Safe Behind Bars Flashcards by Marcos Vazquez

Ch 1. Pg 3 Incarceration or Treatment : Are they necessarily in conflict?

General public wants ____________ (if not punishment) and safety. Most citizens are unlikely to willingly _________ making jails and prisons a more “____________” place.

Having a therapist or case manager on staff, even during regular work hours is considered a _________.
It takes time, insight and unfortunately, sometimes a law suit for agencies to acknowledge the need for mental health care inside their facilities.

justice;
fund;
“livable”;

luxury:

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Pg 4.

Concrete skills- Taser, defensive tactics, threat id, and cuffing are often easier to learn.

Soft skills - communication and body language.

Just with physical traits you must strive to train your verbal responses into “_________________” where you don’t have to think before you effectively react, something that takes practice.

Experts at de-escalation must have the ______________ to move from one style into another if the first doesn’t work.

“pseudo instinct”;

fluidity;

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Structural Issues pg 4

What are three long standing issues that often lead to the mentally ill inmate not receiving a comprehensive adequate level of care?

1.) PHYSICAL PLANT PROBLEMS: There are no dedicated space in jails to care and treat for the mentally ill. General Pop housing is converted for the use of the mentally ill, often lacking appropriate clinical space, step-down or intermediate care units and/or programs.

2.) INADEQUATE INFIRMARIES: not capable of providing crisis level mental health treatment.
Many older facilities do not have air handlers that maintain the proper temperature for heat sensitive medication.

3.) ACCESS ISSUES: Count time, lockdown, feeding , recreation, therapy and locked doors prevents an inmate from being able to physically travel to areas of the jail to routinely access services, as well as interfering the clinic staff from accessing them.

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The Revolving Door (Ch.1 pg 5)

Beyond the funding and structural issues that have already been described, these problems are exacerbated by:

Lack of Staff
Lack of Training
Lack of Mental Health Professionals
Treatment With Only Medication
Staff Turnover
Insufficient Level of Care
Inadequate Assessment and Information Management
Disruption of Care Due to Transfers
Mental Illness May Not Be Noticed
Disciplinary Methods Can Be Destructive

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Figure 1.1pg 6

How scheduling can impede care

Scheduling requires that inmates receive medication in the early evening. If given before bedtime, the inmate can appear to be drowsy and unable to follow directions, Inmate will then be viewed as non-compliant.

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Pg. 8

Time put in on the front end of a situation almost always pays off at the other end:

No Duplication of Services
The Inmate’s Time is Not Wasted
Reduced Training Costs
Limits Manipulation Opportunities for Inmates

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Pg. 10

Deliberate Indifference

Being aware there is a problem, but doing nothing to alleviate it.

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5 Behaviors of the Incarcerated Mentally Ill

Chronic Mentally Ill Inmates: schizophrenia, schizoaffective disorder and/or bipolar disorder
Developmental Delayed Inmates: IDD, affect cognitive abilities and maturity levels, low IQ below 70. (appear childlike)
Violent Mentally Ill Inmates- highly violent and aggressive, hallucinations and delusions (psychotic), resist control (paranoia), make up one of the smallest portions of incarcerated mentally ill inmates.
Crisis Inmates - life breakdown, deterioration in their level of functioning. (functioning members of their community)
Victim Mentally Ill Inmates- controlled by another person, (prostitution);

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pg 12

Why do many attorneys avoid mentally ill inmates or put off working on their cases?

they have their own ideas about their cases, making it up as they go along, while completely believing everything they say. They can be referred as “speaking into being” meaning “if I said it, it’s real”- clinically referred to as magically thinking.

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pg 17 ch 3 Life for the Mentally Ill in Prison

If properly processed and housed at intake, ____________ MI Inmates have the best chance of exiting the justice system without becoming career criminals through proper referral and treatment with the medical and mental health teams.

Crisis

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pg 17. Ch 3 Life for the Mentally Ill in Prison

_____________ MI Inmates cannot operate within the parameters that society has decided upon and more often than not, cannot even function inside a correctional facility.

Violent

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Pg 18 Ch 3 Specialized Housing

___________ custody is when the inmate asked not to be housed with anyone else for fear of harm.

___________________ is when the facility decides to house the inmate separately because of one of the following reasons :
- The inmate would victimize others.
- Other inmates would victimize the inmate.
- Inmates possess a serious threat to the security and safety of the institution ( such as local crime lord or someone involved in a high-profile case)

Protective;

Administrative Segregation;

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Pg 18 Ch 3 Specialized Housing

Inmates housed alone and not allowed to participate in programs that involve other inmates are left with little day-to-day interaction soon learning to cherish any kind of attention or activity that is diversionary, be it positive or negative.

It is often in these circumstances that mentally ill inmates engage in _____________ and _____________ actions such as self-mutilation, destruction of their cell and their own possessions, and feces smearing.

damaging and degrading;

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pg 18. Ch 3

Can mentally ill inmates serve their sentences in the community?

