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LD 37-Class 94 copyLearning Domain 37 People with Disabilities LBPD ACADEMY CLASS 94 Est. 1996 •MET1: Officer Andre Booker & Clinician Grace Bescoby, MHCRN •MET2: Officer Cris Costa & Clinician Emily Brennan, LCSW •MET3: Officer Tonya Dean & Clinician Lovella Parcasio, MHCRN •MET4: Officer Armando Garcia & Clinician Marlo Bautista, MHCRN •MET5: Officer Efrain Cervantes & Clinician Myha Agustin, LCSW •MET6: Officer Mark Brunson & Clinician Samantha Lopez, LMFT Long Beach Mental Evaluation Team Public Perception Kelly Thomas CLIP CUT TO 2 MINUTES 59 SECONDS VIDEO SEEING THE PERSON AND NOT JUST THE ILLNESS POST-Did you know? VIDEO Learning Need #1 Disability Laws The Americans with Disabilities Act and the Rehabilitation Act of 1973: Written to provide clear and comprehensive mandates for the elimination of discrimination against individuals with mental and physical impairments. •Employment•State and Local Government•Transportation•Public Accommodations•Telecommunications Guidelines offered by ADA are separated under five categories: Americans with Disabilities Act VIDEO How does ADA Impact Law Enforcement? The ADA applies to all law enforcement facilities (including local detention facilities) Accommodation must be made for inmates with specified disabilities People with disabilities are entitled to protection and services that are equal to the general population Learning the behavior signs and indicators of various special conditions can assist officers in identifying the proper intervention to bring the situation to a quick and safe conclusion Types of Disabilities A disability may be physical, cognitive, mental, sensory, emotional, developmental, or combination A disability may be present from birth, or occur during a person’s lifetime. It substantially limits a person from actively taking part in one or more major life activities A physical or mental impairment that substantially limits a person from actively taking part in one or more major life activities •walking•seeing•hearing •speaking •breathing•learning•performing manual task•thinking or concentrating •interacting with others •working A major life activity can be any one of the major functions that an average person can perform with little or no difficulty. These include, but are not limited to: Types of Disabilities •Physical/Developmental Disability •Mental disability What are some physical disabilities? •Intellectual disability •Cerebral palsy •Epilepsy•Autism spectrum disorder•Other disabling condition (e.g., Down’s Syndrome, Tourette’s Syndrome, etc.) What are some Developmental Disabilities? A mental disability refers to a group of disorders that can cause disturbances in thinking, feeling, or relating to others. They often result in an inability to cope with the ordinary demands of life. The two primary categories of mental disability are: Thought disorders (e.g., Schizophrenia or other psychotic disorders) Mood disorders (e.g., bipolar or major depression) Walnut Creek Police-OIS Video AT THE END OF THE DAY PEOPLE WON'T REMEMBER WHAT YOU SAID OR DID, THEY WILL REMEMBER HOW YOU MADE THEM FEEL. —DR. MAYA ANGELOU — People with disabilities are capable of committing crimes. They are not relieved from their obligation to obey the law Once the scene is stabilized and there is no threat to life then the officer has a duty to reasonably accommodate the person’s disability, but not before. Hainze v Richards Learning Need # 2 Intellectual/Developmental Disabilities Willowbrook State School VIDEO Lanterman Developmental Disabilities Services Act The Lanterman Developmental Disabilities Services Act, known as the “Lanterman Act,” is an important piece of legislation that was passed in 1969. This is the California law that says people with developmental disabilities and their families have a right to get the services and supports they need to live like people without disabilities. The Lanterman Act: Video Developmental Disability means a disability which: •Manifests before an individual attains the age of 18•Continues, or can be expected to continue, indefinitely•Constitutes a substantial disability for that individual (WIC 4512(a))•Includes but not limited to: ID, Cerebral palsy, autism spectrum disorder, epilepsy, etc. Impact on Law Enforcement The Lanterman Developmental Disabilities Service Act is not written specifically for law enforcement application; however, it does impact law enforcement agencies and department policies and guidelines. Intellectual Disability •ID formerly mental retardation, is characterized by below-average intelligence or cognitive ability and a lack of skills necessary for day-to- day living. •There are varying degrees of ID, from mild to profound. •I/DD disabilities originate before adulthood (age 18) and continue throughout the person’s lifetime General behavioral indicators can include: •confused and/or disorientation•slow response to commands•muscle control difficulty•limited mobility•seizure disorders•self-endangering behavior•inappropriate responses to a situation•lack of awareness of dangerous situations•inability to understand directions•sensitivity to touch/sound ID/Behavioral Cues and Indicators Impaired Communication Shortened Attention Span Poor Sense of Time Immature Social Relationships Overly Compliant Difficulty with Simple Tasks Poor Understanding of Consequences of Actions •Approach in a calm and respectful manner•Be patient•Use simple language •Ask short open ended questions•Speak slowly and clearly in normal tone of voice•Allow the individual to set the pace•Give praise and encouragement ID/Initial Contact •Is the person exhibiting behavior characteristic of physical or developmental disability?