Trinity Mount Ministries

Showing posts with label Mental Health. Show all posts
Showing posts with label Mental Health. Show all posts

Friday, October 2, 2020

Guidance for Teenagers to Stay Mentally Strong During the Pandemic

The pandemic has disrupted many lives, including teenagers who also have a hard time attending school part-time, sporadically, or in a complete remote setting. Like most people, they also get stressed out and may find it challenging to cope up during these times.
Not only are the parents' efforts necessary, but teenagers themselves must also know how to care for their emotional wellbeing to keep themselves steady even with the pandemic going on. Here are some guidelines that teenagers can follow to ensure that their wellbeing is protected.

Take Advantage of Your Emotional Superpowers

Teenagers tend to experience emotions more intensely than adults. This could amplify the psychological discomfort that teenagers experience due to the current situation, but it also means that teenagers also get more out of pleasures and delights than others.
Recently, the only bright spots present seems to be only the small ones, which most adults do not feel satisfying. Teenagers can easily find happiness in simple things like playing video games, eating their favorite treats, cuddling with their pet, or being in nature.
Some adults may find it hard to grasp how these things make teenagers happy. But for teenagers, these small bright spots are more comforting and joyful. Teenagers should make the most out of their happy moments and their emotional superpower.

Trust Your Feelings

The first step in solving emotional distress is acknowledging your feelings. So, when a teenager feels sad, angry, stressed, and frustrated with the current situation, these feelings are undoubtedly right.
In a culture when these feelings are called unnecessary and emotional distress signals fragile mental health, they must know these feelings are valid, especially with what's happening to the world right now.
When at times they feel happy, this too is true. Teenagers must know that acknowledging and processing these feelings will help them cope with the situation and help them stay steady.

Count on Your Psychological Defenses

Every person has their psychological defenses that can either be unpleasant at times or helpful as it protects them from emotional overload. These defenses are often healthy and help people regulate how much upsetting a situation that a person can take all at once.
For example, teenagers use humor to crack up jokes in online classes to manage the frustration of sitting through hours of classes helps them maintain their connection to what is happening while reducing the emotional charge. The point is, the mind is wired in a way that enables the person to get through difficult situations by managing the rational and emotional thoughts to protect a person's wellbeing.

Mental Health Maintenance

Enough sleep and physical activity improves mood and reduce stress. Teenagers should enjoy the company of people that soothe and energizes them and remind them to stay away from people who can make them feel stirred up and spent.
Distribute mental energy with care toward the controllable things. Remember that feeling upset this time is expected as people have every right to be frustrated and resent the challenges of the pandemic. But direct this energy to the right things to prevent causing more anxiety in the future and focus on the power within as it will help make you feel better.

Check out more news and information on Mental Health on Science Times.

Thursday, November 29, 2018

Should Childhood Trauma Be Treated As A Public Health Crisis?

Researchers followed a group of kids from childhood into adulthood to track the link between trauma in early life and adult mental health.

fzant/Getty Images

When public health officials get wind of an outbreak of Hepatitis A or influenza, they spring into action with public awareness campaigns, monitoring and outreach. But should they be acting with equal urgency when it comes to childhood trauma?

A new study published in the Journal of the American Medical Association suggests the answer should be yes. It shows how the effects of childhood trauma persist and are linked to mental illness and addiction in adulthood. And, researchers say, it suggests that it might be more effective to approach trauma as a public health crisis than to limit treatment to individuals.

The study drew on the experiences of participants from the Great Smoky Mountains Study, which followed 1,420 children from mostly rural parts of western North Carolina, over a period of 22 years. They were interviewed annually during their childhood, then four additional times during adulthood.

This study has something other similar studies don't, says William Copeland, a professor of psychiatry at the University of Vermont who led the research. Instead of relying on recalled reports of childhood trauma, the researchers analyzed data collected while the participants were kids and their experiences were fresh. And the researchers applied rigorous statistical analysis to rule out confounding factors.

Even when the team accounted for other adversities aside from trauma, like low income and family hardships, and adult traumas, the associations between childhood trauma and adult hardships remained clear. The associations remained clear.

The study is "probably the most rigorous test we have to date of the hypothesis that early childhood trauma has these strong, independent effects on adult outcomes," he says.

For Copeland, the wide-ranging impacts of trauma call for broad-based policy solutions in addition to individual interventions. "It has to be a discussion we have on a public health policy level," he says.

Nearly 31 percent of the children told researchers they had experienced one traumatic event, like a life-threatening injury, sexual or physical abuse, or witnessing or hearing about a loved one's traumatic experience. And 22.5 percent of participants had experienced two traumas, while 14.8 percent experienced three or more.

The childhoods of participants who went through traumatic events and those who didn't were markedly different. Participants with trauma histories were 1.5 times as likely to have psychiatric problems and experience family instability and dysfunction than those without, and 1.4 times as likely to be bullied. They were also 1.3 times more likely to be poor than participants who didn't experience trauma.