Crisis MI Inmates - ?
Victim MI Inmats - ?
Violent MI Inmates - ?
Developmentally Delayed Inmates - ?
Chronic MI Inmates - ?

Crisis MI Inmates - can adapt to home monitoring and deferred programs.

Victim MI Inmates - may possibly benefit but inmates on programs cannot make money for their pinps or dealers. Therefore, effective parole/probation of Victim MI Inmates must factor in protection from the controlling criminal or they will surely fail.

Violent MI Inmates - rarely meet the needed criteria for most of these programs.

Developmentally Delayed Inmates - can successfully serve their sentences in the community if they have a support network or caregiver.

Chronic MI Inmates - are unlikely to meet the criteria for alternatives to incarceration unless they receive comprehensive wrap around services.

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pg 21 Ch. 4 What do mentally ill inmates need?

The ___________ ___________ determines where the level of care will be implemented; not what level of care is offered.

security classification;

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pg 21 Ch. 4 What do mentally ill inmates need?

In order to achieve a comprehensive mental health program within a jail setting, there a number of essential components:

Training and Consultation - Mental health training is absolutely necessary and in some states is mandatory. Staff should receive routine training related to signs and symptoms of the mentally ill, de-escalation tactics appropriate to specific behaviors as well as understanding the policies and practices of the facility’s mentally ill program.

Suicide Prevention Program

Acute Care intervention Program - a safe place must be established to house and monitor a suicidal inmate until they have been medically cleared, signed a safety plan, or other case management options have been put in place. Need padded cells, cocoon boards to restraint chairs and benches.

Reintegration Planning - spent a few days in transitional housing before returning to their previous or new assignment. (ie. no sharps unit)

Stabilization Planning - Jail populations are mercurial by nature and case managers are nearly always overlayed, operating with a concrete timeline for any of their clients.

Special needs unit - necessary for inmates not requiring inpatient treatment but those who require a therapeutic milieu due to their inability to function adequately within the general population. (ie small dorms or single units with increased accessibility to medical and mental health)

Outpatient Referral Services - Case managers try to send mentally ill inmates out the door with (at least) medication and referrals to outside case management.

Discharge/Transfer Planning - Adequate discharge planning is a fiscally sound process that goes along way towards reducing recidivism and a costly return to jail following a violation of parole or an entirely new crime.

Evolving Issues - include mental health input into the inmate disciplinary process, discharge planning for inmates with serious mental illness, management of inmates with inappropriate sexual behaviors, care of female mentally ill inmates.

Malingering - inmates malingering a mental illness while having a serious mental illness is not uncommon.

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pg 25 Ch 5. The Role of the Correctional Officer in Supervising Mentally Ill Inmates

Jails may be required to provide treatment for the mentally ill, therapeutic substance abuse programs, programs for the developmentally and medically disabled as well as sometimes jails will find grants to implement special treatment programs or other types of programs that enable the inmates to contribute and make _______________ to the community such as __________ or ______________.

restitution;

graffiti or campground clean up;

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pg 26. Ch 5

To be sure, there are times that the only appropriate response is to initiate a ___________ response so that a dangerous mentally ill inmate can be subdued, restrained and removed to a crisis unit for stabilization.

use of force;

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pg 26 Ch 5 A Collaborative Process

Officers, by definition, must remain detached and set themselves to _______________, not building a therapeutic relationship.

The focus of mental health professionals, in contrast, is characterized by __________________ ____________________ , informed consent, and to some degree in a jail setting, negotiated compliance.

resolving issues;

individualized treatment;

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pg 30 Ch 6 Gathering Critical Information

If an inmate requires special housing, their status should be reviewed every __________ days in order to keep track of any changes both bad and good.

thirty (30);

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pg 30 Ch 6 Different Layers in the Intake Process

Incarcerating a person is major violation of their rights unless you have the appropriate charging documents.

________ officers initially focus on the documents (while of course fully attending to safety issues) before their focus changes to the inmate.

Officers will ask if the y have any injuries or if they’ve tried suicide in the past 24 hours. If the inmate states that they are currently suicidal, a ___________ ___________ would be immediately initiated.

Wise;

suicide protocol;

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pg 31 Ch 6 Booking Process

After _________ hours, an inmate has usually detoxed enough (if needed) to be able to give coherent answers.

24;

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pg 42 Ch 8 Policies to Mitigate Drug Availability

What are some of the jail drugs and alcohol reduction strategies?

-Zero-Tolerance
-Training
-Direct and Random Testing
-Sanctions
-Random Searches
-Searches of Visitors
-Searches of Staff
-Monitoring of Correspondence
-Secure Storage of Medical Supplies
-Monitoring of Medications Distributed to Inmates
-Monitoring of Over-the-counter (OTC) Medications
-Proper Equipment
-Drug Detection Dogs
-Inmate Clothing
-Yard Scheduling
-Control of Foodstuffs
-Control of Material Used to Fabricate Pruno
-The Opportunity for Spiritual Support
-Education
-Substance Abuse Groups
-Treatment
-Support Services
-Specialized Unit

See book on descriptions.

