National Drug Court Institute

Drug Court Training

NDCI: A Professional Services Division of NADCP

DRUG COURTSTrauma Informed Police Responses

PRESENTED BY: VANESSA PRICE, INSPECTOR, RETIRED

Collaboration of: Cary Heck, Ph.D.

Steve HansonCharles Armhein, PsyD

Vanessa Price

• Identify the types of Axis 1 Disorders and how to effectively communicate with those having a disorder

• Define and list the symptoms and behaviors associated with Personality Disorder

• Identify the types of trauma and associated behaviors

Presentation Objectives

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• Collaborative approach to treating substance abusing offenders in the community

• Program Participants receive:– Frequent drug and alcohol testing– Intensive supervision by local or state probation

agencies– Appropriate levels of treatment for substance

abuse disorders– Regular contact with the supervising judge

The Drug Court Model

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The Ten Key Components1. Justice and Treatment

Integration2. Non-adversarial Approach3. Early Identification4. Continuum of services5. Drug Testing6. Coordinated Strategy7. Judicial Supervision8. Monitoring and Evaluation9. Interdisciplinary Education10. Forging Partnerships

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• Rewarding behaviors can become routine

• “Subconscious” control of the behavior

• Difficult to extinguish behaviors because people are not always aware when they are initiated

• Resistant to change

Behavior Pathways

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Introduction

Part I Disorders

• Mental illness: Axis • Personality: Axis II

Part II Trauma

• Related Disorders• Traumatic Events

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Mental Illness in Jails

• 2 million annual bookings nationwide

• 16 % males suffer

• 31% female suffer

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• Axis I disorders are like a medical illness, an illness that impairs behavioral functioning in some way:

• Florid• Episodic• Dysfunction • Disruption

Axis I Disorders

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When it’s the personality that’s disordered• Not about an illness but about

difficulties of someone’s personality, what they are like as a person, and how they handle stress.

• Some personality disorders can be a challenge for law enforcement, such as people prone to interpersonal conflicts.

Axis I Disorders

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Broad Categories

• Thinking

• Mood

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What is Psychosis?

Psychosis is when thinking is severely impaired, either how thoughts are put together or the content of one’s thoughts. Most common in schizophrenia and schizoaffective disorder. Three main symptoms:

• Delusions• Hallucinations • Impaired thinking processes

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Delusions

• Paranoid - the person believes that there are people who are trying to hurt him or her, “someone is out to get me.” They may even report this to the police.

• Grandiose - “I own four states and two countries,” superhuman abilities, related to famous people, believes to have great wealth (but can’t get access), etc.

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Hallucinations

False perceptual experience through one of the senses.

• Auditory (voices)

• Visual

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Problem in organizing thoughts, may be hard for the person to communicate or make himself understood.

Disorganized Thinking

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Disorganized Behavior

• Poor hygiene• Inappropriate

clothing• Silence – non

responsive to questions

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• Schizophrenia – a chronic illness, but it can occur in episodes and have remissions. Usually overall functioning is lower than before onset of the illness. Marked by hallucinations, delusions, and/or thought disorder.

• Schizoaffective disorder –Rather the person has episodes of both psychotic symptoms and mood symptoms that are not connected.

The Psychotic Disorders

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Mood disorders

Major Depressive Disorder• Psychological pain• Fatigue• Loss of energy• Poor concentration • Poor memory

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Bipolar

• Once called manic-depression

• Manic episodes • Feeling exceptionally • Irritable and aggressive. • Grandiose delusions. • High level of energy• Paranoid.

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Major Depressive

Major depressive disorder with psychotic features – the person is so depressed that the depression leads to psychotic symptoms.

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Anxiety Disorders

Sense of being…

• Danger• Worry• Fear• Threatened

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Anxiety Disorders

• Obsessive compulsive disorder

• Generalized anxiety disorder

• Panic disorder

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Impulse Control Disorder

• Outbursts• Aggressive feelings,• Poor frustration

tolerance

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The Approach: Talking to People

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Caveat: Follow your training and department policies to assure safety at the scene, safety, as you already know, is the priority. This module will build on your knowledge of mental illness and trauma to help you add skills, but this material does not replace previous training nor department policy guidance.

Talking to People

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That being said, engagement is the key…

Engagement is not only good for the person you are responding to, it is also a good risk reduction strategy when it is appropriate.

Talking to People

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• Do not reason instead, emphasize with emotions: Feelings first: “It sounds like you feel...”

• Don’t try to talk them out of unusual ideas “What you’re telling me is…” “Given all that you told me it must be very difficult

to…”

People with Psychosis

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People with Psychosis

•Give them your full attention.•“I’m sorry I have to interrupt but I need to take care of this quickly.” Add I’m sorry about that you were telling me about … before I had to interrupt. •Maintain calm and open body language.•Silences are okay.

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• If asked do you believe the delusion just simply say, “I want to hear more about what you’re having to deal with, can you help me understand…?”

• Ask him or her: “I want to check if I’m getting this

right, is this it…? ?

People with Psychosis

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De-escalation: Communication that calms someone•One person takes lead communicating•Take your time•Speak slowly and calmly•An attitude of trying to help, vs. threats

or arguing

People who are Agitated

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•Eye contact – neither too much or too little•Maintain safe distance•Sit with person if seated, perhaps at side•But…, avoid unrealistic statements or

promises.

People who are Agitated

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•Show empathy •Acknowledge a grievance•Use open ended questions•Emphasize the person’s point of view, not yours•“Tell me what happened” and “What can I do to

help?” •“I want to help but it’s hard for me to understand

when you’re shouting.”

Talking to People -- Agitation

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The major ones with high relevance for law enforcement include:

• Narcissistic• Borderline• Antisocial

Personality Disorders

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• Grandiose • Self-centered• Entitled• Arrogant• Needs admiration• Lacks empathy

Narcissistic

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Borderline

• Highly emotional and agitated• Poor coping with negative

feelings• Needy and dependent on

others • Impulsive behavior• Suicidal thinking or attempts• History of childhood trauma

(sexual abuse)

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• Schizotypal• Schizoid• Antisocial

Other Personality Disorders

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Caused by exposure to, or witnessing, an event that threatened death or serious injury, along with a sense of fear, horror, or helplessness.

Post-Traumatic Stress Disorder

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Trauma• Events that are beyond

expectable experience and overwhelm the person’s psychological resources.

• Think of the war veteran where the family said he was never the same after he returned.

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• Recent traumatic event

• Chronic PTSD

• Delayed PTSD

• Chronic abuse, in childhood or later

Types Trauma

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Dissociation

Cutting off awareness and connection to memory, thoughts, and feelings.

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Always on the edge

• Memories and thoughts remain unbearably intense

• Thoughts are intrusive and cannot be stopped

• Nightmares are frequent• People react as if they are

back at the traumatic scene

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Following a Traumatic Event

Person may be:• Confused• Numbed• Calm• Severely distressed.

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Trauma

Speaking quickly

Matter of fact tone

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