of the brain

20. Focus: Mental Illness is Real and Treatable • Not rare • Schizophrenia ca. 1% • Bipolar Disorder ca. 2% • Major Depression ca. 5% • Has a Biological Basis • Synapses Crucial • Most medications repair inadequate synapse function • Also has basis in “Nurture” • Nurture can be quite good • Nurture can be awful • Usually somewhere in between

21. Bootstrap Approach? • Common to think that sheer effort is all that’s needed to manage mental illness • Especially in the case of depression • Virtually everyone has been “depressed” at some time or another • Death of loved one • Get fired • Don’t get promoted • The majority work through this • Those with major depression cannot without adequate treatment

22. Tongue Rolling Analogy • Ability Inherited • Either you can or you cannot • Virtually any group of any size will have some who cannot • Can (in a friendly way) chide those who cannot • Try harder - look, it’s easy! • They usually get the point • Can’t treat tongue problem • Can treat mental illness

23. Manage, Not Cure; Chronic illness • Often nay-sayers (read Scientologists) • Disparage treatment • Can’t cure severe mental illness • So why try? • Broken Arm • Break heals, take the cast off • Treatment limited, good as new • Insulin-Dependent Diabetes • With treatment, blood glucose level becomes normal • Cant stop, must continue treatment indefinitely • Same with Severe Mental Illness

24. Data Impressive • Comparisons are striking: Treatment Success Rate Disorder 52% Cardiovascular Care Angioplasty 41% 80% Bipolar Disorder Major Depression 70% 60% Schizophrenia

25. Main points: Treatment works Without our cooperation, the offenders access to the needed treatment is hindered Challenge to be part of the problem or part of the cure!

26. Interacting with Persons who Have a Mental Illness • Our goals for the section • Making mental illnesses “real” for participants • Emphasizing the person not the illness • Presenting personal messages from consumers • Giving very practical directions for interacting

27. Making Mental Illness Real • Comparing mental illnesses with others • No more behavioral than a heart attack • As real as paralysis or amputation • Same symptoms as with trauma • Comparison with Phineas Gage

28. Emphasizing The Person Not the Illness • Points that we make as family • A person has strengths • A person is the member of a family • A person is changed by illness • Illness is to be understood not feared • The role play reinforces these points

29. Presenting Personal Accounts • We read a personal account by a consumer that emphasizes the power of other people to restore him to health • One of our consumers tells of her personal experiences including arrest

30. Giving Very Practical Directions for Interacting • We read point by point interactively from the pocket card that each participant receives as a guide.

31. Responses to the Issues Those with mental illness… So you need to… • Have trouble with reality • Be simple, truthful • Are fearful • Stay calm • Are insecure • Be accepting • Have trouble concentrating • Be brief; repeat • Are over stimulated • Limit input • Easily become agitated • Recognize agitation • Have poor judgment • Not expect rational discussion

32. Responses to the Issues Those with mental illness… So you need to… • Are preoccupied • Get attention first • Are withdrawn • Initiate relevant conversation • Have changing emotions • Disregard • Have changing plans • Keep to one plan • Have little empathy for you • Recognize as a symptom • Believe delusions • Ignore, don’t argue • Have low self-esteem and motivation • Stay positive

33. The 4 “C’s” • Calmness • Caring • Communication • Consistency

34. “In Our Own Voice” • Received remarkable feedback when staff could interact directly with a consumer of mental health services

35. Was all of this worth knowing? • Use of force decreased by 70% • Battery by bodily waste decreased by 50 %

36. “Where do we go from here?”