2013년 11월 23일 토요일

About 'united health care cycling'|...reason, is boiling mad. The United States, the most powerful nation...New Orleans, can’t provide health care for all of its citizens, can...







About 'united health care cycling'|...reason, is boiling mad. The United States, the most powerful nation...New Orleans, can’t provide health care for all of its citizens, can...








               Abstract
               It               is               inevitable               that               first               responders               in               the               justice               system               will               come               into               contact               with               mentally               ill               people               on               a               regular               basis.

While               there               are               some               specialized               programs               in               the               justice               field               to               meet               the               needs               of               the               mentally               ill               there               is               very               little               training               for               most               line               officers.

Most               officers               do               not               know               how               to               properly               communicate               to               these               people               and               their               reports               may               reflect               incorrect               information               regarding               mental               illness.

Research               shows               that               an               increasing               number               of               people               with               serious               mental               illness               are               entering               the               justice               system               every               day.

New               training               and               standards               for               police               officers               must               be               devised               if               departments               want               to               continue               to               protect               and               serve               the               public               in               the               most               professional               way               possible.
               Introduction
               Deinstitutionalization               is               the               process               of               state               run               mental               health               facilities               being               shut               down               in               the               attempt               to               allow               people               with               serious               mental               illness               to               receive               help               from               the               community.

"State               mental               hospital               populations               are               reduced               by               discharging               long-term               residents,               shortening               hospital               stays,               and               attempting               to               reduce               the               number               of               admissions"               (Steadman,               Monahan,               Duffee,               Hartstone,               &               Robbins               1984).

While               the               intentions               were               good,               the               act               itself               has               become               "one               of               the               most               well-meaning               but               poorly               planned               social               changes               ever               carried               out               in               the               United               States"               (Torrey,               Kennard,               Eslinger,               Lamb,               and               Pavle               2010).

This               event               has               had               a               huge               impact               on               the               criminal               justice               system,               causing               jails               and               prisons               to               become               the               main               healthcare               provider               for               people               with               Serious               Mental               Illness               in               the               United               States.
               "The               police               are               typically               the               first               and               often               the               sole               community               resource               called               on               to               respond               to               urgent               situations               involving               persons               with               mental               illness"               (Lamb,               Weinberger               &               DeCuir               2002).

While               this               is               a               true               statement,               and               something               most               of               us               take               for               granted,               we               must               really               think               about               what               it               means.

Due               to               the               criminalization               of               mental               illness               in               the               past               few               decades,               more               and               more               people               with               serious               mental               illness               are               on               the               street.

While               many               of               these               people               are               non-violent               in               nature               the               general               public               views               them               as               a               nuisance               and               desire               the               local               police               to               handle               and/or               remove               these               people               from               their               vicinity.

Because               of               this,               police               are               constantly               in               contact               with               people               who               have               a               serious               mental               illness,               though               many               officers               lack               the               necessary               training               to               properly               to               handle               these               people.

With               all               of               these               issues               it               is               difficult               for               the               average               police               officer               to               know               how               to               identify               and               report               on               offenders               who               have               a               serious               mental               illness.

A               benefit               of               expanded               training               would               include               using               proper               terminology               and               types               of               mental               illnesses               in               daily               report               writing               when               encountering               these               people.
               Deinstitutionalization               has               not               worked               as               planned.

The               current               figures               indicate               that               at               least               16%               of               inmates               in               prison               have               a               serious               mental               illness               (Torrey               et               al               2010).

With               the               decrease               in               state               run               mental               hospitals               jails               and               prisons               are               now               primary               health               care               providers               for               the               mentally               ill.

All               the               act               of               deinstitutionalization               has               done               is               shifted               costs               from               hospitals               into               prisons               where               many               people               cannot               get               adequate               treatment               for               their               symptoms.

The               burden               is               now               on               the               justice               system,               and               the               public,               to               care               for               these               people.
               Healthcare               in               prison               was               constitutionally               mandated               by               the               Supreme               Court               in               1976               in               the               case               of               Estelle               v.

Gamble               (Slate               &               Johnson               2008).

While               treatment               must               be               provided,               the               resources               available               are               not               always               the               best               options               for               individuals.

Costs               are               also               higher               for               caring               for               inmates               with               a               mental               illness,               which               affects               local               and               state               budgets,               taxes,               and               how               money               is               allocated.

