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Mental Health Training Online Material for Security Officers - PDF by zpt23697


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									FRONTLINE REPORTS                                Francine Cournos, M.D., and Stephen M. Goldfinger, M.D., Editors

The Frontline Reports column            the Department of Homeland Secu-              that mental illness could be trans-
features short descriptions of nov-     rity [DHS].) As of October 5, 1999,           missible to persons who have close
el approaches to mental health          the INS had a total of 984 detainees          contact with a person with mental
problems or creative applications       in the San Diego and Imperial                 illness; and a belief that people
of established concepts in differ-      County detention facilities. It was           with mental illness are more violent
ent settings. Material submitted        estimated that 10 percent were suf-           than most individuals.
for the column should be 350 to         fering from some form of mental                  Together with volunteer officers
750 words long, with a maximum          disorder; a portion required imme-            and detainees, we developed a train-
of three authors (one is pre-           diate hospital care.                          ing manual and video based on our
ferred), and no references, tables,        At that time, the INS screened             findings from the focus groups, inter-
or figures. Send material to            long-term detainees for severe men-           views, a literature review, and consul-
Francine Cournos, M.D., at the          tal disorders but did not screen either       tations with mental health profes-
New York State Psychiatric Insti-       short-term detainees or detainees             sionals. The initial versions of the
tute ( or             housed in a contract facility rather          training video and manual were pre-
Stephen M. Goldfinger, M.D., at         than an INS-operated facility. Offi-          viewed with a small group of INS vol-
SUNY Downstate Medical Center           cers could be ill prepared to address         unteers in San Diego and Imperial
(                   situations involving mentally ill de-         Counties for review and comment.
                                        tainees because of a lack of screening        Appropriate revisions were made
                                        procedures and gaps in officer train-         based on this feedback.
                                        ing. This situation mirrors one that is          We held six training sessions with
Training Program in                     not uncommon among law enforce-               INS personnel during a two-year
Mental Illness for                      ment personnel. To address these              grant period. Each training session
Immigration Officers                    gaps in training, we worked with the          covered definitions and diagnostic
Many studies have found a high          INS to develop a training program             categories of mental illness, signs and
prevalence of mental illness and        that would better prepare officers to         symptoms of mental illness, “culture-
mental health issues among various      deal with situations involving mental-        bound” syndromes, issues related to
classes of immigrants. One study        ly ill detainees.                             mental status that may arise in the
found that of 3,035 Cuban entrants         We conducted four focus groups             context of detention, alternatives for
to the United States who were eval-     with INS and INS-contracted per-              resolving such issues, and relevant
uated for mental health after their     sonnel at detention sites in San              INS procedures and available re-
entry in 1980, a total of 1,307 pre-    Diego and Imperial Counties in Cal-           sources. Although such training pro-
sented symptoms of personality dis-     ifornia. Each multiethnic focus               grams are not unique among law en-
orders, schizophrenic disorders,        group of six to 12 men and women              forcement agencies, this program
adjustment disorders, mental retar-     included officers with direct contact         may be one of the few to emphasize
dation, chronic alcohol abuse, or       with the detainees, health care per-          cultural differences in the expression
major depression. Of these individ-     sonnel, ancillary personnel, and su-          of mental illness.
uals, 459 needed more extensive         pervisors. These focus groups ex-                Participant evaluations of the pro-
psychiatric care. Other research in-    plored officers’ experiences dealing          gram have been overwhelmingly pos-
dicates that an increased risk of       with detainees and their perceptions          itive. Officers report that they are
mental illness among immigrants is      of mental illness. We also conducted          better able to distinguish between
associated with lower educational       similarly focused individual inter-           substance use and other forms of
levels, fewer years of residence in     views with five key informants, in-           mental illness and that they are better
the United States, occupational         cluding an officer in charge of a de-         prepared to address individuals who
anxiety, home country anxieties,        tention facility, an officer responsi-        may be suffering from major depres-
lower levels of acculturation, physi-   ble for the development of training           sion. The INS now makes this train-
cal ill health, and previous traumat-   programs, a representative of the             ing available to officers on a nation-
ic experiences.                         then Border Patrol, and two repre-            wide basis.
   A representative of the U.S. Pub-    sentatives of the Department of                             Sana Loue, J.D., Ph.D.
lic Health Service for the southern     Public Health.                                             Linda S. Lloyd, Dr.P.H.
California region has estimated that       Four themes emerged from the
at least 10 percent of the detainees    focus groups and interviews: diffi-           The authors are affiliated with the depart-
of the Immigration and Naturaliza-      culty distinguishing between be-              ment of epidemiology and biostatistics of
tion Service (INS) suffer from se-      havior that was symptomatic of                the Case Western Reserve University
vere mental illness that requires at-   mental illness and behavior that re-          School of Medicine, 10900 Euclid Avenue,
                                                                                      Cleveland, Ohio 44106-4945. This re-
tention. (The INS is now known as       sulted from substance use; a belief           search and program were funded by the
the Bureau of Immigration and           that mental illness is synonymous             Alliance Healthcare Foundation of San
Customs Enforcement [BICE] of           with mental retardation; concern              Diego, California.