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pg 45 Ch.9 Specialized Units

Prisoners with pre-existing psychiatric disorders are of greater risk of suffering further _______________ _________________ when placed in isolation, or segregation/security housing units.

psychological deterioration

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pg 45 Ch.9 Specialized Units _______________ inmates have a very high suicide rate, far more than the suicide rate of inmates in general population. Therefore, ____________ _________ _____________ must occur either prior to or within a short period of time following an inmate's placement in a segregation unit.

Isolated; Suicide risk assessment;

pg 46 Ch.9 Specialized Units Classification officers should also complete __________ days reviews in which they meet with each inmate. Floor officers are the ___________ ___________ _____ _______ for an inmate whose mental health is deteriorating.

thirty; first line of defense;

pg 46 Ch.9 Specialized Units In an ideal situation, a segregated mental health correctional program should offer ______ to ______ hours per week of out-of-cell structured therapeutic activities in addition to unstructured exercise or recreation time.

ten to fifteen;

pg 49 Ch. 10 Mental Health Assessments It is necessary that any inmate manifesting what appears or is known to be mental illness, undergoing a disciplinary proceeding must receive a mental health assessment to determine if their current mental state is a barrier to the inmate's ____________ of the disciplinary proceedings.

understanding;

pg 50 Ch 10 Medication Officers should be present during medication passes to ensure the inmates are actually taking their medications and not "_____________" them (pretending to swallow the medications but actually hiding them in their mouths to save for later, to trade or to store up medications to overdose).

Cheeking;

pg 50 Ch 10 Medication The authors recommend that every unit in every correctional facility be supplied with _________ __________ _________ ___ ________ or similar guide, or have a direct link to a reliable online source, approved by the jail medical staff, in order to help familiarize officers with the various medications available.

Mosby's Drug Guide for Nurses;

pg 51 Figure 10.1 Why do they stop taking their medication? There are many reasons inmates resist taking their medication, discontinue them, or take them intermittently. Among them are:

-Unwelcome side effects -No effect (or so it seems) -No effect (in truth) -The illness is better than the cure -Mania, the "Up-Side" of Manic-Depression -Intoxicants Preferred to medication -Taking Own Medication is Impossible

pg 51 Figure 10.1 Why do they stop taking their medication? There are many reasons inmates resist taking their medication, discontinue them, or take them intermittently. Among them are:

pg 55 Ch11 In Between: Continuity of care requires restoration of benefits It is imperative that a specific individual within your jail is responsible for helping mentally ill inmates get their benefits ______________ before they leave incarceration. Any lag time in the reception of benefits only leaves the inmate open to __________________ and __________________.

reinstated; victimization and decompensation;

pg 57 Ch 12 The Sequential Model for Jail Diversion Sequential Model - ?

Sequential Model - a call is made to a local community mental health agency and refer him for diversion. If you can secure his compliance, you drop the individual off at an evaluation center, and inform him that if he follows up with the referral he will not be cited and may have an opportunity to get treatment and housing.

pg 57 Ch 12 What does "intercept and treat versus adjudicate and house" mean?

having a warrant and going to jail. A second diversion point can occur at the jail, the jail staff and the court chooses to review his case and refer him for diversion rather than wait for another hearing date.

pg 57 Ch 12 Mentally ill offenders will be incarcerated ___________times longer than the average inmate in jail or prison and at seven times the cost, this is obviously a very expensive "________________."

eight; revolving door;

pg 59 Ch 12 Behavioral health diversion provides :

time-saving to law enforcement; decreases the number of event related injuries; improves access to crisis triage systems;

pg 60 Ch 12.1 Upon release from jail, the state now provides each participant with ____________ days of medication.

fourteen (14);

pg 63 Ch 13 There are multiple opportunities for intervention (sequential intercept) from pre-arrest through post-adjudication (Chapter 12). __________ and ____________ services, then, is one of the filters for developing interventions.

Probation and parole;

pg 63 Ch 13 ____________ and _____________ release planning are imperative for any client a PO believes will naturally fall back into the arrest cycle. Case management planning for these offenders should include ____________ or _____________ meetings with local correctional personnel to ensure there is a continuity of care for at-risk offenders. Client decompensation poses a risk of harm (violence, suicide or medical emergencies) to all parties involved.

Pre-arrest and Post; Bi-weekly or monthly;

pg 65 Ch 14 Mental Health and Psychiatric Services on the Outside Taking the lead however, does not eliminate the need or the participation of the other parts of what would otherwise be treatment team. Services must be " ______________" not one-at-a-time.

wrap-around;

pg 65 Mental Health Services It should be the responsibility of jail social services to:

-Find out what services the agency actually has, and what type of client they are able to offer treatment . - Ensure that the inmate is correctly diagnosed. -Ensure that parole/probation is aware of the inmate's mental health needs, and what barriers to treatment the inmate presented while in custody. -Release should include both trip-wires and sanctions to encourage or even enforce compliance with treatment requirements.

