Question: Listen to Me First: Week 3 Transcript
- Speakers: Host, Dr. Grace Telesco
HOST: Welcome to this week's podcast. This week we'll be discussing mental health and addictions. What characteristics do persons with mental health issues or disorders display?
- DR. TELESCO: Well, in order to really answer that question, we want to look at what is positive mental health, right? So we want to say a person who has positive and healthy mental health, if you will, is going to be somebody who is stable, who has self-confidence. Not to say that we don't have our neurosis, because we all do-you know, anxiety and stuff like that. But in extremes, it may not be good. So how do we deal on a day-to-day basis with our normal life on life's terms? How do we deal with it?
- Usually, you know, we go about our day. We're pretty stable. We have some normal alterations in our thinking or our mood. We're not very, very sad all of the time. We're not very, very happy all of the time. So these are the extremes where it starts to become possibly a disorder or an unhealthy mental health situation.
- So characteristics of mental illness really zero in on our thinking, our mood, and how we act-our behavior. And some of these things are disruptions in our daily function, anxiety or personality disorders where there might be delusions. There might be voices I am hearing or things I am seeing that aren't real.
- So it goes from this almost a continuum of mental health: all the way from very good mental health to very, very dangerous, unhealthy mental health situations.
HOST: How does addiction and substance abuse relate to mental health issues(MHIs)?
- DR. TELESCO: You know, let's not forget that this course is about: criminal justice overall. So it's not necessarily just law enforcement. Law enforcement are your first-line service providers. They are going to be the ones who are going to see a lot of people who are suffering from mental illness and addiction. But that is not to say that court officers, corrections officers, even judges and prosecutors and defense attorneys aren't going to be involved and interfacing with people who are mentally ill, because that is true. They do.
- So when you talk about the training, it depends. As a law enforcement officer, I am going to have a component of the curriculum that is going to be dedicated specifically to how we handle mental illness. How do we recognize what mental illness is, and how do we effectively take this person who is sick, actually, not a criminal, although they may have committed a crime, but they are not necessarily going to be adjudicated in a criminal court. They might be adjudicated through - in a psychiatric emergency room and then ultimately maybe a psychiatric hospital or state facility of some. We know that there are prisons with specific sections that are dedicated specifically to people who are the criminally insane.
- So in answer to your question about the training, officers - police officers, court officers, and correctional officers go through a vast amount of training about mental illness, what it is and how to recognize it, and addiction, what addiction is and its characteristics. But let's not misunderstand and think that because you have graduated from the police academy, now you are a psychiatrist. You're not.
- So we deal sort of with apparent mental illness. What is it appearing to be based on one's behavior?
HOST: So what is the relationship between addiction and crime?
- DR. TELESCO: Well first of all, in the DSM IV, which is the Diagnostic and Statistical Manual of Mental Disorders (the big bible so to speak for psychiatry and psychology), addiction and substance abuse are included as mental disorders. So people who are addicted to a substance, whether it be cocaine, heroin or opiates, alcohol, all of these different kinds of dependency issues are in the DSM IV. So it is a mental illness actually. So mental illness and mental health is the big umbrella, and substance abuse and addiction come underneath that umbrella.
- Now, what is addiction? Addiction manifests itself in many different ways, but it is usually a physical and an emotional/psychological dependence on a particular chemical substance. It is a disease model. So what does that mean?
- That means that it is progressive, it is fatal it if goes untreated. Now, how does all of this come to make itself known within criminal justice? About seventy percent of people who are incarcerated and a large, large majority of people who find themselves in the criminal justice system are there because of some type of drug. It is some type of drug-related crime. So that means that we're sort of punishing, incarcerating people because of something that is a mental illness. It falls under a mental disorder and so that is not a judgment call. That is just a fact. That is just making an observation that police officers are undoubtedly going to be involved in some way, shape, or form with people who are suffering from the disease of addiction, like illegal possession, sale, trafficking, prostitution, DWI, whatever it might be.
- And the same goes for correction officers who are going to be interfacing with offenders, inmates, who are incarcerated because of their drug dependency or their drug use, and the same thing with courts. And so this week we talk a lot about drug courts and some of the effectiveness that we see with drug court strategies and how they are helping people. Not as much as we would like, because we see that the recidivism rate is still high, but nevertheless, drug courts seem to be an effective alternative program for people who suffer from the disease of addiction.
HOST What is the criminal justice professional's role in providing intervention and rehabilitation to substance-abuse offenders and persons with mental illness?