When these children grew up, psychiatric problems and other issues persisted. Even after researchers adjusted for factors like recall bias, race and sex, the impact of those childhood psychiatric problems and hardships, the associations remained. Participants who experienced childhood trauma were 1.3 times more likely to develop psychiatric disorders than adults than those who did not experience trauma, and 1.2 times more likely to develop depression or substance abuse disorder.

Participants with histories of trauma were also more likely to experience health problems, participate in risky behavior, struggle financially, and have violent relationships or problems making friends. And the more childhood trauma a person experienced, the more likely they were to have those problems in adulthood.

Copeland acknowledges the study's limitations—it included mostly white participants in rural settings, and a disproportionately high number of Native American participants compared to the rest of the United States due to the area's high concentration of members of the Eastern Band of Cherokee Indians. But the study is nonetheless important, says Kathryn Magruder, an epidemiologist and professor of psychiatry at the Medical University of South Carolina.

"I think it should put to rest any kind of speculation about early childhood trauma and later life difficulties," she says.

Though the link has been shown in earlier research, Magruder says, this new study can help direct future research and policy. "Why are we revisiting it? Because it is time to think about prevention," she says. Trauma is a public health problem, she adds, and should be met with a public health approach.

Psychologist Marc Gelkopf agrees. In an editorial published along with the study, he writes: "If the ills of our societies, including trauma, are to be tackled seriously, then injustice must be held accountable."

The policy implications are clear, says Jonathan Purtle, a mental health policy researcher and assistant professor at Drexel University's Dornsife School of Public Health. "We need to prevent these things from happening to children and support family and community so that people can be more resilient," he says. Policymakers can create coalitions around issues like mental health and trauma-informed approaches in contexts like education and healthcare, he says.

One step in that direction comes with the SUPPORT for Patients and Communities Act, a bipartisan bill to address the opioid crisis that was signed into law October 24. The law recognizes links between early childhood trauma and substance abuse. It includes grants to improve trauma support services in schools, created a task force to provide recommendations on how the federal government can help families whose lives have been impacted by trauma and substance abuse, and requires the Department of Health and Human Services to help early childhood and education providers spot and address trauma.

Bills like the SUPPORT Act enjoy bipartisan and are a promising start, says Purtle — but they don't go far enough. To really reduce trauma and mitigate its effects, he says, policymakers must pursue community investment and policies like minimum wage laws that reduce economic pressure on people who are struggling.

"It's more than just 'toughen up and deal with it,' " he says. "A lot of it comes down to people not having to live their lives in a state of chronic and constant stress."

Erin Blakemore is a science writer based in Boulder, Colo.

Thursday, July 9, 2015

The Importance of Mental Health Training in Law Enforcement

By Nicholas Wilcox, M.S.

