Development and Development and Implementation of a CIT Implementation of a CIT

Training Curriculum Training Curriculum in a County Jail in a County Jail

IntroductionsIntroductions

Joan Cairns, MFTJoan Cairns, MFTDirector of Jail Psychiatric ServicesDirector of Jail Psychiatric Services

Angelica Almeida, Ph.D.Angelica Almeida, Ph.D.Manager with Jail Psychiatric ServicesManager with Jail Psychiatric Services

Michele FisherMichele FisherCaptain and Facility Commander with San Francisco SheriffCaptain and Facility Commander with San Francisco Sheriff’’s s

DepartmentDepartment

Learning ObjectivesLearning Objectives Identify ways to collaborate with multiple Identify ways to collaborate with multiple

agencies to develop a CIT Training agencies to develop a CIT Training CurriculumCurriculum

Identify the steps to implement a CIT Identify the steps to implement a CIT Training Curriculum (e.g., what topics Training Curriculum (e.g., what topics should be covered) in jail settingshould be covered) in jail setting

Identify ways that this intervention Identify ways that this intervention improves treatment of incarcerated improves treatment of incarcerated mentally ill individualsmentally ill individuals

Why Develop a CIT Why Develop a CIT Curriculum Curriculum

for a Jail Setting?for a Jail Setting?

Federal Community Mental Federal Community Mental Health ActHealth Act

Signed into law in 1963 by President Signed into law in 1963 by President John F. KennedyJohn F. Kennedy

Community based care as an Community based care as an alternative to institutionalizationalternative to institutionalization

Led to Led to ““transinstitutionalizationtransinstitutionalization”” and and criminalization of mental illnesscriminalization of mental illness Rather than receiving treatment in State Rather than receiving treatment in State

Hospitals, mentally ill individuals are now Hospitals, mentally ill individuals are now incarceratedincarcerated

Today, approximately 1.1 million Today, approximately 1.1 million people with severe mental illness are people with severe mental illness are admitted to U.S. jails each year.admitted to U.S. jails each year.

“On any given day, between 300,000 and 400,000 people with mental illnesses are incarcerated in jails and prisons across the United States, and more than 500,000 people with mental illnesses are under correctional control in the community.”

~ Mental Health America

Jails TodayJails Today

Rates of mental illness in jails have increased Rates of mental illness in jails have increased upwards of 50% over the last five years upwards of 50% over the last five years (Hirschkorn & Mitchell, 2011; Wiener, 2012)(Hirschkorn & Mitchell, 2011; Wiener, 2012)

Forensic settings now provide significantly more Forensic settings now provide significantly more mental health services to individuals than mental health services to individuals than community based treatmentcommunity based treatment

In 2012, San Francisco County provided mental In 2012, San Francisco County provided mental health services to approximately 2.5% of the health services to approximately 2.5% of the population, whereas approximately 30% of the population, whereas approximately 30% of the jail population has contact with mental health jail population has contact with mental health staff at any given timestaff at any given time

Jails TodayJails Today Most individuals (roughly 80%) are arrested for Most individuals (roughly 80%) are arrested for

nonviolent offenses such as drug and property nonviolent offenses such as drug and property offenses (Baillargeon, Binswanger, Penn, Williams & offenses (Baillargeon, Binswanger, Penn, Williams & Murray, 2009)Murray, 2009)

Individuals with mental illness have higher rates of Individuals with mental illness have higher rates of recidivism (Baillargeon et al., 2009; Steadman, recidivism (Baillargeon et al., 2009; Steadman, Redlich, Callahan, Robbins &Vesselinov, 2010)Redlich, Callahan, Robbins &Vesselinov, 2010)

County jails see higher rates of mental illness than County jails see higher rates of mental illness than prisons (Hatcher, 2012)prisons (Hatcher, 2012)

Custody staff has to be educated on mental health Custody staff has to be educated on mental health issues in order to create a safe environment and issues in order to create a safe environment and work alongside mental health professionalswork alongside mental health professionals

Purpose of CIT in a Jail Purpose of CIT in a Jail SettingSetting

Similar to officers in the community, Similar to officers in the community, custody staff are the first responders to custody staff are the first responders to crises in a jailcrises in a jail

Need to be Need to be ““armedarmed”” with specialized with specialized training to address these situationstraining to address these situations

