Image Descriptions
Image description for Figure 5.15
This image demonstrates the role of Assertive Community Treatment (ACT) services as part of a bigger picture of care options, serving as a bridge or conduit between longer-term more restrictive and shorter-term or less restrictive settings.
A large circle on the left represents ACT services. Arrows in and out of ACT services go to a box on the right, representing more restrictive settings: long-term inpatient hospitals, incarceration, and supervised residential settings. The arrows show that people may go from these long-term restrictive settings into ACT, or people may go from ACT into these long-term restrictive settings.
Two other boxes to the right of the ACT circle represent other settings that relate to the ACT service population: lower-intensity community based services (care management, outpatient therapy, medication management, psycho-social rehabilitation services, and peer support) and more intensive acute settings (emergency department, crisis services, and short-term inpatient hospital). An arrow from the ACT circle to the lower-intensity box shows that people from the ACT population may leave ACT for the lower-intensity community services. An arrow from the lower-intensity box to the acute box shows that people in lower-intensity may need to step up to acute settings. An arrow from the acute settings box to the ACT circle shows that people who have been stepped up to acute care may need to return to the intensive community option that is represented by the ACT circle.
Image description for Figure 6.5
The flowchart for Competence to Stand Trial (CST) involves five stakeholders with interests in the competence process. These are hospital, jail, community, support and court, and they are represented by icons showing when each plays a role in the process.
The flowchart shows four stages in the competence process. The first is when competence is raised, which involves only the court. The second stage is the competence evaluation, involving all stakeholders except the court. The third stage has two options: if the person evaluated is not competent, they go to restoration, and if they are competent, they resume the criminal process. Each of these options at all three stages has arrows back to the left of the flowchart where the word diversion indicates that a person at any point can be diverted out of the criminal process. The first two stages are at Intercept two of the SIM. The second two stages are at Intercept three of the SIM.
The final stage of the flowchart has four options: disposition; not restorable; further restoration, or restored. These options indicate how the case will look after restoration in the third stage. If the person is not restorable, that may result in disposition by alternative means. If the person can be restored, further attempts are made. If the person is restored, the arrow takes them back to stage three, to resume the criminal process. In this final stage, only the further restoration option has an arrow back to the diversion box at the far left of the chart, indicating that diversion would not be available to a person who was unrestorable or who had resolved the case otherwise.
Throughout, the stakeholder icons show that the court is involved in the criminal processes, where the hospital, jail, community and other support may be involved in restoration efforts, indicating back and forth hand-off of the defendant as the process moves through each stage.
Image description for Figure 6.9
A flow chart outlines the four versions of the insanity defense.
The Model Penal Code Rule
The Model Penal Code Rule would apply in either of these two situations:
- Because of mental disorder, defendant lacks substantial capacity to appreciate criminality of conduct.
- Because of mental disorder, defendant lacks substantial capacity to conform conduct to the law.
Irresistible Impulse Test
The Irresistible Impulse Test would apply when, because of mental disorder, defendant cannot control conduct.
Durham Rule
The Durham Rule would apply when defendant conduct is the product of mental disorder.
The M’Naghten Rule
The M’Naghten Rule would apply in either of these two situations:
- Because of mental disorder, defendant does not know the nature or quality of conduct.
- Because of mental disorder, defendant does not know conduct was wrong.
Image description for Figure 7.2
Three steps in the incarceration process
The first step is being accused. A person is accused of a crime by county, state, or local law enforcement. A SWAT team in helmets and bulletproof vests is pictured. A person can also be accused by a federal agency, including the Bureau of Alcohol, Firearms, Tobacco and Explosives; the Drug Enforcement Administration; the U.S. Marshals Service; Homeland Security; the Secret Service; the Bureau of Indian Affairs; the Inspector General’s Office; the Fish and Wildlife Service; or the Internal Revenue Service. Federal agents with guns and walkie talkies are pictured.
The second step is going to jail. Jails house people not convicted of a crime, awaiting sentencing, or serving shorter sentences (less than one year). Persons pending charges are incarcerated, meaning they don’t have access to the community. Convicted people with longer terms are sent to prison after sentencing. A sparse jail cell is pictured with a bunk bed, chair, and locker.
The third step is imprisonment. People may be imprisoned in either a federal prison run by the Bureau of Prison, which houses people convicted of a crime by the U.S. Attorney’s Office. They may also be housed in a state prison, where people convicted of a crime at the state level by a District Attorney’s Office go. There is a picture of a federal prison with guard towers and a state prison, which is a collection of nondescript cement buildings.
Richard J. Donovan Correctional Facility by Don Ramey Logan is CC BY 4.0. Public domain photos by ATF.gov, Spc. Tanya Van Buskirk for the US Army, and BOP.gov. This infographic is designed by Kendra Harding and Michaela Willi Hooper, Open Oregon Educational Resources is CC BY 4.0.
Image description for Figure 8.7
The infographic begins with three definitions.
- Criminogenic factors: Risks and needs that increase an individual’s likelihood of re-offense.
- Criminogenic risk: The likelihood that an individual will engage in future illegal behavior in the form of new crime or failure to comply with probation/parole conditions.
- Criminogenic needs: Dynamic or changeable factors that increase an individual’s likelihood of re-offense but can be remedied or lessened through appropriate interventions or services.
