16' PERSONS WITH MENTAL IMPAIRMENTS

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16. PERSONS WITH MENTAL IMPAIRMENTS
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Note to Instructor Commission Course, Mental
Health Officer (4001) can be used as a
supplement.
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Unit Goal 16.1 The student will be able to
summarize the issues involving persons with
mental impairments at a jail facility.
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16.1.1 The student will be able to discuss the
jails responsibility for persons with mental
impairments.
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A. Americans with Disabilities Act
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1. The National Institute of Justice examined the
implications of the Americans With Disabilities
Act (ADA) for criminal justice agencies at the
state and local levels. Under the ADA,
corrections facilities must do more than just
identify inmates and employees with mental
disabilities. Now they must also provide mental
health screening, evaluation, and treatment.
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2. Approximately 10 million individuals are
confined in jails in the United States each year.

• An estimated 6.4 of these detainees have a
  severe mental disability.
• Some experts believe this percentage is even
  higher, around 8, and that the percentage of
  female detainees with a severe mental disability
  may be as high as 13.
• This means that jails across the United States
  are dealing with 640-800 thousand detainees with
  mental disabilities each year.

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B. Case law and deliberate indifference
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1. The courts now consider a facilitys
deliberate indifference to an inmates mental
disability the same as that facilitys
indifference to an inmates medical condition.
This standard, deliberate indifference, has
evolved from a series of federal court rulings on
the adequacy of health care and mental health
care in prisons (Cohen, 1985, 1988).
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Simply stated, federal courts have generally
found in favor of prison systems in suits filed
on the basis of inadequate health care, as long
as prison administrators and staff have not
demonstrated a deliberate indifference to the
mental or physical health care needs of the
inmate.
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2. A correctional facility should avoid practices
that screen out or eliminate eligible inmates
from programs and services solely on the basis of
a mental (or physical) disability.
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C. Jail standards
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1. Correctional facilities, including local
jails, should screen all inmates to identify
those with mental or physical disabilities.
Inmates with mental disabilities should be
evaluated by a qualified mental health
professional. Health personnel should have
access to crisis intervention, treatment, and
discharge planning services. It is simply not
enough to provide separate services to those with
mental disabilities since mainstreaming is a
major intent of the ADA.
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2. Inmates with mental disabilities, particularly
those in local jails, are the responsibility of
the community, not of just law enforcement
personnel.
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3. The integration of jail services and community
health services is critical to the success of an
inmates treatment and reintegration into the
community and the continuity of care requirements
of the HSC 614.016.
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4. In accordance with the TCJS 273.1, entitled
Health Services The owner/operator of each
facility shall provide medical, mental, and
dental services in accordance with the approved
health services plan. These services may include,
but shall not be limited to, the services of a
licensed physician, professional and allied
health personnel, hospital, or similar services.
In addition, TCJS 273.5 requires that a mental
disabilities/suicide prevention plan be
implemented.
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16.1.2 The student will be able to define mental
impairment.
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A. Definition of offender with mental
impairment - a person with mental retardation,
mental illness, or a developmental disability who
is arrested or charged with a criminal offense.
(HSC 614.001(7))
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16.1.3 The student will be able to define mental
retardation.
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A. Definition of offender with mental
retardation - significantly sub-average general
intellectual functioning existing concurrently
with deficits in adaptive behavior and originates
during the developmental period. (HSC
591.003(13))
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16.1.4 The student will be able to identify the
characteristics of a person who is mentally
retarded.
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A. General information and statistics
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1. Approximately 3 of the American population is
considered retarded. Although a large percentage
of the jail population (up to 10) can be
classified as having mental retardation.
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2. To determine with certainty whether a person
is mentally retarded requires comprehensive
examinations and tests by qualified individuals.
When officers first encounter a citizen, they
must rely on their own perceptions and minimal
information to determine whether referral or
other actions are appropriate.
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B. Possible characteristics
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1. Physical appearance
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a. Physical signs rarely indicate that a person
is mildly or moderately retarded, but they may
provide an initial clue to look further
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b. Does the person have any obvious physical
disabilities?
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c. Does the person move awkwardly or have poor
motor coordination?
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d. Does the person have a slow reaction time?
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2. Task performance deficiencies - inability to
successfully perform relatively simple tasks such
as the following may indicate the person is
mentally retarded
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a. Reading and writing
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b. Identifying oneself
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c. Telling time
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d. Counting or making change
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e. Using the telephone
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f. Giving directions to their home
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g. Understanding directions or instructions
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3. Ask yourself the following questions
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a. Does the person have any speech defects?
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b. Does the person have a difficult time
understanding your questions?
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c. Is the person unable to use abstract reasoning
concepts?
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d. Does the person have difficulty staying on the
subject you are trying to discuss?
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e. Does the person become distracted easily?
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f. Do the persons eyes maintain normal contact
with yours, or do they wander?
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g. Does the person have someone who speaks for
them in certain situations or transactions?
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h. Is the person easily led or persuaded by
others?
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i. Does the person display an inappropriate
social distance during conversation?
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j. Does the person use hostility and anger to
compensate for intellectual deficits?
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16.1.5 The student will be able to identify
effective communication and interaction skills
for dealing with persons with mental retardation.
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A. The interview
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1. Try to arrange a quiet setting for the
interview
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2. Give reassurance and help the person to relax
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3. Identify yourself and what role you play
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4. State the purpose for the interview
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B. Questioning methods
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1. Ask short, simple questions, use simple
language, and speak slowly
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2. When asking questions, be patient for a reply.
The thought process of certain individuals takes
longer. Repeat the question or information if
needed.