As mental health problems within communities have increased over the past 40 years, inpatient services have decreased. Therefore, police departments have had to meet the growing needs of individuals suffering mental health emergencies. Police officers not only are the first responders to these crises but often are the only source of immediate service for urgent mental health activities. Various efforts to address mental illness in communities have been instituted by police agencies; however, the implementation rate is incongruent with the number of mental health-related service calls.
Evolution of the Problem
In 1955, 75 percent of individuals who experienced mental health episodes were treated in inpatient settings; by 1977 only 7 percent received inpatient care.[1] This process, termed “deinstitutionalization” by the mental health community, describes the removal of essential patient services in favor of more decentralized approaches.[2] Deinstitutionalization has occurred over time since the mid 1950s and was implemented to reduce the costs incurred by mental hospitals and shift the care away from state institutions that had negative societal perceptions. This shift is problematic because it creates few inpatient, intensive care opportunities for individuals. Additionally, it requires that each episode begins a new treatment process. Prior to this individuals who experienced episodes in an inpatient setting could continue their existing treatment plans, as opposed to starting all over. First responders—specifically those in law enforcement—often are the first step in the process.
Open quotes
Police officers not only are the first responders to [mental health] crises but often are the only source of immediate service for urgent mental health activities.
The effects of deinstitutionalization can be explained through a fictional example. In 1950 John Doe, Sr., suffered his first schizophrenic break. He was arrested by a police officer during the occurrence and formally diagnosed while incarcerated. He spent the next 2 years in a state mental hospital, where he suffered 20 subsequent episodes that promptly were managed. John was released from the hospital, but was voluntarily readmitted 6 months later. He remained there for 18 months, during which he suffered another 8 episodes. Between 1950 and 1954 John experienced 28 episodes during inpatient care.
John’s son, John Doe, Jr., experienced a similar course of events 30 years later. Unlike his father, the 28 episodes John, Jr., suffered from 1980 to 1984 occurred while he was living in the community. Each of his episodes resulted in arrest and involvement with the criminal justice system. John Doe, Sr., had 1 arrest on his record by 1954; in contrast, by 1984 John Doe, Jr., had 28. Instead of reducing the financial expense to the state, deinstitutionalization shifted the cost from state mental hospitals to law enforcement.
Programs for Change
Police officers have a great deal of discretion when interacting with persons with mental illness at a scene; unfortunately, the most common case disposition is arrest.[3] The correctional system has become the primary vehicle for mental health treatment as state mental hospitals and inpatient treatment options dramatically have decreased. The top three most populous mental health institutions in the United States are jails—New York, New York’s Riker’s Island; Chicago, Illinois’ Cook County Jail; and the Los Angeles County, California, Jail.[4]
A primary concern for officers often is how to effectively de-escalate mental health incidents involving agitated individuals when appropriate procedures are unknown to them. The Crisis Intervention Team (CIT) model is a promising resource for police departments to address and resolve these concerns. The CIT model involves 40 hours of course-based training led by mental health professionals. Its curriculum includes the signs and symptoms of mental illness, medications, de-escalation skills, and treatment options available in the community.[5] Numerous CIT-certified officers have indicated that their specialized training better prepared them for potential events on the street.[6]
Jail diversion initiatives are another important resource, with community-based programs designed to provide greater public safety and reduce the number of incarcerated individuals with mental illnesses. Diversion initiatives are available postarrest to redirect offenders with mental illness into mental health courts. These courts differ from standard criminal courts in that their primary goals are to provide treatment options that would not otherwise be available to offenders and to decriminalize nonviolent actions that are a byproduct of mental illness. By doing so incarceration rates are lowered, the needs of individuals are addressed more adequately, and resources are better employed.
Implementation of a Successful Program
Open quotes
The correctional system has become the primary vehicle for mental health treatment as state mental hospitals and inpatient treatment options dramatically have decreased.
Providing meaningful first-responder services to individuals with mental illness requires the implementation of several core components. First and foremost, a training model must provide a detailed program for officers to follow—the CIT model is one such strategy. The program must partner with local mental health professionals and foster an ongoing, deeply ingrained relationship.[7] Roles must be established at every level of the police organization, from dispatchers to responding officers, supervisors, and administrative personnel. The program should be tailored to fit the community—a “one size fits all” approach does not work with the CIT model. Finally, a significant partnership with community leaders and the mental health community should be established to educate the public on the goals of the program.[8]
Implementation of a broad mental health response program must take into account members of law enforcement reluctant to buy into its goals. Police officers are trained to question their environment and the actions of individuals. Police administrators are seasoned officers with decades of experience as frontline first responders. The CIT model imposes changes on the culture of law enforcement and the way officers interact with persons with mental illness. As a result, some officers may question the necessity of a revamped response process and doubt its methodologies.
The CIT model and jail diversion initiatives hinge on the availability of mental health services and practitioners. The further away these services are geographically, the more logistical challenges exist to implement a successful program. These issues are less common in metropolitan areas than in largely rural areas. One of the key aspects of the CIT model is the relationship between law enforcement and mental health professionals. Police administrators and officers must be willing to perform the additional groundwork to meet the needs of the mental health community.
Open quotes
Some departments have executed programs, such as the CIT model, to train officers as basic frontline caretakers in the assessment and management of offenders with mental illness.
The gradual but substantial shift away from treating persons with mental illness at state mental hospitals has overwhelmed the criminal justice system with an influx of offenders with mental health issues. Police officers frequently are the first step in implementing the mental health treatment process. Some departments have executed programs, such as the CIT model, to train officers as basic frontline caretakers in the assessment and management of offenders with mental illness. CIT-modeled programs potentially can reduce officer line-of-duty injuries, diminish departmental costs associated with use-of-force incidents and unnecessary arrest procedures, provide safer streets for communities, and adequately and efficiently address the needs of citizens with mental illness.
Police officers have a parens patriae obligation to protect those with disabilities.[9] Their actions when interacting with persons with mental illness have ripple effects across the criminal justice system and the communities they serve. Implementing industrywide mental health response programs can provide officers additional training to successfully interact with individuals suffering mental health crises and de-escalate these situations.
For additional information Mr. Wilcox may be contacted at


Thursday, September 13, 2012

Trinity Mount Ministries Video Channels on Vimeo:

Trinity Mount Ministries Video Channels on Vimeo - Missing Children, Child Safety, Mental Health and Inspirational.

DOJ Mental Health Reform - Police of Portland, OR:

Department of Justice Office of Public Affairs - Justice Department and the City of Portland, Ore.

Preliminary Agreement on Reforms Regarding Portland Police Bureau’s Use of Force Against Persons with Mental Illness.

Wednesday, September 5, 2012

The Teen Brain: Still Under Construction:

Logo for the National Institute of Mental HealthNational Institute of Mental Health, Transforming the understanding and treatment of mental illness throught research.

