Transcript for Figure 1.9, Eugenics: In the Shadow of Fairview

[Music.]

[John Kitzhaber, Oregon Governor]: Today, I am here to acknowledge a great wrong that was done to more than 2,600 Oregonians over a period of approximately 60 years: forced sterilization in accordance with a policy known as eugenics.

Between 1900 and 1925, Oregon was one of 33 states that enacted to provide forced sterilization. The Oregon law established a state board of eugenics. The board’s job was to decide which people should undergo involuntary sterilization in the interest of promoting a higher quality of human beings in succeeding generations. That is a part of Oregon’s history.

[Narrator] In 1923, Oregon enacted a eugenics law for the compulsory sterilization or even castration of people deemed feeble-minded, insane, epileptic, habitual criminals, moral degenerates, and sexual perverts.

[Philip Ferguson, Professor Emeritus at Chapman University]: Positive eugenics was the notion of having the best examples of humanity match up and to have children that carried on those paragons of virtue. And then the negative eugenics was keeping the misfits and the threats to social order, keeping them from reproducing.

[Kimberly Jensen, Professor of History and Gender Studies at Western Oregon University]: The eugenics law eventually included terms like antisocial behavior or sexual deviancy, so this was a very wide net. The use of eugenics as a so-called therapeutic tool really meant that there were some very horrible things that happened.

[Narrator]: Fairview Training Center was the state’s institution for those with developmental and intellectual disabilities. For decades, residents were required to be sterilized before they could be released.

[Ruth Morris, Former Fairview Resident]: I lived in Fairview from ’65 to ’72. I was one of these people who got sterilized. My dad and I had to sign a paper that I did not understand until afterwards. I did not have a choice. Before people got to go out in the community from Fairview, they would have to have a sterilization, every one of us.

[Narrator]: At least 2,500 Oregonians were sterilized under the law. The legislature finally revoked it in 1983.

[Kitzhaber]: The time has come to apologize for public policies that labeled people as defective. To those who suffered, I say the people of Oregon are sorry.

[Morris]: I felt good that he apologized.

[Applause.]

[Music.]

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Transcript for Figure 1.15, Dignity Of Risk

[Max Barrows, Outreach Director of Green Mountain Self-Advocates]: One thing that is really big in self-advocacy and the work that I do and we discuss it a lot is the dignity of risk. The dignity of risk is the opportunity and the right to make mistakes. It’s one thing to be told things through lecture but how else can you learn if you don’t make mistakes. Life is about learning from the mistakes you make.

I appreciate and we appreciate protection from people but please don’t protect us too much or at all from living our lives. We are going to have to encounter failures through decisions that we make. But the way to conquer that is to get up on your feet, brush yourself off, and learn from that because people grow by encountering failures and making mistakes in their life. It’s really the number one way of learning of where lines are drawn and also it helps with learning about yourself.

The dignity of risk is one of many opportunities that people with disabilities deserve to have. It’s one thing just to give them like only a select few but clearly, even saying in the Americans with Disabilities Act, people with disabilities deserve to live their lives with no limits of opportunity. It really opens the doors for people with disabilities to really discover what is out there and to take advantage of what is out there and not be limited to only certain things due to the overprotection that people with disabilities unfortunately have to live with.

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Transcript for Figure 2.6, What is PTSD?

[Narrator]: Most people go through some type of traumatic event in their lifetime. In some cases, the effects are short-term, but for many people, those experiences persist for years, causing Post-Traumatic Stress Disorder, also known as PTSD. Events such as a natural disaster, physical or sexual assault, a serious accident, a terrorist attack, war or combat, or the death of a loved one may be the source of developing PTSD.

PTSD symptoms often fall into four categories: intrusive thoughts or images related to the traumatic experience such as nightmares and vivid flashbacks; avoiding reminders of the trauma; negative thoughts and feelings like fear or anger; and reactive symptoms like irritability, and sleep difficulty.

However, not everyone has these symptoms to the same extent or intensity. Each person’s experience of PTSD is unique to them. Fortunately, there are recovery options.

If you think that you or a loved one is experiencing PTSD, social support, empathy, and acceptance are key steps towards recovery. If they are open to it, encourage them to contact a mental health professional who will introduce them to treatment options after conducting an evaluation. The primary treatment may involve psychotherapy and/or medication.

Adequately and appropriately treating PTSD can help them regain a sense of control over their life. Even though PTSD is an intense disorder, it doesn’t have to last forever. For more information about diagnosis and recovery, please visit www.psychiatry.org.

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Transcript for Figure 2.7, What is trauma? The author of “The Body Keeps the Score” explains | Bessel van der Kolk | Big Think

[Bessel van der Kolk]: The most important thing to know is that there’s a difference between trauma and stress. As I like to say to people, life sucks a good amount of the time. We all have jobs and situations that are really unpleasant. But the moment that a situation is over, it’s over.

The problem with trauma is that when it’s over, your body continues to relive it.

My name is Bessel van der Kolk. I’m a psychiatrist, neuroscientist, and author of the book, “The Body Keeps the Score.”

I got interested in trauma on my first day working at the Veterans Administration. 1978 was the year, and the Vietnam war was over by about six or seven years. The very first day that I met Vietnam veterans, I was just blown away. These were guys who were my age, who were clearly smart and competent and athletic. And they clearly were just a shadow of their former self. But their bodies were clearly affected by trauma and they had a very hard time connecting with new people after the war.

Around that time, a group of us started to define what trauma is. And in the definition of PTSD, we write, these people have been exposed to extraordinary events that’s outside of normal human experience. Now, in retrospect, that shows us how ignorant and narrow-minded we were, because it turned out that this is not our usual experience at all.

People usually think about the military when they talk about trauma. But at least one out of eight kids in America witness physical violence within their parents. A larger number of kids get beaten very hard by their own caregivers. A very large number of people in general, but women in particular, have sexual experiences that were clearly unwanted and that left them confused and enraged.

So, unlike what we first thought, trauma is actually extremely common. There’s a lot of debates of what the trauma is to this day. But basically, trauma is something that happens to you that makes you so upset that it overwhelms you. And there is nothing you can do to stave off the inevitable. You basically collapse in a state of confusion, maybe rage, because you are unable to function in the face of this particular threat. But the trauma is not the event that happens, the trauma is how you respond to it.

One of the largest mitigating factors against getting traumatized is who is there for you at that particular time. When, as a kid, you get bitten by a dog, it’s really very scary and very nasty. But if your parents pick you up and say, oh, I see that you’re really in bad shape, let me help you. The dog bite doesn’t become a big issue because the foundation of your safety has not been destroyed. We are profoundly interdependent people, as long as our relationships are intact, by and large, we’re pretty good with trauma. It’s a subjective experience and what may be traumatic for you may not be traumatic for me, depending on our personality and our prior experiences.

The problem with trauma is that it starts off with something that happens to us, but that’s not where it stops, because it changes your brain. Much of the imprint of trauma is the very primitive survival part of your brain that I like to call the cockroach brain. As a part of you that just picks up what’s dangerous and what’s safe. And when you’re traumatized, that little part of your brain, which is usually very quiet, continues to just send messages. I’m in danger. I’m not safe. That event itself is over, but you continue to react to things as if you’re in danger. We are talking about survival. We are talking about staying alive. I say, some people go into fight-flight. Or on a more primitive level, people’s brains shut down and they collapse. Yet, these automatic responses, they are not a product of your cognitive assessments, they’re products of your animal brain trying to stay alive in the face of something that that part of your brain interprets as a life threat. And the problem then becomes that you are not able to engage, or to learn, or to see other people’s point of view, or to coordinate your feelings with your thinking.

Traumatized people have a tremendous problem experiencing pleasure and joy. But the core issue is our hormones and our physiological impulses that have to do with survival. Your body keeps mobilizing itself to fight. You have all kinds of immunological abnormalities. Endocrine abnormalities. And that really devastates your physical health also.

Oftentimes, the physical problems are longer lasting than the mental problems. And the other thing that is terribly important is the impact of poverty, or the impact of racism, or the impact of unemployment. There are other societies that are much more trauma savvy than we are. Where there is not an enormous amount of income inequality, healthcare is universal, childcare is universal. A culture like that really looks at what are the antecedents for certain forms of pathology. So, the big issue is a political issue.

How do we rearrange our society to really know about trauma so that people who grow up under extreme adverse conditions can become full-fledged members of society? The sense of community and people being there for each other is a critical part of surviving and thriving.

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Transcript for Figure 2.9, What is Schizophrenia

[Matthew Diep, NAMI Mental Health Advocate]: Being able to talk openly about our mental health journeys feels like the biggest breath you ever took and that exhale that comes with that.

So what is schizophrenia? Schizophrenia is a serious mental illness that can interfere with the person’s ability to think clearly, relate to others, manage their emotions, and make decisions. It is a complex, long term medical condition. Although schizophrenia can occur at any age the typical age of onset tends to occur from the late teens to the early twenties for those assigned male at birth and the late twenties to the early thirties for those assigned female at birth.

Here are some of the key signs.

• Hallucinations. Hearing voices or seeing or smelling things that others cannot. These are very real to the person experiencing the hallucinations and they can be very threatening or scary for them.
• Delusions. False beliefs or ideas that don’t change even when the person is presented with new ideas or facts that contradict those beliefs.
• Negative Symptoms. So these are things that may diminish a person’s abilities. So, for example, feeling emotionally dull or speaking in a sort of disconnected, flat way. People with negative symptoms may show little interest in life or have a hard time sustaining relationships. And oftentimes this can be confused with depression.
• Disorganized thinking. This can look like struggling to remember things, organizing thoughts or completing tasks.

And whether you’re experiencing these symptoms or maybe your experience is a little different it’s important to seek help so that you can find the right supports and services that work for you.

Some harmful assumptions about people living with schizophrenia that aren’t true are that they have multiple personalities, that they’re a danger to everyone around them or that they can’t live happy and fulfilling lives that work for them. In reality, people living with schizophrenia can find ways to support themselves and manage their symptoms and live very fulfilling lives. The symptoms of schizophrenia can be reduced with medication, psychosocial rehabilitation, which might look like community based care or peer support groups, therapy and family support.

People living with schizophrenia should seek treatment as soon as symptoms start to appear because early detection and treatment can reduce the severity of symptoms. Getting a diagnosis of schizophrenia can be really scary and intimidating. There’s always hope. Whether you’re here to learn more about yourself or to support a loved one, we encourage you to lead with love, compassion and patience and just know that we’re here for you as you’re on this journey.

So when I’m feeling ungrounded or I need something to support myself, oftentimes I’m dealing with a negative emotion or a thought that I can’t get away from. And something I like to do is a breathing exercise where I breathe in an affirmation or a positive thought to help challenge that negative thought. And then on my exhale I’ll think about that negative thought or that emotion leaving my body. Hopefully this is a tool that you can take home with you. To learn more, visit nami.org/schizophrenia. And remember you’re not alone.

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Transcript for Figure 2.10, The Difference in Symptoms Between Schizoaffective Disorder and Schizophrenia

[Music.]

[Breanne Dargon, Clinical Director, BrightQuest San Diego]: Here at BrightQuest, we often see a lot of clients that have been diagnosed with schizophrenia or schizoaffective disorder and those two often can be confused.

With individuals that are diagnosed with schizophrenia, they often have symptoms such as hallucinations, delusions, negative symptoms, things like that. Those that are diagnosed with skis or affective disorder have those components paired with a serious mood component as well. So they might have periods where they are very, very low in their mood, they might have periods where they are very high, but it’s combined with the symptoms of delusions, paranoia, negative symptoms.

What that means when I say positive symptoms is the addition of things. So that means they are experiencing hallucinations, they are experiencing delusions, so they are having extra things happening to them. The negative symptoms is not something that you would typically think of “Things I don’t want.” Negative symptoms actually means the subtraction of things so that might mean that they do not have the ability to show affect. They do not have the ability to have social interaction as well as somebody that does not have those symptoms would maybe

present with.

[Music.]

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Transcript for Figure 2.11, Profile: Phil Y., Living with Bipolar Disorder

[Interviewer]: Tigger or Eeyore. Who’s at the wheel today?

[Phil Yoo]: My name is Phil Yoo and I’m living with bipolar disorder. It always comes a double-edged because the mania is kinda what brings on the depression. Being high that long makes you crash. With bipolar disorder, it’s large, large life events that set off phases. So like, like breakups or blowout, blowout fights with a family member or something like that.

But with me it was a breakup. In that situation I ended up, I ended up going to the hospital because I was so depressed. And they recommended me to their, their inpatient facility. It’s, it’s tough to know where you, where you, end and the, and the illness begins.

[Interviewer]: What is an attribute to you, and what is an attribute to bipolar disorder?

[Phil]: There’s, it’s such a fuzzy line. I’m not sure that there is a difference. The medication definitely makes me feel a little duller. You’re trading this side effect for that symptom. I may not be like at full mental acuity, but at least I’ll be like nice and even. You know.

It’s definitely challenging paying attention to all your cycles, paying attention to yourself, making all your doctor’s visits, therapy, blood draws. But it’s definitely possible to have a normal life with bipolar disorder. You just have to stick with your treatment plan and go forth.

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Transcript for Figure 2.12, Profile: Dan L., Living with Major Depression

[Dan Lukasik]: Nobody could do anything worse than what depression had done to me. When I turned about 40 I was the managing partner at my law firm. I was just sad all the time but things started to go really off the rails when my sleep became fragmented. I just couldn’t get enough sleep and was told at that time that I had major depression and that I needed to go on medication.

People can’t recover from depression by themselves. I mean, that’s what’s so wrong about stigma. At the end of my life, what’s going to count is what I’ve done for other people. And for me, the biggest contribution I can make in that effort is to connect to other people with major depression and let them know they’re not alone. You can be a professional person, you could be a working person and you can live with depression.

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Transcript for Figure 2.13, ECT: Disrupting the Stigma Around An Essential Treatment Option

[Alyssa, ECT patient]: I was diagnosed with catatonia. I was delirious, confused, regression, dementia – I didn’t know what was going on. We had tried everything else – meds, therapy, chiropractic work, ketamine treatments – and nothing was working, so finally we ended up deciding to try ECT.

[Dr. Dan Maixner, Professor at University of Michigan and Director of the Electroconvulsive Therapy Program]: ECT is a procedure that was first developed in the 1930s and has been refined over many decades to reduce side effects and to improve outcomes. It’s used for depression, bipolar illness, psychosis, and catatonia. We’re inducing a very brief seizure under general anesthesia to affect brain changes that will help depression and other illnesses.

[Dr. Neera Ghaziuddin, Professor at University of Michigan and Electroconvulsive Therapy Program]: Stigma is a problem where ECT is concerned; however, there is a big mismatch between reality and the basis of the stigma. So the reality is that ECT is painless, it’s quick, it’s highly effective, and it can be life-saving in many instances.

[Julie, mother of ECT patient George]: ECT has changed George’s life. He was unfunctioning completely, he would cry and hit himself in the head for hours and hours straight, and nothing you could do would help him. You just couldn’t console him so it was a horrific time period for both of us because as a mother not being able to help your child who you are watching suffer and deteriorate before your eyes, it was horrible for both of us.

The ECT clinic is amazing. The people here are some of the most caring people you can ever meet. Coming to ECT has become almost like a safe place for George. He knows he’s going to feel better and I believe that he knows he’s being very well taken care of.

[Dr. Ghaziuddin]: If you were a patient coming in to do ECT, this is what your day would look like. The check-in: The nurse does the intake and IV is set up. They get wheeled into an OR where they receive ECT. They are taken care of by a team from anesthesiology and psychiatry. Your IV is already set up so in rapid succession receive light and very quick acting anesthesia. At that point the psychiatrist along with their team will induce a seizure. There is a set of paddles which are placed either on two sides of your head or they might be placed on one side of your head. Those are the two common placements, known as bilateral and unilateral. Your seizure takes about 30 seconds to a minute or two. Once that’s over, you slowly over minutes wake up and I would say that it takes no more than about five to seven minutes. They’re assisted during their recovery and the whole procedure is over within a few minutes and usually within two to three hours you’re ready to go home.

[Alyssa]: So it’s been about a year since I first started becoming ill. It took like nine sessions before an improvement was noticed and I’ve really noticed it after the last couple of sessions. ECT has improved my life so much.

[Dr. Maixner]: The most common side effects of ECT are headache or nausea. The issue that patients are most concerned about tend to revolve around memory side effects.

One big issue that patients worry about is short-term memory and what’s going to happen after their treatment course but in fact the short-term memory side effect that does happen during the course tends to ease up and dissipate over a matter of days to a few weeks after the treatment course is completed.

[Alyssa]: My side effects are pretty minimal. On occasional headaches right after treatment and did have some disorientation more recently. The past couple treatments I’ve noticed my memory is getting longer. I’m more confident, more motivated, happier – I laugh a lot, that wasn’t the case before.

[Dr. Ghaziuddin]: To be able to see somebody get better – a young person be able to go back to school or go back to their job to do whatever they need to do and function in a safe way – that’s the part that I would say that it really is a game changer.

[Alyssa]: ECT has changed my life. It saved my life, honestly. I feel better than I’ve ever felt.

[Julie]: Prior to ECT, George had zero quality of life. Zero. He now is able to go to school and he’s able to participate in social activities. We lost him for a while and ECT gave him back to us.

[Music.]

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Transcript for Figure 2.14, What is Anosognosia?

[Lauren Kennedy]: Hi, everyone. So today I wanna talk to you a little bit about a concept called anosognosia. So anosognosia is the symptom of a severe mental illness, such as schizophrenia or schizoaffective disorder, that impairs a person’s ability to understand, or to perceive their own diagnosis or treatment. In other words, this is when someone is unaware of their own mental condition, or when they have difficulty perceiving or understanding their condition accurately.

Now, this is different from simply being in denial about an illness, and it’s more a lack of insight into an illness. Anosognosia is the single largest reason why people living with schizophrenia or bipolar disorder refuse medication or refuse to seek treatment. So it’s obviously very hard to understand that you need to take medications, or that you need to seek treatment when you don’t believe that there’s anything wrong, or that you have an illness of any kind. So this is why it makes it so difficult, when individuals are experiencing anosognosia, to ensure proper treatment of their illness.

I myself have gone through periods of anosognosia where I, myself, don’t really think that I have schizoaffective disorder, or that I don’t have a mental illness. And so it’s important to note that anosognosia varies, and it kind of ebbs and flows in individuals. Variations in awareness are typical in anosognosia, so it’s not something that you can just overcome. Sometimes you can gain more insight into your illness and have better awareness of what you need to do in order to keep it under control. But then you can go again into periods of anosognosia where you don’t think that you are ill.

So what do you do about anosognosia? A few things that have worked for me have been research around my illness. So going to the library, doing some research online, taking classes in university, or just taking classes in general, some are offered through local community programs and whatnot, that can just give you more information about your illness, and that can really help with insight. Peer support groups have also been really helpful for me in terms of building up insight. So just getting together with people who are going through similar situations, and people who can understand what I’m going through and kind of normalize it a little bit, have really helped to build insight around my diagnosis and around my illness.

Another thing that has been really helpful for me in the past is keeping a journal about my thoughts and feelings and symptoms. So when I’m experiencing intrusive thoughts or racing thoughts, I often keep a journal about those thoughts in order to just kind of check back and reflect on what I was experiencing, and to gain a bit more insight into what I was going through at that time. It also helps to just keep a daily log of other symptoms of my illness, and of things like sleep, and things like medication, and all that kind of stuff just helps to build insight around the illness a little bit more. So what it really helps to do is to identify patterns in your symptoms or in your illness. So if you’re noticing that you stopped taking medications and your symptoms are increasing or worsening, you can kind of help, or it can kind of help to identify that pattern of stopping medication leading to worse symptoms.

Another possible way to kind of mitigate anosognosia is to just talk about it more with family and friends. So the more open you are around your illness and around your diagnosis, I think the more it’s going to help you in terms of self-acceptance and coming to terms with your own illness, which increases insight.

So just to wrap things up, a quick review of ways to deal with anosognosia are to do your research, to try out peer support groups, keeping a journal or a log of some sort, and talking more openly with your family and friends.

So hopefully you found this video helpful in terms of understanding more of what anosognosia means and what it entails. Thank you so much for watching. If you wanna follow along more with me, you can follow me on Instagram or Twitter. My handles are in the description below. Also, if you wanna help support the creation of future videos, you can become a patron on my Patreon page. The link is also in the description below. So thank you so much again for watching, and have a great day, bye.

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Transcript for Figure 2.18, What Is Conduct Disorder? | Child Psychology

[Dr. Kimberly Williams, Clinical Psychologist]: Conduct disorder in children is very serious.

It’s a disorder of childhood and adolescence that is long term, that’s chronic, where children

have very aggressive impulses, where children are involved in difficulties with the law

and really seem to have no regard for the rules or for authority.

When children have conduct disorder they are definitely at risk of carrying these difficulties

into adulthood which also brings about a myriad of different problems.

Children with conduct disorder often have difficulties in schools, have difficulty with

relationships and have difficulty with employment and lifelong long-term relationships.

It’s important to recognize that if your child is not doing well in school, if your child

has had difficulties where legal action was necessary, if your child is bullying, getting

into fights and this is constant and ongoing, if your child does not get help these complexities

will really exacerbate into other major difficulties.

Look for signs of your child’s grades dropping, look for signs of repeated detentions, suspensions and brushes with the law.

Parents, please recognize that if your child has signs of conduct disorder the sooner you

get help, the sooner your child can start to learn more adaptive behaviors.

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Transcript for Figure 3.9, This is Ableism

[Music.]

Ableism – the belief that it is normal to not have a disability and that normal is preferred. It’s discrimination on the basis of disability.

What’s the impact? Well, ableism –

I live in a world not built for me because of ableism.

I don’t belong.

I am invisible.

I am underestimated.

I am not an equal citizen.

I experience barriers to higher education.

People assume that I have a bad life.

I get funny looks.

My privacy isn’t respected.

I get kicked out.

I am not heard.

I have poor job prospects.

I do a lot of emotional labor.

I live in poverty because of ableism.

My human rights are not respected.

You might not recognize ableism unless you experience it. This is ableism – learn how to take action against ableism in your home, your community, and your sector by visiting inclusioncanada.ca/this-is-ableism/.

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Transcript for Figure 3.12, Crip Camp: A Disability Revolution

[Woman 1]: Wait, you want me to tell ’em what happened?

Well, two people got crabs, and they were spreading.

We were all very hyper about it.

I have to go shower some people.

[chuckles] I’ll see you later.

[Man 1]: I wanted to be part of the world, but I didn’t see anyone like me in it.

I hear about a summer camp for the handicapped, run by hippies.

Somebody said you probably will smoke dope with the counselors.

[chuckles] And I’m like, “Sign me up!”

Come to Camp Jened and find yourself.

There I was! I was at Woodstock.

[Man 2]: You wouldn’t be picked to be on the team back home. But at Jened, you had to go up to bat. Even when we were that young, we helped empower each other. It was allowing us to recognize that the status quo is not what it needed to be.

[Woman 2]: The world always wants us dead. We live with that reality.

[Man 1]: At the time, so many kids just like me were being sent to institutions. It was just a continual struggle. Most disabled people, like myself, are unable to use public transportation.

[Man 1]: We needed a civil rights law of our own.

[Music playing.]

[Reporter]: A rehabilitation program has been vetoed by the president because it was cost prohibitive.

[Woman 3]: We decided we were gonna have a demonstration.

[Woman 4]: You get the call to action. “To the barricades!”

[Reporter]: A small army of the handicapped have occupied this building for the past 11 days.

[Man 1]: So many people from Camp Jened found their way into the building.

[Crowd chanting.]

[Woman 2]: The FBI cut off the phones. The deaf people went, “We know what to do.” That’s how we communicated to the people outside the building. The Black Panther Party would bring a hot meal. We were like this.

[Man over PA]: We are the strongest political force in this country. We will no longer allow the government to oppress disabled individuals. And I would appreciate it if you would stop shaking your head in agreement when I don’t think you understand what we are talking about.

[Crowd cheering.]

[Man 1]: What we saw at that camp was that our lives could be better.

[Boy]: Go!

[Man 3]: Go!

[Music continues playing.]

[Woman 5]: If you don’t demand what you believe in for yourself, you’re not gonna get it.

[Protester 1, mimicking a reporter]: Would you like to see the handicapped people depicted as people?

[Protestor 2]: Excuse me?

[Laughter.]