pg 66 Ch 14 Under healthcare reform, hospitals that readmit patients within ______________ days of discharge are to be fined for readmissions. On the positive side, this has created incentives for hospitals and managed care to reduce the over-utilization of hospital stays and to create a system where follow-up, "care management," and treatment coordination is mandated.

thirty (30);

pg 67 Ch 14 The Emergency Room Systems need to change and adapt, hospitals, community mental health, and jail systems need to work together. Doing this shares the costs and creates opportunities for new alliances and funding opportunities. Adopt the following goals in your hospital referrals:

1. Communicate and build a relationship with the treating physicians and medical staff in the local hospitals. 2. Time for a mental health admission to the emergency room should not exceed the time it takes for a standard medical patient to clear, 3. Use of drug screen for a medically stable patient may be unnecessary and delay discharge or referral.

pg 67 Ch 14 The Emergency Room The goals of emergent psychiatric services are ______________ ___________ and __________ ______________ .

rapid stabilization; brief treatment;

pg 71 Ch 15 The development of safety Mindset The development of correctional awareness is based upon the following three fundamentals assumptions:

1. Being proactive 2. consistency and a common understanding in the application of safety procedures and emergency protocols at all levels. 3. safety preparedness and correctional awareness

pg 71 Ch 15 The development of safety Mindset Beyond those systemic issues just mentioned, attendance to a number of factors will definitely make a safer worksite:

1.) Solid boundaries 2.) Adaptability 3.) Presence and Accessibility 4.) Good training and regular price 5.) Integrity

pg 73 Ch 15 AAR AAR's must focus solely on what can be done to ___________ ______ __________ and enhance everyone's safety for future operations.

improve the process;

pg 79 Ch 16 A sense of of spatial awareness, of potential escape routes, likely weapons, and access to help should become a natural part of the correctional officer's personal and professional life. This routine attentiveness is often referred to as "_____________ _____________."

Correctional awareness;

PG 81 Ch 17 Most importantly, the correctional officer should not _______ ____ _______, particularly by losing his or her own temper. Most people can't sustain anger for more than a couple of minutes, so if you can keep your composure, many inmates will come down on their own.

feed the anger;

ch 17 pg 83 ________________is the ability to be consciously aware of what is going on in your interactions with another person.

Mindfulness;

ch 17 pg 83 By taking notes later on your physical reactions, one type of "after action review," you're training yourself to recognize the patterns _____________ that your survival brain notices ________________.

consciously; unconsciously;

ch 17 pg 84 Always pay attention to what your body tells you, the body is linked to structures in the brain that serve to protect us from danger, through ______________ ______________rather than verbal cognition.

pattern recognition ;

Ch 18 pg 87 _____________ can fuel cynicism, or anxiety, as well as eliciting feelings of contempt or hatred toward inmates.

Stress;

pg 91 Ch 19 A __________ _____________ is an extraordinary event that forces a correctional officer to face vulnerability and mortality during the course of their official duties.

critical incident;

pg 92 ch 19 Typically, the __________ _________ ________ ____________ member will contact the affected Officer once a week for at least one month following the incident and remain in contact with them until they are confident that the affected officer's physical and emotional needs have been addressed.

Critical Incident Stress Debriefing;

ch 20 pg 93 It's Not Personal Unless You Make It So Responding to an inmate, perhaps mentally ill, on a personal or emotional level, no matter what the provocation, will cloud an __________ ____________, while distracting him or her from legitimate safety concerns.

officer's judgment;

Ch 20 pg 94 It's Not Personal Unless You Make It So When our buttons are pushed we react as if we are threatened with bodily harm. Anything that pushes our buttons and sets us off balance puts us at risk. A technique call _________ makes it harder, if not impossible for others to even get to our buttons. Bracketing is a technique that entails facing your vulnerabilities head on and making them bulletproof.

bracketing;

ch 21 pg 99 Circular Breathing: Be the Eye in the Center of the Hurricane Chaos doesn't only take over the day; it may also overtake you. However, when you can respond by stepping coolly into the worst of situations, you embody the eye of the hurricane, with all the chaos coalescing and revolving around you. The root of this skill lies in breath control. Using a method called "__________ ___________" you regain control of your physical self. When you control your body you control your life. Then you are in position to take control of the crisis as well as the person causing it.

circular breathing;

Ch 21 pg 102 Circular Breathing: Be the Eye in the Center of the Hurricane PTSD is not defined by how horrible the event sounds in description. It is defined by the victim's response to the event. PTSD is not exactly a problem of memory; it is a problem because the event has not fully become ________, and rather, is still experienced as if it is happening in present time. When an event is fully a memory, it is experienced as something in the past, over and done with.

memory;

ch 24 pg 111 Rigid Personality: Asperger's Syndrome and Other Similar Disorders People with ______________ syndrome are frequently socially withdrawn, often very intelligent outcasts, who may live their lives mostly in an online environment. Such individuals are becoming more involved in computer crimes, particularly hacking.