Cover image of Teen Brain: Still Under Construction publication

 The Teen Brain: Still Under Construction


One of the ways that scientists have searched for the causes of mental illness is by studying the development of the brain from birth to adulthood. Powerful new technologies have enabled them to track the growth of the brain and to investigate the connections between brain function, development, and behavior.
The research has turned up some surprises, among them the discovery of striking changes taking place during the teen years. These findings have altered long-held assumptions about the timing of brain maturation. In key ways, the brain doesn’t look like that of an adult until the early 20s.
An understanding of how the brain of an adolescent is changing may help explain a puzzling contradiction of adolescence: young people at this age are close to a lifelong peak of physical health, strength, and mental capacity, and yet, for some, this can be a hazardous age. Mortality rates jump between early and late adolescence. Rates of death by injury between ages 15 to 19 are about six times that of the rate between ages 10 and 14. Crime rates are highest among young males and rates of alcohol abuse are high relative to other ages. Even though most adolescents come through this transitional age well, it’s important to understand the risk factors for behavior that can have serious consequences. Genes, childhood experience, and the environment in which a young person reaches adolescence all shape behavior. Adding to this complex picture, research is revealing how all these factors act in the context of a brain that is changing, with its own impact on behavior.
The more we learn, the better we may be able to understand the abilities and vulnerabilities of teens, and the significance of this stage for life-long mental health.
The fact that so much change is taking place beneath the surface may be something for parents to keep in mind during the ups and downs of adolescence.

The "Visible" Brain

A clue to the degree of change taking place in the teen brain came from studies in which scientists did brain scans of children as they grew from early childhood through age 20. The scans revealed unexpectedly late changes in the volume of gray matter, which forms the thin, folding outer layer or cortex of the brain. The cortex is where the processes of thought and memory are based. Over the course of childhood, the volume of gray matter in the cortex increases and then declines. A decline in volume is normal at this age and is in fact a necessary part of maturation.
The assumption for many years had been that the volume of gray matter was highest in very early childhood, and gradually fell as a child grew. The more recent scans, however, revealed that the high point of the volume of gray matter occurs during early adolescence.
While the details behind the changes in volume on scans are not completely clear, the results push the timeline of brain maturation into adolescence and young adulthood. In terms of the volume of gray matter seen in brain images, the brain does not begin to resemble that of an adult until the early 20s.
The scans also suggest that different parts of the cortex mature at different rates. Areas involved in more basic functions mature first: those involved, for example, in the processing of information from the senses, and in controlling movement. The parts of the brain responsible for more "top-down" control, controlling impulses, and planning ahead—the hallmarks of adult behavior—are among the last to mature.

What's Gray Matter?

The details of what is behind the increase and decline in gray matter are still not completely clear. Gray matter is made up of the cell bodies of neurons, the nerve fibers that project from them, and support cells. One of the features of the brain's growth in early life is that there is an early blooming of synapses—the connections between brain cells or neurons—followed by pruning as the brain matures. Synapses are the relays over which neurons communicate with each other and are the basis of the working circuitry of the brain. Already more numerous than an adult's at birth, synapses multiply rapidly in the first months of life. A 2-year-old has about half again as many synapses as an adult. (For an idea of the complexity of the brain: a cube of brain matter, 1 millimeter on each side, can contain between 35 and 70 million neurons and an estimated 500 billion synapses.)
Scientists believe that the loss of synapses as a child matures is part of the process by which the brain becomes more efficient. Although genes play a role in the decline in synapses, animal research has shown that experience also shapes the decline. Synapses "exercised" by experience survive and are strengthened, while others are pruned away. Scientists are working to determine to what extent the changes in gray matter on brain scans during the teen years reflect growth and pruning of synapses.

A Spectrum of Change

Research using many different approaches is showing that more than gray matter is changing:
  • Connections between different parts of the brain increase throughout childhood and well into adulthood. As the brain develops, the fibers connecting nerve cells are wrapped in a protein that greatly increases the speed with which they can transmit impulses from cell to cell. The resulting increase in connectivity—a little like providing a growing city with a fast, integrated communication system—shapes how well different parts of the brain work in tandem. Research is finding that the extent of connectivity is related to growth in intellectual capacities such as memory and reading ability.
  • Several lines of evidence suggest that the brain circuitry involved in emotional responses is changing during the teen years. Functional brain imaging studies, for example, suggest that the responses of teens to emotionally loaded images and situations are heightened relative to younger children and adults. The brain changes underlying these patterns involve brain centers and signaling molecules that are part of the reward system with which the brain motivates behavior. These age-related changes shape how much different parts of the brain are activated in response to experience, and in terms of behavior, the urgency and intensity of emotional reactions.
  • Enormous hormonal changes take place during adolescence. Reproductive hormones shape not only sex-related growth and behavior, but overall social behavior. Hormone systems involved in the brain's response to stress are also changing during the teens. As with reproductive hormones, stress hormones can have complex effects on the brain, and as a result, behavior.
  • In terms of sheer intellectual power, the brain of an adolescent is a match for an adult's. The capacity of a person to learn will never be greater than during adolescence. At the same time, behavioral tests, sometimes combined with functional brain imaging, suggest differences in how adolescents and adults carry out mental tasks. Adolescents and adults seem to engage different parts of the brain to different extents during tests requiring calculation and impulse control, or in reaction to emotional content.
  • Research suggests that adolescence brings with it brain-based changes in the regulation of sleep that may contribute to teens' tendency to stay up late at night. Along with the obvious effects of sleep deprivation, such as fatigue and difficulty maintaining attention, inadequate sleep is a powerful contributor to irritability and depression. Studies of children and adolescents have found that sleep deprivation can increase impulsive behavior; some researchers report finding that it is a factor in delinquency. Adequate sleep is central to physical and emotional health.