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Transcript for Figure 3.19, Exposing Parchman

[Music.]

[Narrator]: This is what we live in in Parchman.

[Shawn “Jay-Z” Carter]: People losing their lives and being covered up.

[Mother of incarcerated person]: The last time I talked to my son he said, “Mom, I’m not gonna be able to make it.”

[Advocate 1]: People are living in a place that was built for them to suffer.

[Advocate 2]: A former Plantation that had a history of slavery.

[Music.]

[Mother]: My son did it wrong but he’s a human.

[Relative]: He was my whole world.

[Mother]: I missed my [unintelligible].

[Speaker 1]: We filed the class action lawsuit.

[Speaker 2]: It’s time for the world to help us correct these wrongs.

[Speaker 3]: If this was an animal shelter people would be going to jail.

[Mario “Yo Gotti” Mims]: Every action that we take is all to get justice for these families.

[Relative]: My son.

[Relative]: My brother.

[Relative]: My nephew.

[Relative]: My everything.

[Speaker 4]: We’re not going to be silenced. Ever.

Exposing Parchmen. Premiere Saturday June 17th at 8 on A&E.

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Transcript for Figure 3.24, Lois Curtis Documentary Trailer – 2023 Anniversary of Olmstead v. L.C. (Lois Curtis)

[Narrator]: 1995. Aspiring artist Lois Curtis was confined to a state-run institution in Atlanta, Georgia. Curtis was not alone. Thousands of people with disabilities were confined to State institutions.

The women argued their right to live in integrated communities fully funded and won.

[Keri Gray]: Lois Curtis to me represents our need and our fight for bodily autonomy.

What I respect about her Legacy is: her fight. She fought for her bodily autonomy and she won. And what I love about her is that she won not just for herself but for the many of us who have come after her.

[Vesper Moore]: For me as a brown disabled person, Lois Curtis’s legacy, Olmstead, is symbolic of ideas of freedom and liberation that are important for disabled people, that are important for brown and black disabled people. That legacy and what that means is that we can live lives in the community just as any other person would.

[Keris Myrick]: As a black, disabled and psychiatric survivor, a person with a psychiatric disability, this means so much to me because so often things have been forced upon me without my choice, without my voice. And when I think about Lois and what she did using her voice being able to talk about the importance of choice, community inclusion, being a part of and developing a community that is for and by her with the supports that she needed, I know that I can speak up and do that as well.

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Transcript for Figure 4.5, NAMI Sharing Your Story With Law Enforcement Program

[Jennifer Paster, Deputy Chief Superintendent, Brookline Police Department]: I’d like to think that the job has changed and that it’s allowed us to slow down a little bit. It’s placed a focus on actually helping people in ways that are not just about locking them up and putting them away.

[Jolissa Hebard, NAMI speaker]: Hi, everyone. Thank you for being here. My name is Jolissa and I’m with NAMI. NAMI is the National Alliance on Mental Illness. We are the largest grassroots organization started by the friends and family of those with serious mental illnesses. So we are not clinicians, we’re not doctors, we’re not therapists. We are people with lived experience.

[Pietro D’Ingillo, law enforcement psychologist, Los Angeles County Sheriff’s Department to police officers]: Our NAMI friends are here today because they want to see you succeed. One of the highlights of the whole week is the presentation from our friends from NAMI. So we have Jolissa and Christine. They’ve both been here before. They do a great job at explaining their stories.

[D’Ingillo]: When they experience that emotional connection with our NAMI presenters, it accentuates their experience and very importantly, it promotes the shift in attitude.

[Paster]: Sure, part of our job is law enforcement, but it’s also about upholding people’s constitutional rights and allowing people to live their best lives.

And sometimes that’s not making an arrest. It’s actually connecting somebody to services for mental health, for substance use.

[Jasminka Jurisaga, senior lead officer, Mental Evaluation Unit – Valley Bureau]: I mean, this is an opportunity that you don’t get too often, where you are in an environment where everyone’s safe and you can ask questions and actually listen to someone who’s willing to share their story because they want you to know. They want the officer to know what they’re going through or what they’ve been through.

[Jose Navarro, law enforcement psychologist, Los Angeles County Sheriff’s Department]: It’s a tough job. It’s a job where… physiologically we’re wired to run away from danger. They’re using their willpower to go towards it, to rescue, to save, to protect. But to be able to get away from that mentality of, “I’m here to fix something,” that in reality is not fixable. It’s something that we need to manage in the moment.

[Paster]: If it’s a younger officer, if they haven’t been to a call where somebody is in crisis, I can guarantee that they will be and definitely before the end of their first year of service.

[Jurisaga]: I specifically remember a call that we went to and the family was calling on their adult son. He was younger, and we had determined almost immediately that he was going to go to the hospital. But I remember putting him in the back seat of the police car

and him screaming out the window like, “You were not even listening to me!” “You’re treating me like an animal!”

I’d still rather be out in the field handling calls, but after going through this training and seeing how beneficial it was to be able to hear someone from NAMI share their story with the police… Absolutely. I’d do this training anytime.

[Paster]: I think a really important aspect of the NAMI training is that we get to see that people do recover, people do get better, and people go on to lead successful lives.

[Navarro]: If I have one word that Share Your Story from NAMI does for the people in the class is “hope.” It provides hope, especially when at times folks come to the class not feeling it anymore because of – just the crisis. And so hope is definitely ignited.

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Transcript for Figure 4.6, Decriminalize mental illness

[Tonya Jones, Peer Support Specialist]: People look at mental illness as a crime. You are a menace to society, and that’s not the case. They’re not a problem. They’re a human being. They’re going through something. How can I help them?

[Sarah Radcliffe, Disability Rights Oregon]: My name is Sarah Radcliffe from Disability Rights Oregon. There are two crises happening simultaneously. One is lack of access to mental health care and the other is lack of access to affordable housing. People with mental health concerns or brain injuries who are living on the streets can become trapped in a cycle of incarceration and institutionalization. Say that I’m charged with a crime, disorderly conduct, trespass, even littering or public urination, and because of my disability I may not be able to understand the charges against me and to effectively work with my defense attorney.

That’s what we call the ability to aid and assist in my own defense. So if I’m unable to aid and assist, the court will probably order an evaluation and I may wait in jail for weeks or months in order for that evaluation to happen. Then if I’m found unable to aid and assist, the court would send me to the state hospital to receive treatment in order to become able to aid and assist. And I may stay at the state hospital for a long time, months, even years. Then I’m discharged, sometimes back to living on the streets because I’m not connected to the services I may need. Housing, healthcare, transportation, food, government benefits.

[Jones]: I’m not getting released to any services. I’m homeless again. One more time, I get arrested, I get released, I’m homeless. So I’m back at square one. It just continues that cycle.

[Melissa Allison, Assistant District Attorney, Marion County]: If we’re just taking them off the street for a couple days and then causing them to lose their benefits, lose their housing, and then really make matters worse for everyone, we’re not really helping anybody in that process.

[Radcliffe]: And it’s created a doubling in the past eight years of the number of patients who are at our state psychiatric hospital on aid and assist orders.

[Allison]: There is a great problem here where people are serving more time in custody just because of their mental illness.

[Jones]: Instead of understanding that this person is struggling with their mental illness, they’re criminalized. That’s a problem. That’s the problem.

[Dorian, former state hospital patient]: It sucks to be out on the streets. I went from being at home living with my mom and my sisters to the streets overnight.

I’ve dealt homelessness since age 20, in and out of jail 45 times. Many of the charges were trespassing, things that mostly a homeless person would go to jail for. The first time I was in the psych hospital was for about four months. My first psych eval was that I was schizoaffective. I went to the state hospital three times. One time was for a year and five months.

[Radcliffe]: Treatment at the state hospital costs $240,000 per person per year. More than half of Oregon’s mental health budget is being eaten up by the state psychiatric hospital.

[Dorian]: They spent all that money. They pretty much dumped me back on the street with no help at all. It’s really hard. It’s really hard. It doesn’t feel that good.

[Radcliffe]: We’re spending a lot of money on this process, which we all recognize doesn’t work.

[Allison]: Take the humanitarian angle out of it and we’re just looking at the fiscal impact. What else could our communities do? What can our communities be doing with this money to avoid these things happening in the first place and making our communities better?

[Music.]

[Jessica Kampfe, Public Defender, Marion County]: There really needs to be an intervention early on that takes the person out of that loop of pre-trial incarceration and hospitalization. We are fortunate in Marion County that we are building good resources to help people with mental illness.

[Ann-Marie Banfield, Marion County Health Department]: The Psychiatric Crisis Center began back in 1995. Our goal is to move people. Out of law enforcement and even acute care services, really to community stabilization.

[Jason Myers, Marion County Sheriff]: Oftentimes law enforcement are afraid if they leave somebody on the scene of a call, they’ll either get hurt or they’ll hurt somebody. Psychiatric Crisis Center is a great place outside of jail, outside of the ED where people can access services because it is manned 24 hours a day. We want to make sure the community is safe and that’s a great alternative and I think that’s why it’s been so successful.

[Banfield]: We do that through the outreach team. We do that through our mobile crisis team.

[Myers]: Working together with law enforcement officers, we have developed case management systems.

[Banfield]: In 2015, we were also able to hire a half-time deputy district attorney to help us focus on the aid and assist cases.

[Allison]: I’m Melissa Allison. I do the aid and assist cases at the Marion County District Attorney’s Office. When we get a case at the DA’s office, we look for signs that this was mental illness driven. If so, can we just connect them with services and not charge a criminal case? And then I dismiss the case.

[Kampfe]: The numbers at the state hospital are now consistently going down, which is different than the statewide numbers, which are consistently going up.

[Myers]: The diversion has helped. Our jail bookings from our historic high in 2009 are down, which is good news. The criminal justice system is not the answer. Treatment-based services in the community is, and that’s where we see the success.

[Josh Smithers, person helped through diversion]: I’m Josh and I’m 23 years old. If there hadn’t been a diversion program, I think I would probably still be homeless and using drugs.

[Cliff Smithers, Josh’s father]: His mother and I used to live on Wilbur. And so when the kids were really little, we’d have picnics here. I didn’t have any idea my son would end up living here. When folks were telling me Joshie was living in the park, it broke my heart.

[Josh Smithers]: I lived in the park for about a year. My day-to-day was kind of searching for drugs, get high and get in trouble, to be honest. I was charged with two misdemeanors, a DUI and possession of methamphetamine. I was hospitalized for 95 days. Diversion is helpful because they got me out of jail. They really got me connected with my family, and that was a huge support that I needed.

[Cliff Smithers]: He’s not using methamphetamine anymore, so it’s really good to have him back at his real home and be able to just come visit.

[Music.]

[Dorian]: There are people that suffer from mental problems that are homeless, run into a lot of problems on the streets and with jails and institutions. They need someone to help them with housing and Social Security benefits, get them ID and get them medication, get them a job possibly. If you don’t have those things, you’re most likely going to end up in jail, a psych hospital, or prison.

[Myers]: You can’t arrest your way out of that issue of behavioral health or homelessness or addiction. It just doesn’t work. Where I’ve seen the work is with an intervention and treatment and wraparound services in the community. That’s where lives are changed and the community’s actually safer because the individual is treated and they’re better for it.

[Jones]: When a person’s basic needs are met, they’re able to become more self-sufficient. Our criminal justice system really should find the money to make that happen.

[Radcliffe]: If you care about this issue, talk to your state and county elected leaders and visit DROregon.org.

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Transcript for Figure 4.15, A rare look inside a mental health court

[Music.]

[Narrator 1]: A mental health court is a treatment court that focuses on the offender and the offender’s mental health.

[Narrator 2]: It is a team of people working hard behind the scenes to help each of our participants be successful in their life.

[Hon. Sally Tarnowski, mental health court judge]: I’m so happy to see you! Have a seat, Wow! How are you guys doing?

Oh, when they come into mental health court, we sit in a circle. I sit down in the well with them; they have the team around them in the courtroom; they have their other participants sitting with them. It is a much more nurturing and supportive environment for them than a regular courtroom.

[Mental Health Participant 1]: My kid’s father got out of prison after eight years, and we were together when he went in; it was just like a whole – just a whole lot – of family issues, family emergencies going on. I felt bombarded with just distress, like emotional distress; and I made, I made choices that you know.

[Tarnowski]: A participant will come in and tell me the judge, in front of the prosecutor, in front of the probation officer, in front of a law enforcement person, that he or she used something over the weekend, used meth or used heroin, something that would be a violation of their probation and would get them in trouble; but which they know we are going to respond in a way that is going to support them and get them the help they need.

[Team member to Mental Health Participant 2]: This is the light that you have in the world and you’ve done so much good work that your light now shines through.

[Participant 2]: I need to write that down.

[Kim Davis, client advocate]: It’s not about getting people to confess, you know I mean. You have to tell us what you’ve done and pretty soon they feel really invested in their truth-telling, that the truth really means something to them, and that the truth means that it’s going to have like a treatment response to it.

[Barry Schull, case manager]: A lot of times when a person will enter the mental health court, they’re homeless or they are in court-ordered treatment, part of the things that we focus on are stability in all of those different Areas, it’s a long process.

[Carolyn Phelps, psychologist liaison to mental health court]: It is not a get-out-of-jail-free card. It is way harder than actually doing your time because of the accountability piece. You can’t get away with not going to treatment.

[John Villa, probation officer]: My name is John Villa. I work for Arrowhead Regional Corrections for the mental health court of St. Louis County today, what we’re doing is we’re doing field visits on clients. It’s a standard thing that we do in the mental health court, where you know not only do clients meet with the judge on Fridays and correspond with their case managers and everything, but part of my responsibility is to go out and see them in their residence to see how they’re doing in the community. Because a lot of that information can then be relayed to the team and, plus, it keeps them connected. It’s not just they come to the court, report to the court, and then it’s done. It’s so it shows them that we’re out here, we’re still trying to help them, we’re trying to support them and we’re trying to to be there for them during this time.

[Villa to client]: So just go ahead and put that in and just keep building up spit. Just leave it in your mouth and don’t take it out because when you take it out the air causes it to dry and I will refrain from asking you questions. I always say I feel like a dentist – “Hey, so tell me about your day!”

[Villa]: There’s a lot of obstacles that we need to overcome. There’s a lot of trust issues that these individual may have, there’s a lot of fear.

[Phelps]: This is not their first go around in the criminal justice system and the criminal justice system has its own level of trauma with it. And then you have us and we’re all about, “Hey we’re different you should trust us,” and that what is truly amazing is that there’s an ever stepping forward.

[Mental Health Participant 3]: Our court systems are overworked, underfunded and completely packed with people. It’s an in-the-door, out-the-door thing. The judge goes to the prosecutor, the prosecutor goes back to the judge. It’s like an oiled system.

I spent my youth and pre-adolescence and pre-adulthood and active use just constantly in trouble, a revolving door of in and out of court systems, and uh by the grace of the good Lord, I got accepted into the mental health program, and that was the beginning of the end for me to start facing the issues I have.

[Villa, taking notes with his phone]: Client and I talked about how the weekend has been for him, and he said that he went fishing and got more fish, including a turtle, period.

[Tarnowski]: You know, I think there’s probably some fear by the public when they hear that people are maybe being placed into a treatment court rather than going to Prison, I think the public should be aware that you know somebody can serve a couple years in prison and come out and commit the same crime again; they may or may not have learned how to deal with the issues that they have when they get back to the community. Whereas we teach them to be in the community.

[Mental Health Participant 4]: I just recently started this program. I’ve been through a lot, a lot of trauma, which kind of led up to self-medicating with drugs and alcohol. I always wanted to give back to the community, and I figured that the best way to do it would be to do a city-wide cleanup, which is happening today. For the past two years, I’ve been wanting to do this. But, I was using. With the whole mental health support team, I’m turning my life completely around; my mind is caught up with my heart.

[Tarnowski to client]: Thor, you’re doing great. Yep, so what are you doing every day with your time?

[Tarnowski to client]: Thor, you’re doing great. Yep, so what are you doing every day with your time?

[Thor, Mental Health Participant]: Um, right now, um, I have community service that I’m going to be doing this week. I have um, eight hours eight hours left. I did two hours, so I have eight hours left to community service, so I’m going to finish that this week.

[Tarnowski]: Where are you doing it?

[Thor]: At Hermantown Community Church, and that was one of the places that I had, um, wronged when I was doing the wrong things. Oh wow, yep, and um Barry, um Barry took over, and he was my, he had suggested maybe writing them a letter and stuff, so I had wrote them a letter apologizing. They mentioned that they had some community service work available and stuff.

[Tarnowski]: Wow, Thor! That’s great!

[Thor]: So it worked out really nice, yeah, and kind of um, kind of healed up a sore spot too, so yeah, real nice too.

[Phelps]: Wow, what a great story. That’s the essence of community service, and you know, you have such a good heart, and when you allow yourself to do well and you’re not blocking that up with self-use or anything, then your good heart really shows through.

[Thor]: Thank you. Yep, I’m very grateful for Mental Health Court. I wasn’t able to do those things when I started Mental Health Court, advocate for myself. This has all developed in the last two years of being on Mental Health Court.

[Tarnowski]: You’ve done a lot of hard work and come a long way. You’ve just really rocked it.

[Thor]: Thank you.

[Tarnowski]: All right, good to see you. See you in a couple weeks.

[Thor]: Okay.

[Phelps]: If we can talk with people in a way that they can hear, that is what builds the trusting relationship and that is also what leads to that next step of change.

[Ambient noise at outdoor ceremony.]

[Tarnowski]: So today’s our big day for Thor and Joel and Clinton. Clinton actually technically graduated a couple weeks ago, but he gracefully agreed to push this off so we could all be together and do this together, all three of you, and I know the rest of you participants have had a lot of experience with the criminal justice system and the courts, and it hasn’t generally been a pleasant experience for you, and coming into a courtroom is probably a pretty traumatic experience for you, especially initially when you come in with us, and it’s really always very incredible to me to see when that flips for you. With each and every one of you, it does. There’s a day that comes that you walk into that courtroom and you go, this is not the place that’s going to be so bad. This is a safe place for me, this is a place where I can tell the judge something that I would never have admitted to anybody, particularly a judge; certainly not my probation officer or the prosecutor or the police officer – all of whom are sitting in that courtroom too. And you come in and tell us because you know that you’re in a safe place and that we’re there to support you. And I know that that has to be such a difficult thing to learn and to believe; but you each have exemplified that.

[Thor]: Before mental health court, I was stealing to support a meth habit, and I was using probably a hundred dollars a day worth, but that’s a lot of money, a lot of stealing, a lot of crime, a lot of different things. Now today I don’t so much as take a penny that doesn’t belong to me. But it was a 180 from how I started to how I finished, um, and I’m just really happy, and I’m happy for anybody that gets to get the privilege of going through the program. It’s a really good program.

[Applause.]

[Mental Health Court Participant 5]: I just like to thank the team judge um, I’ve been doing drugs and dealing with mental health stuff since I was 14, and I think it was my early 20s when I first prayed and I said God, something’s got to change, you know, and uh, just seemed like I could never lose the desire to use you know, and um, something something is different this time, you know. And mental health court has helped me by not just throwing me in jail but putting me in treatment, getting me back on my feet until I learned, you know. And I’m going to continue to learn to keep moving forward, so I’m just really blessed.

[Applause.]

[Tarnowski]: So for each of you, we have a certificate at the bottom, there’s a quote that reads, ‘Challenges are what makes life interesting and overcoming them is what makes life meaningful.’ Whenever you find yourself doubting how far you can go, just remember how far you have come.

[Music.]

[Phelps]: Mental Health Court is the morally right solution for a group of people, for a group of our participants. For the people who would be and should be our participants, it is the morally right solution. It is what makes a better community, it is what makes a safer community, and it is what makes a community that we can all be proud of.

[Music.]

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Transcript for Figure 5.6, NAMI Policy Priorities: Crisis Response For Mental Health

[Anita Fisher, Mental Health Advocate and Caregiver]: Crisis response has affected, I say our family, because I always start with, mental health challenges in an individual in your family affects the whole family. I wish that instead of that call being law enforcement, that we would want that team to look very different, that it could be a clinician and a peer specialist and a family specialist and a case manager, you know, that it looked a little different. And I think it would be more accepting to the individual than to have to go out in handcuffs.

[Stacey Owens, NAMI Board Member]: I’ve seen firsthand the tragedy that can happen when law enforcement responds to someone going through a mental health crisis. In my experience, too, law enforcement responds; people in crisis often end up in jails, in emergency departments, on the street, or even worse, they’re harmed or killed during the encounter.

And that’s why this is so important. NAMI believes that public policies and practices should promote access to care for people with mental health conditions. NAMI supports the development and expansion of mental health crisis response systems in every community.

There are three core elements of the National Guidelines for Crisis Care. First, Regional or statewide 24-7 crisis call centers. Second, mobile crisis teams. And third, Crisis Receiving and Stabilization Programs.

[Fisher]: I know for me personally, it is treating the individual before it becomes a crisis. To me, that’s always number one.

[Owens]: Every community needs a response system that gets people on a path to recovery.

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Transcript for Figure 5.9, Mobile crisis team hits the streets in Clark County

[Mike Fort, Battle Ground Police Chief]: If you take a police officer off the street to devote the necessary time, to devote to those that are in behavior or mental health crisis, then they’re taken away from those kinds of significantly violent types of crimes. So that is why this team is needed now. They take that pressure off of the police.

[Bryant Clerkley, reporter]: Battle Ground Police Chief Mike Fort is speaking about the Columbia River Night Crisis Team, which is in its first week hitting the streets of Clark County. The team has a partnership with the Battle Ground Police. The crisis support specialists are trained in intervention, de-escalation, and risk assessment.

[Fort]: There’s a fair amount of calls that we get that are people that are, and I would say the calls are there’s a suspicious person.

And the suspicious activity may be talking to themselves or randomly walking up and down a street or something like that.

[Clerkley]: Mike DeLay is the program director for the mobile team. He says referrals come in from the Clark County line. They screen them and then contact the team, or law enforcement calls them directly. The goal is to get people help. There’s 19 members that respond throughout the county.

[Mike DeLay, Program Director, Columbia River Night Crisis Team]: We really want to have this team minimize contact with law enforcement, minimize contact with restrictive levels of care, hospitalizations, things of that nature, so a person can stay in whatever place is most comfortable for them, and then connect to supportive services afterwards and hopefully no longer need crisis services.

[Clerkley]: DeLay says the team carries water, food, tents, and sleeping bags. They also have flashlights and branded clothes so people know who they are.

[Clerkley, in the studio]: The night crisis team was funded through a $2 million federal grant. DeLay says that should last about two years. The police chief says he would like to expand the program even more, and get more of these mental health professionals out on the streets. Brittany?

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Transcript for Figure 5.10, How Project Respond supports our community with crisis mental health care

[Lacey Evans, host, Hello Rose City]: There’s a look at downtown Portland from the Hello Rose City skycam. It’s going to be a beautiful day, with temperatures in the upper 80s today. Hard to believe it’s fall, but get out there and enjoy it if you can.

There are a lot of people on our streets who need help, but sometimes it’s not clear how to get them help or who we should call. And that is why Cascadia Health is here. Jackie Thomson is the senior director of Crisis Services for Cascadia. Hi, Jackie.

[Jackie Thomson, senior director of Crisis Services, Cascadia Health]: Hi!

[Evans]: So first, give me a quick overview of Cascadia Health and your mission.

[Thomson]: Yeah, Cascadia Health is definitely trying to incorporate whole healthcare. So we believe that mental health and physical health are combined no matter what we try to do or say differently. And Cascadia is all about providing services that incorporate that.

[Evans]: So how does the Project Respond mobile team work?

[Thomson]: The Project Respond Mobile Crisis team runs 24/7 and it’s an interdisciplinary team, so it’s masters-level clinicians and peer support specialists that go out into the community for anyone that is experiencing a mental health crisis.

[Evans]: And how can people access the Project Respond services?

[Thomson]: We are dispatched by our communities’ crisis response teams, so we are dispatched by our crisis line. So you can call the crisis line anytime 24/7 and they are like the immediate response. So you’re talking to someone on the phone immediately. And then when that mobile response is needed, we come in and dispatch to any location in Multnomah County.

[Evans]: I think a lot of people are nervous about calling 911 in certain situations. Can Project Respond be dispatched by 911? And what would you recommend in that situation?