- DR. TELESCO: So there's two things. Let's talk about substance abuse first, and as we said earlier, about the relationship between addiction and crime that we see manifest in DWI, for example, or possession. Possession is easy. Everybody gets that, possession of controlled substances. But, you know, what about a burglary? How is a burglary related to addiction?
- Well, many times people who are suffering from the disease of addiction will go to any lengths to feed that addiction, and that might mean committing crimes like burglaries. So what happens then in terms of the role of criminal justice and criminal justice professionals in helping these people? Because really - it's easy for us to just put them in jail and incarcerate them, but how are we helping them in terms of helping them change their behavior?
- One way with substance abuse has been through drug court. Drug court programs have really helped. As part of the condition for probation or condition for parole, or the condition for whatever the sentence is, this individual must attend twelve-step meetings or twelve-step groups, and so they have to get their sheet signed and stuff like that, and it is kind of forcing them into trying to get help for themselves and rehabilitate themselves. And we have found that is has been effective. Not only anecdotally, but also there is some empirical evidence to suggest that the drug court as a strategy is very helpful.
- So the role of the criminal justice professional, the judge, for example, who is in charge of drug court. That judge is playing the role not only of serving justice and seeing that justice is served but also to try to rehabilitate and to try to intervene in these addicts' lives.
- So that is one way in terms of substance abuse. As far as mental health and mental illness, you know, we don't want to criminalize people who are mentally ill. And the National Association of People with Mental Illness, NAMI, and the other organization that is Families of People who Suffer with Mental Illness, many times, they are advocating for criminal justice professionals to not criminalize these people who are suffering from mental illness. They are not criminals; they are people who need help.
- And so some of the strategies, as well as the role that criminal justice professionals play, is to try to really intervene effectively in this person's life. One of those examples is what are called crisis intervention teams, CITs. Memphis has it, for example, and some of the police departments that have the resources and are a little smaller are able to implement these strategies.
- But what a CIT program is, it consists of a psychiatric nurse. It consists of a social workers and a police officer who will respond to the scene whenever there is someone who is apparently mentally ill and might be a danger to themselves or others. So there is a kind of on-the-scene, on-site assessment that is made, and then they are appropriately either funneled into the psychiatric community or funneled into some type of psychological services versus being criminalized, versus being incarcerated.
- So the bottom line is that we want to help people, and the choice is always do we want to go to jail or do we want to go to a psychiatric emergency room? If they are mentally ill, we want them to go to a psychiatric emergency room because we want them to really be serviced effectively and be misguided or misdirected into the criminal justice system.
- So CITs work, and the Memphis model is one example, the Memphis Police Department. It has been very effective.
HOST: What strategies can be used for intervention and rehabilitation?
- DR. TELESCO: Crisis intervention teams don't exist in every police department. Some police departments have them and some don't, but clearly all police departments are training their officers in (A) how to recognize mental illness; (B) how to respond effectively; and (C) that safety is paramount above all things, that deadly physical force is going to be used as a last resort. Many, many times police officers are handling and responding to people with mental illness effectively. Nine times out of ten, they are - it's effective.
- One time where it is not effective is when we're using deadly physical force against a person who is mentally ill, and that is a tragedy. We want to avoid that because that is not helping. That is not an effective intervention. That is not a rehabilitative strategy, for sure. Sometimes these things can't be avoided. Sometimes, and that is the tragedy behind it, a person who is mentally ill who is a danger to themselves or others and that danger is manifesting itself right then and there with the police. The police feel in danger and they feel that their lives are in danger, and then they might use deadly physical force. That is the last resort, and we never want to really see that happen because the safety of all persons is paramount.
- However, if we can effectively intervene at the scene when someone is mentally ill and bring them safely and effortlessly to a psychiatric emergency room, or to be assessed by a psychiatrist or a psych nurse, then that is a good ending because then that means that this person is going to be receiving the care they need. Because that is what this is about.
- We go back to Week One when we talked about human service delivery. First of all, the dignity of all human beings is paramount so we want to make sure that we're responding with dignity. We want to make sure that we're responding with safety, and we want to make sure that ultimately, the goal is that this person receives help.
- A lot of the CIT programs have been very effective in accomplishing that mission. Now, some police departments can't afford that because it is a costly program and is also hard to coordinate. We're talking about the mental health community coordinating with the police community, and there are a lot of reasons why some police departments don't have CIT programs. But every police department trains their officers in how to effectively intervene in a mental health or mental illness situation.
HOST: Consider these concepts as you read your materials, complete your assignments, and answer this week's discussion questions. Follow up with your instructor if you have any questions.
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