The Changing Brain and Behavior in Teens

One interpretation of all these findings is that in teens, the parts of the brain involved in emotional responses are fully online, or even more active than in adults, while the parts of the brain involved in keeping emotional, impulsive responses in check are still reaching maturity. Such a changing balance might provide clues to a youthful appetite for novelty, and a tendency to act on impulse—without regard for risk.
While much is being learned about the teen brain, it is not yet possible to know to what extent a particular behavior or ability is the result of a feature of brain structure—or a change in brain structure. Changes in the brain take place in the context of many other factors, among them, inborn traits, personal history, family, friends, community, and culture.

Teens and the Brain: More Questions for Research

Scientists continue to investigate the development of the brain and the relationship between the changes taking place, behavior, and health. The following questions are among the important ones that are targets of research:
  • How do experience and environment interact with genetic preprogramming to shape the maturing brain, and as a result, future abilities and behavior? In other words, to what extent does what a teen does and learns shape his or her brain over the rest of a lifetime?
  • In what ways do features unique to the teen brain play a role in the high rates of illicit substance use and alcohol abuse in the late teen to young adult years? Does the adolescent capacity for learning make this a stage of particular vulnerability to addiction?
  • Why is it so often the case that, for many mental disorders, symptoms first emerge during adolescence and young adulthood?
This last question has been the central reason to study brain development from infancy to adulthood. Scientists increasingly view mental illnesses as developmental disorders that have their roots in the processes involved in how the brain matures. By studying how the circuitry of the brain develops, scientists hope to identify when and for what reasons development goes off track. Brain imaging studies have revealed distinctive variations in growth patterns of brain tissue in youth who show signs of conditions affecting mental health. Ongoing research is providing information on how genetic factors increase or reduce vulnerability to mental illness; and how experiences during infancy, childhood, and adolescence can increase the risk of mental illness or protect against it.

The Adolescent and Adult Brain

It is not surprising that the behavior of adolescents would be a study in change, since the brain itself is changing in such striking ways. Scientists emphasize that the fact that the teen brain is in transition doesn't mean it is somehow not up to par. It is different from both a child's and an adult's in ways that may equip youth to make the transition from dependence to independence. The capacity for learning at this age, an expanding social life, and a taste for exploration and limit testing may all, to some extent, be reflections of age-related biology.
Understanding the changes taking place in the brain at this age presents an opportunity to intervene early in mental illnesses that have their onset at this age. Research findings on the brain may also serve to help adults understand the importance of creating an environment in which teens can explore and experiment while helping them avoid behavior that is destructive to themselves and others.

Alcohol and the Teen Brain

Adults drink more frequently than teens, but when teens drink they tend to drink larger quantities than adults. There is evidence to suggest that the adolescent brain responds to alcohol differently than the adult brain, perhaps helping to explain the elevated risk of binge drinking in youth. Drinking in youth, and intense drinking are both risk factors for later alcohol dependence. Findings on the developing brain should help clarify the role of the changing brain in youthful drinking, and the relationship between youth drinking and the risk of addiction later in life.


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Sunday, August 5, 2012

MAD IN AMERICA - Book Review: Science, Psychiatry and Community

“The most important bit of mental health muckraking since Deutsch’s The Shame of the States was published in 1948.”

                                                 In These Times

About the Book

Mad in America is a history of the treatment of the severely mentally ill in the United States from colonial times until today. The book tells of the introduction of moral therapy in the early 1800 by the Quakers; the eugenic attitudes toward the mentally ill embraced by American society in the first half of the 20th centuy; and the various somatic therapies–the shock therapies and frontal lobtomy–embraced by psychiatry in the 1930s and 1940s. Finally, it tells of the poor outcomes for schizophrenia patients in the modern psychopharmacology era. (See chapters).
Conventional histories of psychiatry tell of how Thorazine and other antipsychotic medications “revolutionized” the care of the severely mentally ill. These drugs made it possible for people with schizophrenia to leave the asylum and live in the community–or so the story is told. Mad in America puts that story of progress under a historical and scientific microscope.
The history told in Mad in America will surprise many readers. In its review of the scientific literature, the book reveals that long-term outcome studies  of antipsychotics regularly showed that the drugs increased the likelihood that people diagnosed with schizophrenia would become chronically ill. The book also investigates the marketing of the new atypical antipsychotic medications in the 1990s, and uncovers the scientific fraud at the heart of that enterprise.