[Thomson]: 911 also partners with our Multnomah County crisis line, so they send calls to each other. So really, it’s about anytime someone’s needing an emergency crisis response, call whatever you feel comfortable with. If it’s going to be 911, they will send it over to the crisis line and dispatch us. And that works kind of – coincides with what we do. Like it doesn’t matter how you try and get ahold of us. We want to be there for them.

[Evans]: And you are available 24/7, you said?

[Thomson]: We are.

[Evans]: That’s excellent. Why are these mobile crisis services so important?

[Thomson]: That’s a great question. We think it’s so important because if, in our community there’s an emergency, we send resources to individuals needing those. Emergencies for health, for fire, and we believe we should do that for an emergency mental health crisis as well. So if somebody feels like they can’t or aren’t able to go into an office, or our urgent walk-in clinic or their doctor’s office, we need to have resources that go out to them in that crisis. So we feel like that’s incredibly important, incredibly important to run 24/7, and also that we don’t bill to insurance. We don’t ask for this financial assistance for getting a resource like that to you in an emergency.

[Evans]: I’ve also heard you say before that your teams drive around in unmarked cars, because unfortunately there is still a stigma around mental health. And some people might not want to draw attention to the fact that they are getting help. Do you want to talk a little bit about that?

[Thomson]: Yeah, we very much don’t deny that mental health is still very stigmatized. And again, that’s why if you want to call 911 or any of those resources to get a hold of us, we’d never want to make that a barrier. And part of that is also not billing for services. Anyone, whether they have insurance, private insurance or no insurance at all, should be able to access care for their mental health. And the unmarked cars are part of that – we don’t want to advertise in case that’s a barrier to somebody accessing our services, that, hey, we’re coming to talk to you about your mental health. We don’t want that to get in the way. If somebody wants it as private as possible, we will definitely make sure that is part of our response.

[Evans]: Excellent. OK, so if people want to donate to Cascadia or just find out more information, where can they go?

[Thomson]: You can go to our website (cascadiahealth.org). Of course, we’re also on social media, but we also have a lovely event coming up on October 27th.

[Evans]: Yes, tell us about the gala.

[Thomson]: The gala – so we will be talking about Cascadia, our services, people that have accessed services from us are going to speak at that event. And really it’s just to show what we’re doing and what we’re trying to do in our community and to see if anybody wants to help support us. You can tune into that event.

[Evans]: Yes, it’s on right here on KGW on October 27th. So yes, definitely tune in and learn more information about Cascadia Health. Jackie, thank you so much for being here with us.

[Thomson]: Thanks for having me.

[For mental health support: 503-988-4888.]

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Transcript for “How Project Respond supports our community with crisis mental health care” by KGW News is included under fair use.

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Transcript for Figure 5.13, CAHOOTS Interview on CNN – Alternatives to Police Response

[Kate Bolduan, CNN Reporter]: So George Floyd’s death and the massive protests that have followed have put a sharp spotlight on racial injustice and police brutality in the country. It also has reignited a debate over what exactly the job of police should be and should not be. Here’s what the police chief of Sacramento told us here just yesterday.

[Daniel Hahn, Sacramento Police Chief]: There’s a lot of mental health calls that we go to that police officers don’t need to be there, but nobody knows who to call other than us. There’s no other resources that can come and deal with the situation. So the fall back is police officers. I think one of the ways we can get a lot better is that we get the people who are best suited to respond to some of these things to go there as opposed to police officers.

[Bolduan]: Chief Daniel Hahn, there echoing a sentiment that seems to be shared by police activists and politicians alike.

We heard Rashad Robinson talk about this at the very top of the show. One alternative model that is now getting new attention now is based in Eugene, Oregon. The city has a different way to handle non-criminal calls with an organization known as CAHOOTS, which stands for Crisis Assistance Helping Out on the Streets. It dispatches teams that are specialized, specially trained and specialized in mental health as first responders. Joining me now is Ebony Morgan. She’s a crisis intervention worker with CAHOOTS. Ebony, thank you for being here. For folks and myself, explain a little bit more about what you all do.

[Ebony Morgan, CAHOOTS Crisis Intervention Worker]: Thank you so much for having us. Right out of the gate, I just want to send my condolences and from the team of CAHOOTS to George Floyd’s family.

As someone whose father died in a police encounter, I just want to be really sincere about that. CAHOOTS as a team has been around for about 30 years. We are made up of a medic and a crisis worker. We’re dispatched through the city, but through the police, fire, and ambulance dispatchers, and we respond to non-criminal calls. We did 20% of the calls in the area. Last year, about 24,000 calls. We can do welfare checks, death notifications. We can transport people to necessary services. One of the things that’s great about it is that out of our 24,000 calls, only 150 of them did we wind up needing to ask for police to assist us. So we can show up on the scene and assess the need and assess the appropriate interventions that will genuinely help our clientele.

[Bolduan]: Ebony, why does this system work? I’ve read that you all handle almost like 20% of the entire public safety call volume for your area. Why does this work? What is it?

[Morgan]: I think our greatest tool is the trust of our community. And then we are as strong as our community resources. So from our perspective, prevention and humanistic approaches are what really is effective. When people see us coming, they know that we are there to help. That’s just our whole goal. We lead with the question, how can I support you today? Or some form of that. And really figure out what the root of the issue is, rather than addressing what we see directly in front of us. It’s how did you get here? What do you need to help you get to a place where you can thrive?

And what if someone’s in a crisis, you know, just addressing it to a degree where they feel seen and heard can de-escalate by itself.

[Bolduan]: Absolutely. I find it fascinating, important to point out that, as you mentioned, you do call in police if that situation is required. So there is work with the police in your community when need be. But in looking at your model, Ebony, CAHOOTS, from what we all know, would not have been called to respond to the situation, specific situation that led to George Floyd’s death. So I say that by way of pointing out that this isn’t a cure-all, if you will, for all of the problems and longstanding issues and systemic issues that we are discussing here.

Why is this, though, do you think could be, could this be a part of the solution of reforming policing in America?

[Morgan]: Absolutely. I think that since it’s a systemic issue, the response and the resolution will also have to be systemic, and we will need more community supports and more, you know, unarmed mediation and decriminalization and a sense of restorative justice and truly mental health care nationwide to get to a place where we need less of that response. And then also in that system, as it’s reformed, I think there’s definitely a place for trained crisis personnel to respond and assess a scene and figure out what the appropriate response is. If it’s outside of our scope, we can call for that. We can call for an ambulance. We can call for backup police. But those initial eyes and objectivity, we have a lens that is not coming from, you know, we’re not armed. We just carry the tools that we need to assist. So we just approach with a really, as objective as we can be with a lens to make sure that we use the right tools to help the person we’re visiting.

[Bolduan]: Ebony, thank you for what you do. This has been around for 30 years, and it looks like it could be a really important thing for a lot of folks around the country to be looking at right now. The work that you do, the care that you give, and the trust that you have for your community. Thank you, Ebony.

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Transcript for Figure 5.14, Stabilization Center Tour

[Holly Harris, Stabilization Center Program Manager]: Hello and welcome to the Deschutes County Stabilization Center. The Stabilization Center serves children and adults who are in need of mental health crisis supports and stabilization. We welcome individuals to walk in who are experiencing a mental health crisis, or they can be referred by law enforcement or other community partners.

Most individuals who come to the Stabilization Center receive a crisis assessment in one of our five intake rooms. The purpose of this is to assess for risk and determine each individual’s needs. We offer connection to additional community resources as well as appointments for ongoing mental health treatment and medication when appropriate.

An additional service we offer for those who qualify is Adult Crisis Respite. This is a voluntary, five-recliner, short-term respite unit for adults experiencing a mental health crisis. This area provides a quiet and peaceful environment for individuals to stabilize and get connected to the appropriate community resources. To qualify for short-term respite, a crisis assessment is conducted and a determination will be made for admission to respite.

If the clinician and the individual determine additional time is needed to stabilize, they may be admitted to the Respite unit if the following criteria are met.

• The person is voluntary and willing to participate in the admission process.
• They are in need of mental health services and not aggressive or assaultive.
• They are mobile, able to communicate, and not known to have a major infection or disease in the communicable stage.

Other services that are housed at the Stabilization Center include:

• civil commitment investigations
• case management
• peer support
• forensic diversion program
• mobile crisis assessment team
• co-responder program
• crisis walk-ins

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Transcript for Figure 5.16, Assertive Community Treatment — Introductory video

[Music.]

[Jimmy]: I went to a Judy Collins concert with my mother and I had a great time, so that’s that shows that – I went to Charlotte and saw Heart and had a good time – so that shows that I can get out and I can be a part of the community. I just want to be a part of the community like everybody else.

[Music.]

[Female Speaker]: Tell us what that was, Jimmy.

[Jimmy]: That’s Beck’s Bolero.

[Jimmy]: There’s some famous people over the years who have had mental illness too, and they’ve learned to cope with a mental illness, and I just want to cope with mine and live out a good life.

[Music.]

[Narrator]: This South Carolina native, whom we will call simply Jimmy, has been struggling to cope with his schizoaffective illness for over two decades.

[Jimmy]: I went through a lot of hospitalizations. I went through 30 or more hospitalizations. I’ve been diagnosed paranoid schizophrenic, borderline psychosis, and I’ve been diagnosed manic depressive. And I think I have a brain disorder caused by a chemical imbalance in the brain.

[Narrator]: Before he was stabilized, in part with the help of medication, Jimmy’s thoughts tortured him. He heard voices, suffered from delusions and fits of temper, and sometimes, devastating self-destructive impulses. Jimmy’s mother, Jessie.

[Jessie]: You know, you’d get up in the middle of the night and the lights would all be on and the TV would be blaring and things that maybe don’t sound that bad, but when you have to live with it.

[Music.]

[Jimmy]: This is relaxing. Oh, my gosh. I’m thinking about getting the great, putting that picture right, that I have right there, that I have right there, up in here. Up in this room. Add a little more color.

[Narrator]: Thanks to a program for assertive community treatment called PAC, Jimmy now lives in his own one-bedroom apartment.

[Jessie]: He just seems to be much more stable. Now he does his shopping and does his cooking, but he calls me up and tells me he’s cooking this. And he’s still, to me, he’s very dependent on someone, though. He needs that person to help him.

[Andrea Boland, Case Manager, OUTREACH]: Jim, good morning. How are you? Okay, we’re ready to do some grocery shopping. I want you to go through your refrigerator and look in your freezer and check real carefully and make up a grocery shopping list.

[Narrator]: In Outreach, a packed model, staff spend about five hours a week with Jimmy in multiple contacts. A melding of support, teaching, problem-solving, and therapy.

[Music.]

[Barbara Julius, Director, OUTREACH]: OC nothing, Almeda nothing. Patty, she gets her medications Monday through Thursday today and she’s a one-to-one with Andrea; we give her a phone call at night to remind her to take her evening medicines.

[Narrator]: It’s a non-traditional approach. Rather than individual caseloads typical with most mental health clinics, the team shares total responsibility for the entire client population. The team of ten mental health professionals meets daily to review each client, but most of the direct client work goes on outside of the office.

[Julius]: Good morning. I’ve got a present for you.

[Client]: Oh, thank you.

[Julius]: Let’s see. Doesn’t your place look nice?

[Narrator]: It’s a kind of therapy to go where no problem is too much. PACT Director Barbara Julius.

[Julius]: What makes mental health might not just be a visit to your psychiatrist, it might also mean having your entitlements in place or it might mean having your rent paid on time. It might mean knowing how to go grocery shopping. So instead of meeting with a person and talking about how they’re doing, how they feel once a month or twice a month, what we do is everything that it takes to keep people in the community living independently.

[Narrator]: Providing assistance with social relations, employment, and basic needs like housing and food.

[Boland]: That corn looks pretty good. What’s the price on that? It’s not bad for three fresh ears.

[Narrator]: Treatment strategies are tailor-made for each client, including facilitating healthcare.

[Boland]: I’ll be right behind you.

[Narrator]: Over the years, clients remain in the program even though their need for services may fluctuate.

[Julius]: Some people come into this program needing all of those services, needing three or four staff interacting with them on a daily basis, lots of phone-call support, lots of emergency crisis intervention. And as they see that support there, they get better. So, that people who once were in this program needing three, four, five interventions a day, every day – might at this point come in weekly for a med refill. We don’t fire people when they get too sick, you know, that’s a key point for us, but we keep them all. They’re all here and we take responsibility for that treatment, and really are willing to try almost anything that it’ll take to support them in getting better.

[Narrator]: This holistic treatment concept, with its shared team responsibility, hands-on individualized service, and lifetime commitment to clients, makes Assertive Community Treatment unique.

[Boland]: It’s extremely rewarding for me because I can see changes; I can see the impact that we’re having. I know that what I do each day really makes a big difference, that’s why I’m here. I do it because it’s worth doing.

[Client, speaking to case manager]: My mother raised the seven of us, right? My father didn’t do nothing but bring in the paycheck. Here you go.

[Narrator]: The intensity of involvement with clients demands a low staff-to-client ratio, one staff to 10 or 12 clients. Low staff ratios pay off, reducing inpatient hospital days by as much as 85 percent. Reduced hospital admissions mean fewer crises, but because of the close contact and constant availability of staff, when a crisis does erupt, the client gets the benefit of early, personalized intervention.

[Relative of client]: He was okay during the evening last night. He was threatening yesterday to break the windows out. Now, he’s still saying the same complaints from yesterday that the pressure’s on. The voices are worse. That’s what’s happening. He’s been working up to this over the last 10 days.

[Client]: I don’t know what I’m going to do. I have to go someplace. I just can’t stand that boredom. I know I hurt myself. I heard somebody or something.

[Narrator]: It’s a rough road for clients and families in crisis, sometimes involving the court, the police or sheriff, neighbors and landlords, hospital emergency room personnel, and 911. Not with PACT. The team handles it all.

[Music.]

With the nurse’s guidance, clients prepare their own medication for the week, and all staff share in making daily morning and evening medication deliveries for those who need it.

[Boland]: All right, you take that, and you take this. It’s nice and cold, isn’t it?

[Male Client]: I already feel like I’m whistling Dixie.

[Boland]: You do?

[Boland]: You load your Depakote?

[Yolanda, Female Client]: Yeah, I used to take three Depakotes at night, and now I take two.

[Boland]: And the reason he did that?

[Yolanda]: The memory.

[Boland]: Your memory. To increase it?

[Yolanda]: No, to decrease it.

[Boland]: To decrease your memory?

[Yolanda]: No, I need to make my memory come back.

[Boland]: Okay.

[Yolanda]: I get paranoid. I think people are after me. I think little creatures are bothering me. And I see things on the floor or on the ceiling. I don’t see it on them anymore. If I take my medicine, I’m fine. If I don’t take them, I get sick, and I end up in the hospital.

[Case Manager]: And tell me why you’re taking the Depakote.

[Yolanda]: The Depakote is for mood swings, and the Mellaril is for clear thinking.

[Case Manager]: When you spoke with Dr. Christie last, you said that you weren’t hearing voices.

[Yolanda]: No, I wasn’t hearing voices. I’m just having a hard time. I’m sleepy.

I was in and out of hospitals because I couldn’t face the fact about being mentally ill. I cried a lot. I didn’t want to take my medicine. I said, ‘I don’t need this medicine.’ This medicine’s not for me. This mental illness will go away. It’ll go away.

[Narrator]: But the mental illness schizophrenia did not go away. Yolanda’s mother, Lillian.

[Lillian]: From the time she was 16 until give or take 18, I could say in the average, she’s been in the hospital about 20 or 30 times within that length of time. After she got into outreach, it was a tremendous burden relieved off of me because at least they would check on her; they would make sure she took a medication; they would make sure if she had any place to go to the store. And I feel so much better.

[Music.]

[Yolanda]: I did pretty good in the program. I came out and then in and out of hospitals sometimes, too. But I have moved into my own apartment for the first time.

[Music.]

[Yolanda]: That’s nice. You can do what you want to do in your own apartment. You don’t have to share anything with nobody. If you want to walk around here with your bra and your underwear on, you can walk around with your bra and underwear on. Can I say that?

[Case Manager]: That’s up to you. That makes it more interesting.

[Narrator]: Now, Yolanda is taking steps toward even greater independence, studying for her GED and learning to handle her own finances with PACT Team help.

[Yolanda]: Can I open the bank account in the Bi-Lo in Savannah Highway?

[Yolanda to case manager]: I can.

[Case Manager]: Okay.

[Jimmy, at PACT BBQ]: This is delicious. Delicious. This is delicious.

[Music.]

[Narrator]: Both Jimmy and Yolanda experienced the documented benefits of PACT with fewer symptoms and hospitalizations, and greater independence.

[Jimmy]: That’s my favorite. That’s a guitar. That’s the ocean. That’s notes. That’s a rose. That’s a rose. That’s greenery. That represents the forest.

[Narrator]: Programs for assertive community treatment offer some comfort and hope.

[Bank employee]: Are you going to be the only signer on this account?

[Yolanda]: Yes.

[Bank employee]: The minimum to open the account is $50. And then our least expensive checks are $11 and $20.

[Yolanda]: Without outreach, I’ll be back in the hospital. I know I would. Sometimes I get upset about certain spats about the program, but it’s best. I wish the whole country could get it. Because it would be very great for millions. It would probably make them feel like a whole new brand new person.

[Jimmy, reading]: A mother in her ninth month, ready for a girl or boy, eight pounds of love, a bundle of joy. To think that a woman can have a man’s child and that child can grow up to be a successful doctor, lawyer, helper, etc.

[Jimmy]: And outreach gives me confidence because I think that it’s given me independence, and that it’s given me the freedom to be myself. And when I’m talking straight, I’m making sense. And when I’m making sense, I’m making progress. And when I’m making progress, I’m getting to my goal. And my goal is to be an educator. I would like to educate people. That they can do something with their lives. That there is hope. There is hope out there. And there is, you know, with hope comes faith and with faith comes hope. And you can do anything you want to. If you just get your mind in the right order, you know, you can do anything.

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Transcript for Figure 5.17, ReImagining Public Safety – Q&A with a Minneapolis Behavioral Crisis Responder

[Shamso, Behavior Crisis Responder, City of Minneapolis]: My name is Shamso and I am a Behavior Crisis Responder. BCR is first responders. We’re dispatched by 911 and we deal with a nonviolent mental health crisis. You know, we come in there, we actively deal with a crisis and connect them to resources. Sometimes people just want to talk.

And sometimes it’s just like somebody called and they were concerned about you. It’s kind of cold outside. We can connect you to shelters if you need to. Sometimes they say no, then we’re like, OK, so then do you need blankets? Do you need snacks? And a lot of times people are like, yep, I’ll take that.

I have family members that suffer from mental health crisis as well as substance use disorder. There is a lot of stigma attached to receiving services in our community. I want to actively be part of a team that is working to destigmatize mental health, but also removing barriers and reducing them for non-English speaking recipients. I am Minneapolis.

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Transcript for Figure 5.21, Police officers take course teaching de-escalation techniques

[Alaric Tucker, police officer, Englewood Police Department]: When we first approached him, he was very combative, didn’t want to talk.

[Leah Mishkin, reporter]: Officer Alaric Tucker remembers the call. It was for a person with mental illness who refused to take his medication and the situation was escalating.

[Tucker]: All the officers were in there just, you know, ready to go; then the sergeant came on scene and it’s like tranquility just came over this dude.

[Mishkin]: Sergeant Lester Martin says it was as simple as speaking about basketball.

[Lester Martin, police sergeant, Englewood Police Department]: He really enjoyed basketball and we had an argument over who’s better, LeBron or Michael Jordan, etc. And then that got him to trust me, and after 45 minutes to an hour of conversation, it was, ‘Listen, I understand you haven’t been taking your medication, maybe we should get you some help,’ and he agreed.

[Tucker]: It was obvious that he had to have gone through some course like this before.

[Mishkin]: The course is Crisis Intervention Team. It brings together law enforcement officers and mental health professionals over a five-day, 40-hour period to learn from each other through various exercises.

We listened to a session on verbal judo which talked about body language and listening skills when speaking with people going through a mental health crisis. For example, avoiding words like ‘come here’, ‘calm down’, and ‘because’ – those are the rules.

[Amie Del Sordo, VP of Hospital and Community Services, CarePlus New Jersey]: It’s difficult for someone who’s in crisis to be able to turn that off; you can’t turn your voices off – they’re there forever, so it really allows them to empathize and understand how to really better work with them.

[Mishkin]: If you look around the room, you’ll notice pill bottles filled with candy on the desk – that’s another one of the training exercises. Each person has to take the fake medication several times a day to understand what it’s like for someone living with mental illness.

Sergeant Martin says what happens is the participants forget to take them a lot of the time.

[Mishkin to Martin]: In your situation it was a matter of taking medication.

[Martin]: Correct.

[Mishkin]: So you could put yourself in a more clear mindset.

[Martin]: Absolutely. Now you understand what they go through on a daily basis. It’s bridging the gap, is what we’re really trying to do.

[Mishkin]: Because one in ten calls for police service are from people with severe mental illness.

[Tucker]: Prior to coming to this, those kind of situations, you know, the guy got tased. A guy had to go to the hospital because, you know, he had to be physically restrained and we had to involuntarily take him up in handcuffs because, you know, we just couldn’t get him under control. Officers got hurt, things like that.

[Martin]: There are times you have no option.

[Mishkin]: And the risk of being killed during a police incident is 16 times greater for those individuals.

[Martin]: We don’t want to get hurt. We don’t want to hurt anybody. So it’s easier to talk to somebody.

[Tucker]: All officers should have to go through this training because the mental health population is just increasing and increasing. It’s rising.

[Mishkin]: In less than two years, 155 mental health and law enforcement officials have been successfully trained in Bergen County, and that number is expected to grow. In Paramus, Leah Mishkin, NJTV News.

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Transcript for Figure 5.24, Alien Boy: The Life and Death of James Chasse – Trailer

[Voice 1]: And you were feeling sympathetic towards Mr. Chasse then weren’t you?

[Voice 2]: He was a guy that you’d think he’s going to write some great poetry; he’s going to do some great art.

[Voice 3]: This person was part of the original punk rock movement.

[Voice 4]: He was dealing with inner demons.

[Voice 5]: He was frightened all the time. He told me that he was living in hell; help me, help me! And it wasn’t Jim Jim anymore.

[Voice 6]: It’s very difficult for people to recover from a mental illness and he was managing things well,

[Officer]: Ten years of being a police officer and I’ve never seen anybody look at me like that with the sheer terror in their eyes. I’ll never forget seeing that face and I knew he was gonna run.

[Voice 7]: Jim was in a bad shape; he needed to be hospitalized again. We felt he had gone off his meds.

[Voice 8]: I looked up just as the four men were hitting the pavement.

[Officer]: If you try and bite me or kick me, it’s gonna be really bad!

[Voice 9]: Take some pictures. Here, take some pictures.

[Voice 10]: Kicked him a few times, hit him three times, screaming, “Don’t kill me, don’t kill me, don’t kill me.”

[Voice 11]: It is my opinion that if he had been transported to the hospital; he probably would have survived.

[Voice 12]: I don’t believe that a jail cell is the right place to help mentally ill people deal with their problems.

[Voice 13]: I don’t believe for a second that there was ever any ill intent on any of those three officers.

[Voice 14]: It sounded to me like he had been beaten to death.

[Voice 15]: It didn’t seem to me that he was urinating. He was standing there looking like a scruffy homeless guy.

[Voice 16]: Picked up the paper. My sister called me.

[Voice 17]: That was Jim Jim.

[Voice 18]: Jim happened to be mentally ill, but he wasn’t beaten because he was mentally ill, and the cover-up didn’t happen because he was mentally ill.

[Voice 19]: You know, I look at what happened to Jim Jim that day and I look at the city’s response, and I just say it’s not Jim Jim who’s crazy.

[Voice 20]: Today, if you were met with the same circumstances, would you chase him down and do the same thing that you did?

[Voice 21]: Assuming none of this were happening?

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Transcript for Figure 5.25, Learning About Police-Mental Health Collaboration Programs

[Mike Sauschuck, Chief of the Portland, Maine, Police Department]: I’m Mike Sauschuck, I’m the Chief of the Portland, Maine, Police Department. We’ve had a police mental health collaborative program since the late 90s, and it would be commonly referred to as a co-responder model, which means that our sworn uniform law enforcement officers are responding to emergency calls for service with trained mental health professionals. So with the idea being that they walk through the door as a team, as a partnership, really the core functions of what we do in law enforcement, we know that the majority of what we do day to day involves some kind of nexus to behavioral health issues. Behavioral health issues being substance use disorders and mental health issues. So if we’re not addressing those two problems accordingly, then we’re not doing our jobs effectively.