Restructuring               of               the               mental               health               care               system               is               something               that               will               have               to               be               done               in               the               near               future               if               we               truly               want               to               shift               the               burden               of               caring               for               those               with               SMI               from               corrections               back               to               a               more               stable,               hospital,               or               community               setting.
               Literature               Review
               The               study               of               deinstitutionalization               and               its               subsequent               effects               on               the               mentally               ill               is               a               subject               that               has               continually               gained               more               interest               year               after               year               since               the               idea               was               first               introduced.

Because               of               this               there               are               many               different,               reliable               sources               with               diverse               points               of               view               and               compelling               arguments               about               deinstitutionalization.

Many               different               areas               are               covered,               from               the               basic               study               of               deinstitutionalization,               the               response               and               training               of               law               enforcement               officials,               mental               health               courts,               and               the               fact               that               jails               and               prisons               now               house               more               mentally               ill               people               than               health               facilities.

One               interesting               thing               to               note               is               that               unlike               other               subjects               where               there               are               clear               pros               and               cons               and               two               sided               arguments,               almost               all               of               the               research               done               on               deinstitutionalization               shows               that               the               overall               picture               and               effects               of               deinstitutionalization               is               the               same.
               There               are               two               main               sources               for               the               initial               research               into               the               correlation               between               mental               health               facilities               and               the               number               of               people               incarcerated.

The               first               was               written               by               Penrose               in               1939               and               the               second               by               Henry               Steadman,               John               Monahan,               Barbara               Duffee,               Eliot               Hartstone,               and               Pamela               Clark               Robbins               written               in               1984.

Penrose's               research               was               done               in               Europe               while               Steadman's               was               a               continuation               of               Penrose's               initial               findings               in               the               United               States.

Penrose's               theory               was               that               countries               with               fewer               resources               for               treating               mentally               ill               offenders               would               have               more               people               in               jails               and               prisons,               and               vice               versa,               and               he               examined               several               European               countries               and               his               data               indicated               that               his               theory               was               correct               (Penrose               1939).

Steadman               and               his               team               combine               the               research               done               by               Penrose               in               1939               to               show               a               direct               correlation               between               Penrose's               results               and               their               look               at               prison               populations               in               the               United               States.

Because               of               Steadman               the               idea               of               deinstitutionalization               became               known               on               a               large               scale               by               American               readers               and               proved               that               Penrose's               initial               findings               were               true               in               the               United               States               as               well               as               Europe               (Steadman               et               al               1984).

Moving               away               from               the               big               picture               look               at               deinstitutionalization,               research               is               typically               done               regarding               the               current               state               of               affairs               with               jails,               prisons,               and               the               justice               system,               or               with               community               outreach               and               response               regarding               people               who               are               mentally               ill.
               While               examining               research               regarding               justice               system               response               we               find               that               most               authors               agree               with               the               fact               that               deinstitutionalization               has               caused               more               harm               than               good,               causing               our               jails               and               prisons               to               become               mental               healthcare               providers.

Lamb               and               Weinberger               examine               the               problem               of               housing               so               many               people               with               a               serious               mental               illness               in               jails               and               prisons.

They               agree               that               our               correctional               institutions               have               become               the               number               one               treatment               options               for               mentally               ill               individuals,               with               the               current               number               of               inmates               with               an               SMI               at               16%               (Lamb               &               Weinberger               1998).

This               confirms               the               same               number               from               several               other               sources               including               Torrey               and               Slate               &               Johnson,               as               well               as               a               recent               study               from               Steadman,               Osher,               Robbins,               Case,               and               Samuels               in               an               attempt               to               see               if               SMI               in               the               jail               and               prison               population               had               changed               any               in               recent               years.
               Knowing               the               mental               capacity               of               a               jail               population               is               important               so               we               can               understand               the               affects               deinstitutionalization               has               had               on               our               correctional               system,               as               well               as               being               able               to               know               how               many               of               those               jailed               need               special               attention               and               care               because               of               their               illness.

In               addition               to               finding               that               the               number               of               prisoners               with               a               SMI               had               not               changed               from               16%,               they               also               found               that               proper               resources               were               not               being               allocated               to               mentally               ill               inmates.

(Steadman,               Osher,               Robbins,               Case,               and               Samuels               2009).
               One               of               the               main               focuses               in               research               right               now               is               on               community               attitudes               and               outreach               for               people               with               mental               illnesses.

This               includes               both               the               criminal               and               non-criminal,               return               to               work               approaches,               and               risks               associated               with               re-entry               into               the               community.