About the Documents

  1. The Evidence for Antipsychotics
  2. Antipsychotic Drugs and Chronic Illness
  3. Antipsychotics and Progressive Brain Dysfunction
  4. Outcomes in the Era of Atypical Antipsychotics
  5. Modern Experimental Programs Producing Better Outcomes
Also, see the timeline for antipsychotics.

Trinity Mount Ministries

Tuesday, October 25, 2011

FBI - Responding to Persons with Mental Illness:

Responding to Persons with Mental Illness
By Abigail S. Tucker, Psy.D., Vincent B. Van Hasselt, Ph.D.,
Gregory M. Vecchi, Ph.D., and Samuel L. Browning, M.S.
Police officer kneeling down to a distressed female sitting on the ground.
While police officers may not consider providing services to persons with mental illness one of their primary functions, they respond to challenges and dangers that ordinary citizens and social service agencies are not equipped to manage. In addition to their roles as investigators and protectors, police still must keep the peace.1 However, a review of case records illustrates the frustrating and often tragic outcome of police calls for assistance pertaining to mental illness. A closer look at these instances demonstrates that officers usually serve as an initial contact for both the criminal justice and the social service systems. Unfortunately, a disconnect exists in the process from the first police response to the next level of appropriate care due largely to a lack of proper training, resources, and collaborative community support.2
Historical Perspectives
The trend toward deinstitutionalization between the 1960s and 1980s contributed to the increased contact between police and individuals with mental illness.3 Further, the curtailment of federal mental health funding and the introduction of legal reforms have given these persons the right to live in the community without treatment.4 However, many of the legal reforms in the 1970s affected people with mental illness by instituting laws for involuntary treatment, as well as those for nondangerous offenses (e.g., responding verbally to auditory hallucinations in public parks, sleeping on park benches). Beginning in the 1950s, officers adhered to the professional model, which used experts from other fields (e.g., psychologists, advocacy lawyers) to bolster police reform and response to mental illness.5 Such goals, while highly commendable, often were not realized by police agencies due to financial constraints, a lack of realistic application, and the inability of the consulting professionals to offer useful guidelines.
Upon confrontation with individuals with mental illness, police have three main options: 1) transport them to a receiving psychiatric facility; 2) use informal verbal skills to de-escalate the situation; or 3) arrest the individual.6 These possible actions stem from basic concepts that guide police in all citizen encounters—the duty of the officer to protect and serve the community and the governing reforms that stipulate the power of an officer to involuntarily protect those behaving irrationally who may harm themselves or others.7

Dr. Abigail Tucker, Psy.D.
Dr. Van Hasselt
Samuel Browning
Dr. Vecchi heads the Behavioral Science Unit at the FBI Academy.

Dr. Tucker is the program manager for the Justice Program at Community Reach Center in Thornton, Colorado. Dr. Van Hasselt is a
professor of psychology
at Nova Southeastern University in Davie, Florida, and an
officer with the Plantation Police Department.
Mr. Browning, a former police officer, is a doctoral candidate in clinical
psychology at Nova
Southeastern University
in Davie, Florida.
Dr. Vecchi heads the Behavioral Science Unit at the FBI Academy.

Recently, more comprehensive and flexible approaches have arisen; however, they are in the minority. Examples include specialized police training and units, community-collaborative programs, and crisis intervention training. As widespread media coverage in the past decade has underscored, these limited options can lead to cases resulting in death or injury. Even more tragic is the increase in police-assisted suicide, defined by Police Officer Standards and Training as “an incident in which an individual engages in behavior which poses an apparent risk of serious injury or death, with the intent to precipitate the use of deadly force by law enforcement personnel toward that individual.” Research shows that a significant number of persons committing this act have some form of mental illness.8
Specialiazed Police Response Models
Officers often receive blame for lethal outcomes in situations involving mental illness. Four decades ago, police were described as often being pigeonholed into making medical decisions with little training and few, if any, response options.9 Ironically, this conclusion still proves largely relevant today.
As one possibility, law enforcement agencies can employ police-referral programs. An examination of a police-referral program that designated an intake unit at a community mental health center (CMHC) found that streamlining the process of how officers refer individuals with mental illness to hospitals bolstered the program’s effectiveness.10 Additionally, the analysis showed that a collaborative response between police and the CMHC reduced recidivism rates in referred psychiatric patients.
Police also can incorporate specialized programs. One report noted that although more than 50 percent of departments nationwide do not have such a program/response, most rate themselves as effective in managing service calls pertaining to mental illness.11 This contradicts research that points to the efficacy of specialized response programs.12 In an encouraging trend, more recent efforts suggest that the number of law enforcement agencies reporting specialized training and units for dealing with persons with mental illness is increasing.13
Open quotes
The trend toward
deinstitutionalization between the 1960s and 1980s contributed to the increased contact between police and individuals with
mental illness.
Close quotes
Crisis Intervention Teams
The Memphis Model of Crisis Intervention Team (CIT) provides a framework for a police-based specialized officer response now well established in the field. CIT was created in Memphis, Tennessee, in 1988 following the tragic death of a suicidal man with schizophrenia.14 Although many officers of the Memphis Police Department knew of his mental illness, the ones responding to the particular incident were unfamiliar with him. When police confronted him and demanded that he drop his knife, the young man became upset and made a sudden move toward the officers, forcing them to shoot (as they had been trained to do in such situations) and fatally wound him. Following this incident, the community demanded a response.
Unfortunately, this does not represent an isolated incident; law enforcement interactions with persons with a mental illness more frequently result in the use of force by police than incidents involving individuals who do not suffer from a mental condition.15 This can lead to injury of both the individuals and the officers. However, some of the incidents that result in the death of citizens at the hand of law enforcement personnel cannot be avoided, as in the case of individuals who commit suicide by cop. CIT offers investigators insight into these persons and, perhaps, options to pursue during their exchanges with them. The CIT model incorporates two main components: 1) a collaborative framework between the community mental health resources, recipients of those services, and local law enforcement agencies; and 2) specialized training for CIT officers in mental health issues, crisis intervention, and de-escalation.16
Collaborative Framework
Collaborations between policy makers, law enforcement, the regional division of the National Alliance for the Mentally Ill (NAMI), persons with a mental health issue, and others from the community began to form in the initial CIT planning stages. One example of these collaborations in Memphis was the formation of a single-location mental health care facility for police drop-offs, called the Med.17 This facility enacted for police a no-refusal policy for officer referrals and streamlined the intake process to allow them to admit someone with mental illness and get back on patrol within about 30 minutes.