Well, I was blessed really to be in the first Crisis Intervention Team training that came to the state of Maine back in 2001. So I’ve really been operating within the system since it began. And then after that as a Chief. About five or six years ago, we made the commitment that I wanted all of our officers certified because I believe it’s that important for everything that we do.

The very first thing we wanted to do is train ourselves internally. So, 100% of our officers are Crisis Intervention Team or CIT certified.

You know, when we provide our officers with additional skills around communication and de-escalation, that makes everybody safer. That makes our consumers, our clients safer, our community safer, and it also makes officers safer.

I can tell people, and I’m proud to say I was in the first, you know, CIT class in the state of Maine, I can tell people where we were in 1997 when I started in comparison to where we are today. I’m familiar with the things that come up when you’re trying to change the culture of not just an agency but of a profession. And that’s not an easy thing to do. So, change is a scary thing for people. So you just have to be able to walk them through the steps and explain why this is so important. And I always come back to two simple facts when you want to change anything in law enforcement. And you change culture by focusing on officer safety issues and resource allocation issues. So, when I’m talking to other chiefs, I always have conversations around those two items.

When we talk about officer safety, I tell people, the chiefs, that your officers are going to be safer because of these programs, and your clients are going to be happier. And then you start talking about resource allocation. You know, from an agency standpoint, 30,000-foot view, I’m looking at our officers and what they do day-to-day. It may be a formal workload analysis. It may be just talking to street cops about what you’re doing, what are you facing out there, what frustrates you. And I think if a chief walked into any locker room in any community in this country, they’re going to, again, come back to those behavioral health issues. So we need to do a better job providing some tools.

And the vast majority of police departments across the country are very small, and they’re very rural. So police chiefs say, I don’t have the officers or the money to send people to a 40-hour crisis intervention team training. I can’t afford to do it, is what I hear. And my response is always, you can’t afford not to do it. It’s that important. It’s a core part of our mission. We need to do a better job. And I don’t want those chiefs to be standing at a podium answering questions about why their officers aren’t trained, why couldn’t they afford to send somebody to a week’s worth of training. I’ve got three cops. I can’t break somebody loose. But if you’re going to the same house 30 times in a month to deal with the same problem over and over and over again, then you’re losing resources on that side as well.

You know, something I also always say is, you’re going to pay now or pay later. Pay now, train your officers, treat people with respect, and then you’re not paying later with the criminal justice system, with the hospitals, and things of that nature. That revolving door is not the way to do business.

You know, to have the training is one part, but you have to have the relationships. You have to have the collaborative partners in your communities to make this work. So how is that scalable? I think it’s very scalable in the sense that chiefs need to branch out. They need to build these relationships, whether it’s a single practitioner that may be in their community or may be in their county in some cases. So take care of it on the front end, front-load this issue, and work with your people. Everybody’s going to be happier for it.

Licenses and Attributions for Transcript for Figure 5.25, Learning About Police-Mental Health Collaboration Programs

Transcript for “Learning About Police-Mental Health Collaboration Programs” by Office of Justice Programs is included under fair use.

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Transcript for Figure 5.27, Bellingham Police Perspective Project / 20E5: Responding to a Behavioral Health Crisis

[Officer Serad]: I heard over the radio that he was attempting to start a car that he believed was his, and that’s really why I became involved. I was thinking there might be a behavioral health component to it, so I happened to be in the area. I saw several officers responding there and I pulled up and made contact with him.

[Music.]

[Officer Knutsen]: Welcome back to the Perspective Project. I’m Officer Knutsen, and in the last episode, I got to introduce you to our behavioral health team, Officer Serad and Laura Woods, our behavioral health specialist. The day before we filmed those interviews, Officer Serad responded to a call where somebody was in crisis and officers had to show up, try to keep everybody safe, and work through the de-escalation process. I was able to get body camera footage from the call to show in this episode. A couple of things to note about the footage you’re about to see. First, when officers actually showed up to this call, it took about 24 minutes from the time they arrived on scene to when they resolved the situation. So for the sake of time here, I’ve shortened that down.

Second, some of the language is fairly graphic, but I felt it was important to leave it in because it shows how heightened and volatile the call started and then where we ended up. And third, there might be points where the audio cuts out or there’s scenes that have been clipped, and that was done intentionally to try to hide the identity and protect the individuals that were involved in this call. While we want to be able to show what de-escalation looks like, we also wanted to be as respectful as possible to the people involved in this call. So with that, let’s take a look.

[Serad]: I got 911 calls made by a couple citizens that were in the area and were watching this gentleman try to break into a few cars. At some point, he was throwing rocks at some vehicles. I heard over the radio that he was attempting to start a car that he believed was his, and that’s really why I became involved. I was thinking there might be a behavioral health component to it. So I happened to be in the area. I saw several officers responding there, and I pulled up and made contact with them.

[Audio from body cam footage]: Stop. We don’t want to hurt you, we’re not going to hurt you. Drop the rock. It’s the Bellingham Police Department. He’s dropped the rock. We’re calling him a citizen. Okay, he’s sitting down now, but I can’t see his hands.

[Serad]: There are numerous concerns, and you’re thinking about your safety, you’re thinking about traffic at the time. It’s right on Meridian Street there. You’re thinking about the folks inside the businesses and the complexes in there. You’re thinking about the reporting parties, the ones that are calling 911. In this case, I was also thinking about people that might be in the vehicles he was trying to steal, and in regards to our safety, if he was willing to throw the rocks at our patrol cars or try to harm us. And really, like any call, trying to figure out what the end goal of this person is, and those are always going through your mind every call you go to.

[Audio from body cam footage]

[Radio dispatcher giving directions.]

[Officer 1]: Hey just drop the rocks so we can talk with you, okay? Can you sit down for me please so we can talk with you? Can you sit right there and just talk with us, please?

[Officer 2]: He said he’s holding his breath, he’s still reaching toward the ground though.

[Officer 1]: Are you willing to talk with us? He said he’s willing to talk with us.

[Radio dispatcher.]

[Suspect]: [Unintelligible.] Don’t come towards me. [Unintelligible.]

[Officer 1]: Hey, bud, can we just talk with you?

[Suspect]: Get the fuck out of my face.

[Officer 1]: Can we just talk with you?

[Officer 2]: Get down on the ground.

[Suspect]: Who’s the big dog, bitch?

[Officer 2]: Get down on the ground.

[Officer 1]: We just want to talk with you, man. All right. Thank you. We don’t want anybody getting hurt, okay?

[Suspect]: Get the fuck off, Dick.

[Officer 1]: We just want to talk with you, man. We just want to talk with you.

[Serad]: When I go to calls like this, I am concerned that they could end up in the news and look poorly on our department and the officers on scene there. It’s a weekly thing that seems like once a week I go to a call, and that is one of my concerns, absolutely.

[Audio from body cam footage]: Hey, what’s your first name? I’m Zach. Okay, listen, we got a bunch of calls about you. That’s why we’re here. We don’t want to bother you too much. No, can we? Can we? Hey, can I? Can I get you some? Hey, can we get you somewhere? Can we get you somewhere? Anywhere? I don’t know.

Dude, I’m the behavior health officer. I deal with housing. That’s what I do all day long. I’d love to, but can you sit down with my partners and I walk up to you at least? All right. Okay, I appreciate that, man. But hey, listen, you got it. You can’t. Hey, hey, listen, you can’t get on my partner’s like that, though. So what else can we do for you to keep you from throwing stuff or getting into cars?

I got juice back here. You want some juice? Stay there for me. You want some juice? Alright. I got grub for you, man. There you go, man. Yeah, there you go, dude. Check it out. Need some food? You’re okay. There you are. Drink up. There’s some Nutter Butters. They’re the best. I like your tattoos, man. Those are clean. Where are you from originally? How long have you been there? I grew up there and lived there. What brought you to Bellingham? My ex-girlfriend. Ex-girlfriend. That happens. That happens. Oh, he was. Yeah. He was stationed there. That’s a cool place, man. Yeah, I’ve never been there. I’ve always wanted to go. How are you feeling today? What’s going on today? Good. I mean, overall, you seem frustrated. It’s okay to be frustrated. Yeah? You need some more food? Are you okay? You want some other grub? No, you’re okay? All right. I got some more food back there if you need it. So what’s going on today, though? How long? I guess let me back up. How long have you been in Bellingham for? Eight months. Okay. How many police contacts you have with us? So check it out. This is your eighth month here, right? It’s their first contact. Something’s going on with you. That’s what I’m worried about. This isn’t you, right?

You don’t do this every day because we’d have more contacts with you, right? Would you be willing to go to the hospital with me? I’ll go with you. I’ll stay with you. Get you all checked in. Yeah? You don’t have to stay. No, you don’t have to. No, no. Don’t stay with me. No. If I leave you there, it takes a long time. I’ll take you in. I’ll get you checked in and get you away from the other people that are sick. I’ll get you back into a different area back there. And you and I can sit down and talk with someone there, let them know what you need. What do you think about that? You want to work with me on that? Yeah. All right. Keep drinking. Keep eating some of your food and drinking some of your drink there, man.

So, my partner’s got to come cuff you up. Are you okay with that? Just don’t. She’ll, hey, she’s a specialized cuffer. If we need, yeah, she’ll get you good. But just to get you to the hospital, yeah? Just stay seated for me. Keep drinking your Gatorade there. You all done? Okay. You want any more of your crackers? Okay. So, if you’re good to go, man, just hands behind you. Stay seated. Stay seated. Just hands behind your back, okay? Stay seated. Very good. I appreciate it. Hey, we’ll bring those Nutter Butters with us if you want me to bring them. Yeah, well, we’re going to hang on to these, okay? Okay. Yeah. Officer Suraj, he’s a rookie fan, so he’s got a whole bunch in his car. I appreciate you talking to us, man. Let’s try to work on this stuff. I’m going to go there with you, and we’re going to sit down and talk to the nurses, yeah? Yeah. Hey, thanks for cooperating, man. You have anything in your pockets at all, sir? No.

You want your window cracked a little bit, partner? Yes, please. Okay.

[Serad]: De-escalation really does come down to the individual. Ultimately, it’s up to that individual how they want to respond. I think, especially now, the past couple of years, our department has done an incredible job with de-escalation, but really, we have to go off of how that person is responding to us.

[Audio from body cam footage]: Are you okay? I want to take him to the hospital, give him some help. Are you okay with that? No, I was saying, good job. Did the officers get you? Yeah. Thank you so much, you guys. Thank you. Appreciate you.

[Serad]: Normally, once that person’s in the jail or the hospital, the patrol officer’s role is done. They get back in the car, and they’re stuck to their screen. It’s on to the next call. In my role with the behavioral health team, we’re able to visit the hospital. They know us very well up there, and I walked in there and sat in the same room with them at the hospital for over an hour. I was able to connect with his mom and learn a lot about him, that I can notify patrol just in case he has another crisis incident in the community. He said his interactions with police in the past were fairly negative, and he’s never been treated like he was with us that day, and that was a good feeling when he said that.

Licenses and Attributions for Transcript for Figure 5.27, Bellingham Police Perspective Project / 20E5: Responding to a Behavioral Health Crisis

Transcript for “Bellingham Police Perspective Project / 20E5: Responding to a Behavioral Health Crisis” by Bellingham Police Department (WA) is included under fair use.

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Transcript for Figure 5.28, Behavioral Health Unit: Ride along with a Behavioral Health Response Team

[Officer Billy Kemmer, behavioral health unit officer, Portland Police Department]: BH4, we can take cover. Hey, you alright? You okay?

[Sarah Scafani, mental health crisis responder, Portland Police]: We just want to see if there’s anything that we can help you with.

[Kemmer]: What do you think you need?

[Patient]: With mental health and the real bad episodes, you guys have literally showed up and saved my life.

[Kemmer]: I’m glad that we can help.

[Music.]

[Kemmer]: This is what policing looks like now. When people talk about police reform, we’re trying to be mindful of how we interact with the community, of populations that need a different approach.

[Scafani]: Building relationships with people, being an advocate for them.

[Kemmer]: To help someone at their worst time, it’s kind of my dream job.

Hi, I’m Officer Billy Kemmer, I’m with the Portland Police Bureau’s Behavioral Health Unit.

[Scafani]: My name is Sarah Scafani, I’m a Mental Health Crisis Responder with the Behavioral Health Unit with Portland Police.

[Kemmer]: Behavioral Health Response Teams are co-responder models with police officers and clinicians, so I’m actually partnered with a mental health clinician all day.

[Scafani]: My partner is Billy Kemmer.

[Kemmer]: For the BHU, we’ve been doing this for four and a half years. You get to see people in a light that’s different than I think a lot of other people ever see.

The bad news is he’s going to just be on the streets with his mental health issues. Behavioral Health Unit has five Behavioral Health Response Teams.

[Scafani]: There’s one for Central Precinct, East Precinct, and North Precinct, and then two specialty teams.

[Kemmer]: Our job is to engage and interact with folks who are experiencing mental health issues.

[Scafani]: We carry a caseload of individuals who are generating frequent police contact due to their mental illness, and so we get those referrals from patrol officers.

[Kemmer]: So if patrol officers come across individuals who are experiencing crisis or mental health issues and they’re kind of at a loss or they need extra assistance or someone to follow up, just deeper follow-up on that person, they’ll send us the referral and why, and then it gets assigned by the sergeants.

[Scafani]: And so our goal is to go meet those individuals out in the community and try to mitigate the contact that they’re having with law enforcement, and get them connected to the appropriate resources.

[Kemmer, to person on street]: All right, we’ll see you tomorrow, okay?

[Kemmer]: There’s a cross-section of folks who exist where criminality is an issue, but mental health or addiction are very prevalent or the driving forces of their behavior. So the Behavioral Health Unit was designed to get to the core issues that people are facing so that we can get effective results.

[Scafani]: Billy and I are the houseless individual caseload.

[Kemmer]: Folks mainly living outside. So part of what we do is take information from reports from patrol and try to locate those folks.

[Scafani]: If we find them, assess them, help them get to the hospital if they need to stabilize or whatever kind of service that would help them mitigate their crisis.

[Kemmer, to person on street]: Can you show us on the wellness check at Broadway and Harveyville? Do you need any help of any kind? Just some water. Okay.

[Scafani]: Sometimes while we’re driving around, we do respond to active 911 calls as well and try to come up with some sort of safety plan for that individual.

[Kemmer]: PH4, we can take over. Did he say anything about what she was, what was going on with her? Hi.

[Scafani]: For this individual, when we approached after we got the 911 call, she was pretty immediately, clearly disorganized, not a lot of what she was saying was making sense, pretty delusional as well.

[Scafani, to person on street]: How are you getting food?

[Kemmer]: Her inability to answer any sort of safety questions when she ate food, anything like that. Due to that, due to her level of disorganization, her vulnerability in the community, we determined that she met hold criteria.

[Kemmer, to person on street]: We’re just concerned that you’re not able to take care of yourself, so we’re going to get you to the hospital so you can get help.

[Kemmer]: Police officer hold or a director’s hold, which are written by qualified mental health clinicians. The criteria is really high, but essentially it’s if we believe they’re a danger to themselves, a danger to somebody else, or unable to care for themselves, we have the legal authority to take them into custody and get them to a hospital for assessment.

[Scafani]: And the doctor then will determine what the next steps are for her. Now we at least know who she is, and if we interact with her again in the community, we have a little bit of history.

[Kemmer]: Whatever connection we make, we try to take that connection to the next level. We’re handing that person off to whatever system is going to be able to take the reins and move forward with them, so it’s not just a drop off and hope for the best. So whether it’s hospital, Service providers, Clinics, or even jail, we want to follow up to make sure that person is getting connected beyond just that entryway.

So all officers get 40 hours of CIT training. It’s crisis intervention training. It’s communication. A lot of de-escalation. How to interact with folks who are in high-crisis situations. The BHU developed enhanced crisis intervention training, which is volunteer officers who are selected to go through another 40 hours of training and then ongoing in-service. The Behavioral Health Unit, where I work, BHRT officers have the foundational 40 hours. We are all ECIT certified. We also have to certify in other trainings. Suicide intervention training. Trauma-informed care training. Involuntary commitment program training. And a threat assessment training. Specific things that we have to certify in order to hold this position.

This is my partner, Sarah.

[Patient]: Oh, you’re the partner.

[Scafani]: I’m a social worker.

[Patient]: Social worker. That’s who I need to see the most. Yeah.

[Scafani]: Between my officer partner and I, we come with different backgrounds and trainings. And so having these two different approaches can be really helpful.

[Kemmer]: Having a police officer and a clinician partnership, we were able to draw from each other, you know, the expertise from both sides of the partnership in order to find better solutions for people.

[Scafani]: You know, sometimes someone doesn’t want to talk to me because I’m a mental health professional and they’d rather talk to my police officer partner or vice versa. And the fact that we have like the flexibility to do that is really great.

[Kemmer]: It allows us to respond to a wider variety of folks.

[Kemmer, to person on street]: Hey, you all right? You okay?

[Kemmer]: In this job, you are able to redirect someone’s absolute worst day into something that can be positive, somewhat positive, at least a different solution for what they thought was going to be the worst outcome possible.

[Scafani]: All right. Thank you.

[Scafani]: Getting them food, clothes, blankets, into a shelter, those immediate basic safety, safety, and daily life needs or getting them connected to housing and working with them until they get permanent housing and kind of just being that support for them until they get connected to longer term supports. And so you get to build that relationship with individuals.

[Patient]: At 2:30, you’ll be here.

[Kemmer]: 2:30? Yeah, we’ll come knock on your door.

[Kemmer]: This is what, you know, policing looks like now. And when people talk about police reform, like, you know, we’re trying to be mindful of what we’re, you know, how we interact with the community, populations that need a different approach. The more that we interact in this way, the more that we’re approaching things holistically, the better outcomes we get for people who are caught in this revolving cycle.

[Scafani]: I really think the community needs to know about the work that we’re doing because it is a resource that can be helpful for those who are in crisis or need services.

[Patient]: Every crisis I’ve ever had with mental health and the real bad episodes, you guys have like literally showed up and saved my life.

[Kemmer]: I’m glad that we can help.

To help someone in their, at their worst time is a very powerful place to be. It’s a fascinating job and it’s a fascinating window into the human experience. And, yeah, it’s kind of my dream job.

Licenses and Attributions for Transcript for Figure 5.28, Behavioral Health Unit: Ride along with a Behavioral Health Response Team

Transcript for “Behavioral Health Unit: Ride along with a Behavioral Health Response Team” by Portland Police is included under fair use.

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Transcript for Figure 6.1, Prosecutors: 83-Year-Old Used Walker To Kill Nursing Home Roommate In Haverhill

[Male news anchor]: An 83-year-old man charged with murder, accused of beating his nursing home roommate to death. The suspect’s son says his father suffers from severe dementia.

[Female news anchor]: And the man who died was engaged to be married. WBZ’s Louisa Moller spoke with his fiancé.

[Beatrice Duchesne, victim’s fianceé]: They said that they had sad news.

[Louisa Moller, reporter]: Beatrice Duchesne says a late-night door knock from police came with the news that her fiancé was murdered.

[Duchesne]: They told me about him being beaten. And I just stood there in shock. I couldn’t even cry.

[Moller]: 76-year-old Robert Boucher, pronounced dead after police say he was brutally beaten by his roommate at this Haverhill nursing home.

[Female voice, speaking about the suspect]: He’s not oriented. While he knew he was at the court, he doesn’t know the day, the month, or even the year.

[Moller]: On Monday, Jose Veguilla appeared before a judge. Investigators say a nurse at Oxford Manor found the 83-year-old holding a bloodied walker above a badly injured Boucher on Saturday. And police say when they tried to talk to Veguilla, he didn’t make any sense.

[Henry Veguilla, suspect’s son]: And we know he was having issues with medications and not taking them the way he should have.

[Moller]: His son telling reporters outside court that his dad suffered a traumatic brain injury last year and has severe dementia. He questions the conduct of the nursing home, which was the subject of a settlement by the Massachusetts Attorney General earlier this year. And also gets a much below average rating on Medicare.gov.

[Henry Veguilla]: How does an 83-year-old man have the time to do what he’s being accused of doing, and no one stepping in to intervene?

[Moller]: Now Veguilla is headed to Bridgewater State Hospital for a competency evaluation. Oxford released a statement saying in part, its staff acted quickly and appropriately in this matter. In Haverhill, Louisa Moller, WBZ News.

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Transcript for Figure 6.8: Jail Based Competency Treatment Program – San Diego County Sheriff’s Department

[Music.]

[Brooke Anarde, Program Director, JBCT]: I am Brooke Anarde, and I am the program director for the Jail-Based Competency Treatment Program at San Diego Central Jail.

We have a 30-bed unit of male patients who have been found incompetent to stand trial for mental health reasons. They have been court-ordered to participate in treatment in an effort to restore their competency so that they will have a rational understanding of their charges and the legal process, and effectively participate in their own defense. For some of our patients, having more of a visual experience like heart therapy can be more of an effective way to connect with them. We do want to foster overall wellness, fitness, and the importance of caring for their bodies.

[Marisa Hoskins, Psychiatric Nurse, JBCT]: Every day is different, so today what we’re going to do is we’re going to facilitate showers because we do have some patients that need help with their hygiene.

We also do lab draws, their weights, vital signs. We all work together as a team. We lean on each other and we help each other.

[John Reis, Deputy Sheriff]: This program is helping people who are suffering through a mental health crisis at the time. They’re seeing psychiatrists weekly, being provided medications that could help them through that process. It kind of helps them come back to a steady baseline.

[Anarde]: We also have mock trials. They’re very unique to the JBCT program. We want them to have an understanding of the roles of different people in the courtroom. And for some patients, role-playing is actually an easier way to learn that.

When someone is found incompetent to stand trial, everything is put on hold. So that impacts not only the alleged, but it also impacts potential victims, the jails, family members. By us being able to provide the competency restoration services, we can be a part of that pursuit of justice.

It’s amazing to see someone who comes in. Maybe they’ve been neglecting their hygiene, refusing medications. To be able to get them to a point that they are receiving all the care they need, and their bodies are healthier, their minds are healthier, they’re feeling worthwhile. There is nothing more rewarding to me than that.

[Music.]

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Transcript for Figure 7.4, Siyad | AVID Jail Project

[Siyad Shamo, incarcerated individual]: To a lot of people it might seem like mental health issues play a little role in people being incarcerated but, I think it plays a big role, man.

[Kayley Bebber, AVID Jail Project attorney]: An issue that we hear about frequently when speaking with inmates in jails in King County [WA] is that many inmates have to wait to have a mental health appointment for so long that they end up leaving the jail before they can talk to a provider.

[Shamo]: My name is Siyad Shamo. Currently in custody in King County, downtown. I recently got diagnosed at Sound Mental Health with PTSD [Posttraumatic Stress Disorder] and a severe case of PTSD and I came in here, and I told them about it. I told them what’s going on, I told them that I got diagnosed on the outs [outside]. I wrote them a kite. I told them my conditions were worsening…. Hearing voices. You know, I can’t pay attention. I can’t concentrate and I haven’t got no response back.

[Bebber]: He was scheduled for a psychiatric appointment eight weeks out, which is the wait time that most people at that jail have to wait to be seen by a mental health provider, and Siyad only spent two weeks at that jail. The average length of stay in most jails in Washington

is two to three weeks, so scheduling mental health appointments out two to three months results in denying care to many people who need it.

[Shamo]: I… to tell you the truth, it’s getting to the point where you don’t wanna do nothin’ about it no more you’re like, nobody cares, why should I care? It’s probably not that serious. Since they’re not really worried about it, why should I be worried about it?

[Bebber]: Another issue that we see across the state, and really across the country is that there’s not centralized oversight over jails, and there’s no uniform standards applied to jails.

We met with Siyad at two jails in King County he informed both jails of his diagnosis, his outside provider, his past treatment, and his current symptoms, and at the 1st jail he was housed in minimum custody, which means he can move around freely and interact with other people. The 2nd jail housed Siyad in administrative segregation or solitary confinement, which means that he was confined to his cell for 23 hours a day. And this is when study after study is concluding that solitary confinement is extremely harmful for people, especially people with mental illness.