The               goal               of               a               1987               article               written               by               Wilmoth,               Silver,               &               Severy               was               to               understand               community               reaction               towards               the               mentally               ill               and               different               forms               of               treatment.

These               include               different               types               of               group               homes               for               various               forms               of               illness,               outpatient               care,               and               state               run               hospitals.

The               research               actually               showed               support               for               deinstitutionalization               as               opposed               to               using               state               run               institutions               for               treating               patients               (Wilmoth,               Silver               &               Severy               1987).

It               is               unknown               if               the               survey               participants               realize               that               without               these               state               facilities               the               majority               of               treatment               for               people               with               a               serious               mental               illness               comes               from               the               justice               system.
               Due               to               deinstitutionalization               there               has               been               a               great               increase               in               the               number               of               mentally               ill               persons               living               in               the               community.

Kelly               and               McKenna               examined               the               effect               of               criminal               activity,               stigma,               and               public               perception               of               the               mentally               ill               communities.

People               with               a               SMI               experience               increased               harassment               and               rejection               from               the               general               public               (Kelly               &               McKenna               2004).

Lack               of               resources               can               be               a               problem               in               many               areas,               and               it               is               not               enough               to               simply               treat               a               person's               illness               and               cut               them               loose               from               the               health               system.

These               people               need               to               be               cared               for               and               supported               if               they               are               to               make               a               successful               transition               back               into               our               communities.
               The               research               being               conducted               is               important               because               it               can               inform               the               public               about               what               is               really               happening               behind               the               scenes               in               the               mental               health               community.

Because               of               the               limited               treatment               options               available,               one               of               the               largest               problems               with               having               jails               as               a               healthcare               provider               is               the               effects               that               mental               illness               has               on               reentry               into               society               (Lurigio,               Rollins,               &               Fallon               2004).

Reentry               is               one               of               the               biggest               and               most               difficult               problems               that               mental               ill               offenders               face               today.

While               some               communities               are               prepared               for               it,               most               places               simply               do               not               have               the               manpower               or               resources               to               aid               these               people               to               be               successful.
               Simply               understanding               the               effects               of               deinstitutionalization               is               not               enough.

We               must               also               explore               different               hands-on               treatment               options               for               placing               individuals               back               into               society.

Brucker's               research               is               to               remind               us               that               we               must               move               on               from               just               studying               the               effects               that               deinstitutionalization               has               had               on               the               mentally               ill.

Returns               to               work               programs               are               designed               for               assistance               to               aid               people               with               SMI               in               living               normally               within               the               community               and               to               teach               them               how               to               contribute               to               society               in               some               capacity               (Brucker               2006).
               These               sources               give               us               a               clear               picture               of               deinstitutionalization               and               the               effect               it               has               had               on               our               justice               system.

There               is               a               correlation               between               the               lack               of               health               resources               and               the               number               of               mentally               ill               people               in               the               justice               system.

Community               based               health               care               is               looked               on               favorable,               but               the               resources               for               it               simply               do               not               exist               at               this               time.

Many               things               hold               back               the               mentally               ill               from               being               normal               members               of               society,               both               from               lack               of               resources               as               well               as               perception               from               the               general               public.

The               most               important               thing               that               can               be               done               now               is               to               allow               this               research               to               reach               the               public               in               greater               numbers.

Not               many               sit               around               reading               scholarly               journals;               therefore               the               information               about               deinstitutionalization               and               the               mentally               ill               is               simply               not               being               heard               by               enough               people.
               Prevention/Intervention               Strategies
               When               it               comes               to               the               criminalization               of               the               mentally               ill               through               the               process               of               deinstitutionalization               there               have               been               a               few               strategies               employed               to               handle               the               situation,               though               none               directly               related               to               report               writing.

However,               these               include               both               preventive               strategies,               such               as               group               homes               and               medical               care,               as               well               as               intervention               strategies               from               law               enforcement,               including               the               introduction               of               mental               health               courts               and               crisis               intervention               teams.

There               has               also               been               a               significant               lack               of               training               for               first               responders               in               indentifying,               reporting               and               handling               a               person               with               a               serious               mental               illness               properly.

The               successes               and               failures               of               these               strategies               have               varied               greatly               from               state               to               state,               and               there               does               not               seem               to               be               one               right               answer               in               the               matter.
               The               current               trend               in               the               law               enforcement               community               of               properly               managing               potential               offenders               with               a               mental               illness               is               through               the               use               of               crisis               intervention               teams,               or               CITs.

