Mental Illness: A Guide for Correctional Employees

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Mental Illness A Guide for Correctional
Employees
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Course Information

• Data source ODOC Correctional Mental Health
  Services, January 2004, Robert J. Powitzky,
  Ph.D., CMHO and Mary Looman, Ph.D., Clinical
  Coordinator
• Additional data source CLEET Training lesson
  plan 04-1086, dated 2/11/2004
• Course design Lynne Presley, Oklahoma Dept. of
  Corrections, Staff and Organizational Development
  Unit,lynne.presley_at_doc.state.ok.us
• Course published July 26, 2004

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Credits
We would like to thank the following people who
helped to make this course possible
Photography Betty Lytle Dennis Cunningham,
Private Prison Administration Additional
Photography Lynne Presley Probation and Parole
Consultant Susan Traywick, SR PPO, Central
District Community Corrections
Actors Linnie Cops, SR PPO, SE District Community
CorrectionsKenneth Batson, COC, Joseph Harp
CCMichael Rayner, COC, Mabel Bassett CCBilly
Moore, SR CTO, Gene Stipe CTAJohnny Nixon, SR
CTO, Gene Stipe CTATerry Goodall, SR CTO,
EmployeeTraining Development CenterDarlene
Hoyt, A.A., Employee Training Development
Center
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Course Objectives
At the end of this course, students will be able
to

• Define the term mental illness
• Understand the ODOC mental health classification
  system
• Learn skills necessary for crisis intervention
  with persons with mental illness

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Who Should Take This Course?
Material in this course is appropriate for all
agency employees. This course is specific to
our agency, and will satisfy the mandatory yearly
requirement for CLEET mental health training.
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What is Mental Health?

• Mental health may be summarized as
• The ability to perform tasks that sustain life
  and relationships
• The ability to carry out responsibilities
• The ability to cope with conflicts and distress
• The ability to realistically perceive the
  motivation of others

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What is Mental Illness?
Mental illness can be defined as a bio-chemical
brain dysfunction that causes the person to have
a substantial disorder of thought or mood that
significantly impairs judgment, behavior,
capacity to recognize reality or cope with the
ordinary demands of life, and that is manifested
by substantial suffering or disability.
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Symptoms Have Other Causes
Dont assume that just because someone is acting
oddly, its due to mental illness. Since some
other medical illnesses and medications have
symptoms similar to those associated with mental
illnesses, its important that a physician
evaluate the patients health.
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Types of Mental Illness

• Mental illness is a complex subject that includes
  different types, symptoms and behaviors. Types
  of mental illness include
• Psychotic disorders
• Mood disorders
• Anxiety disorders
• Personality disorders with psychotic symptoms
  (Cluster B)

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Types of Mental Illness
Psychotic Disorders
People who suffer from psychotic disorders may
experience bizarre and disturbing thoughts -
including hallucinations and delusions - that
cannot be controlled.
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Types of Mental Illness
Mood Disorders
People who suffer from mood disorders have a
state of mind thats excessively sad or
excessively elated. Persons with mood disorders
also have the highest suicide rate of all types
of mental illness.
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Types of Mental Illness
Anxiety Disorders
People who suffer from anxiety disorders
experience excessive or inappropriate fear and
uncertainty. This disorder is the most common
type in the U.S., but only 25 of afflicted
persons seek treatment for it.
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Types of Mental Illness
Personality Disorders with Psychotic Symptoms
Personality disorders are deeply ingrained
patterns of maladaptive behavior. Some of these
disorders are commonly associated with other
symptoms of mental illness or brain injury, such
as psychotic symptoms or impulse control
problems. People with these disorders may have a
long-term history of substance abuse.
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Types of Mental Illness
Personality Disorders with Psychotic Symptoms,
continued
People with these disorders may be self-abusive
and/or chronically hostile toward others,
especially authority figures.
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Symptoms of Mental Illness
The behavior of persons with mental illness can
differ from the population at large. The
following symptoms have been observed in law
enforcement settings, both on the street and
within correctional institutions, and may provide
a signal that the person needs mental health
treatment

1. Extreme behavior changes (from passive to
   aggressive, or vice-versa)
2. Loss of memory or orientation they may not
   recognize your authority, and they may not know
   who or where they are.
3. They may have bizarre belief systems, including
   thinking that someone is plotting against them or
   saying bad things about them

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Symptoms of Mental Illness

1. May have grandiose ideas, e.g. I am God
2. May talk to himself/herself, or hear imaginary
   voices
3. May see visions that dont really exist
4. May act frightened or panicked and jump at sudden
   sounds
5. May become aggressive and try to injure
   himself/herself or others