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3. Ask open-ended rather than "yes/no" questions.
A person with limited understanding may answer
yes/no questions without full comprehension.
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4. To crosscheck their responses, repeat their
answers incorrectly. Most individuals who
comprehend will correct the responses.
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5. Use pictures and diagrams if the person does
not comprehend verbal or written language.
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6. The above questions should only serve as a
guideline to identifying someone as possibly
having mental retardation.
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7. Referral to the appropriate agency in the
community will depend upon your agencys practice
in accommodating the offender with mental
retardation.
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8. Precise identification must come from someone
with the appropriate skills.
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9. It is very possible that you may reach a false
conclusion as to someone's mental capacity.
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10. Even though several signs may point to an
offender as having mental retardation there may
be other explanations. People with other
developmental disorders, mental disorders,
certain health problems and handicaps, drug and
alcohol abuse problems, and people who are trying
to beat the system are sometimes mistakenly
identified as having mental retardation.
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16.1.6 The student will be able to explain
important considerations when supervising persons
with mental retardation.
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A. The mentally retarded inmate needs empathy,
support, and understanding. The following tips
on supervising the mentally retarded should
assist the officer in successfully meeting the
inmates needs and the jails needs.
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1. Be specific about expectations. Do not deal in
complex concepts, analogies, or generalities that
will be lost on the retarded person.
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2. Do not assume understanding. Just because the
mentally retarded inmate agrees with you or even
because he repeats information back to you, do
not assume understanding. Some retarded persons
are very adept at hiding their handicap and one
common method used is to parrot information and
pretend to understand.
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3. Use repetition is an effective way to get
information and expectations across in a manner
that will assist retention. Try saying it again
in a slightly different manner.
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4. Take one thing at a time. Assign one task at a
time or deal with one concept at a time. A
retarded person can be easily overwhelmed by more
than one concept or instruction at any one time.
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5. Use plain language. Use simple, plain language
that is not easily misinterpreted. Do not assume
that just because a person uses a word he
understands its meaning.
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16.1.7 The student will be able to define mental
illness.
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A. Definition of mental illness (HSC 571.003 (14))
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1. An illness, disease, or condition, other than
epilepsy, senility, alcoholism, or mental
deficiency, that
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a. Substantially impairs a person's thought,
perception of reality, emotional process, or
judgment or
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b. Grossly impairs behavior as demonstrated by
recent disturbed behavior. (HSC 571.003(14))
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16.1.8 The student will be able to explain
important considerations when handling psychotic
episodes.
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A. Anyone can help a disturbed person during a
crisis situation
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B. Safety during a crisis situation
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1. Maintain position of safety (seek cover if
subject has weapon)
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2. Request appropriate backup
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3. Develop an initial intervention plan
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4. Wait for assistance, and advise assisting
officers of the situation
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5. Confine and isolate the situation
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6. Delay rapid actions (time is a useful tool)
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7. Remain calm
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C. Entering the disturbance
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1. Be aware of the environment
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2. Determine whether the subject has a weapon
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3. Determine whether there are other persons in
the area with subject
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4. Note the entrances and exits
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5. Survey any site damage to assess the degree of
violence
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6. Determine whether all of the disputants are at
the site and where they are positioned
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D. Approaching the subject
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1. Take time to look over the situation
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2. Introduce yourself (even if the subject knows
you) to create an impression of a non-hostile
authority
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3. Use their name repeatedly
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4. State reason for your presence at the scene
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5. Take charge of the situation
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6. Separate persons who are in conflict
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7. Move dangerous objects out of reach/view of
the subject
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8. Remove people or objects that upset the subject
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9. Use people/objects that have positive effect
on the subject
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10. Do not violate the subjects personal
space
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11. Avoid "crowding" or "rushing" the subject
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12. Avoid one-on-one physical confrontations
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13. Divert the subject from anxious thoughts by
asking them about routine information
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14. Maintain control
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15. Use good communication skills
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E. Any interruptions of a disturbed inmates
medication may result in violent behavior,
hallucinations, suicide attempts, and/or various
other symptoms specific to an inmates
psychiatric disability.
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OPTIONAL MATERIAL
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The instructor is not expected to comprehensively
cover all of these statutes, but to briefly
convey the purpose of these statutes and indicate
where information may be found if the need arises.
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A. HSC 573 - Emergency Detention
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1. 573.001 - Apprehension by Peace Officer
Without Warrant
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2. 573.002 - Peace Officers Application for
Detention
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3. 573.011 - Application for Emergency Detention
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4. 573.012 - Issuance of Warrant
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5. 573.022 - Emergency Admission and Detention
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6. 573.045 - Transportation of a Patient
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B. HSC 574 - Court-Ordered Mental Health Services
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1. 574.001 - Application for Court-Ordered Mental
Health Services
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2. 574.021 - Motion for Order of Protective
Custody
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3. 574.022 - Issuance of Order
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4. 574.023 - Apprehension Under Order
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5. 574.027 - Detention in Protective Custody
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6. 574.034 - Order for Temporary Mental Health
Services
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7. 574.035 - Order for Extended Mental Health
Services
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Additional Resources

• Drapkin, M. (1999). Management and Supervision
  of Jail Inmates with Mental Disorders. New
  Jersey Civic Research Institute.
• First Response to Victims of Crime Who Have a
  Disability. (October 2002). Office for Crime
  Victims. U.S. Department of Justice.
• Rehabilitation Act of 1974 (Section 504).