[Shamo]: So you’re in your cell by yourself all day, you get an hour out a day, and sometimes, you might get your hour out at 1AM, at night. You know what I mean, it depends on where they start from. Sometimes you might get 8AM in the morning, so you don’t even know. You’re just thinking to yourself, talking to yourself. and this is hard man, it’s hard.

[Bebber]: So, the same person was treated completely differently by two different jails, in the same county, from one day to another.

[Bebber]: How long did they talk to you for?

[Shamo]: Like five minutes.

[Bebber]: Okay.

[Shamo]: …like five minutes, yeah. They just, they told me: Are you suicidal? Are you eating your food?

[Bebber]: Siyad received a response to his request for treatment the day before he was released. So, he didn’t receive mental health treatment from either jail.

[Shamo]: They’re not helping and even if they are trying to help, they’re not doing it on time, you know.

[Bebber]: Okay.

[Shamo]: So, I don’t know what to do.

[Narrator]: Follow Siyad’s story and other stories of people with mental illness in jails from the AVID Jail Project at Rooted in Rights on Facebook, Twitter, and Instagram or AvidJailProject.org.

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Transcript for Figure 7.5, Tallon | AVID Jail Project

[Tallon Satiacum, incarcerated individual]: I smile a lot, to be honest. I’m not an angry person. I’m not like how they said I am.

My name is Tallon Satiacum, dash 27-182, inmate at SCORE County Jail. I got fetal alcohol syndrome, bipolar. It’s just a list.

[Kayley Bebber, AVID Jail Project attorney]: My name is Kaylee Bebber, and I’m a staff attorney at Disability Rights Washington. I work on the AVID Jail Project.

Since the beginning of our program, we’ve met with hundreds of inmates with mental health issues. Many jails that we speak with don’t think that jail is an appropriate place for someone with mental health issues. They aren’t set up to be treatment facilities. But at the same time, that’s where many people are. That’s an unfortunate reality. And so that’s why there’s a number of safeguards in place for people with mental illness in jails.

So when someone comes into the jail who has a mental health issue, jail policy requires that there’s a health assessment with a mental health screening within two weeks. That didn’t happen in Tallon’s case.

So we met Tallon Satiacum in late spring, early summer of 2015. I requested Tallon’s jail and medical records, so I looked over those. He reported his symptoms and his diagnosis, the fact that he’d been taking medication about one month after he’d been at the jail. And it wasn’t until another month after that that he actually had the mental health screening and started receiving his medication.

[Satiacum]: I told them I needed pills. I needed medication, basically. Nobody listened.

[Bebber]: His symptoms kept getting worse and worse. He kept exhibiting behavior that appeared to be related to symptoms of his mental health issues.

The jail, instead of responding with treatment, responded with punishment after punishment after punishment. He received 13 formal disciplinary infractions, and he had 20 documented informal disciplinary issues.

[Satiacum]: They were infracting me for every little thing. I could yell at ‘em and it would be an infraction.

[Bebber]: The sanctions that he received included some minor things, like losing commissary, to more serious punishments, like being placed in solitary confinement. At first, it was only for maybe one day, and then it was for 10 days, and then for 30 days, and then he was permanently placed in solitary confinement.

[Satiacum]: I’m isolated. I don’t have nobody to talk to. It’s just me and my wall. They would keep me in there for 72 hours at times. I was getting angry, frustrated. It felt like what they were doing was picking on me.

[Bebber]: There’s no evidence in Tallon’s records that indicate that mental health staff were consulted about the appropriateness of his disciplinary sanctions, even though the jail’s own policy states that the disciplinary process shall consider whether an inmate’s mental disabilities or mental illness contributed to the inmate’s behavior when determining what type of discipline, if any, should be imposed.

[Satiacum]: Yeah, they don’t even care. That’s how I feel.

[Bebber]: We reached out to the jail as we were getting ready to present Tallon’s story in this video and the jail made a valid point that it’s difficult for jails to always know what someone’s mental health and medical needs and history are, because they rely on inmate reporting, self-reporting. But that’s exactly why most jails, including this jail, have policies in place that provide for multiple different times and ways in which inmates and staff can report mental health concerns.

And in any case, he did after one month and nothing was done.

[Satiacum]: I needed to get back on my meds. I needed to get back to me being sane and not going insane.

[Bebber]: So after two months, he finally had his psychiatric medications. After he got his medications, he received drastically fewer disciplinary infractions.

[Satiacum]: The pills that they got me on now changed me. It made me calm, I’ve been just doing, doing good and I’m just trying to maintain.

[Bebber]: This is not unique to this jail or to Tallon’s case. This is a problem that we see in both jails that we go to with the AVID Jail Project and in jails around the country.

So, what we’d like to see is not anything radical. We’d like to see them follow their policies that provide these protections. Inmates with mental health issues shouldn’t have to be subject to harsher punishment than other inmates, solely based on their disability and their mental health condition.

[Narrator]: Tallon was released December 24th, 2015. The AVID Jail Project continues to work with Score Jail on the problems faced by inmates with mental illness, as a result. The jail has cut its wait time for health assessments and reports, changing the disciplinary policy to avoid situations like Tallon’s.

Find out more at AVIDJailProject.org. The AVID Jail Project is a project of Disability Rights Washington. Produced by Rooted in Rights.

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Transcript for Figure 7.6, Living With Schizophrenia, in Prison and Out

[Cindy Rodriguez, WNYC reporter]: Do you feel anxious a lot? Do you have a lot of anxiety?

[Sedlis Dowdy, incarcerated individual with schizophrenia]: I try to stay in my cell as much as possible.

[Rodriguez]: How much of prison and jail is violence and having to sort of be on guard?

[Dowdy]: All the time.

[Rodriguez]: All the time?

[Dowdy]: Yeah. I think that’s just, life is dangerous, so that’s just how you’ve got to expect it.

[Rodriguez]: When you go from facility to facility, does your medical record follow you? So do they know?

[Dowdy]: Yeah, they know exactly what to give you, precisely what to give you.

[Rodriguez]: They do, okay. So when you got here, they knew what to give you?

[Dowdy]: The first day I was here, they gave me my medication. That was good. Because if I don’t get it, then I can’t sleep.

[Rodriguez]: I see, okay. And what about Rikers Island? Did you get it at Rikers Island?

[Dowdy]: Yeah, but sometimes they play a lot of games on Rikers Island.

[Rodriguez]: Like, what kind of games?

[Dowdy]: Not— No. They—how can I explain it? Well, they just—they’re mean down there. I can’t explain it.

[Rodriguez]: New York City is such a loud, crazy place. I mean, it can be.

[Dowdy]: Yeah.

[Rodriguez]: Is that a hard place for you to be?

[Dowdy]: So many things can set you off. You know, it is a hard place to be. The traffic lights, the cars, the buses, the—

[Rodriguez]: Do you ride the subway when you’re there?

[Dowdy]: Yeah.

[Rodriguez]: Does that bother you at all?

[Dowdy]: I see things that other people don’t see and stuff like that. So it’s, you know, it’s dangerous.

[Rodriguez]: Do you hear the car alarm and what do you think after that?

[Dowdy]: I think that it’s a signal to me from God to, you know, do something evil. Or sometimes it might even be something good. Now that I’m on medication, it doesn’t affect me the same way, though. I just hear it and it goes away. It’s not beckoning me or nothing like that.

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Transcript for Figure 7.8, Stories of Life in Solitary Confinement | Short Film Showcase

[Inmate voice]: It can either break you or make you, and if it breaks you, you know what, you’re just gonna just be broken, physically and mentally.

[Inmate voice]: I haven’t seen a tree or a plant since 2003. The only thing that I’ve seen is a spider in the corner, and I find them little bugs sometimes and I feed the spider. That’s about the only closest thing to nature I have.

[Inmate voice]: It’s not to the point where you want to commit suicide, but sometimes I’ve been at the point that I’ve been on the right to judge, saying, just give me the death penalty. Just give me the death penalty, man.

[Music.]

[Inmates in solitary confinement spend 22.5 hours a day in an 8’ x 10’ cell. They have access to a small concrete yard for one hour a day.]

[Inmate voice]: We’re in our cell 22 and a half hours a day. And then our yard is just brick walls.

[Inmate voice]: I’m not able to go out to a yard and be with other people. I’m not able to see things around me, whether it’s trees, grass, birds. To talk to my family, to get sunlight.

[There are no windows, phone calls, or contact visits. (At the highest security level.)]

[Inmate voice]: You had people in here that’s been in solitary confinement longer than I’ve been alive.

[Inmate voice]: If you could put every emotion of the human spirit, of hopelessness, pain, agony, hatred, frustration. A sense of continuous, silently screaming all these emotions while you’re locked in this cage treated like some animal. Most people wouldn’t even treat an animal like that. An animal who was suffering pain, they would take them to the vet and do something for them.

[Daniel Treglia, Pelican Bay S.H.U. inmate]: I had to take a lot of deep breaths before I came in here. Just being around people, it’s not awkward. It’s a good feeling. But it’s still an anxiety feeling because I haven’t been … It’s like, wow, I’m around free people. I’m around regular people.

[Daniel Treglia spent 8.5 years in solitary confinement after being accused of prison gang association.]

[Inmate voice]: This is a behavior modification, psychological, a low-intensity warfare against the mind of a human being. That’s what exists here at Pelican Bay.

[Inmate voice]: It’s the same thing day in and day out. Don’t change.

[Inmate voice]: It’s just psyching ourselves out to make the best of it. I love the day.

[Inmate voice]: It’s kind of robotic. Have you ever spoken to 100 guys today? It’s the same thing.

[Inmate voices]: I get up in the morning. I wash up. I drink my coffee. I roll up my mattress. I get up. I brush my teeth. I wash my face. I drink some coffee. I drink water. I clean the cell. I clean the seat. I wipe the floor. I wipe the walls.

[Inmate voice]: You do certain things just to fill up that time.

[Inmate voice]: Where you can hear the vent and you focus on it, man, did I just hear a whisper right now? And the person starts focusing on this little noise because the noises and the vision are the senses, and that’s what we have to constantly survive. But if I had a window to look out, I think if they came by every half an hour, I’d be sitting in that window.

[Isaac Garcia, Pelican Bay S.H.U. inmate]: Yes, I committed a crime to come to prison, but don’t make the assumption that my current situation, here being Pelican Bay SHU, is due to my continuous criminalization. It’s a criminal behavior because I have grown that a long time ago.

[Treglia]: Humankind has a history of ugliness, and humankind also has a history of beauty. It’s in all of us, and you need laws to have a society not go into chaos. Ultimately, people have the ability. The ability to look at what is bad and good in a way that is not insulting, not aggressive, not with bullets. Through psychology, creating a better understanding of each other, everybody deserves a chance. Thank you for taking the time to hear my voice, because our voices are rarely heard.

[In 2011, inmates across California began the first of hunger strikes to protest prison conditions in solitary confinement. In January 2016, state officials finalized a settlement that will limit its use – but not end it.]

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Transcript for Figure 7.9, Ricardo | AVID Jail Project

[Ricardo Rodriguez, incarcerated individual]: You know, you don’t have rights. There’s no treatment in here, the way there’s treatment out there.

My name is Ricardo Rodriguez, and we’re in King County Correctional Facility, and I’ve been here for six months.

[Kayley Bebber, AVID Jail Project attorney]: With the AVID Jail Project, we go to jails in King County every week. We are constantly meeting new inmates and keeping in touch with inmates that we’ve already met with. When I first met Ricardo, I learned that he’d been infracted, or punished for hurting himself.

[Rodriguez]: I’m bipolar and schizophrenic and I hear voices. I have this diagnosis since I was like thirteen or fourteen. And the voices keep telling me to hurt myself, cut myself, any kind of way I self-harm.

[Bebber]: The fact is that people, in jail, attempt self-harm. They attempt suicide. The suicide rate in jails is three-times the rate as it is in the community. So most jails have policies in place for responding to inmate self-harm, including the jail where Ricardo is incarcerated. If an inmate either attempts to or does hurt themselves, they will receive medical treatment, they get transferred to psych housing, and they receive monitoring by mental health providers, and unfortunately at some jails, and at this jail, you can also receive a disciplinary infraction for self-harm.

[Rodriguez]: I can’t control, you know, what’s going on in my head, like, or my body, you know, like, physically. Like if I’m banging my head and I don’t stop and then they’ll be like, ‘Well, we’re gonna take your hour or we’re gonna infract you.’ Basically, you know, they punish you like that too, like.

[Bebber]: So this is, this is a list of four different infractions that Ricardo received for self-harm. The first one was in October 2015, he was infracted for tearing up his suicide [prevention] blanket, in an attempt to hang himself.

[Rodriguez]: So what happened is like, I start hearing all these voices, and then I took my smock, and I, well not my smock, my blanket and I tear it up. I was planning, you know like, to put it on the sprinkler. The guard came and was like, ‘Well, you know, what are you doing?’ you know, and that’s when they told me to give up, you know, the contraband before I start hanging myself.

The list of infractions that they infracted me with was 203, refusing orders or causing a supervisor to respond. Uh, self-mutilation, which is self-harm. Possession of contraband, that was the teared-up blanket. Property damage, you know like, because I destroyed the smock,

or the blanket.

[Bebber]: Ricardo was infracted again for self-harm on February 2 for hitting his forehead against his cell door and wall. This time, he received serious infractions number 203, refusing orders or causing supervisor response, and 217, self-mutilation, tattooing, piercing. He was found guilty of both, and sentenced to seven days in solitary confinement, where you get one hour out of your cell every other day, and you can receive a bill if any property damage was involved with the self-harm.

[Rodriguez]: $52.90. That’s what they charged me for that security smock that I tear up in that cell for self-harm. They don’t understand like, how I feel about, you know, what’s going through my head, and they’re not doctors, they’re, uh, officers. So, they do things in a different way, you know, like they disciplinary you, they use uh, force on you.

[Bebber]: So instead of responding with discipline to self-harm, we want the jails to stop disciplining people for self-harm. So we reached out to the jail to find out what their reaction is

to Ricardo’s story, what their position is on, on this issue and this is what they said.

[Narrator, reading correspondence]: We agree that there is no benefit in disciplining [inmates with serious mental illness] who self-harm. We also understand that those in isolation, regardless of degree of mental illness, are emotionally challenged as this environment is not therapeutic. We will, therefore, continue to work with [the AVID Jail Project], and evaluate….current policies regarding self-harm and property damage specifically for identified [inmates with mental illness].

[Bebber]: Ricardo is still in jail. Um, we keep talking with him and working with him.

[Rodriguez]: It affects me in so many ways because, I’m alone, I hear voices, I hallucinate and there’s one you know, there to talk to me, or help me, and I start you know, like, thinking that nobody cares. It’s not fair, for them to punish you because of your harming yourself, when you already have a problem. Instead of solving the problem, you creating a lot more problem to it.

[Bebber]: Follow Ricardo’s story and others stories of people with mental illness in jails, at AVIDjailproject.org.

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Transcript for Figure 7.10, Five Mualimm-ak | AVID Jail Project

[Five Mualimm-ak, Director of the Incarcerated Nation Corporation]: My name is Five Mualimm-ak. I am the director of the Incarcerated Nation Corporation (INC). I served twelve years. In 2000, through 2012, and throughout that time, I’ve served over five years in solitary,

some time at Rikers, sometimes at MCC (Metropolitan Correctional Center), and the majority of my time in New York state.

It’s a different lens living in a world of punishment. It’s a different lens to navigate through incarceration because people don’t understand, you know. If you’re problematic in the city,

in New York or wherever you live at in the community, and you need a therapeutic environment to function, you’re going be even more problematic inside of this microcosm of an environment

of incarceration.

The problem in this state is that there was no comprehensive mental health rounds. I mean I did time in Lakeview, Upstate, I never see nobody. Nobody came around, even in a person with Bipolar Disorder or schizophrenia sometimes needs constant talk therapy. Every time before an appointment, I had to prove that I needed that appointment. It felt more that I was proving it

and validating why I was there than treatment.

In the state I’ve done years of solitary at a time. And the problem with that is that you keep getting reoccurring tickets, right. First I went to solitary for reasons that were just ridiculous,

sharpened wooden objects which were described as weapons, and hoarding and unauthorized exchange. The sharpened wooden items were pencils; I’m an artist so I do portraits. The hoarding was too many postage stamps; I had more postage stamps than I was allowed to have. I had too many t-shirts.

For me, it was like [being] locked in there with like two other people. I have two voices in my head – everything seems personal. The wind under the door is talking to me, cursing at me,

and you end up talking to yourself because, you know, you’re just having a conversation out loud, you end up catching yourself, you’re trying to talk to the person two cells down, you gotta repeat yourself everything he says, every little thing frustrates you, and you’re being ignored. Your officers come by, they feed you, they’re not to have any eye contact, they’re not to have any type of physical contact, and it’s an odd impersonal process. They put the tray on the slot,

you step back, you grab the tray, you pick it up and they move on. You try to have a conversation with them, they’re ignoring you, you become upset. You yell at them, “What…you don’t hear me. I’m talking to you,” and the person doesn’t validate you.

And when you suffer from extreme paranoia when a person doesn’t validate you instantly start thinking what that person is thinking, and you’re thinking that, oh this person is…looking at me,

and you get angrier and you get louder. It doesn’t get no attention you start banging, still doesn’t get any attention. But every step that you go gets you even more angry. And you’re like, this guy didn’t even talk to me he’s probably… And you start having this conversation with yourself.

Human validation. It doesn’t mean a lot, but it means a lot when one thing can have your thoughts spinning off and off.

One of the major problems with the system is that we don’t realize that even though you have people with mental illness when you go to jail it’s just unrecognized.

[Narrator]: The AVID Prison Project, Amplifying Voices of Inmates with Disabilities, is a collaboration between The Arizona Center for Disability Law, Disability Law Colorado, The Advocacy Center of Louisiana, Disability Rights New York, Protection and Advocacy for People with Disabilities of South Carolina, Disability Rights Texas, Disability Rights Washington, and the National Disability Rights Network. This video was produced by Rooted in Rights.

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Transcript for Figure 7.11, Daniel Perez | AVID Jail Project

[AVID Jail Project representative]: Would you please state your name?

[Daniel Perez, inmate at Washington State Penitentiary]: Daniel Jay Perez

[Representative]: And can you tell us, can you define segregation for us?

[Perez]: Segregation, for me, was pretty much hell. It’s a 23-hour lockdown, one hour out a day, five days a week, little stimulation, little interaction with anybody, and concrete walls that seem to close in on you.

Like I said, it’s hell, at least that’s the way I would say it would be. Out of the entire time that I’ve been locked up, which is ten years, I’ve only been outside of seg a year and eight months, so that would be, what? Eight years, four months total in solitary.

At this point, I’m diagnosed with psychosis NOS (Not Otherwise Specified) obsessive-compulsive disorder, and mood disorder NOS, and borderline personality [disorder].

Solitary confinement breaks you down, and it’s a form of punishment that can really do some serious harm. I question whether or not I’m able to survive outside of that environment, because I did it for so long. I’m struggling to survive day to day out here, just have a normal life. I can’t go to the big yard because there’s 200 people out there. I can’t go to the little yard because there’s 100 people out there. I’m afraid to come out of my room at times because there’s 30 people, you know? Cause you spend so much time isolated by yourself, so much stimulation, it gets frightening at times.

And there’s days, and today’s one of them, actually, that I feel like I’m not gonna be able to survive in a population, in a setting outside of an IMU (Intensive Management Unit), because of the damage that was done. It caused paranoia, causes me to hallucinate, it causes me to feel unsafe. Today’s one of those days that it’s contemplating, you know, do I give up? Cause I just…

there’s no support here, even though there’s days that I contemplate going back, it’s not something I would… wish on anybody. It can really mess you up, and it has messed me up to the point where I’m out here, not able to function at times being around people, where I have to isolate in my cell.

That’s kind of scary when you don’t know if you can make it outside of an environment that you wanted out of so bad.

[Narrator]: The AVID Prison Project, Amplifying Voices of Inmates with Disabilities, is a collaboration between The Arizona Center for Disability Law, Disability Law Colorado, The Advocacy Center of Louisiana, Disability Rights New York, Protection and Advocacy for People with Disabilities of South Carolina, Disability Rights Texas, Disability Rights Washington, and the National Disability Rights Network. This video was produced by Rooted in Rights.

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Transcript for Figure 7.18, Forced Medication Behind Bars | AVID Jail Project

[Narrator]: According to the Bureau of Justice Statistics, 60% of jail inmates have symptoms

of serious mental illnesses. Jails can force these inmates and others to take psychiatric medications even if the inmates don’t want to. Who gets medicated and how is determined by holding hearings.

[Kim Mosolf, AVID Jail Attorney]: Although they’re lawful, the hearings have to follow certain guidelines and procedures. Because our society highly values a person’s right to control their own medical treatment, the law requires that we follow very specific rules to protect these rights

when considering forcing medical treatment. Certainly the jail can have these hearings, but they need to make sure they have them in a certain way.

I’m Kim Mosolf. I’m an attorney with the AVID Jail Project at Disability Rights Washington.

So generally, you have a fundamental right to control what type of medical treatment you accept or refuse. For example, if you have cancer and you don’t want to get chemotherapy, generally speaking, you can say no and not get it. Similarly, if you have a mental illness and you don’t want to take certain medications or get certain therapies, generally speaking, you don’t have to do that.

[Narrator]: In the case of Washington v. Harper, the Supreme Court held that even people in jails and prisons possess “…a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs under the Due Process Clause of the Fourteenth Amendment.” This case lays out the specific procedures for considering whether to force medication.

[Mosolf]: We came to find last year, though, in speaking with inmates at the King County Correctional Facility in downtown Seattle, that, in fact, there were significant problems in how the jail was protecting these inmates’ due process rights at these forced medication hearings.

[Narrator]: If the jail is successful in ordering forced medication, they must always give the ordered inmate a chance to take medications voluntarily. If the person refuses, corrections officers are authorized to use force in order to physically restrain the person on a board while a nurse gives the person a shot of antipsychotic medicine. These forceful medication orders can last for months.

[Mosolf]: When we’ve spoken with a lot of people in the jail who were subject to these forced medication hearings and orders, they talked about a lot of reasons why they may not want to take the medications.

[Dwayne Stelivant, inmate at King County Jail]: My name is Dwayne Stelivant. Dwayne Fitzgerald Stelivant. Since I’ve been diagnosed with a mental disorder, I’ve been in and out of King County [Jail] several times.

A lot of that medication has side effects. I think I was taking Zyprexa – I noticed my vision getting blurry. I’m knowing that it’s the effects of the medication.

[Tyler Howells, inmate at King County Jail]: I’m Tyler. I’m 23 years old. I’ve had a bad experience once before, a couple of years ago. I got a shot of Haldol and I had tardive dyskinesia. Your muscles seize up. It was pretty awful. It was the worst pain I’ve ever been through in my life.

[Bob Boruchowitz, Director, Seattle U School of Law Defender Initiative]: I’m Bob Boruchowitz. I’m the Director of the Defender Initiative and Professor from Practice at Seattle University School of Law. The impact of the medication, which could be sedating to the person, could affect very much how they look, both to a judge and ultimately to a jury.

[Mosolf]: That can be very relevant if that inmate is not yet convicted. If that inmate is still facing charges and potential trial, because being on antipsychotics can really alter how you present to the world.

[Stelivant]: When I made it back from Harborview [Medical Center] to King County Jail, the doctor I dealt with previously, on a different detention in King County Jail, he’s coming back with the same medication again, “I think you need this medication.” I’m like, “At that time, I was misdiagnosed. Now my diagnosis is Bipolar, and I’m dealing with it with no medication.” He’s like, “No, you’re gonna need medication and I can’t let you move or let you leave.” He’s the one who brought the involuntary panel.

[Narrator]: We asked the King County Jail to comment on the issues of forced medication addressed in this video. They wrote to us saying: “While you underscore in your video a patient’s right to refuse treatment, we also hold that patients have a fundamental right to alleviation of decompensation and acute distress that is a direct result of their current presenting symptoms especially when one of those symptoms is a lack of current insight or reasonable decision making.”

[Mosolf]: Someone might wonder, why does the jail want to force a person to take antipsychotic medication if the person’s already locked up? I think it can be for a variety of reasons. I think, certainly, the jail’s psychiatric and medical staff is trying to help that person and treat that person, and when someone with mental illness is in a jail, which is really not the right place for them to be, it’s not a treatment facility, the jail and psychiatric health staff are really limited in the tools they have available, and for psychiatric conditions, one of those main tools is antipsychotic medications. They can have great success with those, and I think that that is why they oftentimes seek these forced medication hearings.