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Mental Health Issues and You
Why should you, as a DOC employee, be concerned
with mental health issues? Consider this As of
January 2004, approximately 6,000 (26) Oklahoma
inmates 50.3 of females and 24.4 of males -
had a history of or were currently exhibiting
some form of mental illness. These
numbers/percentages have dramatically increased
since 1998.
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Mental Health Issues and You
As of January 2004, approximately 4,000 inmates
were taking some sort of psychotropic medication
as prescribed, and about 20 of inmates with
mental illness refused to take the medication
that was prescribed.
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Mental Health Factors in Prison
There are several factors in the prison
environment that may precipitate symptoms of
mental illness

• Crowded conditions
• Lack of privacy
• Concerns about ones personal safety
• Loss of control over ones life
• Loss of personal identity
• Separation from family and friends

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Inmates with Mental Illness
Studies support the observation that prisons have
become the default mental health system as more
state hospitals and services close due to lack of
funding. Prisons have inmates who

• have a clear history of mental illness at intake
• have an underlying mental illness triggered by
  the prison environment
• have a mental illness combined with substance
  abuse that present complex symptoms

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Mental Illness and Clients
Probation and parole officers also experience
persons under supervision with mental illness.
In fact, the implementation of Mental Health
Courts has increased the number of such clients.
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Mental Health Issues and You

• A common mistaken belief is that persons with
  mental illness are violent. The truth is that,
  as a group, they are no more likely to be violent
  than other people. The predictors of violence
  are common for all groups
• history of violence
• substance abuse
• life style (adherence to treatment)
• Is there anything we can do to help these people
  and lessen the chance of emotional and physical
  confrontations, while protecting the public,
  other employees and inmates, and ourselves?

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Mental Health Issues and You
Absolutely! Remember that mental illness is a
brain dysfunction, and realize that the affected
person does not want this illness. The most
important thing to remember is that 95 of the
time a person with mental illness will function
well. When symptoms of mental illness occur,
accept the situation as it is, and assist the
affected person in solving the problem safely and
humanely. How do we do this? Remember the
acronym SMILE
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Mental Health Crisis Intervention
S ? Safety first M ? Manage your own emotions
and perceptions I ? Influential behavior
creates a working relationship L ? Listen
carefully and empathically E? Explore
alternatives for solving the problem or reducing
stress
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Mental Health Crisis Intervention
S ? Safety first

• Practice safe positioning. Keep your distance
  from the inmate, so that you can make a quick
  exit if necessary.

PPO Home Visit
Facility
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Mental Health Crisis Intervention
S ? Safety first, continued

• Call for backup, so that YOU can focus on the
  inmate, and the backup staff can focus on
  everyone else in the area.

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Mental Health Crisis Intervention
S ? Safety first, continued

• Call for a mental health professional.

Dont hesitate to ask for help from people who
are trained in crisis intervention. Write down
the name of the inmate who needs assistance, so
you can relay the information when you call.
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Mental Health Crisis Intervention
S ? Safety first, continued

• Stay aware of the persons behavior, and take
  the time you need to avoid assertive
  intervention.

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Mental Health Crisis Intervention
S ? Safety first, continued
Home visits for PP clients

• Clients may refuse or forget to take their
  medication. If this happens, a client with a
  mental illness may not recognize you, and may be
  threatened by your presence. Remind them of who
  you are and why you are at their home.

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Mental Health Crisis Intervention
S ? Safety first, continued
Home visits for PP clients

• Be friendly but stay watchful, especially of
  their body language and hands in case they pick
  up a weapon. Dont sit down stay on your feet,
  and position yourself so theres a clear path to
  a door leading outside. If the client becomes
  agitated, speak in a friendly manner.

• If the agitation escalates and the situation
  becomes unsafe, leave.

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Mental Health Crisis Intervention
M ? Manage your own emotions and perceptions

• Maintain a non-judgmental attitude, and dont
  take offensive language or comments personally
• Dont let your biases about the persons
  heritage, crime, race, gender, etc. influence how
  you act
• Stay calm - do not allow yourself to become
  angry. Employees can get into trouble when they
  think theyre going to look bad, or their
  authority is being questioned. Remember that a
  person with mental illness is more concerned
  about whats happening in their world than in
  yours!

