Module 5 - Test 3

Define Impaired thinking

Define Impaired thinking

The Person may be unable to complete simple tasks like dialing a phone or reading simple signs

Define Impaired judgment

The person cannot properly evaluate the propriety of actions, and so, may act in socially inappropriate ways such as grabbing people, making off-color comments, urinating anywhere.

Define intellectual and developmental disorders and distinguish major differences between mental illness and intellectual and developmental disabilities

A. Intellectual disability means significantly sub-average general intellectual functioning that is concurrent with deficits in adaptive behavior and originates during the developmental period.

B. Developmental disability means a severe, chronic disability that
1. Is attributed to a mental or physical and mental impairments;
2. Is manifested before the person reaches 22 years of age;
3. Is likely to continue indefinitely

What are symptoms of delirium?

1. Reduced awareness of the environment
2. Poor thinking skills
3. Behavior changes
4. Emotional disturbances

Who are often the first-line responders?

The Police

Define Mental Health

1. a person's mental health condition with regard to their psychological and emotional well-being.

2.Mental health includes our emotional, psychological, and social well-being. It Affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices.

Define Mental illness

1. An illness, disease or condition that either substantially impacts a person's thought, perception of reality, emotional process or judgment, or grossly impairs a person's behavior, as manifested by recent disturbance behavior.

2. Mental illness means an illness, disease, or condition, other than epilepsy, dementia, substance abuse, or intellectual disability, that:
a. Substantially impairs a person's thought, perception of reality, emotional process, or judgment; or
b. grossly impairs behavior as demonstrated by recent disturbed behavior.

We shall refer to a person with a mental illness as?

A Consumer.

What condition is not considered a mental illness?

Excited Delirium

What are the two most common mood disorders encountered by jailers?

1. Depression
2.Bi-polar Disorder.

What is Depression?

1. Depression is a common, widespread disorder.

2.A major depressive syndrome is defined as a depressed mood or loss of interest of at least TWO WEEK duration accompanied by symptoms such as weight loss/gai and difficulty concentrating. FIVE OR MORE SYMPTOMS ARE GENERALLY PRESENT DURING THE SAME TWO-WEEK PERIOD AND REPRESENTED BY A CHANGE FROM PREVIOUS FUNCTIONING. Depressed mood or loss of interest must also be included as a symptom.

3. Statistics say that 6.6% of adults aged 18 or older had a mjor depressive episode (MDE) in 2014

What is Bipolar disorder?

A mental illness involving mania (an intense enthusiasm) and depression.

Define Schizophrenia

a brain disorder that impacts the way a person thinks ( often described as a "thought disorder"), and is characterized by a range of cognitive, behavioral, and emotional experiences that can include: delusions, hallucinations, disorganized thinking, and grossly disorganized or abnormal motor behavior.

when do symptoms of Schizophrenia manifest?

typically manifest between the ages of 16 - 30.

Define Dementia

Dementia is an umbrella term used to describe a decline in memory or brain function that impacts an individuals daily life.

What are symptoms of dementia?

1. Memory problems
2. Confabulation
3. Impaired thinking
4. Impaired Judgment

Define Memory problems

Memory problems can relate to recent memory or memories of the past.

Define Confabulation

Some people, who do not remember, make up facts to cover lack of memory. "Lying" is not done on purpose but is a part of the mental illness.

Define Anxiety disorders

a group of mental disturbances characterized by anxiety as a central or core symptom. although anxiety is a commonplace experience, not everyone who experiences it has an anxiety disorder. Anxiety is associated with wide range of physical illnesses, medication side effects, and other psychiatric disorders.

What are characteristics of Anxiety disorders?

Anxiety disorders are characterized by excessive fear or anxity that is difficult to control and negatively and substantially impacts daily functioning. Fear refers to the emotional response to a real or perceived threat while anxiety is the anticipation of a future threat. Theses disorders can range from specific fears (called phobias), such as the fear of flying or public speaking, to more generalized feeling of worry and tension. Anxiety disorders include generalized anxiety disorder (GAD), panic disorder, separation anxiety disorder, and social anxiety disorder (social phobias).

Define Eating disorders

Eating disorders are serious conditions related to persistent eating behaviors that negatively impact your health, your emotions, and your ability to function in important areas of life.

Are eating disorders impacting jail populations?

Although eating disorders are classified under the five prominent categories of mental illness this form of mental illness has not significantly impacted jail populations as severely as the other four have.

Define Mood disorder

A psychological disorder characterized by the elevation or lowering of a person's mood, such as depression or bipolar disorder

What is DSM-5?

Diagnostics & statistics manual of mental disorders

People with mental health disorders are more likely to experience _______ more than people without mental health disorders?

An alcohol or substance use disorder

What are symptoms of substance withdrawal?