CITs               are               made               up               of               police               officers               that               have               been               specially               trained               in               assessing               mental               illnesses,               as               well               as               the               appropriate               action               to               take               when               facing               a               dangerous               situation               involving               a               mentally               ill               offender.

(The               CIT               model               has               been               a               joint               effort               between               law               enforcement               and               health               officials               but               is               strictly               operated               by               sworn               law               enforcement.

Overall,               the               implementation               of               CITs               across               the               country               seems               to               be               effective.
               The               big               revelation               in               the               article               is               how               much               better               prepared               and               trained               the               CIT               officers               were               to               handle               a               mentally               ill               person               than               other               police               officers.

Not               only               did               CIT               officers               say               they               were               100%               prepared               to               handle               the               mentally               ill,               as               opposed               to               the               65.4%               officer               that               said               they               were               prepared,               the               officers               in               CIT               said               that               their               confidence               in               the               untrained               officer               preparedness               was               only               30.5%               (Compton,               Bahora,               Watson,               Olivia               2008).

This               truly               shows               how               under               trained               our               first               responders               are,               as               the               CIT               officers               were               once               untrained               as               well.

They               know               how               complicated               mental               illnesses               are,               and               how               much               you               have               to               learn               to               be               prepared               to               deal               with               them               when               the               time               comes.
               The               other               strategy               that               is               being               employed               today               is               the               introduction               mental               health               courts               into               the               judicial               system               The               use               of               mental               health               courts               has               been               one               avenue               in               the               justice               system               geared               at               helping               and               treating               the               mentally               ill               rather               than               simply               locking               them               into               jails               and               prisons               for               their               entire               sentence.

While               the               concept               behind               mental               health               courts               is               appealing,               is               the               process               being               carried               out               as               it               should               and               are               mentally               ill               offenders               being               treated               more               fairly               in               the               system?

"In               the               past               2               years,               mental               health               courts               have               proliferated               from               just               25               to               over               80               today.

Because               of               concerns               about               large               numbers               of               people               with               mental               illnesses               cycling               through               the               criminal               justice               system,               most               commentators               have               spoken               favorably               about               this               latest               problem-solving               court"               (Seltzer               2005).
               What               all               goes               into               a               mental               health               court?

Schneider,               in               his               2008               article,               states               that               "judges               and               lawyers               are               supplemented               by               any               number               of               psychiatrists,               psychologists,               case               workers,               and               social               workers               who               collaborate               on               how               the               particular               needs               of               the               accused               can               effectively               be               met."               The               idea               was               to               open               up               the               operation               of               the               court               to               everyone               would               be               able               to               assist               the               mentally               ill               in               some               form               or               another.

This               way               cases               could               be               looked               at               objectively               and               not               as               a               simple               case               of               blind               justice,               or               locking               someone               up               and               throwing               away               the               key.

While               the               guilty               offenders               will               still               be               punished,               the               assistance               of               doctors               and               social               workers               allows               for               several               different               viewpoints               for               the               best               course               of               action.

"The               traditional               punishment-based               response               of               the               criminal               justice               system               to               individuals               who               are               in               need               of               correction               has               failed               both               society               and               the               mentally               disordered               accused               and               is,               in               fact,               counter-productive"               (Schneider               2008).
               While               the               idea               is               a               good               one,               what               makes               a               mental               health               court               a               mental               health               court?

The               definition               can               be               unclear               at               times.

Steadman,               Davidson,               and               Brown               wrote               in               2001               that               "almost               any               special               effort               by               the               courts               to               better               address               the               needs               of               persons               with               serious               mental               illness               who               engage               with               the               criminal               justice               system               can               qualify               as               a               mental               health               court               by               current               standards.

In               its               diffusion,               the               concept               has               come               to               have               little               meaning."               They               also               suggest               some               criteria               for               defining               a               mental               health               court,               but               so               far               no               one               definition               or               set               of               standards               is               used               to               determine               what               is               and               isn't               a               mental               health               court.
               So               do               mental               health               courts               actually               work?

There               is               no               clear               yes               or               no               answer               in               this               case.

Articles               written               by               McNeil               &               Binder               and               Boothroyd,               Poythress,               McGaha,               &               Petrila               look               to               address               this               issue.

McNeil               &               Binder's               primary               goal               was               to               "determine               whether               participation               in               mental               health               court               was               associated               with               a               longer               time               without               recidivism               compared               with               treatment               as               usual"               (2007).

Of               course,               their               research               did               not               lead               to               a               simple               explanation.