Asperger's;

ch 24 pg 111 Rigid Personality: Asperger's Syndrome and Other Similar Disorders If you're dealing with an inmate with a rigid personality, stating or reiterating, the rules is the first method of _______________.

intervention;

Ch 25 pg 115 Tell It Is: Communication With Concrete Thinkers. ___________ ___________have a lot of difficulty or even a complete inability to understand, metaphors slang, or imagery. Instead, they take everything you say literally. When communicating with concrete thinkers, correctional officers should use short clear sentences using simple language that is easy to understand. Remember, they only understand what you say, in a very literal manner, complying with the specific, while, not even understanding the general principle. show a minimum of emotion. Don't get irritated when the inmate does not immediately understand you. They respond much more to your tone of voice than to what you say.

Concrete thinkers;

ch 26 pg 117 Information Processing and Retention Consolidating Gains In dealings with the mentally ill, the following points have been proven helpful:

1.) least effective method - the least effective method is to repeat using other words. 2.) Repetition by inmate- have the inmate repeat your instructions. 3.) Open Sentences - a better method is open sentences. 4.) Write Down Important Points

Ch 27 pg 119 Coping With Stubborn Refusals If it is not your approach that is creating the problem, what, if anything, can correctional officers do to elicit compliance, without having resort to the violation process?

1.) Focus on the task 2.) Clarify, the message 3.) Control the interview 4.) Use a strong and calm voice 5.) De-personalize your role 6.) state the consequence 7.) Play the power in the inmate's hands

Ch 30 pg 125 Dealing With Mood Swings They can be verbally abusive, provocative, complaining, passive-aggressive, blaming, apologetic, ingratiating, and friendly all in the space of an hour or less. They often try to get control of others even when they have no control over themselves. Remain balanced and emotionally non-reactive. A correctional officer can influence them by being exactly what they are not.

Inmates with Mood Swings

Ch 31 pg 128 They aren't moving what to do? Don't do for them what they can do for themselves. Don't require them to do things that they are in capable of doing. If they are truly noncompliance, use the ____________ _____________for motivation (or sanction if they continue to refuse. Act with dignity don't try to "cheerlead" them into compliance berate them, complain or anyone of a number of actions to compromise your integrity in the interest of getting them moving.

violation process;

Ch 32 pg 129 Should a correctional officer ever apologize? if you have wronged the inmate, if it does not put you in danger and if it, thereby, enhances your authority, then you should apologize. If an inmate is using the grievance or complaint to get control of the exchange, distract you, or simply complain for the sake of complaining, shut it down. Call them on their game and don't allow it to continue.

1.) Acknowledge their concerns - recognize their complaints and then move forward, do not, however, allow the inmate to revisit the issue at every encounter. 2.) Apologize- if you were wrong apologize. be wary of apologizing, an apology may lead the inmate to believe they are now in control and the CO will act cautiously so as not to upset them in the future. 3.) In an apology is not enough - example "You are still upset about this. you want to talk about it again, don't you? " Notice that you don't ask the inmate; you merely state your understanding. This gives them the opportunity to correct or adjust your understanding so that if their complaint is legitimate, you are able to effectively put it to rest. 4.) Complaints as their own reward

Ch 33 pg 131 Useful Tactics for Dealing With Symptoms of Paranoia and Persecution The paranoid inmate has a motto of life: "if there is a problem here, that would be your fault." The paranoid world is one of dominance and submission: they try to dominate the people in their life, and are terrified or enraged at being forced to submit. Character traits and behavior patterns of paranoid inmates include:

- Paranoid Inmates Interpret Relaxation as Vulnerability - being Mistaken or Wrong is another Form of Vulnerability - Paranoid inmates live like detectives - they have ideas of reference- in which they believe that other conversations, glances, or actions are directed at them. - Paranoid Inmates Make others Uncomfortable Or Afraid.

Ch 33 pg 131 Useful Tactics for Dealing With Symptoms of Paranoia and Persecution Paranoia is an "__________" that drives rage in all its various forms. De-escalate the inmate using tactics specific to the mode of rage they are exhibiting rather than de-escalating paranoia itself. Paranoid inmates can exhibit traits of fear, frustration, intimidation and manipulation.

engine;

Ch 34 pg 137 Divide and Confuse: Borderline Personality Disorder and Splitting An inmate with borderline traits believes that whatever feeling they are having right now is their only __________ __________. When the team associated with a borderline inmate get tangled up in intense disputes about what is best for them, this type of conflict is called _____________.

possible reality; splitting;

Ch 35 pg 141 Bad intentions: Recognizing the Strategies of Opportunistic and Manipulative Inmates _____________ _____________ can result from a variety of emotions and intentions, such as those born of revenge, malice, desperation, laziness, guilt, or as the result of drug and alcohol use. This seemingly compliant behavior may in fact be nothing more than an attempt to manipulate and control your behavior. Require _________ ____________ of any information given by the inmate. What the compliant inmate is likely to accomplish is to manipulate you so that you do not see what they are up to. Manipulative inmates ask correctional officers for personal information, such as marital status, children, in which part of town the CO resides, and so forth. They are quite adept at reading body language. They are likely to blame others for their failures and their behaviors. They can be manipulative when they are being flirtatious and sexual.