•Is the person exhibiting behavior characteristic of mental illness?•Is the person under the apparent influence of alcohol or drugs Recognize cues that could identify possible cause for behavior: ID/Questioning •Allow plenty of time for the individual to respond•Be willing to rephrase the questions•Ask for simple and clear description •Ask open ended questions•Avoid questions regarding complex sequences•Avoid questions like: “Why do you think he did that?” “You saw him take the purse, didn’t you?” •Bystanders who may have observed the person’s behavior over a span of time•Family members or acquaintances•Other form of information that a person may carry (e.g., ID cards in wallet, emergency cards) Gather additional information from: ID/Resolution Options •Detention for evaluation •Cite and release•Referral to support services•Arrest •No action Cerebral Palsy •The term cerebral palsy refers to a large group of chronic conditions that affect an individual’s body movements and coordination. •The condition can also affect speech, hearing, vision, bowel/bladder control and eating/swallowing CP/Indicators •loss of motor control (awkward gait and poor balance, impaired coordination of movements, grimacing or drooling due to poorly controlled facial muscles) •use of mobility aid such as wheelchair •limited range of motion •involuntary jerky movement •slow and/or slurred speech Graham Police-Part 1 VIDEO Autism Spectrum Disorder ASD is an ongoing I/DD usually evident by early childhood that affects the ability to function and interact with others and the environment. It is more commonly seen in males than females. ASD/Indicators •Difficulty relating to people•Aversion to being touched, especially by a stranger•Sensitivity to noise•May cover their eyes or ears to prevent unpleasant stimulus•May appear to be fascinated by shiny objects•Few social skills•May be non-responsive to questions•May stare or avoid eye contact•Tantrums, self-stimulation, or self mutilation•Eating nonfood items or objects•Inability to respond to command Graham Police -Part 2. Second clip starts at 2:41 VIDEO Buckeye Police -LD37 video edited to 4 mins 41 sec VIDEO Epilepsy Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells (neurons) in the brain send out the wrong signals. Behavioral Indictors: Epilepsy •Lethargic•Slurred speech •Staggering or impaired gait•Tic-like movements•Rhythmic movements of the head•Purposeless sounds and body movements•Dropping of the head •Lack of response•Eyes rolling upward•Lip smacking, chewing, or swallowing movements•Partial or complete loss of consciousness Field Contacts With Persons With Epilepsy Learning Need #3 Physical Disabilities Can be the result of any of a number of illnesses. Two of the most common are Stroke and Dementia. Acquired Neurological Disorder Signs and Symptoms/Stroke •Muscular weakness•Facial paralysis •Incontinence •Loss of balance •Labored breathing •No or slurred speech •Loss of basic motor skills Signs and Symptoms/Dementia •Memory loss•Verbal repetition•Loss of communication skills •Disorientation of time and place•Wandering or lost•Indecent exposure Traumatic Neurological Disorders Are caused by injury to the brain or spinal cord due to military combat, a vehicle accident, sports injury, fall, act of violence, or any number of other forms of trauma. Example of Traumatic Disorders •Traumatic Brain Injury: TBI is an alteration in the brain function or other evidence of brain pathology, caused by an external force•This altered state can result in an impairment of the person’s cognitive abilities, physical functioning, and/or emotional functioning Brett's Story: TBI VIDEO List of Mobility Assistance Equipment and Devices •Canes•Crutches•Walkers•Braces•Prosthesis•Motorized scooters•Manual or motorized wheelchairs•Service dogs•Personal attendants Blind or Visual Impairment/Indicators Deaf and Hard of Hearing/Indicators? Methods to Communicate With a Person Who is Deaf? Additional Laws Protecting the Rights of People With Physical Disabilities People with physical disabilities have the same right as people without disabilities to the full and fee use of street, highway, sidewalks, walkways, public buildings, public facilities, and other public spaces. (Civil Code Section 54) Additional Laws Protecting Rights of People w/ Physical Disabilities •Equal access: Entitled to full/equal access •Rehabilitation Act of 1973: Requires that school districts that receive any federal funding make programs and activities accessible individuals with disabilities. •Failure to comply: Criminal/civil liability •Blind or visually impaired pedestrians: Are not required to carry a white