Recidivism               of               mentally               ill               offenders               doesn't               just               rely               on               whether               or               not               they               were               involved               in               a               mental               health               court.

It               depends               on               type               of               mental               illness,               severity               of               crime,               involvement               in               other               criminality,               treatment               methods,               and               punishment               levels.
               Boothroyd               and               company's               research               examined               the               Broward               mental               health               court.

They               reemphasize               the               fact               that               there               is               no               clear               definition               on               what               makes               a               mental               health               court               but               "most               of               those               in               existence               today               share               several               common               characteristics"               (2003).

Their               research               detailed               the               process               a               mental               health               court               takes               in               hearing               a               case,               as               well               as               who               is               involved.

The               article               includes               a               section               on               linking               offenders               to               mental               health               treatments               in               an               effort               to               aid               their               illness               and               reduce               the               chance               of               recidivism.

However               as               they               state               in               their               results               "no               significant               difference               was               found               in               the               behavioral               health               service               penetration               rates               between               sites               prior               to               enrollment               into               the               study"               (Boothroyd               et               al               2003)               but               that               levels               of               treatment               were               increased               from               those               who               went               through               the               mental               health               court               setting.

However,               there               is               still               no               clear               answer               on               the               reliability               of               mental               health               courts               to               curb               criminality               and               recidivism.
               People               may               see               this               as               a               fault               in               the               criminal               justice               system,               but               this               could               be               due               to               the               misunderstanding               of               what               the               system               is               supposed               to               do.

Raleigh               Police               Crime               Prevention               Officer               Scott               Womack               stated               "people               always               talking               about               the               system               failing...but               it's               not               failing               if               it               doesn't               recognize               nor               prevent               what               it               was               not               designed               to               the               involuntary               commitment               process               does               exactly               what               it               is               supposed               to               do               identify               folks               in               crisis               (i.e.:               a               psychotic               state)               and               impress               treatment               upon               them               to               alleviate               the               dangerous               state,               it               was               never               designed               for               prevention               or               long-term               remedial               care"               (personal               communication,               11/17/11).
               When               deinstitutionalization               first               started               occurring,               the               idea               was               to               create               community               health               centers               for               the               patients               (Slate               &               Johnson               2008).

This               would               get               them               out               of               state               run               facilities               and               into               their               neighborhoods.

Unfortunately,               the               dream               of               these               community               health               centers               was               never               realized               and               these               patients,               now               with               nowhere               to               go,               started               getting               arrested               for               various               reasons.

While               group               homes               do               exist,               they               are               often               overcrowded               and               underfunded.

This               has               lead               not               only               to               the               increase               of               mentally               ill               offenders               in               the               care               of               jails               and               prisons,               but               has               made               routine               policing               much               more               difficult.

If               the               idea               of               these               community               run               health               care               centers               could               be               revitalized,               it               may               counteract               some               of               the               effects               of               deinstitutionalization.

Until               then,               the               mental               health               court               system               must               be               revised,               with               national               rules               and               regulations,               and               the               training               of               our               first               responders               needs               to               be               increased.
               Plan               of               Action
               The               damage               that               has               been               caused               by               deinstitutionalization               and               the               ongoing               shutdown               of               mental               health               hospitals               is               not               fixable.

Because               of               this,               the               best               place               to               fight               the               effects               of               what               has               happened               is               on               the               street               with               our               first               responders.

It               is               inevitable               that               police               officers               will               come               into               contact               with               mentally               ill               people               on               a               regular               basis.

While               there               are               some               specialized               programs               in               the               justice               field               to               meet               the               needs               of               the               mentally               ill               there               is               very               little               training               for               most               line               officers.

Research               shows               that               an               increasing               number               of               people               with               serious               mental               illness               are               entering               the               justice               system               every               day.

New               training               and               standards               for               police               officers               must               be               devised               if               departments               want               to               continue               to               protect               and               serve               the               public               in               the               most               professional               way               possible.
               While               police               officers               "have               the               power               to               transport               persons               for               psychiatric               evaluation               and               treatment               when               there               is               probable               cause               to               think               that               they               are               a               danger               to               themselves               or               to               others               because               of               their               mental               condition"               (Lamb,               Weinberger               &               DeCuir               2002),               the               option               for               treatment               may               not               always               be               available               or               close               at               hand.

Without               knowing               what               to               look               for               in               a               mentally               ill               person               an               everyday               line               officer               may               mistake               the               person               for               being               hostile,               non-compliant,               argumentative,               or               otherwise               unwilling               to               cooperate.