Develops a collaboration between custody Develops a collaboration between custody staff and mental health professionalsstaff and mental health professionals

Curriculum Development Curriculum Development for Enhanced Practical for Enhanced Practical

Interventions for Interventions for Collaboration (EPIC) Collaboration (EPIC)

TrainingTraining

Community versus JailsCommunity versus Jails

Important to consider the unique Important to consider the unique environment of a jail settingenvironment of a jail setting

Note that research done in the Note that research done in the community does not often translate community does not often translate to forensic settings (e.g., risk factors to forensic settings (e.g., risk factors for suicide)for suicide)

Commitment to the Commitment to the ProgramProgram

Training doesn't work without buy in Training doesn't work without buy in from all partiesfrom all parties

Choosing instructors that represent Choosing instructors that represent all perspectives (i.e., medical, all perspectives (i.e., medical, psychiatric, custody)psychiatric, custody)

Modeling collaboration and mutual Modeling collaboration and mutual respectrespect

Topics for TrainingTopics for Training Introduction to Mental IllnessIntroduction to Mental Illness

Major mental illnessMajor mental illness Personality DisordersPersonality Disorders Cognitive DisordersCognitive Disorders Symptoms that may be seen in custodySymptoms that may be seen in custody InterventionsInterventions

Behavioral PlansBehavioral Plans Collaboration between deputized staff, mental health staff, Collaboration between deputized staff, mental health staff,

medical staffmedical staff Psychiatric Housing UnitsPsychiatric Housing Units Administrative Segregation GroupAdministrative Segregation Group

Topics for TrainingTopics for Training Suicide PreventionSuicide Prevention

Difference between general population and Difference between general population and forensic settingforensic setting

Risk factors and warning signs of suicide riskRisk factors and warning signs of suicide risk Assessing for suicide riskAssessing for suicide risk Intervention strategiesIntervention strategies

Observation HousingObservation Housing Use of direct vision facilitiesUse of direct vision facilities Use of other inmatesUse of other inmates

Do not house aloneDo not house alone Suicide Prevention PosterSuicide Prevention Poster Brief Training Videos in MusterBrief Training Videos in Muster

Topics for TrainingTopics for Training Special PopulationsSpecial Populations

First arrestees and serious chargesFirst arrestees and serious charges VeteransVeterans Transitional Age YouthTransitional Age Youth ElderlyElderly Developmental DisordersDevelopmental Disorders

Substance Abuse Disorders and DetoxSubstance Abuse Disorders and Detox SymptomsSymptoms InterventionsInterventions

Topics for TrainingTopics for Training Active ListeningActive Listening

Communication StrategiesCommunication Strategies

Use of Force with Mentally IllUse of Force with Mentally Ill

Job BurnoutJob Burnout

Community ResourcesCommunity Resources

PresentationsPresentations 2-3 day intensive training2-3 day intensive training

Outings to community programsOutings to community programs

Tangible tools for immediate useTangible tools for immediate use

Use of scenarios, videos, role playingUse of scenarios, videos, role playing

Use of recorded lectures for brief Use of recorded lectures for brief introductions to major topics introductions to major topics

CollaborationCollaboration

Team approach to difficult casesTeam approach to difficult cases

Vital for safety and security of facilitiesVital for safety and security of facilities

Working with mental health and medical Working with mental health and medical staffstaff

Myths held by law enforcement about Myths held by law enforcement about mental health providers mental health providers

Impact of CIT Impact of CIT CurriculumCurriculum

Feedback from deputiesFeedback from deputies

Impact on jail culture and how deputized Impact on jail culture and how deputized staff interacts with inmatesstaff interacts with inmates

Anticipated outcomes based on community Anticipated outcomes based on community model:model: Reduced violence between staff and inmatesReduced violence between staff and inmates Reduced risk of injury Reduced risk of injury Increase use of verbal de-escalation rather than Increase use of verbal de-escalation rather than

hands-on interventionshands-on interventions Increased identification of individuals at risk for Increased identification of individuals at risk for

suicidesuicide

Further InformationFurther Information

Angelica Almeida, Ph.D.Angelica Almeida, Ph.D. Angelica.almeida@sfdph.org 510-520-8239510-520-8239

Joan Cairns, MFTJoan Cairns, MFT Joan.cairns.@sfdph.org 650-219-7275650-219-7275

QuestionsQuestions