cane •Right-of-Way: 21963 VC -Failure to yield to a blind pedestrian (total/partial) w/ cane/dog -guilty of Misdemeanor Service animals According to the ADA service animals are defined as dogs that are individually trained to do work or perform task for people with disabilities. Veteran humiliated over service dog VIDEO Learning Need #4 Person with Mental Illness Mental Illness Mental illnesses are a medical condition that affects a person’s thinking, feeling, mood, ability to relate to others, and disrupts daily functioning. Persons managing a mental illness can have a substantially diminished capacity of coping with the ordinary demands of life. Mental Disorder: •Primarily a brain disorder•Creates problems with feeling, thinking, and perception•Affects a person’s behavior by causing bizarre and/or inappropriate behavior•Can be short term (acute) or long term (chronic)•Can occur at any time during a person’s life San Jose State University Police VIDEO Thought Disorders/Mental Illness A Thought Disorder condition where the person’s thought process is disrupted causing that person to experience delusions, hallucinations, and/or irrational fears, of they may exhibit unusual behavior. Mood Disorder/Mental Illness A mood disorder, also referred to as an affective disorder, is condition where the person experiences periodic disturbances in mood, concentration, sleep activity, appetite, or social behavior. General Behavioral Indictors Associated with Mental Illness, can include: •Fearfulness•Inappropriate Behavior•Extreme Rigidity or Inflexibility•Excitability•Impaired Self-care•Hallucinations•Delusions•Disorganized Speech, Thought Patterns, or Disorientation Officers should not attempt to diagnose mental illness. A mental illness is often difficult for even the trained professional to define in a given individual. Become familiar with the general indicators of mental illness so that appropriate actions can be taken. •Isolation•Sadness, inactivity and self depreciation•Feelings of guilt, hopelessness, helpless, or pessimism•Eating disturbances •Fatigue, decreased energy•loss of motivation•Crying spells•Chronic pain•Sleep disturbances•Relentlessness or irritability•Difficulty concentrating or making decisions•Thoughts of death (attempts or threats of suicide) Clinical depression is the most common of the mood disorders. Symptoms may include: Blue in Blue Police Depression and Stress VIDEO Bipolar Disorder/Symptoms may include: •When in a depressive cycle: may demonstrate the same behavior as with clinical depression•Manic cycle may exhibit: boundless energy and enthusiasm, decreased need to sleep, rapid loud or disorganized speech, short temper and argumentative speech, impulsive and erratic behavior, possible delusional thoughts, hyper religious or hyper sexual. PBS Paton Blough VIDEO Schizophrenia •It is a group of related disorders in which a person’s ability to function is marked by severe distortion of thought, perception, feelings, and bizarre behavior•Most common of the thought disorders. It most often develop in young adults aged 16-25 and remains throughout their lives•Affects the person’s ability to work, relate to others, or take care of oneself Schizophrenia/Behaviors include: •Bizarre delusional thinking•Hallucinations•Incoherent, disconnected thoughts and speech•expression of irrational fear•Declining self-care•Poor reasoning•Strange and erratic behavior Learning activity LD37 VIDEO EDITED TO 4 MINUTES AND 51 SECONDS STARTING AT 9:45 Christopher Remmey VIDEO Law Enforcement routinely encounters persons with mental illness in a variety of settings. The causes and impacts of mental illness vary and are not bound by race, gender, or socioeconomic status. Always respond in a manner that is humane, compassionate, and supportive. John Nash Beautiful Mind VIDEO Postpartum Depression/Indicators •Episodes occur in 1/500 to 1/1000 individuals•May impact maternal attitudes toward infants/children: child abuse, homicidal thinking, disinterest of the infant)•“Baby Blues” are different from Postpartum: Affects up to 70% of mothers within 10 days of delivery/no significant impairment Postpartum Psychosis/Indicators Postpartum psychosis is a rare illness experienced by approximately one in every 1,000 women after giving birth, which can substantially diminish the mother’s capacity for coping with ordinary like demands. Psychosis is a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality Psychosis/Indicators Family Heartbreaking Tragedy Eyewitness News VIDEO Posttraumatic Stress Disorder Symptoms can include:•Dreams and nightmares about the incident•Flashbacks, hyper-carousel, •Distress caused by reminders of the event, survivor’s guilt, •Hyper-vigilance, emotional numbing •Exaggerated, startled response (usually to loud noises) Post-traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a traumatic event or ordeal The Things We See: PTSD VIDEO L37 Video was edited between 1:28 -1:29 The most common personality disorders are: •Narcissistic (entitlement)•Antissocial (manipulative)•Borderline (abandonment)•Histrionic (theatrical) Personality traits (enduring patterns of perceiving, relating and thinking) become inflexible and