[Narrator]: Jails have their reasons for wanting to force medicate, while inmates have their reasons for not wanting to be medicated. The hearing is meant to weigh these two options in order to make a fair decision as to whether or not the inmate will ultimately be forcibly medicated. When you think of a hearing, you probably think of everyone gathering in the courtroom. The jail on one side and the inmate on the other. Each side’s lawyer argues their point of view, offers evidence, and the judge rules. But in this type of hearing, the jail doesn’t tell the inmate’s criminal defense attorney that the hearing is even taking place. The inmate doesn’t get an attorney at all. They get what’s called a lay advocate, who’s a member of jail health staff.

[Mosolf]: The lay advisor advocate is supposed to take a somewhat active role in putting forth the person’s position in terms of whether they want or don’t want medications and why, and we saw pretty consistently that the advisor was not doing that in these hearings, and may not have even understood that that was their role.

[Boruchowitz]: To call the person a lay advocate implies that they’re actually an advocate for the person. If they’re advising them, they should be advising them on what alternatives there might be, as well as on how to present their case to the people making the decision in the jail.

[Mosolf]: Also, a lay advisor or advocate should, under the law, have some knowledge of psychiatric medication. Enough so that they can really challenge the psychiatrist’s recommendation and have some basis in understanding to do that.

[Boruchowitz]: That would be at a minimum what would be needed.

[Narrator]: Jails only give a 24-hour notice of the hearing, making it hard to gather witnesses and basically impossible to call an expert witness, and the jail isn’t required to hear those witnesses. If they do, it’s usually by calling them on a cell phone during the hearing. There’s no judge. There’s no jury. Everyone running and ultimately deciding this hearing works for jail health services and there’s no courtroom. These hearings are usually held right in front of the inmate’s cell where other inmates can hear confidential health information.

[Mosolf]: When there is a hearing held in front of one of those cells, pretty much everyone around can hear what’s happening and the information being discussed. This is confidential health information.

[Boruchowitz]: How a person acts in a jail cell surrounded by other prisoners and guards is going to be very different than they would in a room like this or in a courtroom.

[Mosolf]: Now from the jail’s perspective, I think they probably would like to be able to easily hold all these hearings in a confidential setting, and again, this is why it’s probably not good to have

people with serious mental illness in a jail. So, from their perspective, while they would like to take everyone out of those cells, put them in a room and have the hearing there, they have to work with security staff, who may have reservations about removing certain people from their cells.

[Narrator]: The inmate is generally allowed to argue their point of view at the hearing. But the jail’s not actually required to allow the inmate to participate at all.

[Stelivant]: You could participate if you want, or you don’t have to participate. At the end of it, if we say you need it, then it’s gonna be forced on you regardless to what you want.

[Narrator]: Hearings resulted in allowing for forced medication in 25 out of the 29 cases from King County Jail reviewed by the AVID Jail Project.

[Mosolf]: And when that person, if that person, decided to appeal to the director of psychiatric services there, across the board, the decisions were approved.

[Howells]: The last appeal review I had lasted only, not even two minutes. They just rejected the appeal. They just continued the forced medication.

[Mosolf]: Also, the inmate has the right to access court appeal. It is written in the notice the inmate gets that they have, that nothing that the jail’s doing keeps them from seeking court review. But that’s all that’s written. We found in reviewing records, that they are never really told that, certainly never helped with that process, and oftentimes don’t even know that they have that right.

[Howells]: You’re allowed to have a judge review it?

[Mosolf]: So you didn’t even know that?

[Howells]: I had no idea.

[Mosolf]: When we have sought advice from appellate attorneys, other criminal defense attorneys, about how a person in jail would seek court review or appeal, no one really knows exactly how that would work.

[Boruchowitz]: Basic fundamental fairness, Due Process, requires that there be some sort of opportunity for judicial review. So unless there is an established procedure to get them into court, there’s a real question in my mind as to whether this kind of forced medication administrative decision is lawful, even under the case law that we have, if there’s no meaningful judicial review.

[Mosolf]: So our ultimate point and goal in doing this investigation is not to condemn the jail. I don’t think that the jail health staff is doing this from a malicious standpoint. They are doing their best and they are trying to treat these people as they need to do and as they want to do, to get them out of solitary, to get them services. The issue is that it implicates an incredibly important right to control over your body, to your mind, and when that is at stake, there has to be some process, some protection and some transparency, and that’s where our concerns lie.

[Mosolf]: For more information on the AVID Jail Project and more inmate stories, please visit AVIDjailproject.org.

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Transcript for Figure 7.27, Oregon State Penitentiary Diversion Program

[Nina Volkova, Behavioral Health Services Manager]: I have worked in the addiction field for over 15 years before joining the Department of Correction and I have never experienced what I have experienced here. If we are able to increase insight into one person’s existence, then they’re able to either reach out for help when they’re ready for it or at least recognize that this is going on for them versus dealing with it through you know, either self-medicating or avoiding a problem because it’s so embarrassing or difficult for them to tolerate the pain that they have to go through.

[Music.]

[Theron Hall, CRM/CADC 1]: We recognized that there was a need for substance abuse treatment and support, and peer recovery services is a needed field in the community, and so we thought it would be a good idea to try to mimic it on the inside.

[Austin Boring, CRM]: I’ve seen a lot of guys who have just had no hope whatsoever; didn’t know what walking a path of recovery even looked like.

[Austin Keever, CRM/CADC 1]: Am I in action, taking action to be in groups to get help for whatever I’m going through? I can always receive help. That means I’m in maintenance, that means I’m in recovery, that means I’m growing. So I’m always wanting to receive help, and that’s what you get in the program. If you don’t have a program inside the prison like that, then people are stagnant and don’t grow.

[Volkova]: The diversion program that we have here at OSP does not exist anywhere else.

[James Giggy, CRM/CADC 1]: It means everything. I think opportunity for change creates hope.

[Jordin Stepan, CRM]: This program is something that’s absolutely needed for not only the people that are transferring to society or leaving, but the people that this is their society. If their whole life is going to be here, some people like to do what they’re doing and it’s good for them, but what about the people that don’t know any different that want to change and want to do something more? And this is what they have, but yet the tools aren’t being provided for them.

[Hall]: I think my favorite moment is when I was able to see guys who were a participant of the program graduate, remain clean, and now serve.

[Giggy]: At some level, us, the inmate community and staff, can actually work together to create better chances and opportunities for individuals doing wrong things because we’re always penalized for the trouble we get into. But rarely are you even awarded a second chance or given the opportunity or rewarded for all the good you’ve been doing.

[Keever]: People who wouldn’t even be in recovery right now are in recovery. They would have never been introduced to it. They’re out in the yard talking. To other guys who have never even been in recovery on a maximum security prison yard, talking about diversion and what they’re doing in their classes, talking about it with their families, and they would have never done this without a peer-led support system.

[Stepan]: This program, what it does is it gives people the opportunity to not only be in or work on rehabilitation, but to also transform themselves and evolve into a better person.

[Music.]

[Volkova]: We haven’t done a good job shifting understanding that addiction is inside everyone else’s household. It is no longer a problem of some distant neighbors.

[Music.]

[Hall]: The most effective part of the program is the peer-to-peer rapport that is built. If you are a drug addict or if you identify as someone who has struggled with addiction, people are more likely to respond to that because inherently there’s this belief that, you know, I’m not worthy enough. And so when you’re trying to correct behavior, oftentimes the best way to address that is to show a person that you went through this.

[Boring]: I understand being an addict myself and going through the things that I’ve gone through, what it’s like to be in that headspace and to be in that place of life where you don’t have any worth or want or strive to live and to have a better life.

[Giggy]: I always found myself being part of the drug community one way or the other. And since I grew up in it and I’m so in tuned into it, that I felt if I joined the side of helping people break away from it, I have a better opportunity to find out the problems or the holds it has on my family.

[Stepan]: You’re always going to have things that tempt you. You’re always going to have things that try to pull you back in, whether it be old friends, whether it be triggers, whether it be different things that remind you of the good feeling you got from doing the wrong thing.

[Volkova]: Having them here and watching them, making them grow and questioning their own ability to give it back to the community and fostering that level of integrity and hope, that is really hard to recreate somewhere else.

[Keever]: I had to go through this process and experience all of what it was like to finally surrender and say, like, yes, I am dealing with addiction. Yes, I need recovery. My life has become unmanageable and I need help. And so it took me literally getting arrested.

[Giggy]: I think it’s extremely effective. I do believe in it. We put a lot of energy into it.

[Hall]: It means that I am a professional. It means that I have more job opportunities upon my release. It means that I can see myself in a different light. And one of the things that I foresee is being able to be a mentor in the community. Those who were struggling with mental health as well as addiction.

[Giggy]: My mistakes don’t define me.

[Keever]: It gave me purpose. Yeah. It gave me hope that, like, recovery, my recovery is strong.

[Stepan]: I get to see people that have had severe addictions and just, I guess, been as bad off as they can. To see them be really excited, as excited as they were to use a substance or to get some drugs, they’re now excited about doing the things that keep them away from it.

[Giggy]: I can be a beacon of hope for those who are looking for change.

[Boring]: When I became a CRM, it was probably one of the biggest accomplishments I’ve had in my life.

[Stepan]: Through gaining some self-worth, I can now go help other people do the same thing that are in the same position that I was in.

[Keever]: I’m very thankful for it.

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Transcript for Figure 8.8, “Behind the Tattoos” – Episode 2: Navigators at Homeboy Industries

[Steve Avalos, Navigator]: So imagine having a life or just having a place where you could come and you’re not excluded. You have a sense of belonging. There’s no expectation, no

you’re just good, you know. All we want is the best for you and I don’t think there’s really too many places in this world that you can have that. I feel like as a navigator like that’s what they create, is an environment where everybody belongs. And to have that consistency and mentorship is, um, it’s important, especially in the beginning, because that’s your example of hope. I know that was for me.

[Robert Juarez, Head Navigator]: So a navigator is a mentor and a trainee as are those individuals that walk to our doors and are getting our services and we’re walking with them.

[Jose Arellano, Navigator]: My name is Jose Arellano and I’m a navigator at Homeboy Industries. For me, it’s like, it’s like a family you know, it’s like, it’s like building a relationship that goes beyond friendship. It’s like, I’m there. As we’re getting all of our duties squared away, we’re connecting with one another. You know it’s about saying hey I’m here for you. What do you carry? Let me carry it with you so it’s not heavy.

[Music.]

[Kusema Thomas, Navigator]: My name is Kusema and I am a navigator here at Homeboy Industries. For me it’s very important to join in with the work with the trainees every day because I believe that there is something empowering about working together. It gives them the sense that you care enough to do the same work that they do so they can, too, understand the importance of it.

[Janet Conteras, Navigator]: My name is Janet Contreras. I’ve been a navigator for two years. My relationship with trainees – it’s like a parent, you know, you don’t give up no matter what they throw at you. You’re there 100%, you got their back. I get a phone call from somebody late that they’re going through it and I’m gonna be there you know because I remember and my struggles I needed that one person.

[Cruz Lopez, Trainee]: I’m thankful my navigator is always not giving up on me. When there’s times where I feel like I should give up on a certain goal that I’m trying to achieve and you know I’m like really low, but you know, I’m able to speak to a navigator and they’ll tell me oh whoa don’t give up you know, you come this far, why give up now. My navigators teach me to be strong.

[Music.]

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Transcript for Figure 8.9, Inside the Transition Center

[Narrator]: Every year 13,000 people are released from the Clackamas County Jail, many without a plan or place to go.

[Steve Fletcher, Transition Center Client]: I don’t want to reoffend, but you know what, if a guy’s just like kicked out with nothing and no place to go and it’s pouring down rain and you got some guy in the bus who’s like, “Yeah, come with me,” and you know him from jail, where do you think you’re going to go?

[Narrator]: This time Steve Fletcher, who ended up in jail after relapsing with his addiction, took a different path. He walked over to the Clackamas County Transition Center where he received clothes, food, and help applying for jobs.

[Fletcher]: They weren’t giving me, you know, a hand out – they were giving me a hand up.

[Narrator]: In February Clackamas County opened up the Transition Center, the first of its kind in the state of Oregon. The Center offers low-level offenders leaving incarceration and re-entering Clackamas County, an all in one place to plug into a host of services to help the transition and help prevent them from committing future crimes.

[Bridgette Mountsier, Transition Center Client]: You know, coming here really, like, helped motivate me to just keep pushing cuz they’re just so helpful and they just want the best.

[Brian Imdieke, Transition Center Manager]: And it’s fun to see people, once they start realizing the potential they have, that they don’t have to keep living life that way, that that doesn’t define them, that there is something new that they can go do.

[Fletcher]: I can come in here anytime during the day, take my coat off, plug my phone in, get a cup of coffee and sit down with either your guys or go talk to Shawna.

[Narrator]: At the grand opening it was clear support for this new center is far-reaching. Not just law enforcement but a number of Community Partners who have come together to offer services

here – all in an effort to stop the revolving door at the county jail.

[Cpt. Jenna Morrison, Director of Community Corrections]: Serving someone in the community is much less expensive than serving them either in our local jail or in the Department of Corrections custody, um, it’s, I mean, it’s like a tenth of the cost.

[Narrator]: Saving money and helping put lives back together, one person at a time.

[Fletcher]: I got a roof over my head, I got food, and I got this place where I can go during the day. It’s pretty awesome.

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Transcript for Figure 9.5, What it takes for a patient to be committed involuntarily

[Brenda Gardner, mother to son with mental illness]: I thought he was just a typical obnoxious teenager. Eric was always very social. He was athletic. He had played high school basketball and [had a] good sense of humor. In his senior year of college at the University of Washington, we started to notice some changes.

[John Yang, reporter]: Brenda Gardner remembers her son, Eric, telling her something was wrong. Eric was in his early 20s when he told his parents he needed brain surgery. Brenda and her husband brought Eric home from college to see a doctor. That’s when they first experienced the terrifying symptoms of his mental illness.

[Gardner]: Spittle coming out his mouth, in my face, screaming at me. His parting shot was, and if you try to make me see a shrink, you will never see me again.

We had never seen anything like that before. And then that kind of behavior just continued, this really volatile…. And then just not being in reality, that became much worse over time.

[Yang]: Eric threatened to kill his family members, expressing delusions, acting aggressively, and sending violent and disturbing text messages.

[Gardner]: We put contraptions on each side of the door frame and ran a bar through it at night, so that… he had threatened to kill us. We were afraid he could just break down the door and come in and kill us at night.

[Yang]: After one outburst, police arrested Eric and ordered him not to contact his parents. But after six weeks of staying with family friends, Eric returned home.

[Gardner]: We had no history of this in our family. It can happen to anyone, and it’s not Eric’s fault. What I say is, he is the victim. We’re just collateral damage.

[Yang]: After a suicide scare, mental health evaluators placed Eric on a hospital hold, forcing him to get treatment. He took medicine, some of his symptoms stabilized, and he was released. But his psychosis later returned.

[Gardner]: It just can’t last, right? I mean, they can try really hard to hold it together, and maybe they go through a period where it works for a little while, but, at some point, it crumbles.

[Yang]: Eric is now living homeless in Seattle and still suffering from mental illness. After years of trying to find solutions, Brenda Gardner said she felt helpless. Eric turned down treatment, but he didn’t meet requirements for forced mental health care, also known as civil commitment. The state can force someone to stay in a medical facility and receive treatment for up to six months, but only if they have proven to be dangerous to themselves or others.

[Gardner]: I think that should be his right to refuse medication. But I think that he should be in supported housing. Or, if that was the only choice, I would rather have him hospitalized than spending winters on the street.

[Yang]: Gardner says our mental health system’s failure to get people like Eric the help they need is directly contributing to the homeless crisis. She says, if a person doesn’t choose housing for people with severe mental illness, which is already very limited with long wait lists, they’re left to fend for themselves.

KGW reviewed Multnomah County data between 2013 and 2021. Of the thousands of people who showed mental illness, over a quarter of them were homeless, with mental illness symptoms dangerous enough to warrant a forced hold, less than 7 percent received a civil commitment ruling from a judge. Most people didn’t make it that far.

Some of these people agreed to voluntary treatment, exiting the process. Many others, like Eric, were released because they didn’t meet state standards, left to take care of themselves.

[Gardner]: As far as I’m concerned, the homeless situation is an open air psych ward. It’s those people that should be in psychiatric facilities or in supported housing with, you know, with a caseworker that checks on them, are instead living on the streets and being treated like animals.

[Yang]: But each person’s experience with this process is different. Laureen remembers sitting in the back of a police car in Washington County on the way to a hospital on a mental health hold.

[Laureen, former mental health patient]: I had some beliefs that weren’t accurate and put myself in harm’s way. I easily could have gone to jail for trespassing. I was making people afraid. Because I was not acting like the person that they knew. They’re like, what is going on with her?

[Yang]: She knew people were concerned about her mental health.

[Laureen]: Things weren’t right, but nobody could figure it out.

[Yang]: Except this time she was forced to stay in a hospital as doctors evaluated her mental illness.

[Laureen]: It was only when I couldn’t leave, I was like, oh.

[Yang]: It’s different this time.

[Laureen]: Because I couldn’t leave. I wanted to leave.

[Yang]: A doctor said Laureen’s mental illness was a danger to herself, filing a notice of mental illness. Laureen was diagnosed with bipolar 1 and put on new medication. Then something changed. Laureen says she’s fortunate. Her symptoms became more manageable. She started agreeing to treatment.

[Laureen]: I just remembered a certain point, everybody kind of agreed, well, she’s, she’s doing everything we’re asking her to do. As opposed to if I had refused to participate in treatment, then it could have been different.

[Yang]: Laureen is an example of a voluntary diversion when a person being held against their will agrees to a plan to treat their mental illness.

[Yang]: You’d say in your case, the system worked well?

[Laureen]: Yes. I don’t know if I would be alive. And it’s hard to know what would have happened if somebody hadn’t stepped in. I know my life would be a lot different.

[Yang]: Now she works as peer support for other people experiencing the civil commitment process, telling them she’s been there. It’ll be okay. Even if she knows forced treatment doesn’t always work out like it did for her.

[Laureen]: But I do acknowledge that there are people that do slip through the cracks every single day. And that breaks my heart.

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Transcript for Figure 9.14, Washington State’s Sex Offenders Are Sent To This Island (HBO)

[Ben Anderson, Reporter for VICE News]: And this is the only way onto and off the island?

[Bill Van Hook, CEO, McNeil Island Special Commitment Center]: That’s it. This runs every two hours, both ways.

[Anderson]: This island is where Washington State sends its worst and most dangerous sex offenders. They are deemed sexually violent predators, whose crimes and personality disorders are considered so extreme that they need to be separated from society. Bill Van Hook has been in charge here for almost two years.

[Van Hook]: So this is our central control room. This is where all the security operations are centralized and monitored.

[Anderson]: And do people try and escape?

[Security Officer]: Very rarely. We haven’t had anybody attempt it in years. It doesn’t generally happen.

[Anderson]: While this certainly looks like a prison, legally it’s a treatment center. But all 236 residents were sent here against their will. Despite having already served their prison sentences elsewhere, and when they arrive, none of them have a release date.

[Van Hook]: We are the first civil confinement facility for sexually violent predators in the United States. It was established in 1991. People who have served their prison sentence are evaluated at the end of their sentence. And if they’re evaluated to present a high risk of reoffending, they’re referred to prosecution to have them committed for treatment at our facility.

[Anderson]: Forced confinement facilities like this are legal for people with mental abnormalities who are considered high risk, and only if treatment is offered, and if there is a chance of release. Nineteen other states have similar programs, and in 1997, the Supreme Court ruled that they were legal.

[Van Hook]: There’s nobody here who walked in here and said, please pick me for civil commitment. The way that they’re now seeing the way to leave is, I’ve got to get involved in treatment. That’s how I’m going to get out.

[Anderson]: Is there any way they’re going to get out?

[Van Hook]: Well, they could go out by dying, which is not the preferred way, obviously. They can go out if they become so old and disabled that they no longer meet the criteria.

[Anderson]: Justin, who asked that we only use his first name, began molesting children when he was a child himself. He was convicted at age 13 of first-degree child rape, and molesting his half-sister for over a year. He spent five years in prison, and ten more years here on McNeil Island.

[Justin, inmate at McNeil Island]: We’re going to go to my room now, and I’m going to put my briefcase away.

[Anderson]: And the briefcase and the suit, is that for us, or is that for your attorney?

[Justin]: I always like to dress appropriately, so, yeah. I’m very festive. I like decorating.

[Anderson]: Like many sex offenders, Justin was himself abused. He was also diagnosed with ADHD and antisocial personality disorder.

[Justin]: I’m both a victim of a sexual assault and a physical assault. And. Uh. I will tell you that it took forever for me to forgive myself for what I’ve done. I got my siblings, you know, who I victimized, and it’s like, you know what, I have something to prove to them. I need to leave them a legacy and say, hey, you know what, Justin is not this bad person anymore.

[Music.]

[Elena Lopez, Clinical Director, McNeil Island Special Commitment Center]: So, the predominant modality of treatment here is group therapy, but we also offer something called case management, which is up to an hour of individual therapy a month for each resident.

[Anderson]: Elena Lopez is in charge of the treatment program, which aims to manage residents’ compulsions to the point where they are no longer likely to re-offend.

[Lopez]: This visual depiction helps them understand that certain things come from inside ourselves and certain things are external to us that we still need to be mindful of.

[Anderson]: So, the aim is to manage their urges and instincts rather than get rid of them?

[Lopez]: Absolutely. So, the purpose of our treatment program is to manage their risk. It’s not to eradicate or eliminate or get rid of, because most of our residents may always have a proclivity for deviance in some way, whether that’s for children or non-consensual sex or other.

[Anderson]: Justin, who has spent 19 years of his life incarcerated, eventually engaged with the treatment program and is now convinced he will not commit sex offenses again.

And, you know, given the crimes you did commit, do you think you were born capable of committing those crimes?

[Justin]: Absolutely not. Absolutely not.

[Anderson]: So what do you think now, you know, made you capable of doing those things?

[Justin]: I would beg to ask the question what led up to, you know, being in an environment where I felt hurt, where I felt angry, where I felt rejected.

[Anderson]: But those are fairly common feelings for people to feel. You could feel those things again.

[Justin]: Of course I could. But now I have different ways of dealing with them. You know?

[Anderson]: So you’re managing your desires, your emotions, your reactions to situations. Does that mean you still have desires about children?

[Justin]: No, I don’t. And I. No, I don’t. It’s just. It’s just, it’s a weird thing. I mean, I don’t have any urges towards children. I don’t have any struggles about urges towards children. And I mean, I honestly, I’m baffled. You know, because it’s like, I just stopped thinking about it.

[Anderson]: Whatever it was that worked, Justin has now convinced the state that he should be released. He’s scheduled to get out later this year with major restrictions and monitoring.

Rachel Forde has represented Justin for five years.

[Anderson]: What benefit does McNeil Island actually offer?

[Rachel Forde, Public Defender]: No benefit at all. I mean, if the treatment is better on the outside, the opportunities to reintegrate into society are better on the outside. So there’s no purpose. If our society gets together and says we want life sentences for all sex offenders, then we should just be honest about that and say that and change our laws.

[Anderson]: Good treatment has been proven to reduce reoffending rates. The 30 states deal with sex offenders without places like McNeil Island. There are no studies that show civil commitment is much more effective than community treatment.

Wayne, who also asked that we only use a single name, repeatedly sexually assaulted young children and was convicted of child molestation and statutory rape. But after 13 years on the island, he’s now been released unconditionally and is studying to be a social worker.

Are you, are you still a pedophile today?

[Wayne]: I don’t see myself as a pedophile today.

[Anderson]: You were convicted for multiple offenses against children.

[Wayne]: Yes.

[Anderson]: Are you saying that at the time you had no idea what you were doing was wrong?

[Wayne]: I always knew it was wrong. Okay, but my desire for wanting a form of intimacy and love, even though I learned later that’s not what it was. But growing up in an abused background, I had a lot of conflict. I had a lot of conflict of messages, which are lies we tell ourselves to justify our actions or our behaviors. And I thought it was the truth that what I was doing was out of love.

[Anderson]: You’re definitely no longer a risk?