Manipulative strategies; Proper verification;

Ch 36 pg 145 Tactical and Safety Considerations Related to the Supervision of the Psychopathic Inmate Although ___________ inmates can be charming and ingratiating, they can also be violent, provocative, dishonest, arrogant, and quite willing to break any rule. They feed off vulnerability just like a ______ or a _______; They view themselves as utterly unique and special (grandiose narcissism) and therefore they do not view themselves as being incarcerated for the purpose of rehabilitation. They are good at reading other people;

Psychopathic; leopard, cougar;

Ch 36 pg 145 Tactical and Safety Considerations Related to the Supervision of the Psychopathic Inmate What are the Tactical and Safety Consideration when Dealing with a Psychopathic Inmate?

1.) You will be attacked through your "best" and your "worst" points. 2.) Notice when others start making excuses for the inmates. 3.) Track any manipulative strategies, document well, and alert all other members of your team to the tactics an inmate is using. 4.) You may be intimidated. The most obvious manifestation of intimidation is fear. There is always a reason for fear. 5.) Be aware of grooming behaviors. - making you feel a little off balance, making you anxious, scared or flattered. Then they lessen the pressure while making a request that the correctional officer would have granted anyway. 6.) Guard all personal information. 7.) Don't get beyond the horizon line- Don't meet psychopaths alone! 8.) Detected calculated splitting - inmate uses gossip, rumors, misdirection, and blatant lying to set all stakeholders involved in their supervision and treatment agains each other. Communicate with members of the treatment team to detect and confront splitting.

Ch 37 pg 152 We can choose to speak to the illness, or speak to the ___________ who is ill. For both humane and tactical reasons, it is that _______ part of his or her psyche that we are trying to reach.

person; core;

Ch 38. pg 153 Struggling in a Fog: Dealing With Symptoms of Disorganization ______________ is a general term used to describe what is like when inmates can't adequately organize their thinking, perceptions, behaviors and/or emotions so that they can function well in the real world. Due to their cognitive limitations, Developmentally disabled inmates are not skilled at problem solving. Psychotic inmates also become disorganized when they deteriorate.

Ch 39 pg 157 Latency: Dropping Stones Down a Well __________ is a behavior in which inmates respond in a much-delayed manner. It is often a manifestation of disorganization.

Latency;

Ch 40 pg 160 Withdrawal Inmates Use whatever tactic necessary to de-escalate and control them, based on their behavior, as described in the latter sections of this book. The signs of withdrawal can include:

Unstable Coordination Restlessness and Agitation Unpredictable and Sudden Actions Slurred or Incoherent Speech Abnormally Rigid Muscles Being Argumentative and Demanding

Ch 41 pg 161 Psychosis: Delusions and Hallucinations A __________ is first and foremost a belief that does not fit reality; it is fixed belief that is not reality based. A _________ is an unreal perception through any of the senses.

Delusion; Hallucination;

Ch 41 pg 161 Psychosis: Delusions and Hallucinations What are the types of delusions?

Grandiose- a belief that they have been appointed to a special mission, that they have extraordinary or unusual powers, or are special, remarkable beings. Religious - Often linked with grandiose delusions. Jealous- a belief that their partner is unfaithful to them. Delusional Stalking (Erotomania) - A belief that another person is in love with them. Persecutory (Paranoia) - A fixed belief that people, institutions or other powers have hostile intentions toward them or have committed evil actions against them.

Ch 41 pg 162 Psychosis: Delusions and Hallucinations What are the types of hallucinations?

1.) Auditory - (Two levels) auditory distortion - one mishears what it is said. Auditory Hallucination the voices are real to them as the voice of your co-worker or spouse is to you. The psychotic inmate actually hears the voices. Paranoid inmates in particular often display a "listening attitude" 2.) Visual - Visual distortions - images move, melt, emerged toward them or even speak. Visual hallucinations- objects or beings appear that no one else can see. 3.) Olfactory - If a previously non-psychotic inmate complains of hallucinatory smells, get them immediately checked medically. 4.) Tactile - sensations felt within the body. Formication, the sensation of bugs crawling under the skin.

Ch 42 pg 169 Communication With Inmates Experiencing Delusions/ Hallucinations Differentiation: Distinguish Between Your World and Theirs If you should neither agree nor disagree with their delusions, how can you respond in an effective way to the inmate's delusional thinking, while also trying to get them to recognize the distinction between your world and theirs?

Differentiate yourself from them. To differentiate is to perceive or express difference. Differentiation simply helps you keep the lines of communication open. example: Sal, I only hear two voices in this room, yours and mine. I don't hear a woman's voice at all. What do you hear they say?

Ch 43 pg 175 Welcome to the Rollercoaster: Tactics for Dealing With Symptoms of Mania Mania is a state of ______ _________. Manic inmates need little sleep, and can be excited, grandiose, agitated, or irritable. The manic state is associated with bipolar disorder (1/2 manic-1/2 depression) The manic person feels way better when they don't take their medication.

high energy;

Ch 45 pg 186 What are warning signs of suicidal inmates?