maladaptive Field Contacts/Persons with Mental Illness People affected by mental illness can be unpredictable and sometimes violent. Officers should never compromise or jeopardize their own safety or the safety of others when dealing with individuals who display symptoms of mental illness. Field Contacts/Person in Crisis Once the scene is stabilized and there is no threat to life then the officer has a duty to reasonably accommodate the person’s disability, but not before. Field Contacts/Persons with Mental Illness Not all people with mental illness are dangerous, while some may represent danger only under certain circumstances or conditions. Some may be capable of going very quickly from a state of calm to being extremely agitated. Athens Georgia Police VIDEO Indicators to consider while dealing with a person experiencing a mental health crisis: The availability of any weapons Statements made by the person that suggest that he or she is prepared to commit a violent or dangerous act. History Signs of violence at the scene prior to the officer arriving Statements made by a credible third party The amount of self-control/lack of control (signs of rage, anger, fright, or agitation) Begging to be left alone Request Backup: Situations can be unpredictable Appropriate tactical actions/person in crisis: •Stabilize the Scene •Calm the Situation•Communicate: Acknowledge the person’s feelings, establish auditory/visional hallucinations, do not mock the person or belittle their behavior •Do Not Make Threats•Be Truthful LAPD West Valley -OIS VIDEO Crisis Intervention Crisis by definition is short-term and overwhelming and involves a disruption of an individual’s normal and stable state where the usual methods of coping and problem solving do not work. Crisis Intervention Be aware that your uniform, badge, gun, and police car may frighten the person with mental illness so reassure them that no harm is intended. •Recognize that a mentally ill person in crisis may be overwhelmed by: •Sensation: Seeing you as a devil in an officers uniform •Delusion: Frightening or false beliefs •Hallucinations: Hearing a voice you want to hurt them Crisis Intervention If you take a LESS authoritative, LESS controlling, LESS confrontational approach, you actually will have MORE control. Crisis Intervention Allow person to vent energy, maintain safe distance, talk in low voice, broken record, reassure. Crisis Intervention De-escalation Requires Cooperation illusion of alternatives “Would you like to…” In order to use this, you must understand the subject’s worldview and be able to pick the choices that fit into that worldview Examples of communication with a person in crisis: GUIDELINES FOR DEALING WITH MENTALLY ILL PEOPLE Examples of communication with a person in crisis In order to understand their worldview: Listen carefully to their use of language to describe the personal world (abstract ideas or thoughts and feelings) What do they select from their environment to pay attention to or ignore GUIDELINES FOR DEALING WITH MENTALLY ILL PEOPLE Examples of communication with a person in crisis: Get the person to say yes or ok to trivial questions first Focus on Behavior Don’t identify their behavior for them Instead of saying: “you’re hostile” say “what you said sounded hostile, did I do something to make you mad?” Examples of communication with a person in crisis: Do not try to assume intimacy or friendship when you do not have a relationship with the person Don’t say “You’re a nice guy” That invites the argument “You don’t know me, I’m not a nice guy” Examples of communication with a person in crisis: Will you? vs Can you? Can indicates that you are questioning their capability This can make them angry without even knowing why they are angry Examples of communication with a person in crisis: Do not promise or guarantee anything You will lose your credibility when you can’t deliver Examples of communication with a person in crisis: Resolution options/person in crisis: •Provide Urgent Medical Attention•Arrest of Individual•Referral for Mental Health Services•Report to Child Protective Services: (Required by law to report conditions of child abuse to DCFS)•Cite and Release•No Further Action Learning Need #5 Welfare and Institutions Code Peace Officers must become familiar with the application of Welfare and Institutions Code Section 5150 in order to determine if an individual is a danger to others, or to himself or herself, or gravely disabled and to determine an appropriate response and resolution option. Lanterman-Petris-Short Act Frank D. Lanterman Nicholas C. Petris Alan Short LPS was established in 1968 with the intent to end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders, developmental disabilities, and chronic alcoholism. When a person as a result of mental health disorder is a danger to others, or a danger to himself or herself, or gravely disabled. A peace officer or other designated person may upon probable cause take or cause to be taken the person into custody for a period of up to 72 hours for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment in a designated facility Welfare and Institutions Code 5150 A person that is authorized to write the hold shall consider available relevant information from the person, service providers, or family members about the historical course of the person’s mental disorder. 