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Mental Health Crisis Intervention
I? Influential behavior creates a working
relationship

• Maintain eye contact with the inmate
• Speak calmly, slowly, distinctly, and
  respectfully
• Use a friendly facial expression
• Present open, caring, non-threatening body
  language
• Validate the persons situation and feelings

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Mental Health Crisis Intervention
L ? Listen carefully and empathically

• Whether the problem is real to you or not, it is
  real to the inmate. Ask the inmate, Whats
  wrong? Listen to what they tell you.
• Ask straightforward, simple questions, and be
  patient.
• Seek to understand the inmates feelings they
  are key to the solution.

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Mental Health Crisis Intervention
L ? Listen carefully and empathically, contd.
Listening skills are equally important when
dealing with clients under supervision. If a
confrontational situation develops, its
important to talk reasonably and in a
non-threatening manner. The key is to manage the
situation to avoid an escalation that will lead
to violence. In fact, the intervention
techniques discussed in this course apply equally
to inmates and persons with mental illnesses who
are under supervision.
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Mental Health Crisis Intervention
E ? Explore alternatives for solving the problem
or reducing stress

• Identify the inmates strengths that might
  assist in problem-solving
• Ask how the inmate has attempted to solve the
  problem, and what he/she thinks might solve the
  problem
• Discuss the consequences of each solution
  suggested
• Stay focused on the immediate problem

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Mental Illness Community Clients
Probation and Parole officers do not always have
mental illness information at the time of the
first visit with a client, because of delays in
receiving paperwork. Additionally, clients
frequently have a court-ordered mental health
assessment, and the Probation Parole Officer
must locate community resources to get these
assessments completed. The SMILE steps listed
in the Mental Health Crisis Intervention section
certainly apply to Probation Parole clients.
Here are some additional considerations . . .
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Mental Illness Community Clients, contd.

• Clients with mental illnesses may be late to
  appointments with you, or miss them altogether.
  They may be overwhelmed with a court-ordered list
  of conditions, which confuses them further. Some
  tips that may help are
• Establish a case plan with small, achievable
  steps

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Mental Illness Community Clients, contd.

• Use motivational techniques and listening
  skills. Strive to build a working relationship
  and sense of trust, then hold them accountable
  for their case plan. Be prepared to repeat
  important points to them, because their illness
  may cause them to forget what youve said.

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Mental Illness Community Clients, contd.

• Clients with a mental illness who are medication
  compliant are pretty much like any other client.
  Therefore, the supervising officer should do
  everything possible to insure the client is
  taking all prescribed medication. This will help
  to increase the clients cooperation with you.

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Suicide
We know that inmates are at risk of death by
suicide. We also know that persons with mood
disorders have the highest suicide rate of all
types of mental illness. Corrections employees
are often held responsible (liable) for an
inmates or supervisees suicide. Is there
anything employees can do to lessen the chance of
suicide attempts? Yes! Employees can learn
facts about suicide, debunk suicide myths, and
learn the warning signs of suicide.
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Suicide
Suicide is

• the voluntary and intentional taking of ones
  own life
• the 10th leading cause of death in the U.S.
• the 3rd leading cause of death in prison

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Suicide Myths
You may have heard some or all of the following
statements about suicide. They are myths do
not believe them.

• Myth If a person talks about suicide, he
  probably will not do it.
• Myth If a person tries unsuccessfully to
  complete suicide, chances are he will not try
  again.
• Myth Suicidal people are obviously mentally ill.
• Myth There is nothing one can do to stop someone
  when he has decided to commit suicide.
• Myth It is not possible to identify individuals
  who are considering suicide.

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Suicide Myths, continued

• Myth The environment or weather causes suicidal
  thinking.
• Myth Suicide is a learned behavior.
• Myth Young people rarely commit suicide because
  they have so much life ahead of them.
• Myth Mentioning suicide may give someone the
  idea to try it.
• Myth Women commit suicide more often than men.

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Suicide Warning Signs
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Suicide Warning Signs, contd.

• Threats of suicide - believe it! The threats
  are real.

• Currently depressed, excessively sad,
  withdrawn, or silent

• Acts with strong guilt or shame (downcast eyes
  or looks)

• Prior suicide attempt

• Current or prior mental illness

• Unusual agitation (tense, nervous, pacing)

Unusual agitation and pacing can be a warning of
a suicide attempt
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Suicide Warning Signs, contd.

• Unusual aggressiveness (irritable, snapping at
  others, rude, picking fights)

• Projecting hopelessness orhelplessness (no
  sense of the future)

• Unusual concern over what will happen

• Noticeable behavior changes (not sleeping or
  eating, poor hygiene)

Be alert for unusual aggression

• Sudden calmness or euphoria after being agitated
  or nervous

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Suicide Warning Signs, contd.

