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Monday, August 3, 2015

Portsmouth Police Crisis Intervention Training: Needed Skills for a Community

“Typically, when people are in mental health crisis, it’s a law enforcement officer that has the first contact. Someone experiencing a mental health crisis may be incoherent, emotionally excited, thinking or behaving irrationally or experiencing a variety of other emotions and thoughts,” Ware said the week of the CIT (Crisis Intervention Team) (CIT) training.

“More often than not, these contacts start out as a noncriminal encounter. It is only through a great deal of recognition, understanding and communication skills that an officer is able to bring the situation under control without escalating into a criminal encounter or use of force situation.”

(Frank Lewis. "Ware stresses mental health training." Portsmouth Daily Times. July 27, 2015)

I am pleased to see that Portsmouth Police Robert Chief Ware has recognized a crucial need in police training as police officers are not only the first responders to most mental health crises but also often the sole source of immediate service for urgent mental health activities. That is why he put officers through CIT training. The increased sensitivity is needed.

In May, members of the Portsmouth Police Department and other law enforcement officers received training as to how to deal with mentally ill individuals they might encounter. It was a collaborative effort between law enforcement and the mental health community.

Prevalence of Mental Illness

In 2012, there were an estimated 9.6 million adults aged 18 or older in the U.S. with a serious mental illness (SMI) in the past year. This represented 4.1 percent of all U.S. adults. In that same year, there were an estimated 43.7 million adults aged 18 or older in the U.S. with any mental illness (AMI) in the past year. This represented 18.6 percent of all U.S. adults.

(National Institute of Mental Health. 2012)

About 1 in 5 of U.S. adults will develop a mental illness sometime in their lives. Among the millions of affected Americans, fewer than half get help, even though 80 to 90 percent of mental disorders are treatable using medication and other therapies. These disorders take an enormous toll on individuals and families, as well as society as a whole.

(Susan Blumenthal, M.D. "Overcoming Stigma and Improving Mental Health in America." The Huffington Post. May 25, 2012.)

The numbers are staggering, but those with mental health problems face a profound stigma because many consider mental health problems to be the result of personal character flaws rather than real illnesses, like heart disease or diabetes. Society places illogical taboos on mental health issues over physical conditions. Yet, in fact, mental disorders have a biological and neurological basis.

Mental disorders include anxiety disorders (e.g., post-traumatic stress and obsessive-compulsive disorders), mood disorders (i.e., depression and bipolar disorder), eating disorders including anorexia and bulimia, addictive disorders (such as alcoholism), and personality disorders.

Dr. Susan Blumenthal, Former U.S. Assistant Surgeon General, says children and young adults are at high risk for developing mental disorders, with 13 percent of youth in the United States under the age of 18 meeting the criteria for one of the six most prevalent mental illnesses: generalized anxiety disorder, panic disorder, eating disorders, depression, attention deficit hyperactivity disorder and behavioral disorders.

What We All Must Do

Understanding the causes of mental illnesses and the factors that contribute to them are the first steps for a caring public.

The next step is to shatter the stigma that surrounds seeking help for mental illness because it contributes so much to low rates of detection and treatment. When mental health problems become overwhelming despite personal efforts to cope, that is a sure sign people need additional help. Still, only 2 in every 5 people experiencing a mood, anxiety or substance abuse disorder seek assistance in the year of the onset of the illness.  A supportive, better informed public will improve treatment.

Possible Causes of Mental Illnesses

Mental illnesses, in general, are thought to be caused by a variety of genetic and environmental factors:
  • Inherited traits. Mental illness is more common in people whose biological (blood) relatives also have a mental illness. Certain genes may increase your risk of developing a mental illness, and your life situation may trigger it.
  • Environmental exposures before birth. Exposure to viruses, toxins, alcohol or drugs while in the womb can sometimes be linked to mental illness.
  • Brain chemistry. Biochemical changes in the brain are thought to affect mood and other aspects of mental health. Naturally occurring brain chemicals called neurotransmitters play a role in some mental illnesses. In some cases, hormonal imbalances affect mental health.

Factors That May Increase the Risk of Developing Mental Health Problems
  • Having a biological (blood) relative, such as a parent or sibling, with a mental illness
  • Experiences in the womb — for example, having a mother who was exposed to viruses, toxins, drugs or alcohol during pregnancy
  • Stressful life situations, such as financial problems, a loved one's death or a divorce
  • A chronic medical condition, such as cancer
  • Brain damage as a result of a serious injury (traumatic brain injury), such as a violent blow to the head
  • Traumatic experiences, such as military combat or being assaulted
  • Use of illegal drugs
  • Being abused or neglected as a child
  • Having few friends or few healthy relationships
  • A previous mental illness

Complications Due to Mental Illnesses

Mental illness is a leading cause of disability. Untreated mental illness can cause severe emotional, behavioral and physical health problems. Mental illness can also cause legal and financial problems.

Complications sometimes linked to mental illness include:
  • Unhappiness and decreased enjoyment of life
  • Weakened immune system, so your body has a hard time resisting infections
  • Family conflicts
  • Relationship difficulties
  • Social isolation
  • Problems with tobacco, alcohol and other drugs
  • Missed work or school, or other problems related to work or school
  • Poverty and homelessness
  • Self-harm and harm to others, including suicide or homicide
  • Increased risk of motor vehicle accidents
  • Heart disease and other medical conditions

Certain conditions in Appalachia contribute to poor mental health care. The statistics prove the wide prevalence of mental illnesses in Appalachia.

Researchers commissioned by the Appalachian Regional Commission reported in 2008 that residents of the impoverished mountain region face more mental health issues than the rest of the country. The National Opinion Research Center at the University of Chicago found that people living in the Appalachian coalfields suffer from higher rates of stress and depression and are more prone to prescription drug abuse.

Researchers found:
  • Mental health disorders are proportionately higher in Appalachia than in the rest of the nation.
  • Residents of central Appalachia have higher rates of serious psychological stress and major depression than their neighbors in northern and southern Appalachia.
  • Admission rates for prescription drug abuse is rising across the nation, but at a faster pace in Appalachia, especially in coal mining communities. The rate in Appalachia is more than twice that of the U.S., and it doubled from 2000 to 2004.
(Roger Alford. "Study: Appalachia more prone to mental health, drug problems." Huntington Herald-Dispatch. August 13, 2008.)

Rural Appalachian areas have substantially fewer per capita mental health providers than urban areas. Moreover, providers with higher level of specialization in the area of mental health, with greater expertise are extremely scarce in these areas. People suffering from mental health conditions living in rural areas are also more likely to be uninsured than other residents of rural areas.
(Atkinson, NL et al. “Assessment of the Nutrition and Physical Activity Education
Needs of Low-Income, Rural Mothers: Can Technology Play a Role?”
J. Community Health. August, 2007.)

Public health education campaigns should encourage people to recognize signs of mental illness in their loved ones and urge them to seek help. I believe initiatives such as the Portsmouth Police Crisis Intervention Team training is so important since it greatly increases community outreach to affected individuals and to their families.

I hope this is the beginning of a new, increased understanding of the proper manner in which to handle situations that involve enforcement and those with mental disabilities. Special communication skills should greatly increase cooperation and yield good results. Public servants must continue to update new skills to cope with everyday encounters.

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