Transcript Slide 1
Development and Implementation
of a CIT Training Curriculum
in a County Jail
Introductions
Joan Cairns, MFT
Director of Jail Psychiatric Services
Angelica Almeida, Ph.D.
Manager with Jail Psychiatric Services
Michele Fisher
Captain and Facility Commander with San Francisco Sheriff’s Department
Learning Objectives
Identify ways to collaborate with multiple
agencies to develop a CIT Training Curriculum
Identify the steps to implement a CIT Training
Curriculum (e.g., what topics should be covered)
in jail setting
Identify ways that this intervention improves
treatment of incarcerated mentally ill individuals
Why Develop a CIT Curriculum
for a Jail Setting?
Federal Community Mental Health Act
Signed into law in 1963 by President John F.
Kennedy
Community based care as an alternative to
institutionalization
Led to “transinstitutionalization” and
criminalization of mental illness
Rather than receiving treatment in State Hospitals,
mentally ill individuals are now incarcerated
Today, approximately 1.1 million people with severe
mental illness are 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 Today
Rates of mental illness in jails have increased upwards of 50%
over the last five years (Hirschkorn & Mitchell, 2011; Wiener,
2012)
Forensic settings now provide significantly more mental health
services to individuals than community based treatment
In 2012, San Francisco County provided mental health services
to approximately 2.5% of the population, whereas approximately
30% of the jail population has contact with mental health staff at
any given time
Jails Today
Most individuals (roughly 80%) are arrested for nonviolent
offenses such as drug and property offenses (Baillargeon,
Binswanger, Penn, Williams & Murray, 2009)
Individuals with mental illness have higher rates of recidivism
(Baillargeon et al., 2009; Steadman, Redlich, Callahan, Robbins
&Vesselinov, 2010)
County jails see higher rates of mental illness than prisons
(Hatcher, 2012)
Custody staff has to be educated on mental health issues in order
to create a safe environment and work alongside mental health
professionals
Purpose of CIT in a Jail Setting
Similar to officers in the community, custody
staff are the first responders to crises in a jail
Need to be “armed” with specialized training to
address these situations
Develops a collaboration between custody staff
and mental health professionals
Curriculum Development for
Enhanced Practical Interventions for
Collaboration (EPIC) Training
Community versus Jails
Important to consider the unique environment
of a jail setting
Note that research done in the community does
not often translate to forensic settings (e.g., risk
factors for suicide)
Commitment to the Program
Training doesn't work without buy in from all
parties
Choosing instructors that represent all
perspectives (i.e., medical, psychiatric, custody)
Modeling collaboration and mutual respect
Topics for Training
Introduction to Mental Illness
Major mental illness
Personality Disorders
Cognitive Disorders
Symptoms that may be seen in custody
Interventions
Behavioral Plans
Collaboration between deputized staff, mental health staff, medical staff
Psychiatric Housing Units
Administrative Segregation Group
Topics for Training
Suicide Prevention
Difference between general population and forensic setting
Risk factors and warning signs of suicide risk
Assessing for suicide risk
Intervention strategies
Observation Housing
Use of direct vision facilities
Use of other inmates
Do not house alone
Suicide Prevention Poster
Brief Training Videos in Muster
Topics for Training
Special Populations
First arrestees and serious charges
Veterans
Transitional Age Youth
Elderly
Developmental Disorders
Substance Abuse Disorders and Detox
Symptoms
Interventions
Topics for Training
Active Listening
Communication Strategies
Use of Force with Mentally Ill
Job Burnout
Community Resources
Presentations
2-3 day intensive training
Outings to community programs
Tangible tools for immediate use
Use of scenarios, videos, role playing
Use of recorded lectures for brief introductions to
major topics
Collaboration
Team approach to difficult cases
Vital for safety and security of facilities
Working with mental health and medical staff
Myths held by law enforcement about mental
health providers
Impact of CIT Curriculum
Feedback from deputies
Impact on jail culture and how deputized staff interacts
with inmates
Anticipated outcomes based on community model:
Reduced violence between staff and inmates
Reduced risk of injury
Increase use of verbal de-escalation rather than hands-on
interventions
Increased identification of individuals at risk for suicide
Further Information
Angelica Almeida, Ph.D.
[email protected]
510-520-8239
Joan Cairns, MFT
[email protected]
650-219-7275
Questions