Criminal Justice & Mental Criminal Justice & Mental Illness: Illness:

Principles and Application, A Principles and Application, A New BeginningNew Beginning

NAMI IndianaNAMI Indiana Indiana UniversityIndiana University Purdue UniversityPurdue University

Your SpeakersYour Speakers::

Pam McConey, M.A.EPam McConey, M.A.E.. Mike Kempf, Ret.Mike Kempf, Ret.

Alan Schmetzer, M.D.Alan Schmetzer, M.D. Joe Vanable, Ph.D.Joe Vanable, Ph.D. Joan Lafuze, Ph.D.Joan Lafuze, Ph.D.

Christine Jewell, B.S.Christine Jewell, B.S. Kellie Meyer, M.A.Kellie Meyer, M.A.

How this How this project project beganbegan

Three Largest Three Largest Psychiatric Psychiatric InstitutionsInstitutions

LA County JailLA County Jail Cook County Cook County

Jail in ChicagoJail in Chicago Rikers Island Rikers Island

in NYin NY

Indiana’s largest Indiana’s largest Psychiatric facilityPsychiatric facility

Wabash Wabash Valley Valley Correctional Correctional FacilityFacility

Developing RapportDeveloping Rapport

The Impact of the Family The Impact of the Family PerspectivePerspective

Our Developmental ApproachOur Developmental Approach

Defining Mental IllnessDefining Mental Illness Decisions about CategoriesDecisions about Categories Decisions about TreatmentsDecisions about Treatments Emphasizing the role of our target audienceEmphasizing the role of our target audience

The ProcessThe Process

We spent time as a development team, We spent time as a development team, discussing what was needed and both discussing what was needed and both what we wanted to present and how.what we wanted to present and how.

We did pilot test runs, using ourselves We did pilot test runs, using ourselves as the “audience.”as the “audience.”

We refined and re-wrote – even doing We refined and re-wrote – even doing some minor re-writes as we learned some minor re-writes as we learned more about Department of Corrections more about Department of Corrections (D.O.C.) personnel’s responses to our (D.O.C.) personnel’s responses to our programs.programs.

Defining Mental illnessDefining Mental illness

We wanted:We wanted: ClarityClarity ImpactImpact

To accomplish this, we worked carefully To accomplish this, we worked carefully on:on: WordingWording

Small words rather than large whenever possibleSmall words rather than large whenever possible Use of definitions when big, unfamiliar words were Use of definitions when big, unfamiliar words were

neededneeded Examples – from popular moviesExamples – from popular movies

Conscious Decisions on CategoriesConscious Decisions on Categories

Use of only the diagnoses to which D.O.C. Use of only the diagnoses to which D.O.C. staff were likely to be exposed, for staff were likely to be exposed, for example:example: Antisocial Personality DisorderAntisocial Personality Disorder Alcohol DependenceAlcohol Dependence DepressionDepression SchizophreniaSchizophrenia

Use of both current “diagnostic” names and Use of both current “diagnostic” names and more common terms – for example, when more common terms – for example, when “Bipolar Disorder” was discussed, the older “Bipolar Disorder” was discussed, the older term, “Manic Depressive” was also given.term, “Manic Depressive” was also given.

Keys to “Treatment” PresentationKeys to “Treatment” Presentation

Discuss mainly treatments available Discuss mainly treatments available within D.O.C.within D.O.C. Knowledge of D.O.C. formularyKnowledge of D.O.C. formulary And D.O.C. utilization of mental health And D.O.C. utilization of mental health

professionals’ timeprofessionals’ time When other treatments are When other treatments are

mentioned, such as Electro-mentioned, such as Electro-convulsive Therapy, work vigorously convulsive Therapy, work vigorously to dispel myths.to dispel myths.

Emphasis on How Staff Are Emphasis on How Staff Are ImportantImportant

Discussion of how, as front line Discussion of how, as front line people “in the trenches,” they are people “in the trenches,” they are really the eyes and ears of the really the eyes and ears of the treating professionals.treating professionals.