1.Emotional withdrawal symptoms
a. Anxiety
b. Restlessness
c. Irritability
d. insomnia
e. Headaches
f. Poor concentration
g. Depression
h. Social isolation

2 . Physical withdrawal symptoms
a. Sweating
b. Racing heart
c. Palpitations
d. Muscle tension
e. Tightness in the chest
f. Difficulty breathing
g. Tremor
h. Nausea, Vomiting, diarrhea

Define Psychosis

Psychosis is an illness involving A DISTORTION OF REALITY that may be accompanied and/or hallucinations.

What are the two most common experiences related to psychosis?

1.Hallucinations: are seeing, hearing, or feeling things that aren't there, such as the following:
A. Hearing voices
B. Strange sensations or unexplainable feeling
C. Seeing glimpses of objects or people that are not there

2. Delusions: are strong beliefs that are not consistent with the persons culture, are unlikely to be true and may seem irrational to other, such as the following;
A. Believing external forces are controlling thoughts, feeling and behaviors
B. Believing that trivial remarks, events, or object have personal meaning or significance.

3. Think g you have special powers, are on a special mission, or even that you are god.

Identify the characteristics of a person in psychosis

Unusual attachment to childish toys

Define excited delirium

A serious and potentially deadly medical condition INVOLVING PSYCHOTIC BEHAVIOR, ELEVATED TEMPERATURE, AND AN EXTREME FIGHT OR FLIGHT RESPONSE by the nervous system.

What are the 3 appropriate responses to excited delirium m?

1. Notify medical staff
2. Remove physical restrains
3. When using restraints, monitor the subject for positional asphyxiation.

What are the tree most common personality disorders?

A. Paranoid
B. Antisocial
1. Most commonly recognized in males
C. Borderline
1. Most commonly recognized in females

What are the characteristics of personality disorders?

1. Those who struggle with a personality disorder have a GREAT DIFFICULTY DEALING WITH OTHER PEOPLE.

2. They may use alcohol and illegal substances as a form of self-medication, due to the stress and the consequences of their behaviors. They OFTEN NEED TREATMENT FOR CHEMICAL DEPENDENCY OR DEPRESSION.

What are the 2 characteristics associated with intellectual and developmental disorders

A. Speech/ language
1. Obvious speech defect
2. Limited response or understanding
3. Inattentiveness
4. Vocabulary or grammatical skills lacking
5. Difficulty describing facts in detail

B. Social behavior
1. Adult associating with children or early adolescents
2.Eager to please
3. Ignorance of personal space
4. Non- age appropriate behavior
5. Easily influenced by others
6. Easily frustrated or aggressive in response to direct questioning

What are the differences between mental illness and intellectual and developmental disabilities?

1. Mental illness is unrelated to intelligence, while intellectual disabilities are associated with below- average intellectual functioning

2. Mental illness develops at any point in one's life, while developmental disability occurs before the age of 22.

3. There is no cure for mental illness, but medications can control symptoms. Intellectual disability involves permanent intellectual impairment. No medications can help.

Define traumatic Brain injury

TBI is a blow or jolt to the head or penetrating head injury that disrupts the normal function of the brain.

A. The severity of injury may range from a mild concussion to severe closed or open head injury

B. The injury may not be reported or diagnosed

C. TBI symptoms may not appear for months or years.

Define delirium

Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of your environment. The start of delirium is usually rapid— within a few hours or a few days.

Define crisis as related to mental health

A situation in which
1. The individual presents an immediate danger to self or others.
2.The individuals mental or physical health is at risk of serious deterioration; or
3. An individual believes that he or she presents an immediate danger to self or others, or that his or her mental or physical health is at risk of serious deterioration.

What are the 4 key de-escalation/ communication techniques for the management of individuals in crisis?

1. Build trust and rapport
2. Promote communication by listening
3. Respond effectively
4. Maintain personal space

What are the basic communication guidelines?

1. Use short, clear and direct sentences.
2. Keep the contents of communication simple
3. Keep the " stimulation level" as low as possible.
4. Allow the person time to acclimate to the situation if they are withdrawn or uncommunicative.
5. BE PATIENT! instructions and directions will often have to be repeated.
6. Be pleasant and firm. Make sure your boundaries are specific and clear.
7. Praise all cooperative behavior.
8. Practice active listening
a. "sounds like you are feeling (angry, upset, and sad) - is that right?
9. Remember a person in crisis may be further agitated by intervention, even when they are necessary.
10. Nonverbal communication speaks volumes. A cooperative and open stance may be more effective!

what are the concepts of the de-escalation paradox?

a. The difference between traditional inmate encounters and an encounter with an inmate who has mental illness is the need to be non-confrontational.
1. An inmate with compromised coping capacity who is experiencing a crisis may have unpredictable behavior which can be mistaken for non compliance with your commands.

B. Safety is compromised any time a jailer goes "hands-on" with a person. jailers should use non-confrontational, verbal de-escalation skills to talk them down versus take them down.
1. A non-confrontational approach give you time to think, act, and understand the situation immediately in front of you.
2. Disorganized thinking, hallucinations, and paranoid thoughts can be a reason why command and control approaches may escalate.