[Wayne]: I feel that there’s always potential for a risk based on what a person has done in their past. Okay. But it’s what we do to eliminate those risks. I don’t come down here normally and hang out at the park when I know there’s kids around down here. This is a park that kids frequent during the summer. Because I don’t even want the appearance. You know, the reality is people can change.

[Anderson]: Even if serial child molesters can change, it will take a lot to convince the public that they are anything but monsters.

Do you think this will exist in, say, five years’ time?

[Van Hook]: It’ll be here for longer than that.

[Anderson]: And do you think there’s, you know, there’ll ever be the political will to close it?

[Van Hook]: I don’t know. It would be a tough sell.

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Transcript for Figure 10.2, Law, Public Safety, and Corrections Overview | Career Cluster/Industry Video Series

[Narrator]: The law, public safety, and corrections career cluster is all about protecting and serving the public. People working in this sector deal with protecting life and property, enforcing laws, providing legal counsel, sentencing defendants, and rehabilitating offenders.

Government organizations at the city or county, state, and federal levels are the major employers in public safety. First responders such as fire and police departments, share a mission to keep people and property safe, along with workers that patrol city streets, coastal waters, ski slopes, and swimming beaches.

Laws exist at federal, state, and local levels to guide relationships among people, institutions, and government; workers in the law sector enforce and, at times, create these laws. Lawyers represent individuals, groups of people, or corporations in legal proceedings. Much of their work is to conduct research and prepare documents, as well as to gather testimony, and argue cases before judges or juries. Judges interpret laws and sentence defendants.

The corrections subsector consists of city and county jails, state and federal prisons, community correctional facilities, and juvenile detention centers. The industry confines the incarcerated population, provides for their basic needs, and seeks to rehabilitate offenders.

Quick facts to know:

• About 5 million workers are employed in the law, public safety, and corrections cluster.
• Over 30,000 new law school graduates pass the bar exam each year, emerging into a tight job market of more than 1.3 million lawyers.
• Because laws apply to many different entities, legal specialties vary greatly, from real estate or tax law to family law and environmental law.
• Over 2.3 million individuals are incarcerated in the U.S. annually, with an additional 4 million on parole or probation.

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Transcript for Figure 10.3, The Washington County Sheriff’s Office Serves You

[Pat Garrett, Washington County Sheriff]: No matter what part of Washington County you live or work in, your Sheriff’s Office serves you.

[Deputy Orozco]: The Washington County Sheriff’s Office provides police services to the urban, unincorporated parts of the county.

[Corporal Richards]: And even in the more rural areas, where there’s a little more room to roam around.

[Siren sounds.]

[Jail Deputy Cage]: But even if you live inside the city limits, you can still benefit from a wide variety of county services.

[Jail Deputy Toney]: The Sheriff’s Office operates the county’s one and only jail. With 572 beds, it takes a large staff of dedicated professionals to keep it running safely and efficiently.

[Deputy Cooley]: We even help our city partners by transporting many arrested people. From places like Beaverton and Tigard to the jail located in Hillsboro, which helps keep your local police in your city.

[Sound of brakes and motor vehicle accident.]

[Crash analyst]: And if there’s a serious crash in your community, our interagency crash analysis reconstruction team responds to do the most thorough investigation possible with the latest technology anywhere in the county.

[Forensic scientist]: Here in the Forensic Science Unit, nearly 40% of all work conducted annually by forensic analysts is for other police departments in Washington County.

[Corporal Plewik]: Another benefit that the Sheriff’s Office brings to the entire county is a remotely operated vehicle team. We have robots, and even drones.

[Music.]

[Tactical Negotiations Team Member]: When a dangerous situation arises, the Sheriff’s Office Interagency Actual Negotiations Team, comprised of local law enforcement agencies from the entire county, ensures a safe resolution for everyone involved.

Hands up! Hands up!

[Sergeant Lascink]: If there’s a hostage situation or a person in crisis, our Crisis Negotiation Unit is here to help.

[Mental Health Response Team Officer 1]: Every day, the Sheriff’s Office Mental Health Response Team hits the road with a certified mental health clinician.

[Mental Health Response Team Officer 2]: Our goal is to help connect our mental health community to the best resources possible. Thank you. Oftentimes, instead of taking them to jail.

[Civil Deputy Malensek]: As the enforcement arm of the court, the Civil Unit serves civil paperwork border-to-border within each city and in the county. That includes stalking and restraining orders.

[Search and Rescue Team Member]: No matter where you live or who you are, if you’re lost, search and rescue will search for you. We search local cities and unincorporated parts of Washington County.

[Garrett]: No matter where you live, in Washington County….

[Citizen 1]: Cedar Hill.

[Citizen 2]: Beaverton.

[Citizen 3]: Reedville.

[Citizen Groups and Individuals]: North Plains. Oak Hills. Here we are in Raleigh Hills. Hillsboro. Helvetia. Banks. Forest Grove. Garden Home. Bethany. Gaston. Scholls. Cedar Hills. Gales Creek. Bull Mountain. Tualatin. Cherry Grove. Laurel. Aloha. Cornelius. Tigard. Blooming – Fern Hill. West Slope. Sherwood. West Haven – Sylvan. King City.

[Garrett]: You get it. The sheriff’s office serves you.

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Transcript for Figure 10.6, Snake River Correctional Institution Recruitment Video 2023

[Corporal Valerie Klitsch]: I’m Corporal Valerie Klitsch. I’ve been here for 16 years.

So when you first come into the institution, if you look on the wall, you’ll see a large plaque that’s nearly full. That’s the people that have opened the institution, worked in the institution, and are now retired from the institution. Because of the attrition just through retirement, there is a large movement to recruit and to hire.

[Officer 1]: We look for people that are flexible, moldable, trainable, self-starters, people that want to take pride in what they do.

[Officer 2]: If you have people skills and you enjoy interacting with people, you can do this job. So that opens it up to a wide variety of people. You don’t have to be a certain stereotype of person to work here. We can recruit you. We can recruit you from anywhere.

[Officer 1]: The days of the knuckle-dragging turnkey, that’s gone.

[Officer 2]: When you grow up and you hear about working at a prison, you see what’s on the movies and TVs, it is so not that. It’s a safe environment, especially here at SRCI. Are there times that we have to act and have to respond to things? Absolutely. But for the most part, it’s a real family-oriented place. We have a lot of people develop friendships out here, lifetime friendships.

[Officer 3]: Before I became a correctional officer, I was enlisted in the Marine Corps for five years. The transition from military to corrections was an easy one for me, like putting on the uniform and wearing it with pride and honor. Along with that, with the transition, is obviously the monetary benefit and the insurance for your family. And coming from the military and then going to sole proprietorship, I would definitely recommend this avenue as a career if you’re looking to take care of your family and yourself.

[Officer 2]: Because you’ve got people working their entire careers here and they’re not looking for other places to go because they can retire, and they can retire comfortably, based on what the state of Oregon offers them.

[Klitsch]: At Snake River, after you’ve completed your probationary period, there’s opportunities for you to join teams. You can join the ESS, you can join the field training program, you can be part of the SWAT team. The training is top-notch, the equipment is top-notch, the experience is top-notch.

There’s just all kinds of opportunities once you get out here and you don’t have to stay in security if you find something else within the department that suits you better. For instance, we have plumbing, we have electrical, we have nursing, we have vision. Everything you can find in the city, we have right here at SRCI.

You should come out here and apply. At least check it out and see what it’s all about. Come out for a tour, get a feel for what’s going on in your community. Don’t let your education, your background, your associations, don’t let any of that prevent you from coming out here because we are a diverse culture. We want everyone that has an interest in the progress of human life to come, apply, and help us get there.

[Officer 2]: I mean, this is a job, but it’s also a career. And it’s a career. It’s a career that you can go from a basic standard, whatever you start at, all the way up to, you know, the sky’s the limit on that.

[Klitsch]: There are those that wouldn’t normally look at corrections, but because of the way we’re doing our recruiting and letting people know: this is not just a prison; this is a place where we have individuals who are trying to make a better life, who are going to be our neighbors.

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Transcript for “Snake River Correctional Institution Recruitment Video 2023” by Oregon DOC is included under fair use.

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Transcript for Figure 10.7, Parole and Probation Mental Health Unit

[John McVay, Criminal Justice Manager]: Officers with the Mental Health Unit work with a particularly difficult population, and the amount of dedication that they have to the folks that they serve, both the community and the folks on supervision, is extremely admirable.

[Music.]

[McVay]: The acuity level of the symptoms that we have in the mental health unit really vary. We have folks who are maintaining pretty well with medication, and then we have folks who really are not on medication yet and who are extremely symptomatic.

[Music.]

[Harley Earl, PPO Mental Health Unit]: From our point of view, again, we are going to be one of the positive encounters they have throughout their day. So they know if they come here, they’re able to talk to someone, they can get something to eat, they can maybe get some referrals and some resources, and stuff can improve for them from that sort of interaction. So we have bus tickets, we have snacks and usually some sort of juice or something like that for them. And then we have a lot of very talented staff here in the building we can connect them to, whether it’s for housing, employment, nurses, counselors, things like that.

[Music.]

[Earl]: For a lot of our clients, this is one of the calmest, safest places for them to be, is here in our building. So, if they are homeless and if they’re out on the street during the night, they may not sleep more than 45 minutes or an hour. So they come in here exhausted in the morning, some of them will come to our breakfast club, which is something that […] run for many, many years. And then a lot of them will come up here and try to catch some sleep up here where it’s kind of a safe spot for them.

[Music.]

[McVay]: The idea of it is to create a bit of a sense of community for the individuals who are on mental health court because a lot of them don’t have a lot of sense of community. Unlike a kind of a traditional court is really for folks to be able to check in at a particular place and kind of receive feedback on how well they’re doing and also receive praise if they’re doing well or kind of redirection from the court.

[Earl]: Dogs are always very calming so just having them around there a lot of clients can kind of you’ll see them when they’re kind of get a little more anxious they’ll reach out and they’ll go to something to calm them.

[Music.]

[McVay]: It takes a while for individuals to really begin to manage their symptoms and to realize that there could be something different for them out there and that the life that they have right now is not the life that they are stuck with or that they have to have.

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Transcript for “Parole and Probation Mental Health Unit” by MultCoPresents is included under fair use.

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Transcript for Figure 10.8, Inside The City: Victim Advocate

[Gwen Anderson, Victim Advocate]: Hi, my name is Gwen and I’m a victim advocate for the City of Vancouver in the Domestic Violence Prosecution Center. The Domestic Violence Unit is made up of both city and county employees. We’re a collaborative agency. The purpose here is that all of us are working towards eliminating domestic violence by holding domestic violence perpetrators accountable.

My role here is to provide victim advocacy for domestic violence survivors. What that entails is informing them of court dates, of what their rights are as victim survivors, and helping them find any particular resources necessary to help them overcome barriers in leaving a domestic violence relationship.

I love being a victim advocate because it allows me an opportunity to affect change within the community that I grew up in. It’s a very fulfilling role and although very challenging at times, I get to see firsthand how aiding a survivor in overcoming those barriers, whether that be helping them find housing or a support group or additional financial resources or filing a protection order, all of those things help them overcome escaping a domestic violence relationship.

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Transcript for Figure 10.9: Victim Assistance Program: Sarolyn (2021)

[Ms. Morgan, ICE Victim Assistance Specialist]: She was brought here from El Salvador by some traffickers to be trafficked. She was 16 in the midst of being trafficked, she suffered a lot of trauma, forced, drugged, forced to sell sex. She said, ‘Miss Morgan, I stopped counting after 20 men.’ When I met her, she had already been placed in a safe house by the agent. She was terrified; she was also pregnant by her trafficker.

As a victim assistance specialist, my job is to provide psychological 101 care, which means I’m making sure their basic needs are met, making sure they know they’re safe, providing trauma-informed healing help and hope so that they can be willing to engage with law. Enforcement because oftentimes they don’t trust law enforcement.

I visited her three times a week initially, I took her to appointments, helped her with finding information, and then I took her to the police station and I took her to the police department. Helped her with baby shower. After we got her situated, she got a job; she decided to leave her safe home and get an apartment. By this time she’s 18 years old, but when she went to her apartment, she realized she didn’t know how to budget; she realized that she didn’t know how to manage money; she realized the freedom that she had in an apartment was much different from a safe house. So, those are some of the things that I had to help and teach her. Even went with her when it was time to go to court; sat with her in court as she faced her traffickers.

I will be a friendly face, and I will just coach them in breathing, helping them with their posture, helping them to stay focused. I’m a safe place to look at. She made it through court successfully; she was able to testify, face her traffickers. But she survived it, and that young lady today is now again living in her home apartment. She has two children; she’s living on her own with some transitional support, but not as intense, and she’s learned a lot of great lessons, and we’ve been able to help her in some great ways.

The Victim Assistance Program provides trauma-informed care for individuals that have been victimized, whether it’s human trafficking [or] identity fraud. We advocate for them, we educate, we provide outreach to the community; we also do anything that needs to be done as it relates to victim services. So is it a difficult job? Yes, but when you’re called to do it, it makes it rewarding and it makes it worth it.

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Transcript for Figure 10.10, Drug and Alcohol Counselor: Careers in Mental Health

[Michael Kemp, Director of Peer Recovery Services]: My name is Michael Kemp. My title here at the hospital is Director of Peer Recovery Services, but I’m also an addictions professional.

When I practice addiction counseling, I basically develop a relationship with the person who has been referred or has come to me to get to know that individual and then discuss their relationship with the substance, what their desire is in regards to their substance use and changes in their life. And then I work with them to develop their own individualized plan, help that person gather the resources and the necessary instructions to be able to make those changes and continue to evaluate as we go along.

Some of the qualities that I think I have are the ability to be there with the person, to really actively listen to who that person is and what they are experiencing in the moment and what their story is, and also what they would like their story to become. I think that the ability to encourage, the ability to reflect back what they’re saying to make sure that I’m hearing correctly, the ability to help them figure out how they can best use their strengths in their own personalized recovery program is a skill that is essential for a counselor to have and one that I continue to try to improve upon.

One of my own philosophies is: I need to be down there interacting at least several times a week. And one of the things that I’ve chosen to do is become involved with Dual Diagnosis Anonymous, which is an offshoot of a 12-step program that was developed by a person out of California, called Corbett Monica, and he developed a support group program specifically for people who have been diagnosed with both substance use and mental health disorders because there are various groups that would say, you know, well, you have mental health issues, you can’t be part of the substance use recovery. People in mental health say, but you’re, you know, you’re a drug addict.

My interactions with patients are usually with patients that are working towards advocacy and leadership within the hospital and having their voice listened to. We have a patient advisory council made up of patients who desire to be part of it to address some of the issues to make their living conditions more tolerable, to attempt to provide input to how we can run a better hospital, better treatment, better environment.

The reward from this profession is, again, based upon my own personal belief. Part of my native heritage is to believe in making the world better for several generations. And I believe that when people find their own recovery, they make the world a brighter place. They make a brighter place for their spouses, their children, their families, their communities. And that’s the effect that I desire for the world that I live in. So to watch that happen, to watch people’s stories evolve. To see people that were, I was involved with years back, just making the world such a greater place just inspires me to keep showing up.

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Transcript for Figure 10.11, Co-Occurring Disorder Treatment – CRCI 2023

[Narrator]: Outside the Columbia River Correctional Institution, you see a prison. But inside these walls, there’s so much more happening. Addictions counselors and mental health professionals are working hard to prepare these adults in custody to re-enter society successfully.

[Shawn Wise, adult in custody]: The tools that they teach here are indescribably life-changing. I came here with very low self-esteem, very secluded and kind of reserved. And being here has opened me up into being a productive person, a leader, somebody that uses his tools and takes into perspective that other people are human too and that other people have their issues.

[Narrator]: Shawn Wise is one of the dozens of adults in custody taking advantage of the co-occurring disorders program called New Foundations.

[Willie Shaffer, qualified mental health associate]: So the name in itself is huge for me because it’s about building new foundations. And with anything that you build, a foundation is key to having that strength at the base and to be able to build on top of that.

[Narrator]: Willie Shaffer has come full circle. He used to live at the facility as an AIC, his room across the hall from his office. Now nearly two decades sober, he works as an addictions counselor and mental health associate.

[Shaffer]: It just reminds me of where I’ve been but how far I’ve come. And I share with my clients on a daily basis in group and individuals that I’m no better or worse than them. Like, I just decided that I was willing to do whatever it took to change my life after paying my debt to society. And I’ve done that. And I just encourage them that they can do it. And that we will support them and give them every opportunity and every skill that we have to allow them that.

[Marnie Holmes, qualified mental health associate]: We are a co-occurring program, meaning that we address both substance use as well as mental health issues simultaneously. That’s important. Research shows that when someone has an addiction and a mental health issue, addressing both of those at the same time gives you a better outcome. People tend to be more successful.

[Narrator]: AICs usually spend 9 to 12 months in the program. Each day consists of group and individual counseling sessions with several different addictions and mental health specialists.

[Joshua Allen, qualified mental health professional]: There’s trauma exploration-based groups. And then there’s just a lot of addiction-kind-of-based groups. There’s a lot of different groups. We also have just supplemental things like art group we try and run. The benefit of this program is we just get to be out there and play chess and play Uno and play Connect Four.

[Holmes]: This is the most in-depth and supportive program I’ve ever worked in. The curriculum that we use is evidence-based. It has been proven to help others that are incarcerated to be successful upon leaving prison. And we really are vested in our clients and their futures.

[Wise]: I was scared at first. I didn’t really necessarily want to change. But as I started going through the program, it became a habit. And it became a comfortable habit. And then it became a lifestyle. And then here I am. I mean, I’m out in like 15 days. I feel rejuvenated. So we’ve all got big plans in our head. But we’ve got to be able to learn something new. So rehabilitation is very important. Very important. I don’t want to come back here again.

[Holmes]: If we can help one man change his life, the outreach of that is so important. We’ve come so far that people don’t think about that. They don’t think about how that one man being clean and being successful affects his children, his family, his neighbors, and society as a whole. We need to support these men and not put them down and not judge them, but give them what it is that they need and they want so that they can be successful in the world.

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Transcript for Figure 10.12, Peer Recovery Specialist: Careers in Mental Health

[Malcolm Aquinas, peer recovery specialist]: As a peer recovery specialist at the Oregon State Hospital, and that role takes on many different responsibilities. Sometimes it is responding to requests for support from either a resident, so somebody who currently is receiving services at the hospital, or from a team member, someone who is providing services. It could be also someone from treatment mall, which is a part of the hospital where people go and take classes or other groups to help in their recovery journey. Additionally, I serve on different bodies within the hospital that are designed to improve the treatment that people receive. The ultimate goal, of course, always is helping people to regain a sense of empowerment, of their own voice, and establishing a path forward for themselves from the place where they currently find themselves, which is unfortunately at the Oregon State Hospital, a place of confinement.

Peer means somebody who has a similar shared life experience. Now, the word ‘similar’ is very, very important because we always want to make sure that we know that my experience is not your experience, and your experience is not my experience. And what we do then is we allow at least a sense of some maybe more global understanding of, for example, I have been involuntarily hospitalized, I have been arrested before during a mental health crisis, I’ve had involuntary medications, I have been restrained forcibly. These are things that when people come to know this about me, it allows an equaling of the relationship and, in fact, when I do trainings around for people who are coming into the field, one of the things that I always get asked is, you know, well, how do you know if you’re doing it right?

And I answer, I think, somewhat differently. I said, if you ever find yourself saying to someone what they should or ought to do, you might be doing something that’s helpful, you might be doing something that’s beneficial, but what you are not doing is peer support. Peer support is always non-prescriptive, non-directive.

All these that I think serve me the best as a peer recovery specialist are patience. It takes a long time for people to be able to feel comfortable with another person who starts out as a stranger. The next is related to that, and that’s bringing compassion, you know, being present and understanding that, you know, people have gone through difficult circumstances, they are going through difficult circumstances, and they anticipate there will be more difficulty ahead before they reach the end of this current journey at the Oregon State Hospital.

And lastly, one that is spoken of many times in the peer movement, sometimes referred to as the consumer-survivor-ex-patient movement, is called holding hope. And holding hope means you’re coming alongside someone, and this is typically somebody who everything that they’re saying, is I can’t go on. I can’t take it anymore. This is unendurable. And whatever form that takes of what they’re going to do, it’s some form of I’m going to quit. It might be I’m going to quit in that I’m going to seclude myself in my room. Or it could be I’m going to quit, I’m going to fight back against everything they give me. I don’t care if they’re offering me, you know, ‘You get a walk out the door right now,’ I’m going to tell them where they can shove the door.

Or it could be I’m going to look for the opportunity to take my own life, if I have it. And what you do then is you come alongside, you listen, you validate, and then you share with respect similar times that you have found that. And you tell them, ‘Will you allow me to hold hope for you?’ Because I have hope for you. I know and believe you will be better. That time will pass and things will improve. And I have never had a person, and I’ve been doing this formally for about seven years, informally for about 35, I’ve never had a person who has said no to that. And I have had countless people come to me later and say, ‘I’m here today doing what I’m doing because you held hope for me.’

What I frequently will offer is peer walking as an option because then it allows me to do the peer support work, which is that nonjudgmental, mutual, equal-level relationship and where I’m listening. But also it’s incorporating some of the trauma-informed approach recommendations, which is, get people moving. And what I have found is that helps people be very successful in talking through otherwise complicated and upsetting issues while remaining very, very calm, having a very conversational approach.

My greatest rewards in this job are the times when I get to see people move from despair where they are disconsolate. They can’t see anything getting better. Where family members come in and say, ‘I’ve lost my child or I’ve lost my husband, I’ve lost my wife.’ And then, after a period of time, when people are crying and hugging each other, and they’re hugging me, and they’re saying, ‘Thank you for not giving up on me. Thank you for being there through all the hard times.’ And now I’m going to go out, and I’m going to carry forward the same mission that you gave to me, and I’m going to help someone. I’m going to pay it forward. You can’t put a dollar value on that for me.

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Transcript for Figure 10.13, Psychiatric Social Worker: Careers in Mental Health

[Kristy Dees, psychiatric social worker]: I am Kristy Dees, a psychiatric social worker.

I started off wanting to go into nursing, changed my mind, went into criminal justice, changed my mind, went back to nursing, changed my mind, went and had a family, went back to school in my late 30s, got my degree at Chemeketa, my associate’s of transfer degree, then went and did night classes at PSU for my bachelor’s degree for a couple years and then started the distance option program with PSU to get my master’s in social work and that took me three years. I’ve been here for over 12 years at the hospital but I’ve only been a social worker for a year and a half. I was a mental health therapist for the previous ten and a half or so years.

I had a real compassion for those patients who were suffering with mental illness because, like cancer, none of us asked to become mentally ill, none of us asked to become you know cancer patients. So that’s what led me to go back and to work here; and then as I worked here, I slowly started wanting to have more of a voice on the team and have more of a clinical opinion. I love my job. I get to really support the recovery model and work, and help patients leave the hospital. Social work is very broad, but I think one of our main focuses is discharging patients. It’s getting patients ready to go out into the community, getting the community ready to accept their people back, working with partners to provide the best care possible when the patient leaves.

I’m able to be a part of a team who stabilizes a patient and moves them back into their community and I meet them the day they come in and discharge is talked about from the first meeting. We really want to pin down what we need to do to get this patient back into their community so I try to be involved every step of the way.

Teaching them the expectations, what’s expected from them on the outside is another big thing. Getting them prepared for what’s going to happen when they leave the hospital. I have a client right now who’s having a lot of stress about leaving the hospital. He’s been here four or five years and it’s every day, it’s a new question. Am I going to be able to do this? Am I going to be able to do that? And it’s having, it’s very gratifying to be able to sit down, let him vent his frustrations, his unknowns, his stress, and then validate that for him and say this has to be very, very, you know, scary for you. And so being able to say that you’re stressed out so that somebody can help you, I think is important.

My greatest rewards are when I can work with a client, maybe one-to-one, to accept a discharge. On my end, I have patients who don’t always want to leave the hospital. And when I can do that and I can work with them, I can do individual therapy with them, and we can move them out into the community in a safe manner, that’s always rewarding. Any discharge is a rewarding discharge. Getting someone back to their community.

The way community views people with mental illness is the greatest challenge we have. Not in my backyard, not in my neighborhood. We can’t have a patient in our neighborhood. Well, and the fact of the matter is, is that these patients are just like you and I. They have, but they have a mental illness. And who knows, you and I may have a mental illness, too, that just happens to be, you know, controlled, and maybe this one doesn’t. But that still means that they’re humans, and they deserve to be treated like humans.