The staff truly know “the population.”The staff truly know “the population.” They can identify those who need They can identify those who need

evaluation.evaluation.

Suggesting AlternativesSuggesting Alternatives

Helping the staff members feel Helping the staff members feel empowered.empowered.

Letting them know that we do not Letting them know that we do not expect them to be diagnosticians.expect them to be diagnosticians.

Giving them options about what to do Giving them options about what to do in typical but difficult situations.in typical but difficult situations.

Letting the Audience ParticipateLetting the Audience Participate

The role play activities were The role play activities were opportunities to:opportunities to: Have fun.Have fun. Laugh about how things could be handled Laugh about how things could be handled

poorly.poorly. Practice responses that were more likely to Practice responses that were more likely to

succeed.succeed. Break up talks that – let’s face it – could be Break up talks that – let’s face it – could be

boring!boring!

FlexibilityFlexibility

We have a program that can be We have a program that can be modified for special needs.modified for special needs. For example, concentrating on suicide in For example, concentrating on suicide in

a facility dealing with two recent such a facility dealing with two recent such episodes.episodes.

This is very useful for our different This is very useful for our different D.O.C. facilities and their leaders at D.O.C. facilities and their leaders at different times.different times.

TeamworkTeamwork

The importance of all team members The importance of all team members cannot be over-emphasized:cannot be over-emphasized: Family membersFamily members ConsumersConsumers EducatorsEducators PsychiatristsPsychiatrists A NAMI-Indiana AdministratorA NAMI-Indiana Administrator And a Theater Major!And a Theater Major!

All had a lot to offer for each module.All had a lot to offer for each module.

The importance of the knowing The importance of the knowing the Biological Basis of Mental the Biological Basis of Mental

IllnessIllness

The Role of the Nervous The Role of the Nervous System & SynapsesSystem & Synapses

Most of our Most of our behavior is behavior is controlled by controlled by neurons in the brainneurons in the brain

Ten billion neuronsTen billion neurons Many different Many different

regions of the brainregions of the brain

Focus: Mental Illness is Real Focus: Mental Illness is Real and Treatableand Treatable

Not rareNot rare Schizophrenia ca. 1%Schizophrenia ca. 1% Bipolar Disorder ca. 2%Bipolar Disorder ca. 2% Major Depression ca. 5%Major Depression ca. 5%

Has a Biological BasisHas a Biological Basis Synapses CrucialSynapses Crucial Most medications repair inadequate Most medications repair inadequate

synapse functionsynapse function Also has basis in “Nurture”Also has basis in “Nurture”

Nurture can be quite goodNurture can be quite good Nurture can be awfulNurture can be awful Usually somewhere in betweenUsually somewhere in between

Bootstrap Approach?Bootstrap Approach?

Common to think that sheer effort is all Common to think that sheer effort is all that’s needed to manage mental illnessthat’s needed to manage mental illness Especially in the case of depressionEspecially in the case of depression Virtually everyone has been “depressed” at Virtually everyone has been “depressed” at

some time or anothersome time or another Death of loved oneDeath of loved one Get firedGet fired Don’t get promotedDon’t get promoted

The majority work through thisThe majority work through this Those with major depression cannot Those with major depression cannot

without adequate treatmentwithout adequate treatment

Tongue Rolling AnalogyTongue Rolling Analogy

Ability InheritedAbility Inherited Either you can or you cannotEither you can or you cannot Virtually any group of any size will have Virtually any group of any size will have

some who cannot some who cannot Can (in a friendly way) chide those who Can (in a friendly way) chide those who

cannotcannot Try harder - look, it’s easy!Try harder - look, it’s easy! They usually get the pointThey usually get the point

Can’t treat tongue problemCan’t treat tongue problem Can treat mental illnessCan treat mental illness

Manage, Not Cure; Chronic illnessManage, Not Cure; Chronic illness

Often nay-sayers (read Scientologists) Often nay-sayers (read Scientologists) Disparage treatmentDisparage treatment Can’t cure severe mental illnessCan’t cure severe mental illness So why try?So why try?

