Monday, March 06, 2006

Seeds of an Idea

Training for the Mental Health Team was conducted today with very mixed results. There's no doubt that Corrections staff who deal with the mentally ill need specialized training, the issue is that people outside the field don't seem to understand what we need. When we design and deliver the training ourselves it seems to work best.

Sometimes we have experts. I recall one outside expert we brought in. He was a retired street cop who had made his reputation from maybe thirty encounters with mentally ill people in crisis. It was enough of a reputation that he lectured nationally... it was less experience than one of our deputies will get in one year. The other end of the spectrum are the subject matter experts who try to cram a college psychopharmacology class into one hour.

What we need is very basic- how to tell if someone is mentally ill, and if so how much of their behavior is voluntary (it would be nice if you could be crazy OR an asshole, but not both. Reality is you can be both.)

What kinds of mental illness and what kinds of crises we can expect and how to identify them.

How to communicate with them, especially in crisis.

Honestly the deputies, especially the experienced ones, excel at these points. The next points are harder:

Give us the terms and dignoses for what we see so that we have a common language with the counselors and medical staff.

What medicines do we need to watch for? How long before a therapeutic level is reached (some medications take over a month to show an effect). How do we tell if someone is over medicated? What are the signs of an immediate medication-triggered emergency? What are the signs of long-term use (being able to recognize tardive diskenesia, the "thorazine twitch" can give you a big head start in knowing who you are dealing with). Which drugs are commonly sold to other inmates?

We also need to know what resources are available outside the jail. We're just a phase in the life of a mentally ill criminal. Where do they go and what can they access when they are on the streets? Where can we send them? If one talks about a program, how do we contact that program?

The lieutenant had an idea today. It can only work because all involved personnel have signed their federal medical privacy pledge: Take the booking pictures of a dozen of our regulars. Here's the picture. This is the behavior we see. This is the diagnosis, the medical term for that behavior. These are the strategies that have worked consistantly with those behaviors. This is the standard treatment. If you see these behaviors, think of this person.

It's brilliant. It encapsulates everything with an easy touchstone to personal experience. Even outside our agency, we could use silhouettes instead of pictures and names and still tie stuff together.

A new project. Cool.
Bipolar, paranoid schizophrenic, substance withdrawals, dual diagnosis, delusional, excited delirium; the common personality disorders: asocial, borderline, narcissistic....

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