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Transcript for Figure 10.14, Clinical Psychologist: Careers in Mental Health

[Franz Kubak, clinical psychologist]: I’m Dr. Franz Kubak. I’m a clinical psychologist.

Oregon State Hospital is a large place, but I think a lot of people are here for the same reasons, you know. We have a lot of people here who have compassion and want to help these folk out and kind of understand the mission. And all of our work does overlap in a lot of ways. I mean, the patients that come in here on admissions will have a lot of different teams along the way, but our work kind of carries over from team to team. So I think that collaboration is just like a huge part of what we do. A lot of my clinical work actually focuses on creating what we call wellness recovery action plans, pretty much relapse prevention plans, where we teach the person to recognize, like, what are the early warning signs of mental health relapse? What are some things in the environment that could increase their stress or lead to worsening of mental health problems? What are the plans for dealing with that when they show up? So part of being able to do that is understanding the responsibility that they have to manage their own mental health after they leave here. And I like to help them create plans on how to do that.

We offer a lot in the way of treatment classes. Like, I’m heavily involved in the dialectical behavior therapy program, or DBT for short. But at this point, I focus more on individual therapy because one person’s needs are going to be very different from another person’s needs. Like, someone might be learning how to manage their symptoms of schizophrenia. Another person might be learning how to manage themselves more in interpersonal relationships or romantic relationships. Someone else might have substance abuse issues. So individual work is required there.

My version of recovery, I want the person to become their best expert in knowing, like, what they need. And to be able to also know that information so well that they can share with other people the skills that they’re using. Make them understand why it’s so important that they keep a consistent sleep schedule, what they use to, like, reduce their stress, why exercise is so important to them. Like, whatever it is to that person. Like, what types of cognitive techniques. Just so other people can, well, understand. And they are their own best advocate to, like, remind themselves of the skills and the reasons why they’re using them.

Greatest rewards for my work? I can think of a lot. I can think of seeing people really progress through the system here at the hospital to really learn to manage their mental illness on their own, to come to terms with the realities that brought them here and not to resist them or fight against them. To learn how to be more effective in their day-to-day life and in their own care. And then eventually being able to leave the hospital and have productive, happy, meaningful lives. Like, when I get a card sent to me from an old patient who’s now, like, pursuing education, I think that’s awesome. I also find satisfaction in working with teams and getting people to collaborate and to really put their heads together on, like, what a patient needs or what the community needs to be able to manage a person safely.

I like teaching, and that includes both patients as well as staff, and getting people to understand the importance of things like relapse prevention planning. So there’s a lot of reward available here at the hospital, whether it’s working with our patients or working with our other team members.

I think that a good therapist role is a teacher because you are not going to be there for your patients, following them around in the community, telling them how to, like, take care of their mental illness or make healthy decisions, right? You want them to learn how to do that for themselves. So I am most gratified when my patients learn from, like, what I’m trying to teach them, and they understand it and kind of take it and do well with it. Like, nothing’s more gratifying than seeing someone leave the hospital and just not coming back.

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Transcript for Figure 10.15, Forensic Psychiatrist: Careers in Mental Health

[Michael Duran, forensic psychiatrist]: My name is Michael Duran. I’m a forensic psychiatrist. For me, it’s a great job. And so, I am a medical doctor, so I’ve gone to medical school and I’ve completed training in psychiatry and particularly in forensic psychiatry. And what I do is I have the, really, I find it the kind of deep privilege of talking with people about their lives and then trying to sort out, based on what I’m being told and what I’m observing, what do I need to do both in my talking but also with medications to help that person feel better and to get more stable.

For a psychiatrist, your stethoscope in many ways is your mouth and your ears. It’s the human interaction part of our job that creates the most healing. So, you’re using your, what people are telling you and your questions that you ask them to try to figure out what is the mental illness that I’m seeing. And an important part of that is not only what the patient is telling you but also what their history is. You also utilize things like labs. So, you may do blood work to make sure that things like their kidneys are working properly, their liver is okay. It may involve doing like CAT scans or MRI scans to make sure that there’s not some tumor or other issue that could be causing the mental health problem that you’re seeing. And once you’ve gathered all of that data, you then think through what medication will be most helpful for this person.

We function absolutely as teams. And here’s why that’s really important. We have patients that are in the hospital 24 hours a day, seven days a week. And as the psychiatrist, the physician on the unit, I may only see the patient, you know, 20 minutes every week. And so you’re really relying on your whole team to be observing and giving you information about how they’re doing. On a treatment team there are various disciplines like the psychologist, social worker, rec therapist, nurses. All of those individuals take progress notes, work with patients maybe in groups or observe folks on the unit. And then all of that information is brought together in what’s called a treatment team meeting, where it’s basically just a meeting of everyone working with the patient where you discuss what are you seeing, what am I seeing, is it consistent across different areas. And then based on all of those observations, you put that data together to formulate what you’re seeing and then how to be of help.

For me, there’s a couple big challenges here. The first would be that there’s really some pretty deep human drama here of folks that have had really tough goes in life and have been under really tough circumstances. And listening to the stories and trying to care about that person can affect you. And you have to figure out how do you keep yourself healthy and present to be able to hear those stories, be empathetic, but also not to let it affect you negatively. A second big challenge is that some of our folks can be aggressive and violent. And as the physician on the unit, oftentimes you feel responsible for the decision making of certainly medicines, but also safety precautions and treatment.

This is a really deeply rewarding job. And I would say for me, the most poignant remembrances or memories I have of where I’ve just felt incredibly humbled, delighted, happy for working here, is when families get reunited. So it’s not uncommon that we’ll have someone that comes in from another state, for example, and they have been homeless, they’ve been traveling, they end up in our system, and I get the privilege of being able to call their mom and say, you know, Ms. Smith, I just want to let you know Johnny’s okay, and we have him, and we’re working with him, he’s safe, and they’re like, oh my god, we didn’t even know if he was alive. And those experiences happen in this facility daily. There are miracles that happen here, and it’s deeply rewarding work.

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Transcript for Figure 10.16, Within the Walls: Nurse Practitioner – Women’s Prison

[Rhonda Smith-Bass]: I love my job because I make a difference. When I can walk in here and an inmate says to me, ‘thank you so much.’ That makes me feel good because it makes me feel like I’ve done my job.

When I came here and I started talking to these women and finding out the traumas and the things that they went through, I became more interested. So I decided to start a program. Self Love Breakthrough teaches women to love themselves and help them understand the trauma that happened to them in the years. A lot of them are here because of child abuse. A lot of them have been raped. A lot of them have been abused. So once they grow up and get older, they start getting involved with people that draw their energy, that kind of control them.

If you love yourself, you wouldn’t take that kind of treatment. A lot of people leave out of here, even people that are on drugs, they leave out of here trying to seek that love again. Once you connect with that child that was hurt years ago and become old, they can heal.

Women’s care is my passion because when I look at these women coming in here I realized that it could be my mother, my daughter, my sister. It was more of a ministry to me than a job because I really love what I do.

Licenses and Attributions for Transcript for Figure 10.16, Within the Walls: Nurse Practitioner – Women’s Prison

Transcript for “Within the Walls: Nurse Practitioner – Women’s Prison” by OhioDRC is included under fair use.

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Transcript for Figure 10.17, Psychiatric Nurse: Careers in Mental Health

[Lori Martin, psychiatric nurse]: My name is Lori Martin. I’m a psychiatric mental health nurse practitioner. I currently work on two different units where I take care of five patients on each unit, so I’m considered the clinical lead of the team for my patients and I will work with them figuring out what their diagnosis is, then work with them trying to figure out if they need medications and what medications they need. I think it’s really important to try and work with my patients to find out the best medicine for them.

My goal is to help people feel relaxed, help them feel like I care about what they have to say and that my goal is to understand what they are going through and try and help them along their path to recovery.

You know, I could come out and have the list of questions that they’ve gone through a million times, or I can just have that conversation to see if they’re improving. Within that conversation, I can find out if they’re doing well with their memory – how’s their long-term memory? How are they oriented? I can figure all that out just by having a nice conversation. So sometimes that might be for instance the flower in my hair. I started wearing a flower every once in a while, and pretty soon when I didn’t wear one people would say, ‘Laurie, where’s your flower?’ So now I wear the flower, and what I’ve noticed is that sometimes that in itself will start a conversation.

Same with my fancy shoes I have a pair of shoes that are bright red, and when my toes are together they say ‘smile’ on the toes of them. Somebody who, last week may not have been able to answer a question or make a statement like, ‘Oh, Lori, where’s your flower?’ Or ‘I liked the one you wore yesterday better.’ Remembering that I was wearing a flower yesterday, or remembering that I’m not wearing a flower today. So things like that can help me know if the things that we’re doing for this patient – is it helping them along the way or are they still not understanding what’s going on? So just the privilege of being able to spend time with people and have these conversations and I get to do this and it’s my job and it’s so amazing.

Because we work in a team environment where we have somebody here 24 hours a day recording and watching our patients, we can make changes pretty quickly. So if we see improvement and we know we’re on the right track, like fabulous. We can keep moving down that track. If we see something that’s not seeming to be good, we can make assessments and make adjustments based on what people are seeing. Oftentimes my biggest challenges are also the things that are so rewarding. As a chief nursing officer, trying to figure out how to make sure that our new employees got the orientation that they needed. I was able to help create a training program that could help do that. And then now getting to see how it’s seeming to help on the units and change the way that we provide care.

I love what I do. I love the staff that I get to work with. I love the idea that I get to see people when they come in who maybe are not doing well. Just recently, I had a young lady who came in and she had been very, very sick. She’d been using drugs. Two weeks later, I’m talking to her. She’s doing really well. And she said, ‘Thank you so much for being here for me. I feel like getting arrested and having to come to the Oregon State Hospital was what saved my life.’

It feels really satisfying to end my day knowing that somebody’s life might be better just for the fact that I was willing to listen, I was willing to understand where they’re at and try to help them in their recovery.

Licenses and Attributions for Transcript for Figure 10.17, Psychiatric Nurse: Careers in Mental Health

Transcript for “Psychiatric Nurse: Careers in Mental Health” by oshmp is included under fair use.

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Transcript for Figure 10.20, A Psychologist and Former Cop on Mental Health and Suicide | We Are Witnesses: Chicago

[Carrie Steiner, former Chicago police officer]: My first day as a Chicago police officer on the street, I was sent to the 18th District. The field training officer said that we were going to go to a wake tonight and I said okay and I thought that was kind of strange and I was like ‘Well, who is the wake for?’ and he said ‘Well, it’s for an officer in the 18th District that had killed themselves.’

I grew up in Appleton, Wisconsin. It was very safe. I kind of felt like I lived a little sheltered life, so when I came to Chicago, it was quite a big surprise. I never thought of being a police officer when I grew up. I was kind of a rebel and a punker. My boyfriend at the time said he was going to go to the public library to get an application for the Chicago Police Department, and I said, ‘Hey, why don’t you pick up one for me, too?’ So I thought that would be cool, because I can show that a woman can do the same job as a man can, and I love adventure, and I would love to try to get bad people. So I applied, and I got in.

As a police officer, your day starts out by putting on your bulletproof vest and your gun belt. And that being a reminder that you’re wearing all of those things, because it’s a dangerous job. When Chicago police officers or I had to deal with gang members shooting each other, I expected that. So those incidents usually don’t bother me, but it’s those incidents where you’re not expecting it, or another person was hit rather than your target, that’s when it’s going to be more difficult.

I remember one time. I was responding to a call where officers just said that they had seen a stolen vehicle. So I started heading into that location. There was a family of five, a mom and her four kids, and they were all young. And one of them was in a baby stroller. And the vehicle was an SUV, and it ran all of them over, and slammed into a business. And I ran out of my vehicle, and I was running to them. And I knew as soon as I saw the four- or five-year-old kid on the ground that he was bleeding from his nose, ears and mouth. I knew he was dead. And he looked exactly like my nephew at the time that was around the same age. And it was difficult because I knew that it could have been my sister just crossing the street. And it could have been my nephew right there. And the four-year-old did not make it.

One of the things that bothered me a lot is when I heard that woman scream when I first got on scene. There’s nothing like a woman’s scream when they see their child injured, and I had that scream in my head; the dad came in, and then I had to tell him what happened. He screamed like the mom did, and that was really hard.

Then after that, I was told I had to go to a traffic complaint violation of a parked car, and it was very difficult going there and talking to someone about a car being parked too close to their driveway. You learn as an officer to not be emotional and to keep it in. Well, I kept it in because I’d already gone to calls where people were shot, or I saw a baby sexually assaulted; so I already learned how to just gulp it down and keep it down, and don’t share it, and don’t feel it. Numb yourself out. Put it in a little box, put it over here, and forget about it.

I started to see more and more traumas happen and more officers doing things that weren’t normal and that weren’t right, and I even saw that in myself. It was just very common that after work you would go out drinking with everybody and that’s when you would talk about what happened on the street or the difficult things that occurred.

I was very hesitant to get treatment for myself because I didn’t think that they would understand. I thought that they would pathologize me or think that something was wrong with me, or try to take my gun, and I didn’t want that to happen, so I didn’t want to get treatment. I know that’s how a lot of officers feel.

I’ve known 18 officers personally that have killed themselves, and that’s not all that I know have killed themselves on the Chicago Police Department, but that’s all the people that I know in my 13 years.

Licenses and Attributions for Transcript for Figure 10.20, A Psychologist and Former Cop on Mental Health and Suicide | We Are Witnesses: Chicago

Transcript for “A Psychologist and Former Cop on Mental Health and Suicide | We Are Witnesses: Chicago” by The Marshall Project is included under fair use.

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Transcript for Figure 10.23, Recognizing Compassion Fatigue, Vicarious Trauma, and Burnout in the Workplace

[Lisa Callahan]: Compassion fatigue really extends beyond being empathetic with someone. This is something that can affect anyone who works with people, and it’s especially important for people who work in very trauma-filled situations, like in the criminal justice system, to be aware of the fact that working with people with problems can become emotionally exhausting. Compassion fatigue takes some time to develop. It’s not something that’s going to come on in the first two weeks where someone is on a job. It really extends over a longer period of time, where it just becomes a weariness of listening to and responding to and helping people with their problems.

Compassion resilience is a really important, relatively new concept that is being examined. Compassion resilience is the counterbalance to compassion fatigue. For people who do work with people with complex problems, it can be very rewarding and very professionally and personally satisfying to see people make accomplishments and reach goals in their recovery journey. So that positive response that you feel both as a team and as an individual would be considered compassion resilience, and can help to outweigh the effects of compassion fatigue with working with a very complex population.

The difference between compassion fatigue and vicarious trauma is that vicarious trauma resembles primary trauma. What I mean by that is that the symptoms of vicarious trauma are often the same symptoms that people experience when they have experienced a primary trauma, such as hyper-vigilance, being very jumpy, having a lot of difficulty sleeping, having difficulty concentrating. Compassion fatigue, on the other hand, is more of an emotional exhaustion. It’s more of a fatigue in working with people with complex problems, but it doesn’t include developing symptoms of trauma that vicarious trauma does.

Burnout is another term that you frequently hear people talk about, especially in organizations that work with people. But burnout is something that develops over a long period of time, similar to compassion fatigue. It is a form of emotional exhaustion. But it doesn’t necessarily arise from the interactions with the clients that people actually work with. It can result from work overload, too little time to do too much. It can result from work conflict among coworkers and your supervisors. Burnout really takes a while to develop, whereas compassion fatigue can develop in a relatively short period of time. Burnout takes a while, and it’s when people really eventually just become ineffective in the job that they’re doing.

I think that one of the major difficulties that organizations have when working with people with complex trauma histories, especially those in the justice system, is they don’t care for themselves very well. People who are trained in behavioral health, such as social workers, psychologists, psychiatrists, and others, part of their training and education is to practice self-care. Whether they do or not is a different issue, but they’re at least aware of the fact that, when you work with people, you need to take care of yourself also so that you can help them effectively. In the criminal justice system, there’s no similar kind of process in the education of going to law school or getting your degree in criminal justice and becoming a probation officer.

Basically, the attitude in many criminal justice agencies is just to suck it up and to just move on to the next case. We’re realizing that that is not a very effective way to keep your workforce well. It’s just as important for people who are justice professionals to practice self-care around the issues of compassion fatigue, and burnout, and vicarious trauma as it is the behavioral health professionals. It can affect anybody in the criminal justice system. It can affect people who sit on juries. It can affect the prosecutors, defense attorneys, probation officers, correctional officers, and judges. Everyone who works with people in that environment, especially as they get to know defendants and participants’ stories more, they can experience the same kinds of difficulties of burnout, and compassion fatigue, and vicarious trauma.

The kinds of areas to really be on the lookout for in yourself and in coworkers would be probably the most obvious first step would be if someone’s work product begins to slip. If they’ve previously been a very conscientious coworker or a person who you supervise, and they no longer are, that may be a red flag. Also, take into consideration their health, their general medical health. People who begin to take a lot of sick leave, are tardy a lot, have a lot of illnesses also might be underlying signs of vicarious trauma or compassion fatigue.

You also can look at mental health issues and included with that, substance abuse. If again, you see an increase or a change in the kinds of ways in which people deal with stress, maybe they become more angry, more irritable, become more frustrated, detached, no longer are participating in activities in the workplace that they typically have. Those would be all signs that you should look for and be concerned about in your co-workers and also in yourself as you become more aware of the importance of self-care, working with this population.

There are both individual level and organizational level ways of addressing self-care and wellness. There are lots and lots of resources available through employee assistance programs. And if they don’t have specific workplace wellness programs around dealing with stress, dealing with complex trauma, ask them to develop a program and tell them that your organization needs that because that organization can’t simply be the only one who they serve that need that input. Also, you can practice self-care in that you can seek out different forms of stress relieving exercises, practicing mindfulness, meditation, yoga. All of these have been shown to reduce stress on an individual level. And obviously, if people find that those interventions, those practices aren’t helpful, they should seek professional care through a psychologist, psychiatrist, or social worker who specializes in dealing with traumatic stress, dealing with complex issues like this.

Licenses and Attributions for Transcript for Figure 10.23, Recognizing Compassion Fatigue, Vicarious Trauma, and Burnout in the Workplace

Transcript for “Recognizing Compassion Fatigue, Vicarious Trauma, and Burnout in the Workplace” by Policy Research Associates, Inc. is included under fair use.

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Transcript for Figure 10.24, 3 signs that you’ve hit clinical burnout and should seek help | Laurie Santos

[Laurie Santos, Professor and Cognitive Scientist at Yale University]: These days we talk a lot about burnout, but as a psychologist I recognize that we have a lot of misconceptions when it comes to burnout. We think burnout is anytime you’re feeling a little bit overworked or a little bit stressed or a little bit tired, but it turns out that burnout is a very special kind of clinical syndrome that has a couple very particular symptoms. One of the symptoms we often think about is a sense of emotional exhaustion, but this is richer than just a sense of physical exhaustion. Emotional exhaustion isn’t just about being tired. It’s really about feeling like you cannot emotionally handle another thing on your plate. If one thing comes on, you know, that’s it. The whole house of cards is gonna fall.

Even when you get a really great night rest or a week off, you’re still feeling kind of emotionally tired and overloaded. That’s the first symptom, this sense of emotional exhaustion. The second symptom, which I think is even more profound, is a sense of what’s often called depersonalization or cynicism. You’re just kind of on a short fuse with the people around you, whether that’s the people you’re serving in your job, your clients, or your patients, or your other teammates. It’s like everything they say kind of irks you a little bit and it feels like if there’s one more request, you’re just gonna lose it and freak out. You’re also very cynical about people’s intentions. You kind of feel like they have bad intentions for the asks that are coming your way.

That’s a sense of depersonalization. But the third symptom is the sense of personal ineffectiveness. You just feel like even if you were doing your job perfectly, it wouldn’t matter. Or there are structural constraints that make it impossible to do what you really value doing. So even if you’re doing your job well, you feel like it kind of doesn’t matter. It’s not giving you the same value it was before.

So this is burnout. It’s not just a sense of stress or overwork. I think it’s important to distinguish between stress and burnout. We sometimes lump the two together, but burnout is a very particular kind of clinical syndrome. We tend to think of burnout as a modern phenomenon, but there’s evidence that something like burnout has been happening for a while, at least since the Industrial Revolution.

But some of the best research on burnout happened in the 1980s and 1990s, and was mostly done by this fantastic researcher, Christina Maslach, who’s talked about some of the features that tend to lead to burnout. One of the features that tends to lead to burnout is an increased workload, or a workload that really feels just too overwhelming. That isn’t enough to lead to burnout over time, but this can be an exacerbating feature. Another feature that tends to lead to burnout is what Maslach calls a values mismatch. You get into your job thinking you’re doing something, but in practice, in the trenches, the job feels like something else. I’m speaking about burnout right now as a scientist, but also as somebody who’s experienced the syndrome a little bit myself.

I feel like I became a college professor and a head of college on campus because I wanted students to have a fantastic experience, but then when COVID hit, it just felt like what we were doing wasn’t what I signed up for anymore. There was this mismatch.

Another feature that can lead to burnout in an organization is a sense of unfairness. This can also cause a certain sense of community breakdown. When there’s a sense that things are a little bit unfair, maybe there’s differences in compensation, that can lead to a sense of burnout.

The final thing that’s really important for burnout is your sense of reward. What leads us to kind of get flow and feel happy in our jobs, is a sense of intrinsic reward. When things become pushed more towards the extrinsic reward, and also when those extrinsic rewards, especially when they start feeling a little bit unfair, that can lead to a sense of burnout over time.

If you’re wondering if you’re going through burnout, a few questions you can ask yourself involve those big symptoms we just talked about. First, this sense of emotional exhaustion. Are you really, really exhausted? Not just physically exhausted, but emotionally exhausted. When you take a weekend off, are you still as depleted when you go back on Monday morning? And does it really feel like a form of exhaustion that’s very emotional? It’s not just that you’re tired, but that you’re feeling really depressed, that emotionally you’re on just a really short fuse. Are you experiencing changes in how you relate to people at your work? Either the people that you serve, your clients, your patients, or the people that you work with. Are you embarrassed about the length of your fuse? Do you feel like you’re going through some compassion fatigue? That’s a clear sense that you’re experiencing depersonalization. And is your sense of meaning going away in terms of what you’re doing? Do you feel like your work has changed, that you simply can’t do a good job right now because of some of the structures of what you’re asked to do, or the fairness in your own institution? If you’re answering yes to some of those questions, you may be on the verge of burnout, and it’s important to address that before it gets worse.

So what if you’re already feeling a little bit emotionally exhausted, a little bit cynical, a little bit like your job isn’t effective as much anymore? This is the point when you need to think about treating burnout. And we can think about treatment as having an organizational side and a personal side. Organizationally, I think different industries need to pay a lot of attention to burnout. And one of the main ways to fix burnout is to make some changes to people’s workloads, to people’s sense of values, and to the rewards that people are getting. Those changes are really essential steps to treating burnout once it’s there. But as an individual, you know, the best thing that you can do, aside from kind of trying to promote more of these structural changes at work, is to really take good care of yourself. And I mean that in particular, not just in terms of the kinds of things you do which matter, getting more social connection, making sure you have some free time, but also to think about how you’re structuring your relationship with work.

Often, we bring the best of ourselves to work and leave the leftovers for everything else, for our families, for leisure, and so on. If you’re really putting too much of your identity emphasis on work, that’s the kind of thing that can lead to burnout, because those values feel like they matter so much to you. It’s all of your identity that’s wrapped up in this. When there’s a mismatch, it can hit you even harder.

So to address my own burnout, I decided to take a sabbatical, but it was important that I stayed very intentional about paying attention to my value systems during that sabbatical. I really tried to invest more in my relationships outside of work, so it wasn’t just friendships at work that were making up my whole social life. I tried to re-engage more with other things that I value, hobbies, things as silly as like playing a little bit more Guitar Hero. But also engaging a little bit more with things like my health, like making sure I’m moving my body. It’s really trying to engage all the values and the things you care about outside of work, so you can start to develop an identity in that and not just in what you’re doing for your job.

Licenses and Attributions for Transcript for Figure 10.24, 3 signs that you’ve hit clinical burnout and should seek help | Laurie Santos

Transcript for “3 signs that you’ve hit clinical burnout and should seek help | Laurie Santos” by Big Think is included under fair use.

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