Reports               may               be               written               incorrectly,               and               the               lack               of               knowledge               may               lead               to               more               difficult               situations,               escalations               in               use               of               force,               and               safety               concerns               for               both               the               person               and               the               officer.
               In               the               article               "Law               Enforcement               Responses               to               People               with               Mental               Illness,"               written               in               2009,               authors               state               that               due               to               their               experiences               police               officers               now               realize               the               need               for               training               more               than               ever               and               local               consultants               are               available               for               help               on               a               call               by               call               basis.

However               policymakers               "need               more               than               personal               experiences;               they               need               data               that               quantify               the               nature               and               extent               of               the               problem               in               order               to               commit               resources               and               energy               toward               a               potential               response"               (Reuland,               Schwarzfeld,               &               Draper               2009).

This               is               a               common               occurrence               no               matter               where               you               look.

Everywhere               officers               need               more               training               but               the               resources               and               funding               just               isn't               available.

It               may               not               be               until               further,               more               serious               problems               with               mentally               ill               offenders               are               reported               that               new               training               will               be               implemented               for               everyone.
               Why               should               the               public               be               concerned               with               this               issue?

Simply               because               of               the               number               of               people               who               end               up               prison               every               year,               and               the               number               of               those               who               have               a               serious               mental               illness.

Recent               studies               show               us               that               at               least               16%               of               all               inmates               have               a               serious               mental               illness               (Torrey               et               al               2010).

This               number               may               not               sound               like               much               until               you               look               at               how               many               people               are               incarcerated               every               year,               somewhere               around               1.6               million.

This               does               not               include               the               very               large               amount               of               people               who               come               in               and               out               of               local               jails               every               day,               all               year               long.

Because               of               these               high               numbers               every               law               enforcement               officer               in               the               country,               whether               it               be               local,               state,               or               federal,               will               come               into               contact               with               the               mentally               ill               on               a               regular               basis.
               While               training               standards               need               to               be               updated,               this               is               not               to               say               that               there               is               not               some               select               training               in               place               in               a               few               areas,               as               well               as               crisis               intervention               teams.

These               teams               specialize               in               people               with               serious               mental               illness,               and               what               training               that               is               available               to               officers               may               offer               some               assistance               but               are               not               up               to               the               level               it               should               be.

The               CIT               model               currently               has               over               400               teams               in               place               throughout               the               country               (Watson,               Morabito,               Draine,               &               Ottati               2008).

While               CIT               teams               are               a               specialized               area               in               law               enforcement,               Watson               states               "Training               such               as               the               CIT               curriculum               may               influence               an               officer's               knowledge               and               attitudes               about               mental               illness…officers               who               can               reliably               understand               how               these               factors               relate               to               mental               illness               may               be               more               apt               to               decide               to               access               mental               health               treatment               in               lieu               of               arrest."               Of               course,               the               mental               health               option               is               not               always               available,               and               local               jails               play               their               part               again               in               the               health               care               system.
               Crisis               Intervention               Teams               involve               specially               trained               officers               who               respond               to               calls               involving               mentally               ill               people               as               well               as               having               to               "act               as               liaisons               to               the               mental               health               system"               (Watson               et               al               2008).

While               the               concept               of               CIT               is               a               great               idea,               there               are               still               many               departments               around               the               country               who               have               no               CIT               team               or               model               to               build               one               from.

The               type               of               training               they               receive               is               a               prime               example               of               what               every               first               responder               should               be               taught               in               basic               training.

The               results               show               the               training               works.

A               2008               study,               headed               by               Michael               Compton,               details               the               results               of               CIT               teams.

In               Memphis,               TN,               CIT               officers               responded               they               were               100%               prepared               for               situations               involving               the               mentally               ill,               as               opposed               to               65.4%               of               other               officers               who               said               they               felt               prepared.

Also,               CIT               officers               only               felt               confident               that               30.5%               of               regular               officers               would               properly               handle               a               situation               involving               a               mentally               ill               person.

They               also               found               more               help               from               the               health               care               system.

It               is               this               kind               of               training               and               confidence               to               respond               to               situations               involving               the               mentally               ill               that               must               be               implemented               for               every               police               officer               on               duty.
               An               increase               in               confidence               in               handling               mentally               ill               people               would               not               only               improve               officer               performance               in               the               field,               it               would               reduce               injury,               recidivism,               arrests,               allow               for               more               accurate               and               detailed               reports,               and               increase               the               use               of               mental               health               resources               in               the               community.