C. Reasons for non compliance are more about the brain disorder than a power struggle.

How serious is the suicide problem in the nation and the state of texas?

National statistics state:
1. More than a third (425 of 1,053 deaths, or 40%) of inmate deaths occurred within the first 7 days of admission.

Texas statistics show:
1. 24% of suicides in Texas jails occur within the first 24 hours of incarceration.
2. 20% of the suicides occurring in Texas jails involve victims who are intoxicated at the time of suicide.
3. 93% of suicide victims in Texas jails use the hanging method for suicide.

What are myths about suicide?

1. People who make suicidal statements or threaten suicide don't commit suicide.

2. Suicide happens suddenly without warning

3. People who attempt suicide have gotten it out of their systems and wont attempt it again.

4. Asking about and probing the inmate about suicidal thoughts or actions will cause him to kill himself.

What are some risk factors and signs and symptoms of potential suicide?

Situational factors include:

1. First-time arrestee or insignificant arrest.

2.Harsh condemning, rejecting attitudes of jailer or an authoritarian environment-regimentation.

3. Recent, excessive drinking and /or use of drugs, or withdrawals.

4. Recent loss of stabilizing resources: such as :

a. Loss of loved one.

b. loss of job or expulsion from school.

c. recent, pending, threatened divorce, separation or break-up.

d. rejection by peers( common among young inmates)

e. Loss of home and etc...

f. business failure or financial disaster

5. rape or threat of it.

6. Current mental illness, poor health, or terminal illness.

Segregation increases risk of ______ difficulties among the mentally ill and juveniles?

psychological difficulties

what are key times to observe signs and symptoms of suicide?

1. at arrest and booking
2. during transportation
a. sentencing, court appearance or to and from state correctional facilities.
3. first 24hrs of confinement
4. intoxication or withdrawal
5. waiting for high profile trial or sentencing.
6. impending release
7. holidays
8. darkness (during lights out)
9. decreased staff supervision.

what are warning signs and symptoms of suicide?

1. Talks about or threatens suicide
2. Signs and symptoms of depression.
3. feelings of hopelessness or helplessness
4. extreme sadness and crying.
5. withdrawal or silence
6. loss of or increase in appetite and or weight.
7. pessimistic attitudes about future.
8. sudden change in an inmates mood or behavior.
9. sudden change in regular sleeping pattern.
10. loss of interest in people, appearance or activities.
11. excessive self blaming.
12. expresses or evidences strong guilt and or shame over offenses.
13. previous suicide attempts and or history of mental illness.
14. may act very calm once the decision is made to kill themselves.
15. speaks unrealistically about getting out of jail.

when do we utilize the screening form for suicide and medical, mental, or developmental impairments?

in the intake area before admitting.

what is the first step and is crucial to determine which inmates require more specialized mental health assessment?

Intake screenings

when should an intake screening form be completed?

they must be completed on all inmates immediately upon admission to the facility.

who should complete the intake screening form?

by trained booking jailer or medical/ mental health personnel.

what should happen if the inmate is unable or refuses to answer questions?

notify supervisor and place the inmate on suicide watch until a form can be completed. notate the reason why the form cannot be completed and complete a new form when the inmate is able to answer the questions.

what is CCP ss 16.22?

EARLY IDENTIFICATION OF DEFENDANT SUSPECTED OF HAVING MENTAL ILLNESS OR INTELLECTUALLY DISABLED.
(1) Not late than 12 hours after receiving credible information that may establish reasonable cause to believe that a defendant committed to the sheriffs custody has a mental illness or is a person with an intellectual disability, including observation of the defendants behavior immediately before, during and after the defendants arrest and the results of any previous assessment of the defendant. THE SHERIFF SHALL PROVIDE WRITTEN OR ELECTRONIC NOTICE OF THE INFORMATION TO THE MAGISTRATE (JUDGE).

What cells are designated for inmates on suicide watch?

1. violent cell- a single occupancy padded cell for the temporary holding of inmates harmful to themselves and or others.

2. Administrative separation- the assignment of an inmate to a special housing unit, usually a separation or single cell, when staff determines that such close custody is needed for the safety of inmates or staff, for the security of the facility, or to promote order in the facility

3. single cell- a cell designed to accommodate 1 inmate. the cell minimally contains 1 bunk, toilet, lavatory, table, and seat.

what are some supervision requirements for inmates on suicide watch?

observation shall be performed at least every 30 minutes in areas where inmates known to be assaultive, potentially suicidal, mentally ill, or who have demonstrated bizarre behavior are confined.

what methods are used while approaching a suicidal inmate?

1. Remember that the inmate may attempt to have others kill them.
2. remain calm
3. develop a plan and follow it: rushing to rescue increases the risk to all those who are involved

what methods are used while approaching an inmate that has hung themselves?

1. First jailer on scene will conduct a visual assessment of inmate from outside cell to determine if inmate has article around neck and is attempting to hang self:

2. avoid cutting the knot for investigative purposes