Understanding Mental Illness

A Review of the Disorders

 Defining Mental Illness

Clinical definition :
• Clinically significant behavioral problems
• Associated with distress (painful symptoms)
• Causes disability (impairment in functioning)
• A biological illness that responds to treatment
• Not to be confused with weakness of character
 Facts about Mental Illness
 Has nothing to do with  Mentally ill are not all
intelligence dangerous
 Can happen to anyone  Should not be confused
 Chronic but not contagious with terms psychopath or
 Difficult to diagnose and sociopath
to treat
 Treated but not cured
 General Signs of Mental Illness
• Observable • Behavior Changes
• Confusion • Flat Affect
• Disoriented • Withdrawn
• Darting looks
• Sad or anxious mood
• Talking to self
•
• Panic
Poverty of Speech
• Pressured speech • Psycho somatic complaints
• Poor hygiene
• Inappropriate attire
 Schizophrenia
Symptoms
• Brain disease
• Includes psychosis
• Impacts 1 out of every 100 people. Does
not differentiate across SES
• Onset is late teens, early adulthood.
• Positive Symptoms include :
– hallucinations
– delusional thinking
• Negative symptoms include
– apathy
– withdrawal.
 Schizophrenia
Symptoms in Jail
 May appear non compliant
 Agitated by voices and delusions -may look and act dangerous
 Command hallucinations may actually be dangerous
 More likely to respond to clear directions, and reassurance in a
kind tone of voice
 Poor hygiene - Not aware of their surroundings enough to know
that they are not clean
 Mood Disorders
Major Depression
Symptoms
• Affects 5 percent of the general population
• Sad mood that lasts 2 weeks
• Loss of interest or pleasure in daily activities
• Changes in sleep, appetite, decreased energy
• Thought problems affect concentration, memory, decisions,
feelings of guilt, worthlessness
• Risk of suicide is high
• Important to differentiate mental health from
physical problems
• Responds well to treatment
 Mood Disorders
Major Depression
Symptoms in Jail
Loss of interest in food and self care
May not care about legal situation
Suicide risk is real and must be monitored
Risk of suicide may increase after medication
 Mood Disorders
Mania/ Bipolar Disorder
Symptoms
 Euphoric Mood (elevated, high or happy)
 Irritable Mood (touchy)
 Three Stages of Mania Hypomania, Acute Mania, Psychosis

 Bipolar Disorder - mood swings from depression

to mania
 Can be Rapid Cycling
 Mood Disorders
Mania/ Bipolar Disorder
Symptoms in jail
Jail may be the consequence of the disorder
Mood can swing from entertaining to hostile
Talkativeness can be irritating
If depressed, often cry, feel hopeless, become suicidal
Can be restless, pacing, demanding and destructive
Often non-compliant
Can be professional and well-educated
 Anxiety Disorders
Panic Disorders
Symptoms
 Prevalence is 1 to 2 percent of the population; Women twice as high as men.
 Panic attacks occur without warning
 Symptoms include intense fear, heart palpitations,chest pain,
shortness of breath, dizziness
 Person is concerned that the attacks will strike again

Symptoms in Jail
 Jail environment and structure of holding can
induce symptoms
 Referral is indicated
 Anxiety Disorders
Obsessive-Compulsive Disorder
Symptoms
 Obsessions are recurrent thoughts, images, impulses that cause
anxiety. They are illogical,at times repulsive and/or center on
violence or harm.

 Compulsions are behaviors that are repetitive - attempts at reducing

the anxiety created by the obsessions.