Broken ArmBroken Arm Break heals, take the cast offBreak heals, take the cast off Treatment limited, good as newTreatment limited, good as new

Insulin-Dependent DiabetesInsulin-Dependent Diabetes With treatment, blood glucose level becomes normalWith treatment, blood glucose level becomes normal Cant stop, must continue treatment indefinitely Cant stop, must continue treatment indefinitely

Same with Severe Mental IllnessSame with Severe Mental Illness

Data ImpressiveData Impressive

Comparisons are striking:Comparisons are striking:Disorder Treatment Success Rate

Cardiovascular Care

Angioplasty

Bipolar Disorder

Major Depression

Schizophrenia

52%

41%

80%

70%

60%

Main points:Main points:Treatment worksTreatment worksWithout our cooperation, the Without our cooperation, the offenders access to the needed offenders access to the needed treatment is hinderedtreatment is hinderedChallenge to be part of the Challenge to be part of the problemproblem or part of the or part of the ccureure!!

Interacting with Persons who Interacting with Persons who Have a Mental IllnessHave a Mental Illness

Our goals for the sectionOur goals for the section

Making mental illnesses “real” for participantsMaking mental illnesses “real” for participants Emphasizing the person not the illnessEmphasizing the person not the illness Presenting personal messages from consumersPresenting personal messages from consumers Giving very practical directions for interactingGiving very practical directions for interacting

Making Mental Illness RealMaking Mental Illness Real

Comparing mental illnesses with Comparing mental illnesses with othersothers No more behavioral than a heart attackNo more behavioral than a heart attack As real as paralysis or amputationAs real as paralysis or amputation Same symptoms as with traumaSame symptoms as with trauma Comparison with Phineas Gage Comparison with Phineas Gage

Emphasizing The Person Not Emphasizing The Person Not the Illness the Illness

Points that we make as familyPoints that we make as family A person has strengthsA person has strengths A person is the member of a familyA person is the member of a family A person is changed by illnessA person is changed by illness Illness is to be understood not fearedIllness is to be understood not feared

The role play reinforces these pointsThe role play reinforces these points

Presenting Personal AccountsPresenting Personal Accounts

We read a personal account by a We read a personal account by a consumer that emphasizes the consumer that emphasizes the power of other people to restore him power of other people to restore him to healthto health

One of our consumers tells of her One of our consumers tells of her personal experiences including arrestpersonal experiences including arrest

Giving Very Practical Directions Giving Very Practical Directions for Interactingfor Interacting

We read point by point interactively We read point by point interactively from the pocket card that each from the pocket card that each participant receives as a guide.participant receives as a guide.

Responses to the IssuesResponses to the Issues

So you need to…Those with mental illness…

Have trouble with reality Are fearful

Are insecure Have trouble concentrating

Are over stimulated

Easily become agitated Have poor judgment

Be simple, truthful

Stay calm Be accepting

Be brief; repeat

Limit input

Recognize agitation Not expect rational discussion

Responses to the IssuesResponses to the Issues

So you need to…Those with mental illness… Are preoccupied Are withdrawn

Have changing emotions

Have changing plans

Have little empathy for you Believe delusions Have low self-esteem and

motivation

Get attention first

Initiate relevant conversation Disregard

Keep to one plan

Recognize as a symptom

Ignore, don’t argue Stay positive

The 4 “C’s”The 4 “C’s”

CalmnessCalmness CaringCaring CommunicationCommunication ConsistencyConsistency

““In Our Own Voice”In Our Own Voice”

Received remarkable feedback when Received remarkable feedback when staff could interact directly with a staff could interact directly with a consumer of mental health servicesconsumer of mental health services

Was all of this worth Was all of this worth knowing?knowing?

Use of force decreased by 70%Use of force decreased by 70%

Battery by bodily waste decreased by 50 Battery by bodily waste decreased by 50 %%

““Where do we go from here?Where do we go from here?””