Crisis Intervention Team Training for Corrections:

New Dimensions & Directions

CIT International ConferenceSan Antonio, Texas

June, 2010

United States Correctional System

The United States is the world leader in incarceration, with a higher proportion of its population behind bars than any other country.

World Incarceration Rate per 100,000

The Nation’s Federal or State Prisons or in Local Jails Held 2,424,279 Inmates on June 30, 2008 (BJS).

One in every 31 U.S. adults is in the corrections system, which includes jail, prison, probation and supervision, more than double the rate of a quarter century ago.

In 2007

Who is under the umbrella of CJ?

Why do these numbers matter to us?

What do they have to do with understanding

Crisis Intervention Team skills?

The size and scope of the mentally ill incarcerated was clarified in a recent report by Henry Steadman, Ph.D., Fred C. Osher, M.D., and colleagues :

From June 2006-2007 more than 2 million jail admissions of the total of 13 million represented individuals with a serious mental illness.

THE MENTALLY ILL INCARCERATED

A 2009 American Psychiatric Association study

“found that 14.5% of male and 31.0% of female inmates recently admitted to jail have a serious mental illness, [confirming] what jail administrators already know – a substantial proportion of inmates entering jails have a serious mental illness and women have rates two times those of men.”

Bureau of Justice Statistics Sept 2006

MENTAL ILLNESS

Jail detainees had

the highest rate of symptoms of a mental health disorder (60%) compared to federal or state prisoners

Approximately 24% of jail inmates reported at least one symptom of a psychotic disorder

SUBSTANCE ABUSE

Among inmates who had a mental health problem, local jail inmates had the highest rate of dependence or abuse of alcohol or drugs (76%)

Among inmates without a mental health problem 53% in local jails were dependent on or abused alcohol or drugs.

The Los Angeles County Jail, the Cook County Jail (Chicago) and

Riker’s Island Jail (New York City) each hold more people

with mental illness on any given day than any psychiatric facility

in the United States. (E. Fuller Torrey, 1999)

Where are the Largest Concentrations of those with Mental Illness?

Why we brought the idea to Sheriff Tom Dart and

the Cook County Department of

Corrections Training Institute to do Crisis

Intervention Training in a jail setting

In Illinois, the Largest Concentration of Detainees with Mental Illness is CCDOC

The New Asylums – Jails Have Become the Mental Hospitals of Last Resort Belcher, 1988

The nation’s local jails are becoming the dumping ground

for the mentally ill.

•54% of local jail inmates report symptoms of mania•30% report major depression•24 % report psychotic disorders

Cook County Jail and Criminal Court of Chicago, 54 W. Hubbard Street – (1874-1892)

Why are the numbers important to us?

Cook County Department of Corrections – The Cook County

JailLargest single site detention

facility in the U.S. (over 100 acres) located in the third largest metropolitan area in the country.

Average daily population of ~10,000

Average yearly admissions of 100,000

Average daily intake 300-325 in the “bullpen” for distribution to the 11 Divisions

Bureau of Justice Statistics 1999

 Jail

DetaineesProbationers

State Prison

Inmates

Federal Prison

Inmates

Percent Identified As Mentally Ill2

16.3 16.0 16.2 7.4

Percent of Mentally Ill Reporting Alcohol/Drug Use at Time of Offense

64.6 49.0 58.7 46.5

Percent of Mentally Ill With History of Alcohol Dependence

37.9 34.8 34.4 23.9

Dr. Linda Teplin’s Research at CCDOC

Found 6.1% of male detainees met diagnostic criteria for a major mental disorder on intake

Found 15% of females met diagnostic criteria for a major mental disorder

The disorder included Schizophrenia, Bipolar Disorder, and Major depression

More than 50% of all jail detainees have other MI diagnoses including Dysthymia, Anxiety Disorders, and Antisocial Personality Disorders

Treatment Alternatives for a Safer Community, TASC

Pursuant to its statutorily defined role, TASC is the linkage case management agency for the Cook County Mental Health Court.

The Problem

The Big Picture……..

Jails Become Mental Institutions

Daily, ~ 200,000 people behind bars, or more than 1 in 10 inmates, suffer from: schizophrenia bipolar disorder major depression

70% of MI population are nonviolent offenders

Nearly 90% of inmates with MI have aco-occurring substance abuse problem

(Abram KM, Teplin LA, 1991)

Jails Have Become the Mental Hospitals and Social Service Systems of Last Resort

Cermak’s Mental Health Services is the largest provider of psychiatric services in the State of Illinois.

The Cook County Jail is now, in effect, the largest mental hospital in Illinois. There are more people with mental illness in our state prisons than in all our public and private

psychiatric institutions combined.