"There               is               still               a               lot               to               learn               about               law               enforcement               encounters               with               people               with               mental               illnesses               and               specialized               responses"               (Reuland,               Schwarzfeld,               &               Draper               2009).

It               is               the               current               data               we               have               that               we               can               use               to               model               new               training               programs               for               first               responders.

Between               CIT               successes,               help               from               local               mental               health               facilities,               and               the               need               for               officer               safety,               there               are               plenty               of               sources               from               which               to               start.
               First,               new               training               standards               should               be               implemented               early               in               one's               law               enforcement               career.

New               officers               should               begin               to               learn               these               skills               while               in               basic               law               enforcement               training               (BLET),               or               while               in               the               academy               of               their               department.

By               starting               to               learn               new               skills               early               officers               can               continue               to               implement               them               throughout               their               career.

While               it               will               not               always               be               an               option,               those               departments               with               CIT               resources               should               be               using               the               specially               trained               officers               to               both               train               new               recruits,               as               well               as               instructors               on               proper               procedure.

Hands               on               experience               with               the               CIT               program               would               be               a               great               eye               opener               for               trainees               as               well.

In               departments               that               do               not               have               a               CIT               program,               further               training               will               have               to               be               performed,               possibly               by               bringing               in               CIT               professionals               to               aid               in               the               beginning               stages               of               the               new               training               programs.

When               the               training               staff               has               been               fully               certified               in               the               training               of               new               recruits,               and               on-the-job               training               of               current               officers,               this               will               continue               to               become               an               easier               task.
               In               service               training               will               be               a               must               for               departments               who               wish               all               officers               to               be               in               compliance               with               the               standards.

This               can               be               done               by               bringing               officers               into               a               classroom               setting               or,               in               the               best               case               scenario,               by               having               officers               join               CIT               for               periods               of               time               (when               this               option               is               available).

Again,               the               CIT               program               is               not               in               place               everywhere               but               will               be               essential               and               instrumental               in               training               officers               when               it               is               an               available               resource.
               The               biggest               issue               facing               the               new               training               and               standards               is               the               budget.

In               this               economy               departments               are               not               willing               to               spend               any               more               than               they               have               to,               and               many               may               view               the               new               training               as               a               waste               of               time.

They               must               be               convinced               with               the               ever               growing               number               of               people               with               a               serious               mental               illness               coming               in               contact               with               their               officers               that               training               cannot               be               overlooked.

Tales               of               success               from               CIT               programs               across               the               country               may               help,               but               starting               training               in               small               numbers               and               closely               monitoring               and               watching               (positive)               results               will               greatly               aid               in               a               budget               allocation               for               across               the               board               training.
               Reuland               stated               that               "No               two               communities               are               identical,               and,               although               this               research               provides               a               broad               understanding               of               some               common               issues               many               communities               face,               it               does               not               obviate               the               need               for               an               in-depth               review               of               local               problems               and               resources               to               address               them"               (2009).

This               could               not               be               truer.

What               works               for               training               in               one               area               may               not               necessarily               work               in               another.

Because               of               this,               once               the               new               training               standards               have               been               put               in               place,               actions               of               officers               must               be               monitored.

This               includes               number               of               calls               involving               the               mentally               ill,               whether               they               are               violent               or               non-violent,               what               kind               of               action               was               taken               on               the               scene,               if               the               person               was               arrested,               or               if               the               person               was               delivered               to               someone               in               the               mental               health               field.

All               of               these               factors               can               form               a               guideline               on               how               to               shape               and               modify               training               for               each               local               department.

Departments               must               be               able               to               observe,               adapt,               configure,               and               change               training               as               needed               for               the               best               results.

Lamb               (2002)               tells               us               that:
               Across               the               United               States,               persons               with               mental               illness               have               been               killed               or               seriously               injured               during               attempts               to               manage               their               crises.

These               events               have               outraged               the               community               and               frustrated               law               enforcement               and               mental               health               professionals,               and               rightly               so.

If               we               are               to               reduce               these               tragic               mistakes               and               ensure               better               safety               for               all,               we               must               develop               an               effective               working               partnership               between               the               law               enforcement               and               mental               health               systems.
               New               training               for               every               police               officer               is               not               just               a               good               idea;               it               must               be               implemented               in               the               future,               and               soon.

More               and               more               people               who               are               mentally               ill               are               coming               into               contact               with               the               justice               system               every               day.