Cop Car in front of Hospital

Officer Training
In addition to collaborations and policy changes, certain officers are selected or volunteer to receive specialized training as part of the 40-hour CIT training program. The CIT curriculum includes recognition and understanding of the signs/symptoms of mental illnesses (e.g., schizophrenia, depression, personality disorders); pharmacological interventions and their side effects; crisis intervention and de-escalation skills; and knowledge of the user-friendly mental health resources available to individuals. In addition, role playing gives officers opportunities to practice crisis situations involving persons with mental illness. Feedback and reinforcement are provided concerning the officers’ verbal and nonverbal behaviors in these scenarios.
Mental health professionals from the community teach the majority of the course components; patients and their families also participate in educating the officers on relevant mental health challenges and issues to add perspective. Police learn how to recognize severe mental illness and how these different disorders affect the individuals. At the end of the course, officers graduate with CIT certification and receive a pin to wear on their uniforms, identifying them as CIT officers. This allows persons with mental illness in crisis to recognize CIT officers and also serves as a source of pride for the law enforcement professionals.
Research Support
Experts evaluated the Memphis CIT model by comparing perceived preparedness, quality of response to persons with mental illness, diversion from jail, officer time spent on these calls, and community safety and found empirical support for the effectiveness of this approach.18 Additional researchers expanded on this work by using arrest rates and feedback from referral sources.19 Their results provided further support for the Memphis CIT model with findings of higher response rates and fewer arrests. Also, it appears that an integral component of CIT training is the use of crisis intervention and active listening skills (e.g., paraphrasing, reflecting emotions, asking open-ended questions), which are critical for de-escalating crisis situations in general and situations involving individuals with mental illness in particular.20 Apparently, psychological evaluation concerning mental health issues, as well as crisis intervention skills training, both comprise important aspects of CIT.
Barriers and Concerns
One barrier in the development of police-based specialized officer response is the definition of training in the field of law enforcement. Basic officer training will prove inadequate in addressing this growing and volatile problem without ongoing review and skill maintenance. Researchers note the common misperception that all police officers have the same mandated training and available resources.21 Other experts contend that for specialized response programs to work effectively, training is a crucial element. Law enforcement training is most effective when it includes consultation with mental health professionals and other administrative and social service systems.22
The mental health care system itself appears to be another barrier to policing progress involving mental health situations. Social service agencies often refuse to admit intoxicated or psychotic persons referred by police. In addition, the “revolving door” phenomenon of recidivism supports the reality of overworked and underpaid staff in receiving facilities, such as hospitals and community mental health centers. Specifically, many treatment facilities require police custody in the waiting area for individuals transported for a mental disturbance. Also, no systematic and hierarchical structure exists that links first responders (e.g., police, EMS) with the appropriate level of care in the mental health system (e.g., medical versus psychiatric hospitals, social service shelters versus drug rehabilitation centers).
Overall, research supports the use of a specialized law enforcement response to address the needs of persons with mental illness. In particular, the Memphis CIT model is functional, generally accepted by police departments, and, most important, effective.23
Open quotes
…research supports
the use of a
specialized law
enforcement response
to address the needs
of persons with
mental illness.