5150.05 Because deprivation of personal liberty is involved and officer must clearly articulate the circumstance under which the person’s condition was brought to the officer’s attention. Officer must: •be able to state known facts•that would lead a person of ordinary care and prudence to believe or to entertain a strong suspicion •that the person detained•is a danger to others, or self, or is gravely disabled Danger to Self Indicators might include, but are not limited to the individual’s: •words or actions that imply an intent to commit suicide or inflict bodily harm on self•exhibition of gross neglect for personal safety which could lead to that person receiving or being at risk of receiving serious injury •statements or actions implying a specific plan to commit suicide or inflict harm on self•plans and the means available or within the individual’s ability to carry out Danger to Others Indicators might include, but are not limited to the individual’s: •words/actions indicating the intent to cause bodily harm to another person•appearance of being agitated, angry, or explosive •engagement in or intent to engage in acts or behavior of such an irrational, impulsive or reckless nature as to put others directly in danger of harm•acts or words regarding an intent to cause harm to another person being based on or caused by the individual’s mental state Gravely Disabled: Indicators might include, but are not limited to the following: •The person must "presently" be unable to provide and or utilize food, shelter and clothing due to a mental disorder.•Mere inability to provide for needs is not sufficient nor is refusal of treatment evidence of grave disability •Regardless of person’s past, the question is whether they are presently gravely disabled. Gravely Disabled Minor A person 17 years old or younger who, as the result of a mental health disorder, is unable to utilize the elements of life, which are essential to health, safety and development, including food, clothing, shelter, even though provided to the minor by others, (WIC 5585.25). Examples may include but not be limited to: •surviving safely with the help of responsible family, friends or others who are both willing and able to help to provide basic personal needs •using poor judgement or displaying eccentric behavior does not necessarily mean a person is incompetent •chosen lifestyle or lack of funds Not Gravely Disabled Deprivation of Personal Liberties Officers must be aware of the responsibility involved when they evoke WIC Section 5150. Detention and commitment can mean the individual: may be deprived of contacts with with friends and family, may be subject to medical and psychological examination, and/or the administration of medications, and can be held against the person’s will for up to 72 hours. The detention under WIC Section 5150 can not be based on vague, ambiguous, unspecific, or potentially dangerous behavior. Rights of Detained Person People who are detained under WIC Section 5150 are entitled to basic federal and state constitutional rights. Prior to transporting, officers must give the following advisement: “My name is (Officer A. Foley), I am a (Police Officer) with (LBPD). You are not under criminal arrest, but I am taking you to for an examination by mental health professionals to (College Medical Center or any LPS Designated Facilities). You will be told your rights by the mental health staff.” Rights of Detained Person “You may bring a few personal items with you which I will have to approve. Please inform me if you need assistance turning off any appliance or water. You can make a phone call and/or leave a note to tell your friends and/or family where you have been taken.” Section 835(a) (2)A peace officer shall not use deadly force against a person based on the danger that person poses to themselves, if an objectively reasonable officer would believe the person does not pose an imminent threat of death or serious bodily injury to the peace officer or to another person. New Senate Bill 392 Whenever a person who had been detained under Welfare and Institutions Code Section 5150 is found to own, have possession of, or have control of any firearms or deadly weapons, peace officers will confiscate those weapons. 8102 WIC Application for 72-Hour Detention, Evaluation, and Treatment form (DHCS 1801), a standard application includes: •verification that the detainment advisement was given•the name of the designated facility to which the person is taken•the name and address of the individual who is being detained•factual circumstances and observations constituting probable cause for the officer to believe that the individual is in fact a danger to others, self, or is gravely disabled There is no such thing as a voluntary 5150 WIC Confidentiality of medical reports Officers are responsible for being aware of state and federal statutes that govern the release of medical records. Health Insurance Portability and Privacy Act [HIPPA] News clip-Officer suicide on the rise VIDEO