Symptoms in Jail
 Rarely seen in jail and do not pose high risk
 Post Traumatic Stress Disorder
Symptoms
Exposure to an extremely stressful event.
Painful memories, nightmares,, suspicion, anxiety, depression, feelings of
guilt and sleep difficulties
Symptoms worsen with exposure to similar events
Substance abuse is a common method to cope
Symptoms in Jail
Jail environment can trigger symptoms
Jail inmates and personnel can trigger symptoms
Lack of privacy and loss of control are issues
 Personality Disorders
 Inflexible, maladaptive, ways  Antisocial
of coping and relating  Narcissistic
 Difficulty in holding steady  Borderline
work and relationships
 Difficult to change
 Avoidant
 Can co -exist with other
 Paranoid
mental illnesses  Dependent
 Behavior problems  Schizotypal
precipitate jail  Schizoid
 Personality Disorders
 Predominant disorders in jail are
Antisocial and Borderline
 Jail environment heightens symptoms
 Effective management requires
consistent limit-setting
 Suicidal risk is real and must be
monitored
 Jail personnel must professionally
manage housing unit, inmates and
themselves
 Substance Abuse
Symptoms
 85% of jail population have substance abuse problems
 High correlation of substance abuse and other mental illnesses
Symptoms in Jail
• Monitor risk of OD or withdrawal
• Monitor abuse of prescription drugs
• Can mimic other Mental illnesses
• Long term abuse can cause dementia
 Co-occurring Disorders

 Presence of both a mental illness and substance abuse disorder

 High prevalence rates
 60% of persons with a mood disorder also have a substance
abuse disorder
 50% of persons with schizophrenia also have a substance abuse
disorder
In Jail - More prone to violence, impulsivity, paranoia and
anxiety
Common Factors of Mental Illness and
Substance Abuse
 Brain disorders
 Lack of Insight
 Chronic
 Impacts Family
 Shame and guilt
 Needs Treatment
Dementia and other Cognitive Disorders
Symptoms
• Memory problems
• Confabulations
• Impaired thinking
• Impaired Judgement

Symptoms in Jail
• Poor memory and may not follow directions
• Treat individual as you would any with a disability
 Mental Retardation
Symptoms
 Poor adaptive functioning from birth
 Related to intelligence, not thoughts, feelings and
behaviors

Symptoms in Jail
 Not to be confused with mental illness
 Requires patience
Effective Communication
 Keys to Communication
Empathy

Warmth

Genuine
 Promoting Communication
Listening:attend to both Respond Effectively
verbal and nonverbal cues, Maintain Personal Space
hear and observe, and Open ended questions
avoid distractions
Non verbal Cues
Clarification:
Restate.Repeat, Clarify,
Question
Dealing with Silence
 Basic Communication Guidelines

Low take
Don’t stimulation level
actions or reactions personally

 Short,
Simple
Don’t
Be clear
consistent
force direct
content sentences
communication
Basic Communication Guidelines



 Practice
Bepatient
Praise
Know
Be pleasant
Person cooperative
may
your reflective
not
nonand firm
“get” listening
behavior
all
verbal the information
communication
 Basic Communication Guidelines
Short, clear direct sentences Person may not “get” all the
Simple content information you provide
Low stimulation level Be patient
Don’t force communication Be pleasant and firm
if person is withdrawn Praise cooperative behavior
Be consistent Practice reflective listening
Don’t take actions or Know your non verbal
reactions personally communication
 Types of Non-Verbal
Communication

Body Posture
Facial Expression
Eye Contact
Gestures
Crisis Management
 Crisis Management
Crisis defined

What is crisis intervention

Recognizing a person in
crisis – behavioral
and verbal cues
 Violence
The incidence of violence Substance use greatly
is no greater in persons increases violence
with mental illness than it Greatest risk, males in late
is in the general population teens to early 20’s
Incidence increases 60% if Past behavior best
the illness is untreated. predictor
 Warning Signs
Tremors
Hyperactivity
Rigid Posture
Clenched jaws and fists
Pulsing arteries
Verbal abuse/profanity
 Effective Crisis Intervention
 Reduce Stress