1.) Inmates booked and are under the influence have a higher risk as they don't have the clarity of thought needed to reason themselves out of it. 2.) negative changes in life : divorce, break up, death of a loved one, pressure form gang, sexual assault, 3.) radical changes in appearance, weight loss, loss of appetite, removing themselves from a work detail. 4.) the Officers intuitive sense.

Ch 45 pg 186 What are warning signs of suicidal inmates?

Ch 47 Essential Questions pg 193 What are the four essentials questions for assessing suicide risk?

1.) Are you planning to kill yourself? 2.) how would you do it? 3.) Follow up questions like Do you have any pills, what kind, where are they, Do you know what would happen if you took them all? 4.) When will you do it? Do not ask this questions as a mere checklist!!!

Ch 48 pg 199 Self-Mutilation When it is potentially life threatening, but somehow has survival "built-in" it is referred to as "_________-_________ _________." This primarily includes cutting ones wrists or other actions that could, taken to an extreme, have resulted in death. Other actions are not life threatening, and are referred to as "self-injurious behavior" or "self-mutilation".

Para-suicidal behavior;

Ch 48 pg 199 Self-Mutilation What are some of the reasons why an inmate would commit self-mutilation?

1.) Self- hatred 2.) Attention Seeking 3.) A struggle to feel something 4.) Stress reduction 5.) Primitive Medicine 6.) Rehearsal 7.) Psychosis

Ch 49 pg 206 The Cycle of Aggression When we are calm we are at baseline, which is represented "________" at baseline we used the parts of the brain most responsible for our better human characteristics: thinking, creativity, and forming social relationships. Anger represents the numbers _______________. To de-escalate and control an angry inmate, the correctional officer should attempt to "line-up" with them. Rage is represented as ________. when someone is angry they may be concerned, upset, hurt, confused and/or frustrated. When someone is enraged they are in effect trying to switch themselves on to becoming violent.

0-20; 20 through 95; 95-99;

Ch 49 pg 206 The Cycle of Aggression What are some of the prime inhibitors an inmate is trying to overcome when enraged?

Fear of Consequences Morality Self-Image The Relationship Learned Helplessness

Ch 49 pg 206 The Cycle of Aggression _____________ is a set of behaviors, including both physical actions and verbalizations that serve to do away with one's self-inhibitors, so that nothing holds them back from violence. Inmates in a rage state they are no longer trying to communicate they are working themselves up to an attack. Fear is just a wake up call; remember a sense of powerlessness is not fear. It is a conclusion that some people reach when they are afraid, limiting their ability to control the situation or to defend themselves with the end range inmate do my sis tablets control.

Rage

Ch 50 pg 211 Why would an inmate become aggressive? What are some of the factors that can drive an inmate to become aggressive?

-Feels confused or disorganize, -Feels enclosed trapped in or visit with problems. -Has a fear of an attack -Feels wrong, or feels a loss of power -Is hallucinating or having delusions, -Drugs, alcohol and other organic stressors, -Feels shame, or humiliated, -Is acting out of protective aggression -Act out of a sense of entitlement, or they simply enjoy it -Anything that elicits Profound emotion can cause an inmate to become volatile or aggressive, -Prison gang subculture.

Ch 56 pg 244 Guidelines for limit setting As soon as you draw a line, it will become the main focus of your interchange don't ever set a limit that you can not enforce or one that is not reasonable and simple to understand. When dealing with a profoundly anxious inmate limit setting is a _____________ rather than oppression

kindness

Ch 56 pg 244 The following will help in setting a full stop limit:

-Your tone of voice should be matter-of-fact -Give clear directives with no wiggle room -Give praise if he complies -If he does not comply with the directive depersonalize the reiteration -Don't get them caught up in manipulative word games

Ch 56 pg 245 After interrupting the inmate, the first thing you should do is to _____ ____ your understanding of what he or she just said this proves that you were indeed listening to them and are interested in solving the problem. Once you have summed up, you can either go in to problem-solving mode, or if they are still heated shift into tactical paraphrasing.

sum up

ch 57 pg247 What is paraphrasing?

Paraphrasing is perhaps the most important technique for calming angry inmates. You sum up in a phrase or sentence what the angry inmate has just said in a paragraph. If you paraphrase accurately, you have establish that you have gotten it that far so they don't have to repeat it, or try to say it in other word the best thing about Parra pricing is that you don't have to be smart and interpret anything you simply had to listen carefully.

ch 57 pg 247 We select what we will sum up from the complex, sometimes almost incoherent, communication that the inmate has just given us shows in the most rational aspect of what they have just said this matter is ___________ ___________ whereas passive summation call mirroring can make things worse . If you sum up an aspect of what they have said, that is in direction of conflict resolution, you will draw out of them that which does wish to resolve the conflict

self-correcting

ch 57 pg 252 We know we have reached the core level when there is no more progress. the inmate _________ _____ _________ they may use different words, but they say essentially the same thing over and over again

spins his wheels

Chapter 59, page 261 working with incarcerated youth When one's parents use drugs and alcohol, their attentiveness and caring towards their children, is lessened in the best of such circumstances abuse of all kind increases _________________ in drug or alcohol abusing homes.

exponentially.