1458                                     PSYCHIATRIC SERVICES   ♦ ♦ November 2005 Vol. 56 No. 11
                                                                                                     FRONTLINE REPORTS

An Intensive Mental Health                     chosis, violence, or self-injurious be-       To date, more than 100 youths
Unit for Adolescents in the                    havior or had a recent suicide at-         have been treated on the intensive
Correctional Setting                           tempt. Some of the youths who are          mental health unit. Upon stabiliza-
                                               referred to this unit might meet com-      tion, nearly all have been successful-
The need for psychiatric services for          munity standards for psychiatric hos-      ly transitioned to nonintensive men-
incarcerated adults with mental ill-           pitalization. However, finding a com-      tal health settings or general popula-
ness has received considerable at-             munity hospital that is willing to treat   tion within ODYS. These youths con-
tention in recent years. However,              adjudicated youths can be difficult.       tinue to receive ongoing support and
less emphasis has been given to ado-           Some need specialized services to en-      treatment through multidisciplinary
lescents with mental health prob-              hance functioning within the prison        personnel for the duration of their
lems who are committed to correc-              setting, and many may have lengthy         commitment.
tional facilities. Given that adoles-          commitments, depending on the                 A small number of the most se-
cents are particularly vulnerable to           criminal offense.                          verely ill youths are deemed unsuit-
substance use, suicide, and emerging              The unit is equipped with 24-hour       able for transfer from the intensive
psychotic or mood disorders, the               nursing and psychiatric availability       mental health unit. One individual
recognition and treatment of psychi-           and one-to-one monitoring as neces-        with catatonia was subsequently
atric disorders among youthful of-             sary. The medical needs are coordi-        transferred to a long-term psychiatric
fenders represents a serious public            nated by the on-site clinic, and spe-      facility. Approximately four other
health issue. In July 2000, a partner-         cialized tests (such as EEGs, CTs,         youths remain on the intensive unit
ship between the Ohio State Univer-            and MRIs) are available locally. The       for the foreseeable future because of
sity (OSU) department of psychiatry            youths participate in individual and       their inability to tolerate larger popu-
and the Ohio Department of Youth               group programming on the unit in           lations. These youths evidence ap-
Services (ODYS) was initiated to               addition to institutional program-         propriate functioning on the inten-
provide treatment for adjudicated              ming when clinically acceptable. Fa-       sive mental health unit, but one dis-
youths with mental illness.                    milial involvement, including family       played recurrent violence toward
   The goals of this partnership were          therapy, is available and encouraged.      others and the other self-injurious
to approximate services available in           Students may receive individualized        behavior when in alternative settings.
the community and to develop a spe-            academic instruction or attend class-      With individuals like these, allowing
cialized treatment unit for the most           es with other youths, depending on         them to make the transition at a slow-
severely ill youths. The partnership           clinical status. A multidisciplinary ap-   er pace to institutional programming
was formed in recognition of the need          proach is emphasized, and psycholo-        appears to be successful.
for intensive mental health treatment          gists, psychiatrists, social workers,         Both ODYS and OSU consider the
for incarcerated youths and would al-          nurses, teachers, unit managers, and       partnership, now in its third year, to
low for research initiatives to examine        juvenile corrections officers—who          be a success. The academic affiliation
the relationships between adoles-              are with the youths around the             provides ODYS with specialized psy-
cence, mental illness, and criminality.        clock—collaborate to identify indi-        chiatric expertise and the opportuni-
A relative lack of community alterna-          vidual treatment needs.                    ty to educate and train personnel
tives and the volume of seriously                 Youths who are referred to the in-      who are less familiar with mental ill-
mentally ill juvenile delinquents com-         tensive mental health unit have had        ness. The unique population of
mitted were also instrumental in the           diagnoses including schizophrenia,         ODYS provides OSU with valuable
formation of the intensive mental              mood disorders, posttraumatic stress       research opportunities to further the
health unit.                                   disorder, conduct disorder, and at-        understanding of mental illness and
   With the OSU-ODYS affiliation, an           tention-deficit hyperactivity disorder.    juvenile delinquency—two issues at
intensive mental health unit opened            A majority of the youths also have co-     the forefront of several societal and
in September 2000 at a newly built             morbid substance-related disorders,        ethical crossroads.
maximum-security institution for               and some have intellectual impair-                       Julie Niedermier, M.D.
males aged 13 to 20 years. The intent          ment. The length of stay varies. Some                      Glenn Thomas, Ph.D.
of this 12-bed unit was to provide spe-        youths have had extensive mental
cialized care to young inmates with a          health treatment history, including        Dr. Niedermier is assistant professor of
psychiatric diagnosis who were de-             repeated hospitalizations and med-         psychiatry at The Ohio State University,
                                                                                          1670 Upham Drive, Columbus, Ohio
compensating or otherwise unable to            ication trials. Others may be experi-      43210 (e-mail,
function in the general population.            encing the onset of psychiatric symp-      Dr. Thomas is affiliated with the Depart-
Often, these youths exhibited psy-             toms for the first time.                   ment of Youth Services in Columbus.

PSYCHIATRIC SERVICES   ♦ ♦ November 2005 Vol. 56 No. 11                                        1459

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