• Unrealistic talk about gettingout of the
  facility

• Inability to deal effectively with the present
  preoccupied with the past

• Giving away possessions or shipping them home

• Attention-getting gestures by self-injury

• Excessive risk-taking inviting assault

Self-injury can be a gesture for attention
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Suicide Prevention
Utilize the Mental Health Crisis Intervention
SMILE tactics discussed previously in this
course, and be observant about suicide warning
signs. Prevention of suicide is infinitely
preferable to the loss of a life.
Intervene before you facea situation like this.
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ODOC Mental Health Classification System

• Most employees know that our agency uses a
  classification system that determines where an
  inmate is housed. We also have a mental health
  classification system that gives all correctional
  professionals basic information for better
  management and supervision. By knowing an
  inmates MH-level, you will have a basic idea of
• History of problems
• Current seriousness of symptoms/behaviors
• Probability of risk of need for skilled
  interventions

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Mental Health Service Levels
The ODOC mental health classification system uses
five basic MH-levels

MH-C1 MH-C2(Charlie 1 2)
MH-B(Baker)
MH-A(Able)
MH-DDelta
MH-0
Remember - the MH levels increase in level of
seriousness, from 0 (no history of mental
illness) all the way to D (most serious level of
mental illness).
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Mental Health Service Levels
MH-0 Inmates who do not fit the criteria in the
Able Delta service levels. No known history or
symptoms of mental illness.
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Service Levels, contd.
MH-A (Able) Clear history of mental illness
(including suicidal behavior), but currently no
problems. Current observation of
mild-to-moderate symptoms of mental illness.
Symptoms may be acute or episodic, not chronic.
Can be seen on outpatient basis. Seen on
self-referral or staff-referral, not on scheduled
monitoring or therapy, or participates in
non-prescribed scheduled psycho- educational
program or therapy. Does not currently require
psychotropic medication. Mild to moderate
adjustment problems. Does not need blanket
exemption from random housing assignment.
Includes criteria that distinguishes this level
from lesser level
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Service Levels, contd.
MH-B (Baker) Requires psychotropic
medications. Major diagnosis of Psychotic
Disorder, Bi-Polar, or Major Depression. Requires
scheduled periodic to frequent clinical
monitoring. Requires prescribed, scheduled
treatment program or therapy (Which may not
include psychotropic medication). Suicide
attempts/ideation within last twelve months
and/or current suicide ideation. Needs exemption
from random housing assignment, although may be
housed in regular housing as appropriate.
Self-injurious behavior within the last 12
months. Moderate adjustment and/or impulse
control problems. Can be seen on outpatient
basis. Includes criteria that distinguishes
this level from lesser level Indicates
criteria met independent of resources available
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Service Levels, contd.
MH-C1 (Charlie 1) Requires special intermediate
housing unit with intensive treatment track(s) to
be able to adjust to incarceration.
Adjustment dependent upon special
arrangements administrative overrides/housing.
History of cycling or consistent
non-compliance with prescribed treatment with
resultant behavioral and/or mental
deterioration. Requires specialized intensive
treatment track(s) and release planning to be
able to function upon release to community.
Needs exemption from random housing
assignment. Includes criteria that
distinguishes this level from lesser level
Indicates criteria met independent of resources
available
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Service Levels, contd.
MH-C2 (Charlie 2) Developmentally disabled
and/or significant cognitive deficits Requires
special intermediate housing unit with intensive
treatment tracks to be able to adjust to
incarceration. Requires specialized intensive
treatment track(s) and release planning to be
able to function upon release to community.
Needs exemption from random housing
assignment. Includes criteria that
distinguishes this level from lesser level
Indicates criteria met independent of resources
available
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Service Levels, contd.
MH-D (Delta) Due to mental illness, is a danger
to self or others or is grossly impaired in
ability for self-care. Requires 24 hour
medical monitoring. Needs exemption from
random housing assignment. Includes criteria
that distinguishes this level from lesser
level Indicates criteria met independent of
resources available
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Management Issues Policies

• Mental health management issues are covered in
  these policies
• OP-140127 Mental Health Units
• Criteria for referral Serious mental illness
  which results in danger to self or others or
  inability to provide basic necessary life-care
• Transfer process
• OP-060204 Inmate Transfers
• Sec. V Medical Transfers
• Types of situations
• Transfer approval process
• PROPOSED OP-140113 Medical Transfers
• Referenced in OP-06204
• Simplified process
• ICHU transfers

Click buttons to view online policies
OP-140127
OP-060204
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Conclusion
Thank you for taking the time to complete this
course. Before you go, remember this
Exit Course