Chapter 60 page 263 no brake pads, a consideration of the impulsive youth Per Orthodox theory, attention disorders come in two major forms. in the first type the main manifestation is a short attention span attention deficit disorder ADD. in the second type hyperactivity is also present attention deficit hyperactivity disorder. _________________ can be particularly valuable with these kids, because you demonstrate that you get their desire and frustration rather than argue with them

Paraphrasing;

Chapter 61. Conduct disorder, fierce youth. The majority of the children who fully merit the diagnosis of conduct disorder don't grow up to be psychopaths. The fierce youth typically displays rages in three major categories, fury, manipulation and ________________.

predatory behavior

Chapter 63 opposition defiant kids "even if you make me I'll still make you miserable" If you're losing your temper, they are winning, and they hold you in contempt for it. The watch word in dealing with these kids is to pick your battles. Don't waste energy arguing about anything that isn't important when it is important become _______________.

implacable

Chapter 67 page 281 _______ __________ is typified by profound disorganization of cognitive and perceptual processes, and can be engendered by severe psychosis that has crossed over into a delirium state wether engender from Mania, intoxication, drug withdrawal, severe intellectual, developmental, disabilities, snail, dementia, overwhelming emotions, or as a result of rain, injury, or trauma

chaotic rage;

Chapter 67 page 281 ____________ ___________ inmates are often very impulsive and unpredictable and striking out in all directions. our symbol for this state is TAZ, the fanged whirling tornado of arms and legs in the Warner Bros. cartoons

enraged disorganized

Chapter 67 page 283 ____________ is a very rare very bizarre condition in which an inmate stays in a fixed posture, not congruent with injury or seizure. It is cause either by mental illness schizophrenia, or an organic condition for example, drug use. The intimate posture may be quite awkward or twisted, seeming to require great flexibility a classic symptoms of true catatonia is waxy inmobility.

catatonia

Chapter 67 page 284 when dealing with a ____________ inmate, as you move them, treat them like a bomb about to go off firm hands, lots of them in one person talking. Stay smooth in control and powerful do not grab at their limbs, digging your fingers into the flesh.

catatonic

Chapter 67 page 284 _____________ ________ is a rare condition at the extreme end of the hyper aroused wing of the delirium spectrum. etiology can be varied, but it is most commonly associated with long-term use of stimulants, particularly cocaine and methamphetamine. This people die this is a medical emergency, manifesting a physical danger. The longer the struggle in the more intense the exertion the more likely the person will die.

excited delirium;

______________ inmates believe that they will be violated or abuse they appear apprehensive and furtive looking halfway ready to run halfway ready to strike. Terrified rage can be like a the wolf.

Terrified

Chapter 69 page 293 The primary method of de-escalation for hot rage is called _____ __________ the technique itself is simple identify the most dangerous behavior and repeatedly demand that it cease. Use short sentences and easily understood commands. Once they stop that particular dangerous behavior, identify the next problematic behavior and use the same technique, continuing until the inmate is under control. This technique is only effective right before during, and after the peak of the crisis because it is a control tactic, rather than the lining up de-escalation tactic used for anger. As described earlier facing an enraged inmate causes us to experience fear in a way that anger does not.

the ladder; example: step back step back Jamison will talk about it. When you step back Jamison step back step back Jamison. We will talk about it when you step back.

Chapter 69 page 296 Hot Rage Subtype #1: Fury What does fury look like?

Furious inmates are very tense, looking as if they are about to explode for a mental image If they are of a big stature, think of a grizzly bear they are smaller think of a wolverine.

Chapter 69 page 297 hot rage subtype #2 In keeping with the animal analogy, when describing the furious inmate, the aggressively bluffing inmate is like a ___________ beating his chest a display of aggression designed to keep you at a distance.

gorilla;

Chapter 69 page 300 heart rage subtype #3 aggressive manipulative inmates the symbolic image for this inmates is a __________ ____ not because it is meant to be demeaning but because rats are survivors, they are all about winning not honor, not image winning by whatever means they can dealing with the aggressive manipulator is like being placed in a maze your test is to walk right through the wall

large rat.

Chapter 70 predatory or cool rage Inmates with this type of rage are intimidators, who threaten with either vague innuendos or explicit threats. Their aggressive behavior is calculated, but unlike the manipulator violence is often the first choice rather than one of many options. The predatory inmate deliver threats in cool danger tones often after a clear and strongly stated demand. Our symbol for them is either a _____________ or ___________, depending on if they present as warm blooded or stone cold

leopard or shark

Chapter 74 page 314 the aftermath If the mentally ill inmate is really frightened or devastated by what happen, the first priority is _______________ and ____________. If the inmate has the cognitive ability to understand, then an educated follow up is necessary.

Reassurance and orientation