The infographic contains 8 small diamonds with the eight Criminogenic risk factors. These are:
- History of antisocial behavior,
- Antisocial personality pattern
- Antisocial cognition
- Antisocial associates
- Family or marital problems
- Work or school problems
- Lack of healthy leisure or recreational pursuits
- Substance use
The 8 diamonds encircle a larger diamond with the text, Criminogenic Risk and Need Factors. Each factor is associated with a static risk and changeable need that should be assessed and addressed through treatment and services. The large diamond has a dotted line around it with dotted lines connecting to the small risk factor diamonds. This illustrates that multiple risk factors can be addressed individually, but they interact and combine to represent an individual’s assessed criminogenic risk, which informs treatment levels.
The bottom of the infographic contains a description of the Risk-Need- Responsivity (RNR) model. The Risk-Need- Responsivity (RNR) model is used to help identify the appropriate treatment for individuals to reduce the risk of re-offending.
- Risk principle – match the level of service to the individual’s risk to re-offend.
- Need principle – assess each individual for known criminogenic needs and target treatment to the most salient needs.
- Responsivity principle – maximize the potential success of the intervention by providing cognitive behavioral treatment and tailoring the intervention to the learning style, motivation, and strengths of the individual.
Image description for Figure 9.1
This flowchart demonstrates the progression of the civil commitment process based roughly on the process in Multnomah County, Oregon.
The image begins with a white circle in the upper left corner where the civil commitment process is triggered by “a concern about safety of a person with a mental disorder.” From there, arrows point right, the option of an emergency hold or a notice of mental illness, or down, to a box labeled voluntary treatment. Arrows back to the voluntary treatment box from other steps in the process show that a decision to engage in voluntary treatment can stop the commitment process.
From the emergency hold box, an arrow goes to a box stating that the person can be held for up to five days, and a decision about whether to have a hearing is to be made in three days. From the five day box, an arrow points to a box labeled “investigation:is the person unsafe due to a mental disorder?”
If the answer to that question is YES, the arrow points to a box labeled: “hearing: is the person imminently unsafe due to a mental disorder?”
If the answer to that question is YES, the arrow points to a box labeled “Involuntary commitment: up to 180 days.”
If the answer to the investigation or hearing boxes are NO, the arrows point to a label that the “person is released,” with further arrows pointing to the option of voluntary treatment that is still available.
The box labeled “Involuntary commitment: up to 180 days” has arrows pointing downward through three stages: treatment options (hospital and/or community), stabilization, and legal discharge, signifying the end of the commitment process.
Image description for Figure 9.2
This is an image of a form that would be used in the State of Oregon as one way to initiate a civil commitment. The form has a number of blanks that have been filled in with example names and information. This blank form was created in December, 2018.
The form is titled Community Mental Health Director’s Written Report Regarding Peace Officer Custody of an Allegedly Mentally Ill Person.
The form is directed to a treating physician of a designated person alleged to be mentally ill.
The form contains the name of the Community Mental Health Program Director, the County, the relevant law (ORS 426.233(1)(a)), the Peace Officer who will take the person into custody, including the officer’s agency and badge number.
The form identifies the person to be taken into custody by name (example John Doe), date of birth, and address, and identifies the place and time of custody. It specifies the reasons the person is to be taken into custody. As an example, the form is completed with the following information: Mr. Doe attended his individual therapy session and appeared tearful with pressured speech. He reported suicidal ideation with a plan to end his life, specifically with a firearm, which he has access to in his home. Thought of suicide began earlier in the week at a recent court hearing where he was sentenced to a term of imprisonment. He reported a plan to end his life later this evening with a firearm. Doe has a history of hospitalizations for attempted suicide within the past year.
The form cites the law allowing the person named to be taken into custody: pursuant to ORS 426.233(1)(b) because the above factors establish probable cause to believe the above-named person is a mentally ill person who is dangerous to self or others and in need of immediate care, custody or treatment for mental illness; or the person is on conditional release, outpatient commitment or trial visit, and is dangerous to self or others, or is unable to provide for self.
The form has a signature line and contact phone number for the Community Mental Health Program Director or Designee.
The form specifies that If more than one hour is required to transport the person to an approved hospital, a physician must complete an additional certification prior to transport pursuant to ORS 426.228(3). The certification states: I certify that I have personally examined the above-named person and believe the person is dangerous to self or others and in need of immediate care, custody or treatment for mental illness and that travel to [blank for location], a
hospital or other approved non-hospital facility will not be detrimental to the person’s physical health. The certification has a blank for date, time, and physician signature. These are not completed on the example form.
The form specifies at the bottom that it is to be delivered to the treating physician at the receiving facility, not filed with the court.
Image description for Figure 10.27
The Trauma Stewardship Institute’s Tiny Survival Guide Image Description
- Protect your mornings (or whenever you go outside). Less cortisol, more intentionality.
- Go outside (or look outside). Perspective, context, and something larger than this.
- Be active (avoid stagnation) in mind, body, and spirit.
- Cultivate relationships. Those that are edifying and healthy.
- Nurture gratitude. What is one thing, right now, that is going well?
- Detox. If navigating addictions, be wise and safe. Limit news and social media.
- Spend time with animals to lower stress hormones and increase comfort.
- Metabolize all you are experiencing. Re-regulate your nervous system.
- Simplify (less is more). Be aware of decision fatigue and cognitive overload.
- Admire art. The gift of feeling transported.
- Laugh. Pure humor = a sustaining force.
- Foster humility and extend grace. Self-righteousness + hubris = unhelpful
- Sleep. To cleanse and repair the body.
- Clarify intentions. How can I refrain from causing harm? How can I contribute meaningfully?
- Be realistic and compassionate (with yourself). Be mindful of the quality of your presence. It means so much to others.