60’s – deinstitutionalization

70’s – increase in homeless populations

80’s – “War Against Drugs”

Basic Critical CJS Problems

The potential public safety risk posed by the mentally ill offenders

The difficulties associated with housing the mentally ill in local jails

The inadequacy of the criminal justice process in dealing with the mentally ill defendants in all matters

Initiation of the Cook

County Mental

Health Court

System-wide Collaboration of State and County (2001-The Process Begins)

Cook County Criminal Justice System

Leadership Chief Judge Timothy Evans Presiding Judge Paul Biebel Lead Judges – Judge Jay Crane and Judge Thomas

Gainer

Adult Mental Health Probation Unit

Cook County State’s Attorney Office

Cook County Public Defender’s Office

Mental and Health Issues Affecting Clients

Schizophrenia – 8 Schizoaffective

Disorder – 10 Bipolar Disorder –

24 Major Depression –

2 Psychotic Disorder

NOS – 3 Substance Abuse

Disorders – 49 Mood Disorder NOS

- 2

Post-traumatic Stress Syndrome – 1

HIV+ – 2 Hepatitis C – 2 Herpes Virus – 1 Cancer - 2

What we learned about our participants:

The program participants have:Much more extensive criminal

backgrounds(compared to a 9 year review of Cook County drug court participants)

Much more extensive psychiatric histories (including major Axis II Personality Disorders)

Most identified individuals have long-standing mental health and addiction/dependency issues

Current Charges

Possession of a controlled substance (PCS) – 20

Retail theft – 15

Theft – 3

Burglary - 8

Residential Burglary - 1

Manufacture/Delivery – 1

Forgery – 1

Prostitution - 1

Types of Facilities Currently in Use

Residential treatment facility – 5

Psychosocial rehabilitation (PSR) day program – 15

Nursing home – 6

Inpatient psychiatric unit – 1

Receiving CST Services - 11

Employed – 3

Recovery/halfway house/ACT house – 18

Individual housing - 16

Enrolled in educational program – 2

Outpatient Substance Abuse Services – 11

Suboxone Therapy - 5

Program Impact

Decreased criminal activity

Decreased hospitalizations

Decreased incarceration

Decreased county cost expenditures

Improved quality of life

Crisis Intervention Team Training

From the Street to the Jail

Initially

Class representation included:

Cook County Sheriffs Police

Department of Correction Officers

Juvenile “Boot Camp”

Court Services

Woman’s Justice

We found

Centralized: Training all Departments and Divisions together

Vs

Decentralized: Training similar Divisions together

Emergency Response Team

ERT is a specialized team of heavily armored, trained individuals responding in force to gain compliance from a resisting detainee where physical takedown and extraction is used to gain compliance and control.

Crisis Intervention Team

CIT uses de-escalation techniques by a single trained staff individual with support by other officers to insure safety and gain the trust and compliance of the detainee in crisis without the use of force

Crisis Intervention Team

CIT is first, foremost and always a safety program for correctional staff

Tactical response is always an option

CIT training offers an option in a situation

CIT training arms law enforcement and corrections with additional tools for 21st century situations

Components

Continuum, Continuity

Corrections

Collaboration

Curriculum

Courts

Challenges

Continuum-It Doesn’t Stop at the Jail Door

Mental Illness

Substance abuse, Co-occurring Disorders, Addiction

Intellectual Disability

Elderly & Medical Issues

Prison Rape Elimination Act-Sexual Harassment, Intimidation, Abuse, Violence & Rape

Suicide-Recognition & Prevention

Corrections-Transitioning

Law Enforcement-Serve & Protect the public-20% of emergency 911 calls for service in Chicago include a mental health component

Corrections-Safety & Security of Detainees –among the 11 divisions, detainees with MI range from 1.5% to 85%

What Correction Officers Say

Interviews were conducted anonymously in the past with officers and revealed that mental health training did not adequately prepare them for real-life situations they face daily on the job

Improving training in skills and mental health issues enable staff to better identify signs of stress in detainees & improve effectiveness in prevention of violence and self-harm

Contribution from Correction Officers

Prevention of violence and self harm requires observation, intervention and communication skills

When staff detect detainee agitated behavior and respond calmly, nonviolently and communicate in a positive manner, there is a high likelihood of a safe outcome

Collaboration Correction Administration and Training

Division

Interaction of line Correction Officers, Supervisors and Mental Health Services

Family Panels

Community Services

Curriculum

Eliminate Juvenile Block

From involuntary petition to General Orders & protection of constitutional rights

Role Playing

Courts

Awareness of Corrections of specialty therapeutic courts:

Domestic Violence

Drug

Mental Health

Veterans

Prostitution

ConsiderAll Truth Passes through three stages:

• First, it is ridiculed

Second, it is violently opposed

Thirdly, it is accepted as being self-evident

Arthur Schopenhauer

Challenges

Current correctional barriers-lack of General Orders, creation of CIT response as option to ERT when appropriate

Inertia-institutional change

Stigma & stereotypical beliefs-”mentals”

Effective treatment & preparation for release-transitioning 93.7% of the prison population who will eventually be released back into the community

New Directions Advanced Veterans CIT training

New Directions Advanced Juvenile Training

New Directions

Elders at Risk

Faith Based Community-clergy

Probation and Parole Officers

College and University Security Agencies

Veterans Administration Hospital Law Enforcement

Expand partnering of peer to peer groups with Law Enforcement-Veterans, Disability advocacy organizations

Acknowledgements Cook County Sheriffs Training Institute, Dr.

Carl Alaimo

Urban Institute

Cook County Mental Health Court, Mr. Albert J. Pizza

Questions