 Force as the last resort

 Consider the symptoms of mental illness

 Identify precipitating factors

 Goal is to de-escalate
 5 Stages of Successful Interventions
 Immediacy- Intervene as  Assess the situation- let the
soon as possible. Goal is to person talk, watch for
reduce anxiety. nonverbal cues, be a guide
 Assume Control - via and avoid judgements and
providing the structure the putdowns
person needs, not be  Situation Management
overwhelming them  Post crisis intervention
 5 Stages of Successful Interventions
 Immediacy- Intervene as  Assess the situation- let the
soon as possible. Goal is to person talk, watch for
reduce anxiety. nonverbal cues, be a guide
 Assume Control - via and avoid judgements and
providing the structure the putdowns
person needs, not be  Situation Management
overwhelming them  Post crisis intervention
Suicide and Suicide Prevention
 Facts about Suicide
Jail suicide is 9 times higher than
general pop.
8 of 10 have given prior warnings
Ambivalent about death
Ambivalence is not the same as
manipulation
Most jail suicides are not impulsive
Risk does not increase with discussion
 Facts about Suicide
Prior attempts increases risk
by 33%
Mental illness increases the
risks -
61% have major depression
48% have personality disorder
40% Alcohol use
10% Anxiety
6% Schizophrenia Understanding SI behavior
increases prevention!
 Why Jails are Suicide Prone Settings
 Authoritarian environment  Fears
 Loss of control over future  Police and Jail staff
 Isolation immune to arrest and
incarceration
 Shame
 Officers and jail staff
 Dehumanizing overlook or
aspects of misunderstand
incarceration symptoms
 Terms related to Suicide

Ambivalence
Ideation
Lethality
Attempt
Gesture
 Evaluation Tool
The Sad Persons Scale

 Sex  Previous Attempts

 Ethanol
 Age  Rational Thinking Loss
 Depression  Social Support Losses
 Organized Plan
 No Spouse
 Sickness
Why Do People Die by Suicide?
Impulsive
Depressed
Escape from suffering
Communication
Loss of a loved one
 Understanding Suicidal Thinking
 Suicide is a solution to a problem, what is the
problem ?
 Most suicides are acts to end intolerable feelings
 Coping Patterns Fail
 “Tunnel Vision” interferes with seeing alternatives
 Person feels “unheard”
 Ambivalence
Recognizing Suicidal Risk In Jail

Psychological Factors

Social Risk Factors

Behavioral Warning Signs

Special Features of Jail Suicide Risk
 Legal Status Factors

 Time of the year

 Long Term Factors

 Intervening
Create a safe Evaluate potential
environment Refer for treatment
Only one person Do not lie
communicate
Talk about plan
Emphasize positives
 Prevention
 Admission Screening
 Utilize a formal screening worksheet
 Develop tiered assessments - intake,
supervisor, mental health professional referral
 Observe for risk factors, even after intake
 Assure treatment
Collaboration and The Team
Approach
 Shared Goals
 Diversion of inmates from jail to appropriate
community care
 Assure adequate mental health care while
incarcerated
 Assure Continuity of Care for those inmates at the
time of their release.
 Steps to Meeting Shared Goals
 Screening and  Provision of emergency
identification mental health services
 EvaluationClassification  Assure care
 Diversion  Supervision
 Crisis Prevention  Suicide Prevention
 Pre release planning
 Team Approach Options
 Employ Mental Health Staff
 Formal Contractual Agreements with Providers
 Informal Agreements (MOA)
 Characteristics of a good Working
System
 Shared Vision, mission and values
 Involvement of all stakeholders
 Established written documentation
 Formal and informal verbal communications
 Ongoing Commitment
 Formal Agreements
 Purpose
 Range of Services
 Time Frame
 Remuneration, if applicable
 Expectations of the jail re documentation,
referrals, medication administration, etc
 Confidentiality
 Mechanism for review, evaluation and
modification
 Comprehensive Service Array
 Diversion
 Timely and effective treatment
 Placement in programming
 Linkage with support groups
 Housing assistance
 Educational Assistance
 Entitlements
 Other supports
 Systematic Planning
Cooperation
Coordination
Collaboration
Integration
Key Issues Identification of problems,
barriers and solutions
 Technical Assistance Resources
• National Institute for Corrections (Jail Center) 1-
800-995-6429
• The GAINS Center for People with Co-Occurring
Disorders in the Justice System 1-800-311-GAIN