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The utility of such programs is enhanced by the use of collaborative drop-off sites. These allow for greater flexibility, provide ease and speed in application, and serve as a more economical option. However, a few important guidelines can make a substantial difference in effectiveness. For example, researchers recommended police-friendly procedures that include a no-refusal policy, an intake process with streamlined paperwork, and consistent procedural steps.24
Police officers maintain and enforce public order. Their role as both first responders and peacekeepers remains a challenge in many ways. The law enforcement response to mental disturbance calls with ethical, practical, and effective strategies requires interagency collaboration. Numerous examples attest to the efficacy of police-based interventions and collaborative policies and procedures. In particular, current research supports the use of a specialized law enforcement response to meet the needs and demands of persons with mental illness while ensuring their safety and dignity.
1 G.W. Cordner, “A Community Policing Approach to Persons with Mental Illness,” Journal of the American Academy of Psychiatry and the Law 28 (2000): 326-331.
2 A.S. Tucker, V.B. Van Hasselt, and S.A. Russell, “Law Enforcement Response to the Mentally Ill: An Evaluative Review,” Brief Treatment and Crisis Intervention 8 (2008): 236-250.
3 M. Zdanowicz, “A Sheriff’s Role in Arresting the Mental Illness Crisis,” Sheriff 53 (2001): 2-4.
4 L.A. Teplin, “Keeping the Peace: Police Discretion and Mentally Ill Persons,” National Institute of Justice Journal 244 (2000): 8-15.
6 Teplin.
7 Ibid.
8 H.R. Hutson, D. Anglin, J. Yarbrough, K. Hardaway, M. Russell, J. Strote,
M. Canter, and B. Blum, “Suicide by Cop,” Annals of Emergency Medicine 32 (1998): 665-669; V.B. Lord, “Law Enforcement-Assisted Suicide,” Criminal Justice and Behavior 27 (2000): 401-419; and A.J Pinizotto, E.F Davis, and C.E. Miller, “Suicide by Cop: Defining a Devastating Dilemma,” FBI Law Enforcement Bulletin, February 2005, 8-20.
9 A.R. Matthews, Jr., “Observations on Police Policy and Procedures for Emergency Detention of the Mentally Ill,” The Journal of Criminal Law, Criminology and Police Science 61 (1970): 283-295.
10 L.A. Teplin and E.P. Sheridan, “Police-Referred Psychiatric Emergencies: Advantages of Community Treatment,” Journal of Community Psychology 9
(1981): 140-147.
11 M.W. Deane, H.J. Steadman,
R. Borum, B.M. Veysey, and J.P. Morrisey, “Emerging Partnerships Between Mental Health and Law Enforcement,” Psychiatric Services 50 (1999): 99-101.
12 Teplin and Sheridan; R. Borum, M.W. Deane, H.J. Steadman, and J. Morrissey, “Police Perspectives on Responding to Mentally Ill People in Crisis: Perceptions of Program Effectiveness,” Behavioral Sciences and the Law 16 (1998): 393-405; T.M. Green, “Police as Frontline Mental Health Workers: The Decision to Arrest or Refer to Mental Health Agencies,” International Journal of Law and Psychiatry 20 (1997): 469-486; and H.J. Steadman, M.W. Deane, R. Borum, and J.P. Morrissey, “Comparing Outcomes of Major Models of Police Responses to Mental Health Emergencies,” Psychiatric Services 51 (2000): 645-649.
13 J. Hails and R. Borum, “Police Training and Specialized Approaches to Respond to People with Mental Illness,” Crime and Delinquency 49 (2003): 52-62.
14 B. Vickers, U.S. Department of Justice, Bureau of Justice Assistance, “Memphis, Tennessee, Police Department’s Crisis Intervention Team,” Bulletin from the Field: Practitioner Perspectives, (accessed August 20, 2010).
15 R.S. Engel and E. Silver, “Policing Mentally Disordered Suspects: A Reexamination of the Criminalization Hypothesis,” Criminology 39 (2001): 225-253.
16 R. Dupont and S. Cochran, “Police Response to Mental Health Emergencies: Barriers to Change,” Journal of American Academy of Psychiatry and the Law 28 (2000): 338-344; and Vickers.
17 Vickers.
18 Borum, Deane, Steadman, Morrissey, “Police Perspectives on Responding to Mentally Ill People in Crisis.”
19 Steadman, Deane, Borum, and Morrissey, “Comparing Outcomes of Major Models of Police Responses to Mental Health Emergencies.”
20 G.M. Vecchi, V.B. Van Hasselt, and S.J. Romano, “Crisis (Hostage) Negotiation: Current Strategies and Issues in High Risk Conflict Resolution,” Aggression and Violent Behavior: A Review Journal 10 (2005): 533-551.
21 DuPont and Cochran.
22 H.J. Steadman, K.A. Stainbrook, P. Griffin, J. Draine, R. DuPont, and
C. Horey, “A Specialized Crisis Response Site as a Core Element of Police-Based Diversion Programs,” Psychiatric Services 52 (2001):
23 Dupont and Cochran.
24 Steadman, Stainbrook, Griffin, Draine, DuPont, and Horey.

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Sunday, August 14, 2011

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