A               misstep               by               the               police               could               lead               down               any               number               of               roads,               including               harassment,               abuse,               unneeded               arrests,               injury,               and               death.

If               we               can               properly               train               first               responders               on               identification               of               mental               illness,               and               the               proper               way               to               handle               a               situation,               a               new               breed               of               law               enforcement               professional               can               emerge               that               will               continue               to               protect               and               serve               everybody               in               the               years               to               come.
Works               Cited               Amy               Watson,               M.

M.

(2008).

Improving               police               response               to               persons               with               mental               illness:               A               multi-level               conceptualization               of               CIT.

International               Journal               of               Law               and               Psychiatry               ,               359-368.
               Arthur               J.

Lurigio,               A.

R.

(2004).

The               Effects               of               Serious               Mental               Illness               on               Offender               Reentry.

FEDERAL               PROBATION               Vol               68               No               2               ,               45-52.
               Brucker,               D.

(2006).

Re-Entry               to               Recovery               :               A               Promising               Return-to-Work               Approach               for               Certain               Offenders               With               Mental               Illness.

Criminal               Justice               Policy               Review               Vol               17               ,               302-313.
               Dale               McNeil,               R.

B.

(2007).

Effectiveness               of               a               Mental               Health               Court               in               Reducing               Criminal               Recidivism               and               Violence.

Am               J               Psychiatry               164               ,               1395-1403.
               Henry               Steadman,               J.

M.

(1984).

THE               IMPACT               OF               STATE               MENTAL               HOSPITAL               DEINSTITUTIONALIZATION               ON               UNITED               STATES               PRISON               POPULATIONS.

Journal               of               Criminal               Law               and               Criminology               Vol               75               No               2               ,               474-490.
               Kelly,               S.

M.

(2004).

Risks               to               Mental               Health               Patients               Discharged               Into               the               Community               .

Health,               Risk,               &               Society               ,               377-385.
               Lamb,               H.

R.

(2002).

The               Police               and               Mental               Health.

American               Pyschiatric               Associates               ,               1266-1271.
               Lamb,               H.

W.

(1998).

Persons               with               Severe               Mental               Illness               in               Jails               and               Prisons:               A               Review.

American               Psychiatric               Association               ,               483-492.
               Michael               Compton,               M.

B.

(2008).

A               Comprehensive               Reveiw               of               Extant               Research               on               CIT               Programs.

Journal               of               the               American               Academy               of               Psychiatry               and               Law               36:1               ,               47-55.
               Penrose,               L.

(1939).

Mental               Disease               and               Crime:               Outline               of               a               Comparative               Study               or               European               Statistics.

Medical               Psych.

,               1-15.
               R.

Slate,               W.

J.

(2008).

The               Criminalization               of               Mental               Illness:               Crisis               and               Opportunity               for               the               Justice               System               .

Durham:               Carolina               Academic               Press               .
               Roger               A.

Boothroyd,               N.

G.

(2003).

The               Broward               Mental               Health               Court:               process,               outcomes,               and               service               utilization.

International               Journal               of               Law               and               Psychiatry               26               ,               55-71.
               Rueland,               M.

S.

(2009).

Law               Enforcement               Responses               to               People               with               Mentall               Illnesses:               A               Guide               to               Research               Informed               Policy               and               Practice.

New               York,               NY:               Council               of               State               Governments               Justice               Center.
               Schneider,               R.

D.

(2008).

Mental               health               courts.

Current               Opinion               in               Psychiatry               21               ,               1-4.
               Seltzer,               T.

(2005).

MENTAL               HEALTH               COURTS:               A               Misguided               Attempt               to               Address               the               Criminal               Justice               System's               Unfair               Treatment               of               People               With               Mental               Illnesses.

Psychology,               Public               Policy,               and               Law               ,               570-586.
               Steadman,               H.

O.

(2009).

Prevalence               of               Serious               Mental               Illness               Among               Jail               Inmates.

Psychiatric               Services               ,               761-765.
               Torrey,               E.

F.

(2010).

More               Mentally               Ill               Persons               Are               in               Jails               and               Prisons               Than               Hospitals:               A               Survey               of               the               States.

Arlington,               VA:               Treatment               Advocay               Center               &               National               Sheriff's               Association.
               Wilmoth,               G.

S.

(1987).

Receptivity               and               Planned               Change:               Community               Attitudes               and               Deinstitutionalization.

Journal               of               Applied               Psychology               ,               138-145.






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